Psychotherapist Nica Selvaggio on LGBTQIA Mental Health

An Interview with Psychotherapist Nica Selvaggio

Dominica (Nica) Selvaggio, LMHC is psychotherapist at Seattle Anxiety Specialists, PLLC. Nica has experience working with clients on a wide variety of issues, including anxiety disorders, eating disorders, substance abuse, sexual orientation and gender identity, acculturation and systemic oppression related to race and gender, trauma and PTSD, mood disorders, personality disorders, self-harm, relational issues, and attachment struggles.

Jennifer Smith: Hi, thanks for joining us today for this installment of the Seattle Psychiatrists Interview Series. I'm Dr. Jennifer Smith, Research Director at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology and psychotherapy practice specializing in anxiety disorders. I'd like to welcome with us today, Dominica Selvaggio, who is one of the psychotherapists at our practice. Nica has worked as a therapist for roughly a decade in the Seattle area and works with adults and adolescents aged 13 and older. Before we get started today, can you tell our listeners a little bit about yourself?

Nica Selvaggio: Yes, and thank you so much for the introduction, Jen. I'm really excited to be here talking with you today. That's always such a broad question. I never know where to start, but I guess that is the place to start that from a very young age, I was diagnosed with ADHD, and so my inability to pick where to start is a reflection of what I deal with in my brain. I love being a neurodivergent therapist because it brings a sense of understanding and compassion for folks who struggle with this sort of tangential thinking or not knowing where to start, that I find really, really helpful and I just get a lot of joy out of it.

So all that to say, I'm your local ADHD therapist. I'm originally born and raised in Chicago, the Midwest, and I've been in the Pacific Northwest for most of my adult life. I did spend three years living in Hawaii, and that was a really life-changing experience. And ultimately, I came back to the Seattle area because this land really has my heart.

Jennifer Smith: Wow.

Nica Selvaggio: I always describe myself as someone who's incredibly creative and just a lover of nature.

Jennifer Smith: That's great. And so you moved to the Seattle area from Hawaii. So what would be your favorite parts of the Seattle area, or just Washington as a whole?

Nica Selvaggio: It's the land, it's the mountains, it's the water, the plant life, all of it. I always say because of growing up in the Midwest that I was raised in corn and concrete. So when I moved to the Pacific Northwest and saw these huge mountains for the first time, even after a decade of being here, I'm still in awe. Yeah, I just really, really love the landscape.

Jennifer Smith: That's great. What is it that got you interested in being a therapist?

Nica Selvaggio: Big question. There's this storyline of The Wounded Healer that I think a lot of us are familiar with, that archetype of someone who has gone through their own experiences of pain and suffering, have tended to them, and then turned that compassionate attention outwards towards others who are struggling with similar wounds. My story as a therapist is not so different from that. I became interested in working in mental health out of necessity of caring for my own mental health throughout my life.

I'm a former foster care survivor and an adult adoptee, and so I had exposure from a very young age to some of the suffering in the world and in my own world and experience. So walking that path has really led me to wanting to provide a hand to hold for other folks on their own paths.

Jennifer Smith: Wow, that's really fantastic. Thank you for sharing that. What areas or disorders do you specialize in, besides ADHD?

Nica Selvaggio: Well, I got my start working in the clinical world specializing in eating disorders. So the bulk of my career was spent working in high acuity treatment centers, inpatient level residential, partial hospitalization, intensive outpatient, and working with folks who struggle with things like anorexia, binge-eating disorder, bulimia, ARFID, avoidant restrictive food intake disorder, which is often accompanied with neurodivergence. And when you work with eating disorders, you work with everything.

So people often think of eating disorders as being about literally food and body, and while those are absolutely components of a person's experience with an eating disorder, it's a symptom for an underlying issue. And often what underpins eating disorders is trauma, depression, anxiety, huge contributing factor, and other ways that the brain is sensitive. So for example, someone on the autism spectrum might really struggle with their sensory experience with food, be labeled with having an eating disorder, when really, it's something that's going on in a sensory way for them. It's not accompanied by cognitions and things like that.

So that's the bulk of my experience and I could talk about that forever. But because I'm an ADHD person, I have a million interests and my path has diverged many a time from that foundation of working with eating disorders. So through that work, I found my way into the somatic world in treating trauma because trauma is a huge underpin of most folks with eating disorders. And I got my foot into somatic experiencing, which is working with folks more so through the visceral felt-sense experience of trauma held in their bodies and helping them to let go of it rather than talking the story to death, which can be re-traumatizing for folks at times. Absolutely has some value in reclaiming our narrative and making meaning. However, I found working in the body to be a lot gentler.

Through that world, I found my way into psychedelic assisted therapy. I did a fellowship last summer in Jamaica, working with mushroom assisted therapy, and I've done a couple of trainings in San Francisco for ketamine assisted therapy. So that is a world I'm very interested in. And then gender and sexuality. So I'm non-binary. My pronouns are she/they, and working with trans folks, working with gender sexuality came out of working with eating disorders as well because those populations tend to struggle with eating disorders, body dysmorphia, those sorts of things at a much higher rate than the general population.

Jennifer Smith: Wow.

Nica Selvaggio: And then from there, add in interest in couples work, sex therapy. So a little bit all over the place, but a really strong foundation underneath all of it.

Jennifer Smith: Wow, that's fantastic. And basically that means you can help a lot of different people, which is really great. Your online bio notes that you've been trained in several evidence-based approaches. Can you let our audience know what those are?

Nica Selvaggio: Yeah, and I'm noticing in myself through this interview, I'm talking very fast and not breathing very much because I'm oriented to my own body. I'm going to take a moment and just take a deep breath before I answer you.

Jennifer Smith: Yeah, absolutely.

Nica Selvaggio: Thanks. And if anything-

Jennifer Smith: Oh, I was just just saying-

Nica Selvaggio: Yeah, go ahead Jen.

Jennifer Smith: That's great for our audience to see too. You need a moment, take a moment. There's nothing wrong with that, and I think we could probably all do that at times and we just don't, unfortunately. And then we feel awful.

Nica Selvaggio: Well, we're not really given permission to in our culture and our systems that we operate in.

Jennifer Smith: Yeah, which is unfortunate.

Nica Selvaggio: Yeah. Which ties into that question a little bit about what evidence-based therapies I work with. Most of them I learned when working in treatment settings. So in a lot of eating disorder treatment centers, the foundation of the treatments are evidence-based therapies such as dialectical behavior therapy, DBT, which was developed by Marsha Linehan, and that was a therapy originally developed to treat folks who struggle with extreme emotional dysregulation who are feeling suicidal or are diagnosed with borderline personality disorder. So these extreme swings of mood and inability to regulate.

Off of that came... And that approach is really good for folks who are... The temperament under controlled. So under UC versus OC, under controlled versus over controlled, so more impulsive behaviors, you're going to see things more expressive. You might be able to tell I'm more on the UC side. DBT is great for that. And then on the other side, you've got OC, over control. Those folks are going to have higher levels of generally OCD type thinking, more restricted, flat affect, much more wanting to control their outer experience because their internal world feels so chaotic that it reflects on the outside. In those folks, you're going to see things more like anorexia, restricting behaviors, much more flat affect.

RO-DBT, radically open DBT came out of DBT to help over control folks. So those are two different therapies, even though they have the same name in them, but essentially they're both skills-based therapies that are laid on the foundation of mindfulness and some of our Eastern inspired practices. So as well as another evidence-based therapy that's used a lot in treatment centers, ACT, acceptance and commitment therapy by Stephen Hayes. But these therapies are really trying to bridge the worlds of that grounded mindfulness foundation with concrete skills that people can use to actively change the behaviors that are causing them distress in their lives.

I love a lot of those therapies so much because they work, they can really shift things quickly. I often use those in conjunction with therapies that maybe don't have as much of a robust research base because they haven't had the time or the funding or whatever it is, such as somatic experiencing and more experiential therapies. I went a little bit all over the place.

Jennifer Smith: Thanks. And what about your treatment approach? What's that like?

Nica Selvaggio: Yeah, so I was trained in a clinical mental health counseling master's program and the foundation of my training and program was person-centered humanistic therapy. So for folks who don't know what that means, my foundation of who I am as a clinician, as a counselor is very much through the egalitarian lens of I am not an expert in your life. You are the expert in your life and I'm coming here to join human to human to witness and perhaps equip you with skills that you need in order to change the things that you're wanting to change.

That said, that's the foundation I weave in depending on what a person needs after collaborating with them on what sort of therapy they're interested in working with, all different kinds of approaches. So again, the somatic work is a huge part of my work, bringing in the body. I also do a lot of parts work, internal family systems, and for folks not familiar with that, that involves accessing the different parts of ourselves that are often in conflict. Everyone has different aspects of self that they might connect with at different times. The part of me that's doing this interview with today is my manager part, right? I'm going to present my best self today, but maybe my inner child part is like, "This is scary. I don't like talking in front of people that I can't see." That's an example of parts work.

Who else? Again, super interested in growing more in the psychedelic assisted therapy world. It's really profound powerful work that can really jump start a person's journey, but not to be used without caution and a lot of discernment and support. Yeah, it's just different for everyone.

Jennifer Smith: That's fantastic. I'd like to go back and talk about one of the areas that you can help clients with, and that's regarding their sexual orientation and gender identity. And I was reading on The Trevor Project’s website that they offer 24/7 free, secure access to counselors for young people who are LGBTQ. In a nationwide survey that 41% of LGBTQ people age 13 to 24, so the younger range, seriously considered committing suicide in the past year.

So clearly something's going on here that's severely impacting this population's mental health. So I just have a few questions regarding this, that maybe you can shed some light on.

One is, what types of issues does someone usually struggle with regarding their sexual orientation or gender identity?

Nica Selvaggio: Yeah, I love this question. Thank you for asking this. And first I want to name... I always experience a lot of heaviness in my body when tapping into the sense of powerlessness or hopelessness that comes in for a person to feel like the best option is to end their life, that they've exhausted all of the avenues and this is the best way to escape the pain that they're experiencing when that becomes the option in their brain. This is for so many different reasons and ties to what a lot of folks in the LGBTQIA+ community struggle with, which I want to differentiate that struggling to know what your sexual identity is or your gender identity is, is not in and of itself a pathology or an issue that someone's struggling with.

What people are struggling with is how the systems in the world, how our culture, how our families, how our religions, how all of these things reflect our worthiness of access to resources, safety, the right to use the bathroom in the public. Our daily lived experiences of oppression are the issues that we struggle with, not the fact that we are part of the rainbow community.

So that being said, because of operating or living in a system that... And I can give so many examples of it's February 1st and how many anti-trans legislation bills have been pushed forward this month in January alone? The visceral, physiological, emotional, spiritual, psychological response to being faced with that. Those issues can look like suicidality, that can look like depression, that can look like anxiety, that can look like a nervous system that's chronically stuck in fight, flight or freeze because they're in survival mode because the world is reflecting to them that they're not safe.

Things more classically associated with folks in the LGBTQIA community are things around identity formation. How do I know who I am? How do I put a word or a label to who I am? Do I even want to do that? Is there even a necessity for me to come out and name myself as such? Where do I fit in and belong in this LGBTQ community? How do I move through the world in the straight world? A lot of identity formation issues in that. And again, that's not an issue of pathology in and of itself. Culture's response to that question is the issue.

Substance use is often higher. Again, this is a way of coping with all the things that I've named and eating disorders and body dysmorphia tend to be much higher incidences in the trans and LGBTQ community.

Jennifer Smith: Wow. And eating disorders too, they're often highly correlated with suicidality, correct?

Nica Selvaggio: Yes, yes. Can be. Not all, but yeah, they tend to be.

Jennifer Smith: Wow. Another question I had is often when you're doing paperwork now for a medical provider or surveys, they ask about someone's preferred pronouns. And can you talk a little bit about that, preferred pronouns and how can that affect someone's mental health? Why do they matter? Why do pronouns matter?

Nica Selvaggio: Yeah. Yeah. And I love how you changed the sentence at the end. Why do pronouns matter? Because even the language of preferred can insinuate that it's someone's choice in terms of... Okay, how can I put this? If you knew that the sky was blue and someone came up to you and was like, "You're nuts. The sky is not blue. I see yellow, and you are bad and wrong for thinking that the sky is blue. How could you?” Take it a step further: “You're going to a bad place because you think this sky is blue."

And then I said to you, “Well, you just prefer it to be blue.” Is that a preference or is that just what you see? So a person's preferred pronouns implies that it's an actual preference, when in reality, it's just their lived experience. And so when someone is vulnerable enough to even name their pronouns, even if we don't understand, even if we think the sky is yellow, the reason it's important is because it indicates a level of belief that that person understands and knows themselves better than we could possibly know, their internal experience.

Jennifer Smith: Right.

Nica Selvaggio: It indicates respect for their beingness, and it creates a level of safety for that person who may have moved through many different systems in their life where it was not accepted or not safe for them to use the pronouns that fit for them.

Jennifer Smith: That's fantastic. Thank you. One anecdote that I wanted to share is that in our practice, we were trying to decide internally, "Should we all put our pronouns in our signature block?" And I'd say one-third were gung ho for, "Yes, we should." One-third didn't care. And there were other people who didn't want to, and one of the members of our team said, "Maybe we shouldn't do this, because if a person isn't comfortable saying what their pronouns are, we're forcing them to either disclose their pronouns or force them to put stereotypical pronouns that you would think that they should be.” And for me, that was really eye-opening.

So for that reason, I went on the bandwagon of I'm not putting pronouns. That way, if someone else didn't want to, they didn't feel like they had to as well.

So I thought that was really interesting, that pronouns can really mean so much to a person and just... Yeah. So thank you for explaining that, that it really does matter.

Nica Selvaggio: Yeah, absolutely. And I love, thank you to that person who brought that point up because that's always what I like to... Oftentimes when we're trying to show up as allies in support of a community that we're not part of, it's easy to misstep and to do things out of good heart and good intention, but ultimately can contribute further to harm. And the pronouns in the bio or in your email signatures requirement is one of those ways where it's like, "Oh, we're trying to help normalize it for everyone." But again, you don't know who you're requiring to out themselves or to live falsely.

Jennifer Smith: Right. That's fantastic. And that's why part of the reason that we do this series is to help educate people and just explain things. Thank you.

Nica Selvaggio: Yeah, thank you.

Jennifer Smith: Yeah. So what can you say to people who simply might not have any understanding or have confusion about what we've just been talking about and just don't understand the distress that some people might have about identity or orientation or pronouns? Why is it a big deal?

Nica Selvaggio: Yeah. I always come back to why do we need to understand? I don't even understand myself. Why do I need to understand another person's experience for their experience to be legitimate and valid for them? I don't. In fact, it's often impossible to try. I can do my best, but I can't ever fully step into another person's experience. And so we don't actually require understanding. We require respect and compassion, just to be believed. Right? And you can compare this across many different experiences of identity. I will never know what it's like to walk through the world, say, as an Arabic man, I don't know what that is.

Jennifer Smith: Right.

Nica Selvaggio: It's not for me to try to understand. It's for me to listen and believe and provide respect. So first throwing away that word understanding, we don't need to understand. What I would say is have you... I would invite folks who really just don't get what the big deal is about to reflect on if there's ever been something in their own life that was really important to them, that they really cared a lot about, but that was dismissed or diminished, or they were told that they were foolish or crazy even for caring about that thing.

And we can do this together too, but just to take a moment and really call to mind that feeling, that memory and see what happens inside. So I notice immediately I start to contract, I start to constrict, and I start to want to feel small and to hide myself. Other folks might have a different experience. Maybe they feel angry, they want to fight back. There's no wrong response here. Just notice how do you feel when you're invalidated, misunderstood, and told that you're wrong to care about the things that you care about? Generally not pleasant.

So when we show up in that way, we're often perpetuating more of the same for people around us. If we've experienced that, then we're going to put that out on others too. Like, "Well, I had to conform. I had to shut down this part of myself, so how dare you not do that?" Right? We face a lot of anger from folks oftentimes as a result of that. Yeah. And what would the world be like if we had more spaciousness for those pauses to actually feel into, what am I reacting to in my not understanding? Am I being reminded of a time that I didn't feel understood? How can I show up in a more compassionate way?

Jennifer Smith: That's great. Thank you. Our final question, which I'm a little bummed to say because I thought this has been great. Do you have any words of advice or anything else that you'd like to say to our listeners today?

Nica Selvaggio: Be gentle with yourself. Working as a clinician, as a counselor, as a therapist, through some of these major world and global events that we've been experiencing collectively over the past decade, something I've noticed in the broader populations is that levels of fear are very high. Anxiety is very high, which makes sense. And levels of burnout, feeling like we just cannot continue on are very high. Levels of trauma and secondary trauma are very high.

In the midst of all of that, I want to invite all of us to both stand in the center of honoring and witnessing our sacred human struggles together, and also find those spaces in which things feel a little bit lighter, or we can expand more and access things like rest and pleasure and resilience, and that both of those things need to coexist in order to show up in a more whole way. So gentle, gentle, gentle, gentle. Show up when you can. Rest when you can.

Jennifer Smith: That's fantastic. Thank you so much, Nica, for finding time to speak with us today.

Nica Selvaggio: Thank you for having me.

Jennifer Smith: And for our listeners, if anybody is interested in scheduling an in-person or telehealth appointment with Nica, you can do so and self-schedule at seattleanxiety.com. Thanks again and have a great day.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Professor Irina Zlatogorova-Shulman on Leadership Influence & Employee Wellness

An Interview with Professor Irina Zlatogorova-Shulman

Irina Zlatogorova-Shulman, Ph.D., MBA is a professor of business psychology and organizational leadership at Southern New Hampshire University and the Chicago School of Professional Psychology. She specializes in business psychology and organizational leadership.

Tori Steffen:  Hi everybody. Thank you for joining us today for this installment of the Seattle Psychiatrist Interview series. I'm Tori Steffen, a research intern at Seattle Anxiety Specialists. We are a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.

I'd like to welcome with us today industrial organizational psychologist Irina Zlatogorova-Shulman. Dr. Z., as some students call her, is a professor of business psychology and organizational leadership at Southern New Hampshire University and the Chicago School of Professional Psychology. She's an expert in the field of business psychology and organizational leadership, and has written several publications on the topic, including the dissertation thesis, "Leaders' Influence on Employees' Participation and Wellness Programs and Organizational Productivity, Correlational Quantitative Case Study," as well as the book "Overcoming Mediocrity Resilient Women," which provides life lessons to overcome obstacles in a professional setting. So before we get started, can you let us know a little bit more about yourself, Dr. Z, and what made you interested in studying leadership influence in an organizational setting?

Irina Zlatogorova-Shulman:  Of course. Thank you, Tori. First of all, just want to thank you for the invitation to participate and contribute to the discussion on leadership influence and employee wellness in organizational settings. A little bit about me, I immigrated to the United States from Russia 30 years ago in 1992. I received my PhD in business administration specializing in industrial organizational psychology from North Central University and an MBA from Northern Illinois University. I'm also a writer, a public speaker, and a member of the American Association of University Women, AAUW. And as you mentioned, I'm also professor of business psychology and organizational leadership at Southern New Hampshire University and the Chicago School of Professional Psychology.

Because of my work ethic, willingness to learn and continuous pursuit of education, I progressed very quickly in my leadership career. I worked in a corporate environment for over 20 years. In one of my last roles, I was a senior executive for a large retail organization. I managed a department with over 100 business professionals and $4 billion in expenditures for purchasing retail-related services, at my workplace, which was a huge corporate facility, I saw many stressed, anxious, and burned-out people, and the overall environment in that organization would be considered toxic by many employees. So, when I decided to switch careers and become a college professor, I selected a dissertation topic related to the improvement of wellbeing of employees at their workplaces. I was also curious to find out through research how leaders impact employees' sense of wellbeing and why some people do not participate in the wellness programs offered at their places of employment. I hope this information answers what interests me in guiding leadership influence in organizational settings.

Tori Steffen:  Absolutely. Yeah, that sounds like really impressive background and experience to have in relation to those topics, so that's wonderful. Well, getting down to basics, could you explain for us how leadership influence presents itself in an organizational setting?

Irina Zlatogorova-Shulman:  Sure. When researching leadership influence in organizational settings, I used a theoretical framework consisting of the employee wellbeing theory and the authentic leadership theory. The stakeholders for that research were corporate employees and their employers. After finishing the study and publishing the findings, I met with individual leadership teams and shared my discoveries illustrating that their influence in organizational settings is significant. Would you like me to share some of that information, some of the findings?

Tori Steffen:  Yes, please.

Irina Zlatogorova-Shulman:  The results of my research showed that the perception by employees of their leaders' care about their wellbeing, including physical and mental health, influenced their work engagement and job satisfaction. In one company, leaders' care about workers' health will assess at 93% versus the national average of only 9.3%, which is low, so it was 10 times higher. That particular organization was voted as one of the best workplaces for 11 consecutive years. That was the main connection that I found, is that the more employees think or believe that their management cares about them, the more likely they will stay with the company and enjoy working there.

Tori Steffen:  Okay. Definitely some interesting findings there. That's great to know. What are some connections that you've found between leadership influence and employee mental health?

Irina Zlatogorova-Shulman:  Well, first of all, I want to talk about productivity and engagement. Because both productivity and engagement can be improved by positive leadership support. It can also reduce levels of absenteeism and presentism. As you know, absenteeism is the temporary absence of an employee from work due to personal reasons. But presentism is when an employee presents, attends the work, but performs sub optimally because of illness, emotional exhaustion, depression or burnout. And productivity-related discussions could be a sensitive topic among researchers and practitioners because productivity is affected by so many factors, and it could be hard to measure. Job-related stressors may include job role ambiguity, alienation, worklism, and workload. So, these issues influence productivity due to workers' illness and poor mental health. According to Statista, and I just pulled the statistics from today, in 2022, the following professions were found the most stressful jobs in the United States. First one is the enlisted military personnel, second: firefighter, third: airline pilot, fourth: police officer, and fifth: broadcaster. Fifth one surprised me, but it is what it is. So many organizations seek new solutions to mitigate work-related stressors, to improve productivity, and also now to survive in today's economy and remain profitable.

The situation got even more stressful for workers during the Covid-19 pandemic, and same thing related to engagement. Doing my research on engagement, the results of employees self-assessed levels of wellness were directly related to organizational engagement. For example, according to Gallup's research, about 26% to 30% of employees were actively engaged at work in the United States in 2018. In the United States alone, disengaged workers cost anywhere between $450 to $550 billion per year in lost productivity. Again, according to Gallup. However, in my research, those companies that invested in their employee's wellness through wellness programs and other health initiatives, they saw up to 90% engagement scores, which were three times higher than the national ratings. So again, employees' wellness level directly related to productivity and engagement.

Tori Steffen:  That's amazing. Thank you for sharing those statistics. It definitely helps paint a picture around how important the wellness programs can be for employee mental health, productivity, engagement. So thank you. Could you describe for us how employee wellness levels relate to organizational productivity and engagement from a research perspective?

Irina Zlatogorova-Shulman:  Yes. I just kind of covered those two topics related to productivity and engagement. I can also expand a little bit more on how wellness programs themselves also impact their mental health, engagement, and productivity. Is that okay?

Tori Steffen:  Absolutely.

Irina Zlatogorova-Shulman:  Okay. So, if implemented correctly, wellness programs can have a positive impact on employees' overall mental health and reduction of stress. It can also reduce their anxiety, depression, and mental burnout. However, the research unfortunately also shows that wellbeing initiatives will fail if they lack top level support, for instance. In some cases, employees may not be aware of workplace wellness program, or their leaders do not communicate available health benefits or promote awareness. Also, leaders' inability to handle their own stress at work can negatively affect the effectiveness of wellness programs implementation. I have seen that wellness programs adoption increases when employees see their leadership support of those initiatives. For example, when managers enroll and participate in company-sponsored programs, they lead by example and the employees follow. Therefore, wellness programs can produce a positive impact not only on employees' overall mental health, but also on the mental health of their leaders.

Tori Steffen:  Okay, perfect. Thank you so much for giving us that background.

Irina Zlatogorova-Shulman:  Sure.

Tori Steffen:  Okay. And how effective would you say are those wellness programs in producing a positive impact on an employee's overall mental health?

Irina Zlatogorova-Shulman:  Again, I kind of covered that information in my previous response. And I would also say that people in leadership positions can do above a lot more than just wellness programs. They can create a positive atmosphere and welcoming environment for their employees. So, as they participate in wellness programs, they also notice how their leaders behave and follow those examples. For instance, if they see that their managers participate in wellness programs, they can also more likely to enroll and participate in those initiatives, versus if they observe that their managers are reluctant to participate in programs and see it as a waste of time, they may also choose not to participate in those programs.

Tori Steffen:  Okay. Sounds great. Have you seen anything in the literature in regards to maybe anxiety or depression in relation to wellness programs?

Irina Zlatogorova-Shulman:  I have seen a lot of information related to authentic leadership styles that followers and mental health. Would you like me to cover the leadership style that is authentic leadership style for your listeners?

Tori Steffen:  Yes, please. If you could explain authentic leadership as a style for our listeners, that would be great.

Irina Zlatogorova-Shulman:  Okay. Well, authentic leadership is a specific style that leaders display based on their moral values, their beliefs, and their behaviors. Those leaders, authentic leaders, play a critical role in creating positive organizational cultures and ethical work environments. Authentic leaders are generally in tune with their emotions. They're passionate about their mission and adaptive to changes. Authentic leaders also convey self-confidence, self-discipline, self-knowledge. They clearly express their thoughts and they're able to choose and listen. So two years ago, I was invited to present information on authentic leadership style to the Society of Human Resources Management, SHRM, and many HR managers admitted that although this style sounds wonderful and is attractive, it is challenging to be authentic at some places of work due to their organizational culture.

Tori Steffen:  Okay. Yeah, that's interesting, bringing in the aspect of the company culture as far as leadership influence. Great. One thing that your research discusses is the ways that authentic leadership can impact individual sense of wellness and productivity. Could you describe for us how this might work in an organizational setting?

Irina Zlatogorova-Shulman:  Of course. So, leaders with authentic qualities can definitely promote positive relations and effective commitment. They can empower their employees. And in an organization that attempts to create a climate that promotes employees' involvement and engagement, authentic leaders serve as role models. They convey appropriate behavior based on their moral values, and overall individuals in leadership role greatly influence how they can demonstrate and share similar goals with their followers through leading by example. And in multiple studies, even outside of my research, the authenticity of a leader was found to be effective in preventing employees' burnout. Plus, since the authentic person can listen patiently with understanding and without judgment, employees feel much more compelled to approach them without feeling being judged or feeling retaliation. When followers identify themselves with authentic leaders, they are also more likely to develop self-advocacy, self-esteem, confidence, optimism, passion, hope, and resilience to job-related stressors. They can also become more engaged.

Tori Steffen:  Great. It sounds like authentic leaders would have a lot of great qualities and be able to lead by example in an organization. What are some of the different types of leadership styles and how might they impact employee wellbeing and productivity? Have you seen any negative ones out there that you might be able to speak about?

Irina Zlatogorova-Shulman:  Oh, thank you for asking this question, Tori. So, scientists and theorists are still arguing and trying to identify the best leadership style and practices that would eliminate the negative trends related to employees' health at work. Overall, since the beginning of research on leadership, the paradigm shifted and reflected significant changes in leadership progression from total dominance by leaders to group decisions, and from the power of leaders to values of groups, and from leaders' goals to group visions. So, if you look at leadership as a continuum, you would see autocratic style in one side and authentic servant leadership style on the other side. The leader's roles change from active to passive. And out of all leadership styles. I would say that the autocratic leadership styles could potentially negatively affect employees' morale, productivity, and wellbeing depending on the work environment. Autocratic leaders tend to make decisions quickly without input from others, and usually when they're pressed for time. This can lead to subordinates experiencing work stress, anxiety, lower wellbeing, and most of the research on autocratic leadership has shown that subordinates dislike managers use this leadership style they call the micromanagers. And they experience more job stress when being managed by such individuals. They also have lower levels of job satisfaction.

Tori Steffen:  Okay. Yeah, that's definitely important to know how the different styles might have an influence on those factors, so thank you.

Irina Zlatogorova-Shulman:  You're welcome.

Tori Steffen:  Your research was also investigating a correlation between leader involvement and employee enrollment in wellness programs. Could you explain for us your findings about that relationship?

Irina Zlatogorova-Shulman:  Sure. During my research, I collected data about employees' participation in the wellness program and compared it to their management enrollment statistics, and I found significant positive correlation between leaders and employees' enrollment in wellness programs. I think there are three factors that could explain that correlation. First one was transparency of a self-tracking and reporting system that companies use to monitor everyone's participation. In some cases, employees could see if their managers enrolled in the program or not, including their CEOs. The second one was positive correlations could also indicate that individuals had higher personal commitment toward their health and wellbeing if they saw that their leaders are also committed to their health. And finally, surprising finding was that employees and their managers were motivated by financial incentives to participate in wellness programs. For example, when one company introduced financial incentive of up to $560 per year for all employees, including top leaders, the wellness program's enrollment and participation rates went up from 17% to 57%.

Tori Steffen:  Wow.

Irina Zlatogorova-Shulman:  I hope these information examples answer your question, Tori.

Tori Steffen:  Okay. That's great to know. Definitely a big jump there in the enrollment, so that's great. What else might leaders be able to do to promote employee wellness and productivity levels, maybe besides the high involvement in those wellness program enrollment?

Irina Zlatogorova-Shulman:  Yeah, I touched a little bit on this before, but to promote employees' wellness and productivity leaders can also create a welcoming, inclusive, safe, and pleasant work environment. Several research studies that I reviewed during my dissertation confirmed that authentic leadership style influences the positive emotions of their followers and directly impacts employees' engagement and turnover rates. In those work settings where employees can voice their concerns without fearing retribution, they feel more secure and less likely to leave. Also, in my research on wellbeing, I found that flexible work arrangements can improve employees' morale, increase their engagement and lower turnover. For instance, more and more organizations are now considering creating flexible working arrangements for their employees, such as hybrid work, telecommuting, remote work, condensed work week, flex time, part-time, shift work, or even job sharing. So here are some additional ideas.

Tori Steffen:  Awesome. Those are great to know. We personally do remote work and flex time, and I definitely find that that helps with work-life balance, so that's great. Do you work on any other research projects or maybe activities that relate to the topics of our discussion today?

Irina Zlatogorova-Shulman:  Yes. I am currently researching data and findings related to mindfulness practice. Mindfulness refers to a mental state or focus on the present moment while noticing and accepting all feelings, thoughts, and bodily sensations. So, in the past two years, I've been participating in educational seminars and workshops on mindfulness. This topic is getting more and more interest because it can be applied to any field, any area, from businesses to schools, and from arts to sports. I was very grateful to lead one training session at Southern New Hampshire University and deliver a presentation to our faculty about how mindfulness can be integrated into the online learning environment for our students. I also did an educational zoom session on mindfulness related to financial health for one of the investment firms and their clients. And now, I'm working on an article for Silent Sports Magazine on how athletes could integrate mindfulness techniques into their training and improve endurance and performance. Finally, I'm teaching yoga and meditation classes. I'm a certified yoga instructor at the local park district, and I see more and more people becoming interested in these activities, mindfulness, meditation, yoga, and relaxation techniques because they find those helpful in enhancing their emotional wellbeing and building individual resilience to stress.

Tori Steffen:  Great. Those are all really nice topics to touch on as far as mindfulness, and I can see how it would be very helpful for students, athletes and teachers too.

Irina Zlatogorova-Shulman:  Yes.

Tori Steffen:  Well, great. So Dr. Z., do you have any final words of advice, anything else that you'd like to share with our listeners today?

Irina Zlatogorova-Shulman:  Yes, I would like to share some final thoughts. When employees are unhappy with their jobs or workplaces, they start searching for different opportunities. And with the COVID-19 pandemic, many people began reevaluating their life commitments and where and how they spend their time and talent. Now, many organizations struggle to attract and retain their most productive workers. However, they can stop employees from leaving by creating and promoting a healthy culture. It all starts at the top, at the senior management levels. And I know I'm repeating myself by saying this, but the leadership influence on employees mental and physical health is significant.

Tori Steffen:  Absolutely. Well, great. That is amazing, helpful information. So thank you so much for joining us today, Dr. Z., and contributing to our interview series. It was really great speaking-

Irina Zlatogorova-Shulman:  Thank you very much for participating, for inviting me to participate in the session. I appreciate.

Tori Steffen:  Absolutely. It was really great speaking with you today, Dr. Z.

Irina Zlatogorova-Shulman:  Thank you, Tori.

Tori Steffen:  And I hope you enjoy the rest of your day.

Irina Zlatogorova-Shulman:  Thank you, you too.

Tori Steffen:  Thank you.

Irina Zlatogorova-Shulman:  Bye-bye.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychologist David Rosmarin on Spirituality & Mental Health

An Interview with Psychologist David Rosmarin

David Rosmarin, Ph.D., ABPP is the founder of the Center for Anxiety (New York & Boston) a psychologist at McLean Hospital and an associate professor in the Department of Psychiatry at Harvard Medical School. Dr. Rosmarin specializes in the relevance of spirituality in one’s mental health.

Tori Steffen:  Hi everybody. Thank you for joining us today for this installment of the Seattle Psychiatrist Interview series. I'm Tori Steffen, a research intern at Seattle Anxiety Specialists. We are a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.

I'd like to welcome with us today psychologist, David Rosmarin. Dr. Rosmarin is the founder of Center for Anxiety, which has offices in both New York and Boston. He's also a psychologist at McLean Hospital and an associate professor in the Department of Psychiatry at Harvard Medical School. Dr. Rosmarin's research at Harvard focuses on the relevance of spirituality to mental health. At Center for Anxiety, his team uses a combination of cognitive behavioral therapy (CBT) and dialectical behavior therapy, also known as DBT. These approaches are used to help patients struggling with moderate to severe symptoms of anxiety, depression, and other concerns.

Before we get started, could you please let us know a little bit more about yourself, Dr. Rosmarin, and it sounds like you have two different aspects of your career, the spirituality and then the anxiety piece. Are these related?

David Rosmarin:  Well, first, thanks very much for having me on your program and I'm really happy to be here. They can be related for some individuals. Spirituality is an interesting variable. It's the kind of thing that most people in mental health don't get a lot of training in, and my program of research seeks to remedy that, to give clinicians tools to be able to assess for and address aspects of spiritual and religious life when it's relevant, which is more often than you would think, but it's not for all individuals.

In terms of anxiety, sometimes it's relevant and sometimes it's not. Center for Anxiety doesn't practice spiritual psychotherapy per se, unless individuals need specific spiritual and religious supports. I would say it is somewhat unique about our practice that it's a domain that we're not uncomfortable to address, unlike a lot of others. But it's not the only unique thing about Center for Anxiety.

Tori Steffen:  Okay. Very interesting. Well, getting down to basics, could you explain for our audience what spirituality is?

David Rosmarin:  Sure. Spirituality is any way of relating to that which is perceived to be sacred or set apart from the physical world. These kinds of beliefs are pretty common. In the United States, 80 to 90% of the general population has some sort of spiritual beliefs, and more importantly, in mental health settings, there's data to suggest that more than 80% of patients, even in some of the least religious areas of the United States, utilize spiritual ways of coping when they are distressed by mental health concerns.

Tori Steffen:  Okay, perfect. Thank you for explaining that for us. What are some connections that you have found between spirituality and mental health?

David Rosmarin:  Sure. Like any domain of life, it can be positive or negative, and spirituality is no different. In many cases, people have spiritual resources, and they might think that their faith gives them a lift. It might help them to deal with depression. It might protect them against certain things like substance abuse or alcohol abuse or suicidality. There's some very strong research to suggest that completed suicide is substantially less among people who have certain types of faith. It might give them a sense that they can get through difficult periods of life. We've seen some evidence here at McLean and elsewhere that when individuals have spiritual and religious resources at the beginning of treatment, that can help them to reduce quicker through their treatments even if the treatment has nothing to do with spirituality, interestingly.

On the other hand, though, it can be a source of strain, I mentioned. It can definitely be negative, and a lot of individuals struggle with their faith. They might think, why am I dealing with depression again? What's God doing to punish me? What did I do wrong? They might feel guilty or estranged from a faith community. They might feel bad about certain feelings they have; they might have certain conflicts which are sometimes very serious. To be able to discuss all of these, the positive and the negative and all points in between is just part of being a good psychotherapist, frankly.

Tori Steffen:  Okay. Yeah, it seems important to know about the spirituality piece, especially when you're treating patients with suicidality and it's great to know that that can help too. Well, could you describe for us how the methods of both CBT and DBT work as those naturalistic treatments for anxiety?

David Rosmarin:  Sure. You mentioned my career has two parts to it, and I would say there is some connection and overlap, but a lot of it is really disparate. At Center for Anxiety, we use a combination of cognitive and dialectical behavior therapy, which is somewhat innovative in the treatment of anxiety disorders. Most individuals treating anxiety concerns would really stick more to cognitive behavior therapy. But these days, anxiety, as I'm sure you're seeing out in Seattle, a lot of individuals come in with some pretty severe symptoms. They might have self-injury, they might be debilitated by their anxiety or other symptoms that they have. There's also high levels of what we call comorbidity where people have co-occurring anxiety with other concerns, whether it's substance abuse or depression, as I mentioned before, or any number of issues, obsessive compulsive and related disorders and these concerns and the complexity and the severity that people have today, they really, we have found can benefit from a broader toolkit of strategies that we can provide in psychotherapy to them, and that's why it spans both cognitive and dialectical behavior therapy in the practice.

Tori Steffen:  Okay, great. That definitely helps introduce our topic today with CBT and DBT. How effective would you say are both approaches, CBT and DBT in treating those symptoms of anxiety, depression, suicidality?

David Rosmarin:  Yeah, that's a scientific question and fortunately we have research to study it. Center for Anxiety has a research protocol and all patients at all sessions are administered measures, and we track over time their progress. We a couple years ago did an evaluation of our IOP, our Intensive Outpatient Program, which are individuals who needed three or more sessions per week.

One of the things that's unique about Center for Anxiety as I mentioned before, is that we provide really a higher level of care than just standard once a week outpatient. Individuals coming in with a lot more severe concerns and symptoms, I'd say about 50% of our patients at this point, require IOP, Intensive Outpatient Program or treatment, IOP we call it, and our data was very positive. We saw substantial reductions and clinically significant reductions in anxiety and depression for substantial decreases in those symptoms over the course of treatment. In fact, none of the patients in that study had an increase in their anxiety or depression over the course of treatment, which I think was particularly encouraging given the severity that they had when they came in.

Tori Steffen:  Wow. Yeah, that's definitely good to hear that there's those treatments out there to be able to help with those symptoms. Have you seen any limitations that might prevent the treatment of anxiety, depression using those?

David Rosmarin:  Being in an outpatient setting, one limitation is the cost of treatment. Unfortunately, with the era of managed care, and I'm sure you have a similar situation out in Seattle, these are out-of-pocket services, and it does limit the people who can come, which is really truly unfortunate. One advantage though that I think we have, and one way of addressing this is we do have a training program and many of our trainees are learning these techniques and they are able to be accessible at lower fees. Also, some of them move on to different sites which can provide services to individuals using insurance or having no insurance at all. I do feel like we're having an impact on the field more broadly, but in terms of our actual caseloads, that's a very significant limitation.

Tori Steffen:  Okay. Definitely makes sense. Well, your research discusses the ways that CBT and DBT involve behavior activation and mindfulness. Could you describe how those might work for audience?

David Rosmarin:  Yeah, so DBT is a broad set of tools, principles, really, and tools to help individuals struggling with severe levels of distress, moderate to severe levels of distress. One of the core tools is called mindfulness, that was the word that you mentioned. Mindfulness means being attentive to the present moment and not being judgmental of oneself. One of the things that happens is not only do people feel depressed or anxious or have other symptoms, but they judge themselves for feeling anxious, depressed, and that judgment instead of simply being anxious or being depressed and allowing oneself to feel that way, that judgment of oneself and negative perception of that feeds in and actually creates more of a surge of adrenaline. It suppresses dopamine, serotonin, other neurotransmitters and individuals are more likely to struggle substantially when they judge themselves. Mindfulness is a training of simply allowing oneself to be in the moment and to experience whatever they're going through without that critical eye.

Tori Steffen:  Okay, great. Thank you for explaining that for us. Your research was also discussing how psychoeducation plays a role in the treatment. How might that work to address those symptoms for anxiety and depression?

David Rosmarin:  There are a lot of basic facts around anxiety and depression and other symptoms that people don't know. For example, if you're feeling depressed, you probably will not want to engage in this much activity because hey, you're feeling sad, you're not enjoying things as much. You're struggling to have the energy and your sleep might be dysregulated. However, to the extent that people simply keep a schedule, even if they're feeling depressed, their depression can and often does remit.

Scheduling an activity which is supposed to be so to speak, pleasurable, even if it isn't, can actually be a part of that. Going to an exercise class, simply going for a walk, lacing up one's shoes, getting out of bed, not sleeping during the day. This is what we call behavioral activation, which is actually in some ways invented in Seattle in your backyard over there and certainly came to be a tour de force in the world of behavioral psychology in Seattle. But in any event, this is a concept that we can just educate patients.

Another one is with anxiety, the more you avoid, the more anxious you will be. If you're afraid of something and you avoid it, you're going to become more anxious of it, not less, even though it feels better in the moment. These are basic concepts that have been clarified through the literature, through experimental science, through clinical science, and they're grounded in theory that patients and anybody just needs to know. So, sometimes just some basic info can go a long way.

Tori Steffen:  Okay. Yeah, that definitely makes sense how important psychoeducation can be. Are there any other approaches than CBT or DBT that individuals can utilize to combat those symptoms?

David Rosmarin:  Yeah, one of the DBT approaches that we really love is called distress tolerance. People often think that one of the goals of treatment is to reduce the amount of distress they're experiencing, and to some extent that's true, but to a larger extent, one of the goals, a better goal, I would say, is to increase the amount of distress that we can tolerate. There's a big difference between trying to reduce my distress versus trying to increase my capacity to withstand distress, and when we think about it the other way, the increasing our distress tolerance in of itself, we're not expected to never be distressed. It's not a surprise when we're having a really rough day and the goal then becomes to weather the storm as opposed to getting the weather to change. As we all know today, climate's very hard to predict and to control, not that we shouldn't try, but we can and certainly should learn to tolerate more with the situation that we have, especially when it comes to our emotions.

Tori Steffen:  Okay, awesome. Thank you for sharing that. While CBT and DBT are best and ideally done under the treatment and guidance of a licensed mental health professional, what are some things one can do on their own to potentially reduce or lessen some of those symptoms of anxiety or depression?

David Rosmarin:  I'm thinking about another DBT module called emotion regulation and simply the idea of being aware, for example, on a scale of 0 to 10, how stressed are you right now?

Tori Steffen:  Myself, I would say maybe a four. Not too bad.

David Rosmarin:  Four, not too bad for a mid-morning west coast kind of vibe. I get that, even though it's a Monday. That's great and you're aware of it right away, and maybe that's because you're involved in the field. Other people will fumble, I don't know, is it high? Is it low? I don't have a baseline. Simply being aware of how sad you are, how anxious you are, and throwing a number to it. If you don't want to throw a number to it, at least is it high, is it medium, is it low?

Being able to share that with someone, that's another factor in emotion regulation. Being able to just communicate how you feel to other individuals, whether it's a professional, as you mentioned, or a friend. Whether it's a post on Twitter, hey, feeling a little bit sad today, whatever it is. Then these kinds of things, it's important to maintain awareness and then to recognize also that we can shift our emotional states. Sometimes you might all of a sudden feel really dysphoric and sad and part of that we can't necessarily control, but we might be able to indirectly influence that. Listening to reggae music, right? Hard not to bop. Going for a walk, calling up an old friend, eating ice cream. But sometimes those can have negative effects, as well. Being aware of our emotional states and how what we do affects those, that's really the core of emotional regulation and that's something everybody can benefit from today.

Tori Steffen:  Okay, great. Awesome advice. Well, do you have any final words of advice or anything else that you'd like to share with our listeners today?

David Rosmarin:  I guess I'll share this, that we're living in very challenging times. People have higher levels of anxiety and depression than ever before in history for a variety of reasons. It's very real, these concerns, and they have very significant and real effects on people's lives. Our phones are ringing off the hook. The other day, I think they're 22 intakes that came in and that's very significant for a modest practice of our size.

I think it's important for people to know that they're not alone today, that if they're struggling, there's plenty of other people that are there. More importantly, that there are treatments that really are helpful, and in not a lot of time. I mean, our treatments will often see people 5, 6, 7 sessions and see a decrease. They might stay on longer to target other aspects of their mental health, but A) people are not alone and B) there is hope to be had and a lot of hope, so I think those are probably some important messages to get out there.

Tori Steffen:  Definitely important to keep a positive perspective on things, so that's very helpful. Thank you so much. Well, it's been really great talking to you today, Dr. Rosmarin, and thank you again for joining us and contributing to our interview series.

David Rosmarin:  Thanks for having me on your series.

Tori Steffen:  Thank you very much. Hope you have a great day.

David Rosmarin:  You too.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Author John Purkiss on The Power of Letting Go

An Interview with Author John Purkiss

John Purkiss is the best-selling author of several books, including:“The Power of Letting Go: How to Drop Everything That’s Holding You Back” and “Brand You: Turn Your Unique Talents Into A Winning Formula.” He is an expert on the notion of “letting go” while utilizing mindfulness to improve performance and mental well-being.

Preeti Kota:  Hi, thank you for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Preeti Kota, a research intern at Seattle Anxiety Specialists. We are a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.

I'd like to welcome with us author John Purkiss, who joins us from England today. Mr. Purkiss is the author of several books, including “The Power of Letting Go”, he began his career in banking and management consultancy. He now recruits senior executives and board members, he also invests in fast-growing companies. Before we get started today, can you let our listeners know a little bit more about you and what motivated you to write “The Power of Letting Go”?

John Purkiss:  Certainly. Well, thanks for inviting me. So what happened in my case was... like a lot of people, I got the message that if I was intelligent and hardworking, then everything would be fine, so I did that until I was 26, so I went through economics degree, banking, consulting, MBA and it all worked extremely well. And then, I was diagnosed with clinical depression, which nearly killed me, so that was my wake up. I now see it as a blessing, it was like the beginning of the destruction of the ego. But from a medical point of view, it was very bad news so that's when I realized. What I was offered, electroconvulsive therapy, Freudian psychoanalysis or pharmaceuticals. I didn't do the electrical thing but I did do the Freudian psychoanalysis and I did do the pharmaceuticals. And then, I just thought there has to be another way so I started searching for other options so that's how the journey began.

Preeti Kota:  Can you describe the Vedic tradition that inspired the concept of letting go?

John Purkiss:  Yeah, certainly. While I was searching around, I read lots of books. Everything from Californian self-help to Eastern philosophy. And what I found was pretty much everything points back to the Vedic tradition. So Veda simply means knowledge, it's a Sanskrit word which means knowledge. As you may know, science also means knowledge, scientia. The difference is that Western science is largely based on looking outwards, doing experiments in laboratories and social experiments. Whereas, the Vedic tradition is more of a download, so it's looking inwards. And people downloaded things thousands of years ago, which are now being tested in laboratories. So the Vedic tradition goes much faster because it doesn't have the empirical process, but it seems to be leading to very similar conclusions.

Preeti Kota:  How do you find the balance between letting go and giving up?

John Purkiss:  I don't give up. I think giving up is completely unhelpful. Answer, no balance. Letting go is not giving up. I don't recommend giving up.

Preeti Kota:  I feel like when people are trying to start to let go, they are afraid of giving up.

John Purkiss:  Yes. Well, it might be helpful if I distinguish between the two. So giving up is, you just stop trying and you lose hope. Well, you might just hope that somehow things will work out, which they might, but it's powerlessness, it's like, "I have no power, I can't do anything so I give up." And in some situations, I suppose, that could work, actually. I mean, I've never done it, but I've heard about it, if someone attacks you and you just give up, then they kind of loosen their grip, so there are situations maybe that works. But letting go isn't that at all. Letting go, at least as described in the book and in the Eastern traditions, letting go is... what you're actually doing is letting go of your ego.

So if I describe it this way, in the West most of us have been brought up to believe that we are the body-mind. So Eckhart Tolle to talks about this in “The Power of Now”, for example, he talks about the body-mind. And I studied economics. So economic, psychology, finance, arguably even engineering, medicine, there are so many disciplines which are based on the idea that you and I are body-minds. And we're trying to get what we want and avoid what we don't want, so like a brain and a body.

And so when we let go... If that's how you see yourself, it may feel like, "Oh, I'm giving up now, because I'm not trying anymore." The Eastern traditions of which the Vedic tradition is largely the origin is saying, "Your brain and body are part of something extremely intelligent, which is running everything all the time. And when you let go, you stop trying to figure everything out using your brain, and you basically tune into this universal intelligence, which is running everything."

And I think, if you've been brought up as an atheist, that's very hard, because you have this strong belief system that there's nothing beyond human intelligence. Whereas, if you've been brought up in any of the spiritual tradition... I mean, I was brought up as a Christian, at least when I was ill, I had some understanding that there was something extremely intelligent that was running everything. And then, when I let go, I very quickly began to tune into it. And then, things started to work out. I mean, one example is your body, even if you don't think about it, your body will run itself. In fact, most people interfere with their bodies and stop it from running correctly. But if you don't do anything crazy, your body will run itself without any intellectual intervention.

Preeti Kota:  Yeah. So, you're mentioning the ego, so a little bit on that. How does our ego affect us, particularly our mindset?

John Purkiss:  Okay. There are two definitions of ego. Two main ones. The one which is most common in the West is the Freudian definition, which is... I'm sure you know, you have the super ego, the ego, and the Id. And the Id wants to do kinds of crazy things, and the ego regulates the Id, and stops the Id from doing stupid things. So the ego is useful. I mean, ego is a Latin word. It simply means I. So that's the ego in the West. In the East, the ego is not helpful at all, because what the... for example, the Vedic tradition is telling us, is that you are not the body-mind. How should I put it? You are supreme consciousness. You are the consciousness which is running everything.

So the guru who I follow, he says, "I'm not here to convince you that I'm God. I'm here to convince you that you are God." So the message of the Eastern traditions is you are divine, and ego is hugely unhelpful because ego is when you start seeing yourself separate from the divine, from the cosmos. So clinical depression for me was an extreme example of that. I felt completely separate and desperate. I felt separate from everybody and everything. And I was running around trying to solve problems and I wasn't tuned in at all. And of course Freud died, I think, in 1939, that's very recent. The Eastern traditions have been talking about the ego for millennia. So two totally, completely different view points.

And I think, you used the word, mindset, is that right? Yeah. So mindset. So in the West we have this idea of the mind as a thing. The mind is like some box. And we try and fix the box using medication or using maybe some therapy or self-help books or whatever, that's the idea. Whereas, the mind in the Eastern traditions is more like a process. It's a series of patterns. And you can do this on your own, or you can have professional help. If you look very carefully, you can start to see all the patterns, the really unhelpful patterns which are causing the mess, I think. And so the definition of the mind is different. So the West, I would say, sees the mind as a thing, and the East sees the mind as a process.

Preeti Kota:  Okay.

John Purkiss:  Yeah. Or processes, as you would say in the US.

Preeti Kota:  How is the ego formed?

John Purkiss:  I don't know. I don't know what Freud's view was on the formation of the ego. So my guru is called Sri Nithyananda Paramashivam, the way he describes it, which I talk about in the Power of Letting Go is he says, "The ego is made up of incompletions." So for example, when you are a small child. Small children are generally blissful, and then, occasionally they cry when they're hungry or something. And then between the ages of two and seven, we have painful experiences. And those painful experiences form the ego. So for example, I'm sure you've had this experience, if you're in a meeting or a conversation and the other person suddenly gets annoyed with something you said or something that happened, it's because some pain pattern has been triggered. And that's the ego.

And I mean, in the West we tend to say, "So and so has a massive ego because they think they're superior to other people." For example, they might suffer from poverty when they're small, when they grow up, they have lots of money. So they have an ego relating to money, that's a common. But you can also have an ego, which makes you feel inferior to other people. So some people who feel inferior to other people, they actually have massive egos on the eastern definition because they have so much pain in their system, which they accumulated between two and seven. But it's still ego. It still makes you feel separate and it still causes suffering.

Preeti Kota:  So they project the opposite.

John Purkiss:  Unfortunately, ego, we project it all over the place. So if you have some pain pattern about racism, or unfairness, or dishonesty, or something, you project it onto other people, you start accusing other people of that. Yeah. So it causes chaos, unfortunately.

Preeti Kota:  How can you simply follow your intuition when you have a fear that you might be making the wrong decisions?

John Purkiss:  Okay, that's a good question. So my favorite definition of intuition is immediate insight without reasoning. So you have an insight. For example, you might have an insight that you should call your mother or that you should turn left, whatever it is. And that doesn't require a massive thought process. You just act on it. And real intuition comes out of love. It's guiding you to do the right thing. There is a thing called false intuition. So we just talked about the ego, these accumulated pain patterns. What can happen is that, false intuition is you have a reaction to something or someone, and it's coming from pain. And so it's not really intuition, it's just a pain pattern asserting itself.

For example, you might see someone from another ethnic group walking down the street and immediately avoid them, because you have some pain pattern. Or, you might see a dog, or a cat, or a spider, and it triggers some pain pattern. That's not intuition, that's just a pain pattern getting triggered. We'll talk about it later, but if you use the correct technique, you can remove those pain patterns and you stop getting triggered. And then, your intuition operates freely because you're not getting triggered the whole time, you're just seeing things as they are. And you have a feeling about what you should do next.

Preeti Kota:  Yeah. So how do you let go of the fear?

John Purkiss:  Well, the completion technique removes the fear. So we can talk about that now. So in chapter three of the book, I describe a technique called Completion. It's been trademarked, it's now called the Science of Completions. So I learned it eight years ago from Swamiji behind me. That's why I went to India to meet him. And it's very simple. I'll give you an example. So my first day at school when I was five, I arrive at school and I have this accent. So I don't know if you know, this is the accent which the BBC sells to foreigners. This is the export version of British English. I mean, the BBC in the UK uses all kinds of accents, but when they're talking to foreigners, they tend to use this accent, which is what I grew up with.

And when I was four, we moved about hour and a half, two hours north of London. And the accent there is different. So it's my first day at school and I'm five years old. This is my first day in the world without my Mum and I arrive at the school and I want to make friends. And they don't make friends, they just laugh at me. And someone says, "You're a bloody nutter, you're crazy." And I feel really bad. So that's how the pain pattern starts. So, Swamiji calls it, self doubt, self hatred, self denial. So the self doubt is, "I'm unacceptable." There are all these patterns. "I'm unacceptable. I'm a failure, I'm trying to make friends, but it's not working. Other people don't support me."

Then all those patterns start developing. As far as I can tell, it all happened within five minutes. And everybody has this before the age of seven. I mean, in some people, it can be something that seems far more traumatic or less traumatic, either way it happens. So when that happens, you then live the rest of your life based on those patterns because we suppressed the pain. So what happened in my case is I grew up in Lester, in the Central England, and after a while I realized that nearly all of my friends were not English or they were not White English people, they were Indian, or they were Jewish people from Central Europe, or they were Ukrainian or whatever they were, Irish.

And I was aware that I had this feeling that I was an outsider. I wasn't in the football team, soccer team, I felt like an outsider. And then many years later, I realized when I met Swamiji, I realized I had this pattern of, "I'm unacceptable." So I ended up hanging out with all the other people who felt unacceptable. And it was, in a way, it looked beneficial because a lot of us went to Oxford and Cambridge. I mean, because we didn't get any love from the other people. The only way to get on was to work hard. So we all worked hard and went to Oxford, Cambridge and did all this stuff.

But there's still this underlying pain pattern, which is, "I'm unacceptable," which is very bad news in terms of relationships, business, all kinds of things. And so the technique is incredibly simple. The technique is... I become five years old. I've got my mirror here. I've got this mirror that I use every day. So I become five years old. And I look at myself in the mirror, I'm talking to the person in the mirror, and I relive intensely those first few minutes at school.

So, I allow all those suppressed emotions to come out. So in my case it just feels bad and eventually it starts to die down. There have been cases, I mean, some people cry, some people throw up, they vomit. But basically this pain is stored in your body. And what happens is if you do the reliving intensely... and you can relive any episode in your life, what I find is, at some point it feels almost like an electrical charge has left my body. And what I'm left with is an empty memory. So it's a memory, which I can go and find a book in a library, but it's not a memory with an emotional charge, which is running my life.

Preeti Kota:  Okay.

John Purkiss:  And for me, it's such a powerful thing because, I mean, one of the really great things about it is you then become nonviolent. So much violence in the world is people being triggered, right?

Preeti Kota:  Yeah.

John Purkiss:  And then attacking each other, either mentally or verbally, so if you're not triggered, you won't fight people.

Preeti Kota:  That's true. So I guess you've already touched on this, but what are pain patterns?

John Purkiss:  Yeah, it's a good question. So pain pattern, that's a simple word. The Sanskrit word is samskara, like a scar. Swamiji uses the word incompletion. So one way to describe it is, in an ideal world, if you were completely conscious all the time, you would have a painful experience and you would live it from beginning to end. Or, a happy experience, so let's imagine you have a happy experience, you live it completely, and then it's finished. You've done it right, you've completed it. Or, you have a painful experience and you allow yourself to feel all of the pain. And then you complete the pain and then it's finished.

But what happens in reality is... By the way, British men are experts at this, is we have a painful experience and we don't like the pain, so we suppress it and we pretend everything's okay. And that suppressed pain is now stored in our bodies. I often do this. Well, I can do it with you if you want. You don't have to tell me the experience. But can you think of the most painful thing that happened to you before the age of seven?

Preeti Kota:  I don't really remember.

John Purkiss:  Okay. All right. The most painful experience you can remember at all doesn't have to be before seven.

Preeti Kota:  Okay.

John Purkiss:  Right. How old were you?

Preeti Kota:  Maybe 15.

John Purkiss:  15? Okay. So can you feel the pain of that experience now without telling me what it was?

Preeti Kota: Yeah.

John Purkiss:  Okay. And where is that pain in your body?

Preeti Kota:  I think in my mind.

John Purkiss:  In your mind. But where? Can you point to it? You can feel the pain. You're 15 years old. You can feel the pain. Where is it? Is it in your head or where?

Preeti Kota:  Yeah, I think in my head.

John Purkiss:  Okay. All right. So in 99% of cases, when I ask people that question... I say, "Okay, think of an event, feel the pain. Where is the pain?" 99% of cases, people can point to the pain in their body. They know where it is. It can be in their heart, it can be in their chest, or their stomach, wherever. But the point is it's been stored. Swamiji calls it muscle memory or bio memory. But the point is, it's not some abstract thing. I was in management consultancy for a while. I once asked this question as a former management consultant, and he said, he could feel the pain, but he didn't know where it was. Which strikes me, maybe that's very intellectual person, but most people like 99% of people, they can find it in their bodies, right?

Preeti Kota:  Yeah.

John Purkiss:  So the pain gets stored. Swamiji uses lots of analogies. My favorite one is, he says, it's like putting a carpet on a wound. So imagine you have a wound and it's all horrible, and then instead of treating it and disinfecting it, and you actually just put a carpet on it, which makes the whole thing worse. And that's what most of us do. We just suppress it because it's painful. And completion is removing all the pain. So the wound heals and then we would become whole, then you're fine.

Preeti Kota:  What is flow and what are its benefits?

John Purkiss:  I'm sure you know, there's a famous book called “Flow” by Csikszentmihalyi. Are you familiar with him? The Hungarian psychologist who invented the word flow. So it's a very thick book. I would say, for me, flow is a symptom. I mean, the state of flow has lots of benefits. So people experience flow when they are completely immersed in some activity, usually they really enjoy it. In my case, photography. If I'm immersed in photography or writing or something like that, there's a feeling of flow. You're not agonizing or analyzing, you're just enjoying the process and it happens very naturally.

But I would say, for me, that flow is more like a symptom. So maybe we'll get onto the topic of unclutching, as well. But if you are complete and you are unclutched, then flow happens naturally. One way of describing it is you become one with existence, or one with the cosmos. And so everything's happening very naturally. And you may have read about this, there are American football players, for example, who say that, when they're in a flow state, everything slows down. There's almost no thought involved and everything just happens really smoothly. But for me, there are ways of getting to that. It's a result rather than something you just do. Sorry.

Preeti Kota:  What are the benefits of it?

John Purkiss:  The benefits of flow are... of being in that state, are little or no stress, things happen very easily, relationships are easy, it's very productive. I mean, I have times when I can just sit down and write a thousand words in an hour or two. And a book is only 40,000 words. So yeah, I mean, flow is a fantastic thing. I mean, yeah, it's definitely good for your health. It's good for productivity, good for relationships, good for creativity. Yeah, definitely.

Preeti Kota:  Okay. How can people with anxiety or depression who are stuck in negative thought patterns about the past or future start to let go?

John Purkiss:  Okay, well there are two techniques. One of which I mentioned before when we were preparing for this. So we'll deal with them in a minute. So one is completion, which I've just described. So if you keep practicing the Completion Technique, you'll remove the negative thought patterns. And what happens is, that those repetitive negative thoughts start to die down. So for example, if I have a cognition from my first day at school that I'm a failure or that I'm unacceptable, if I complete that incident and remove that pain pattern, then I won't have thousands of negative thoughts about being unacceptable or being a failure, so that's one thing. You can remove the cause, which is the pain pattern. The second thing is... and this is a wonderful technique which fits beautifully with completion. This second technique is called Unclutching, which I didn't write about in the book I'm going to write about it in the next book.And I sent you a video. So there's a six minute video and a one hour video, which you can share with everybody. But the principle is very simple, unclutching is very simple. So, are you familiar with mindfulness?

Preeti Kota:  Yeah.

John Purkiss:  Yeah. Okay. So mindfulness has become huge in the West, and it also comes from the Vedic tradition. But mindfulness, there are various ways to do it, but my experience of mindfulness was... So I'm present, I'm sitting here quietly, and then I have a thought and I get distracted by the thought and my mind follows the thought, which morphs into another thought, and another thought, and another thought. And what I need to do is bring my attention back to the present. So that can be by putting my attention on my breath or the end of my nose or whatever, or the sensation of my hands on the table. There are all kinds of things I can do to bring my attention back to the present. And that works. I mean, I did that for six years and I talked about it in The Power of Letting Go. For some people that works perfectly well. Steve Jobs did zen meditation, which is similar, for decades. Unclutching is even simpler.

So what happens is... so Imagine you're sitting there and you have this negative thought, you now have a choice, you can either engage with the thought or you can unclutch from it. So if you engage with the thought, you might for example say, "That can't be true. Or, Oh dear, here's that thought again." Or get distracted and start thinking about whether or not that thought's true. A whole thing. You'll be there for hours. You can either engage with it and allow that to happen, or you can unclutch. Swamiji invented the term. Unclutch means, "I choose not to engage with it." It's a bit like, a small child is pestering you and you ignore the child.

So this thought comes up and you have the choice not to engage with it. Right?

Preeti Kota:  Yeah.

John Purkiss:  You just unclutch, you just step back mentally. You step back from it. And my experience as a Westerner is, initially, it felt to me like incredibly lazy. Surely if I have a thought, I should engage with it, and I should analyze it, and I should deal with it, and address it, and bladi, bladi, blah. Yeah, but then you're going to be in this mess. So what I do now is if I'm doing something and I have a negative thought... which can happen. I'm winning some business or working on a book or something I have a negative thought, I can just choose not to engage with it.

Preeti Kota:  Do you just distract yourself?

John Purkiss:  Sorry?

Preeti Kota:  You just keep distracting yourself?

John Purkiss:  No, don't distract about it. It's just a choice. Okay. I mean, we can do it now. You sit there, a thought comes up, you don't have to engage with it, you don't have to think about it. You can just notice it. And then, after a while it'll go away and another thought will come. And you don't engage with that one either. You don't think about it. You don't analyze it. You don't find evidence to contradict it. You don't suppress it. It's like bubbles in a fish tank. "Okay, there's a thought." And I encourage you and anyone listening to this or watching this to do this is, if you unclutch what you will notice is... Okay, so I'm doing something and I have a negative thought and I unclutch from it. Within a few minutes you'll find there's some other thought. And they are like bubbles in a fish tank, because... the way Swamiji describes it is, we create shafts.

So one thing we do is we have a painful thought or experience and we connect it to other painful thoughts and other pain. And we create this narrative like, "I'm a loser," or, "I'm a winner," or, "I'm a good father," or "I'm whatever, I'm a victim." We create this whole narrative. Whereas in reality, these thoughts are separate and unrelated. So if you slow down a film of bubbles in a fish tank, they're all separate, they're unrelated, right?

Preeti Kota:  Yeah.

John Purkiss:  So if you start treating our thoughts like that, if we just unclutch from them, they start losing their power over us.

Preeti Kota:  That's a good metaphor, the bubbles.

John Purkiss:  It's the simplest one. Yeah. I mean, that's the way Swamiji describes it. And I find that I still have negative thoughts. Sometimes I'm doing something really ambitious and I have a thought about how it's not going to work or it isn't working, and I just unclutch. I just carry on doing what I'm doing. Right?

Preeti Kota:  Yeah. I feel like that prevents you from spiraling then.

John Purkiss:  Yeah. Otherwise, you're going to spiral. Well, you're going to waste loads of time. You're going to feel terrible. You may go and say something to somebody which causes you a problem. Instead, all you need to do is unclutch. The metaphor, I didn't understand it first. In the US, I think you call it a stick shift gearbox in a car. So I know you have mainly automatic gear boxes. But with a stick shift gear box, the clutch enables you to disengage. So, basically the gears aren't running and the motor isn't driving the car anymore. It's a bit like that. You're having all these thoughts and you just disengage and you stop engaging with these thoughts which are coming up. And then the thoughts die down. And then you can start working. And when you start working, you may need to think, but you're thinking constructively. You're not just responding to random thoughts.

Preeti Kota:  How do you build faith or trust in the idea that good things will happen when you let go or surrender? What do you do with the thought? What if it doesn't get better?

John Purkiss:  So if you've been brought up in one of the big spiritual traditions, certainly the Asian ones, so Hinduism, Buddhism, Jainism, Daoism, all of those traditions say that there's something extremely intelligent, which is running everything. They all say that in different ways. And the Vedic tradition specifically says, "This intelligence is blessing you all the time." It's beneficial. It's benign.

What we are doing is we block it. We block with our our egos. Our body is trying to run itself very efficiently and healthily, and we do crazy things. We put crazy things in our bodies which stop that from happening. So, that's those traditions. And then, we've got the Abrahamic traditions, which come from Abraham. So you've got Judaism, Christianity, Islam, which have a different view of God, but you've still got an intelligence which is running everything. So in my case, as I mentioned, I was brought up as a Christian, although I didn't understand what was going on, especially when I became ill. I did have this understanding there was something intelligent running things.

I think the difficulty is if you are an atheist. And as I understand it, there are two types of atheists. So one type of atheist is you don't believe in deities, you don't believe in a God because you haven't seen any enough evidence or whatever. Which for me is completely fine because you're being empirical. I mean, I just see how amazing nature is, and for me, that's pretty solid evidence. For some people that's not enough. But okay, so you might say, this world has been operating for 4.5 Billion years perfectly. But that's not enough evidence for me. Fine. It's okay. I think the real problem is … you can at least say by the way, when I was clinically depressed, one of the psychiatrist I talked to, he said, "Look at the animals. They're not running around being depressed, they're just getting on with things." And I do that.

But there's what I would call maybe militant atheism, which is being convinced that there is no intelligence running everything. And for me, that's completely unscientific viewpoint. I don't know. Are you familiar with Karl Popper?

Preeti Kota:  No.

John Purkiss:  Karl Popper was a very influential philosopher of science. And what he said was, "For a statement to be scientific, it has to be capable of being falsified." There has to be a means of proving it wrong. So for example, if you say the earth is flat as a hypothesis, there are ways of proving that wrong. But if you say there is no God, how do I construct an experiment to prove that's wrong? You see what I'm saying? It's an unscientific statement, but there are people who are absolutely convinced that there is no God and there's no intelligence running it and running their lives. And I would say, well, A, that's unscientific. B, I would suggest it's probably ego. And C, it makes life very difficult because if you are absolutely convinced of that, everything falls on your shoulders. It means the only way for you to be happy and successful is for you to do everything using your brain and your body.

And maybe that’s why … I mean, I don't know if you know the history, but after the Soviet Union ended, lots of people, Eastern European people came to the UK. And I've met lots of people in the West, as well. But I've met a lot of people who were atheists who were brought up as atheists. It's like atheism was a religion in the Soviet Union. And in those countries like Poland and all those. Well, Poland has a lot of Catholicism. Let's say Estonia, Latvia, Lithuania, a lot of these countries they were taught atheism at school. And a lot of them are really depressed because they've been brought up to believe that the only way to do anything is using your brain and your body. And when that doesn't work, you're stuck.

So for those people, I would just say, I invite you to entertain the possibility that there's something extremely intelligent, which is running your body, which is running nature. And if you tune into it … To answer your question, when we let go, we start tuning into all of that and life gets much easier. We're not holding onto this idea that only my brain and my body can solve everything. Does that make any sense?

Preeti Kota:  Yeah.

John Purkiss:  Okay.

Preeti Kota:  So what are daily practices people can do to realize the power of letting go?

John Purkiss:  Okay. Well, what I do is, as I mentioned, I did mindfulness for six years. Then I learned transcendental meditation, which I've been doing in 20 years. I've done it twice today. And that is wonderful. I mean, it removes nearly all of my jet lag. For those who haven't experienced it, when you let go during transcendental meditation, you go into this state called Turiya, which is the fourth state of consciousness it is also from the Vedic tradition. You experience pure consciousness without any thoughts. So it's blissful and it's deeply restful.

And in terms of letting go, this was one of my early experiences of letting go was, if I have a problem or I need to have some creative idea, frequently it comes during or after transcendental meditation, because what you're doing is you're switching off your mind. You hear a mantra, you go into this state of pure consciousness, and then solutions to problems or ideas, they just come because what you've done is create a massive gap between thoughts. I mean, the gap could be up to 20 minutes. I mean, it might be just a few seconds. So, that transcendental meditation is great. Unclutching, which I've just described is also great.

So here's a really practical thing for anyone listening is, imagine you want to do something but you don't know how, and you're worried about it, you might be worried about it. So if you get really clear about what you want to create, and you can write it down, you can have pictures, whatever you want. First thing, is make sure that it's something you want to do. It's a genuine desire. It's not something you've borrowed from somebody else. It's loving. It's going to be for everybody's benefit. So it's a genuine desire. Now what you do is unclutch, so do that unclutching exercise, very simply, just disengage.

Actually, you can do this, write down on the paper. Your mind will tell you all the reasons why it can't happen. So if you pick something you want to happen and write it down, your mind will tell you all the reasons why it can't happen. Just write those down. And then, when you see all the reasons why it can't happen, that tells you where you need to complete, where you need to relive the original incident. It's like software. You've got all this software telling you bad things. So you can use the completion technique to remove all those negative patterns.

And then, when you unclutch, so what I do now is I want to do something I don't know how, is I get really clear about what I want to happen, and then I unclutch. I disengage from thinking. And then I have a flash of intuition, which tells me what to do. So having been brought up as a Christian, I would just ask myself, "Please guide me." It's in The Power of Letting Go. When I got completely stuck, I asked to be guided to the right job or business. And I was guided to the perfect job. What I do now? I mean, because Swamiji is 44, so now I just ask him to guide me. But essentially I'm letting go of the thought process asking to be guided, and I unclutch. And then I suddenly have an idea, I need to call this person, or send an email to that person, or go to that place. So you start functioning out of intuition instead of agonizing about everything.

Preeti Kota:  Yeah. Those are great useful techniques, I feel like, that are easy to implement.

John Purkiss:  Yeah, I mean they're not mine. I just found they're the easiest ones to do. And they work.

Preeti Kota:  So do you have any parting words of advice or anything else that you'd want to share with our listeners today?

John Purkiss:  If you like reading, please read The Power of Letting Go. If you don't like reading, well it's on audiobook, as well. The other thing is I would definitely take a look at Swamiji's videos on YouTube. If you type in Nithyananda, which is N-I-T-H-Y-A-N-A-N-D-A, if you type in Nithyananda... By the way, it means eternal bliss. At the end of his satsangs, his talks, he always says, "Be blissful." So step number one is be blissful. So if you type Nithyananda and unclutching into YouTube, you'll see the videos where he explains unclutching. If you type Nithyananda and completion into YouTube, there's a 20 minute video where he talks about how to use completion for health, wealth and relationships.

Preeti Kota:  Okay.

John Purkiss:  And in fact, any problem that I have, I just type Nithyananda and whatever. Like, Nithyananda and diabetes, a video will come up.

Preeti Kota:  Amazing.

John Purkiss:  So that's a great resource for people to use.

Preeti Kota:  Okay, great. Well, thank you so much for your time today and I really enjoyed hearing all the advice and strategies on letting go.

John Purkiss:  Well, thanks for inviting me. And if anyone wants to contact me, it's johnpurkiss.com. I've got a form on the internet.

Preeti Kota:  Thank you so much.

John Purkiss:  All right.

Preeti Kota:  Thank you.

John Purkiss:  Thank you very much. Thank you.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.