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Most people with anxiety disorders don't have just one type of anxiety; more than half have a second type of anxiety, and the majority also have depression. Many people ask, "Why did I get an anxiety disorder?" It comes after an event, and they think, "I got sick after this. I got sick from this company. I got sick from this relationship." Yes, this event triggered your predisposition to anxiety, but there's a history of contributing factors before that. We don't see a single cause for mental disorders. For example, now I'm going to go to Professor Doctor, and you might completely disagree with the conclusion you reach. He will diagnose you in ten minutes. Okay, do you understand me? He might diagnose you with narcissistic personality disorder because you two specialists can't pinpoint one thing. Forget about me, I'm a patient. Excellent. I'll tell you the problem with diagnoses. Just a moment ago, I asked "Wahhab," "Are you anxious?" He said, "I don't know, but I think a lot." Is this anxiety? It depends on how these thoughts are affecting him. It depends on his performance and feelings because of these thoughts. It seems I've told everyone this story... The story is that he thinks excessively about something that happened, right? But are you comfortable in your life in light of this? Yes, then, thank God, it's normal anxiety, still within normal limits. We have anxiety that should help us live, but when it gets out of control, it becomes a disorder. Anxiety is part of... Anxiety gives you motivation to do important things. But first, to set up the episode, we need to know, what is anxiety? Because a moment ago we were talking about it coming to mind. Is this normal anxiety? Anxiety immediately comes to mind as something negative. Generally, we all feel anxiety that makes us do good things in our lives, take care of important things, my work, my relationships, my health, and my affairs. This anxiety is within the normal range. But the word "anxiety" for people is associated with it being a disorder, and anxiety disorder is an extreme form of anxiety and worry, and it involves suffering. But in the normal situation, like when I'm anxious because I have an exam, I'll go study, pay attention, focus, and do what I can. When I'm anxious because I'm excited about something that matters to me or that I love, that's what we're talking about in the normal situation. In the abnormal situation, it has gotten out of control and started to negatively affect my life. Instead of making me productive, do good things, and then rest, no, it's something out of control over many matters, and sometimes some of them don't warrant anxiety. So, why... If we consider anxiety a disorder, and it's the most prevalent disorder in Saudi Arabia, yet no one talks about it. Even in our episodes and in much of the discussion of psychiatry or psychological symptoms, depression takes the greater momentum. So why is anxiety always absent, even though it's the most impactful? Many people who have anxiety disorders think this is normal because they often come from families where anxiety is very high and frequent. You'll rarely find someone with an anxiety disorder all alone; usually, there's someone in the family with an anxiety disorder or any other mental disorder, but usually, there's more than one person in the family. So the person thinks this is the default and normal situation. Sometimes some cultures might reinforce a part of the anxious style, so they don't notice where normal is and where it's not normal. For example, someone with anxiety might think that they are responsible. I am responsible. When I deal with the thoughts and risks that come to my mind seriously and affect my life, and I do many things and am careful about some matters, this indicates that I am responsible. And those around him might also reinforce the same pattern. So, as I told you, sometimes if everyone around you has anxiety, how will I know that this is a disorder and start to notice? Some deal with it as the normal situation to be tense and stressed, carrying the worries of things. On the contrary, it should be normal to be relaxed most of the time, to be cheerful. When some things happen, I get anxious, an anxiety that helps me achieve and then rest. But anxiety isn't constant all the time. So many people worry, and yes, this is part of normal. But when does it become a disorder? I think most people are supposed to worry, carry worries, and it affects their colleagues or their home. So if he has something at work, for example, you'll find the situation at home is chaotic because he has something very important he wants to finish. So he spends two or three days before or after until he finishes. Is this normal, or is this a disorder? We have two criteria that clarify that there is a mental disorder in general, whether in anxiety or otherwise. First, the person feels distress, meaning there has been distress, annoyance, and distress for a long time. The second criterion: there has been a disruption in his performance of important life roles or areas. His role, for example, as a family member, an employee, or a student. There has been a clear disruption; he can no longer perform it as he used to because of this condition. So, if we talk about anxiety, what is anxiety itself? It has components. When we talk about the experience of anxiety, we talk about a cognitive component, which is: what is the cognitive content of this person? The cognitive content is usually a focus on risks, all potential and non-potential risks, as if they are under a microscope all the time in his mind. And when I think about risks a lot, this sometimes includes worry and making scenarios in my mind, how to prepare for them? And the cognitive content also includes that I will focus on future risks and how to prepare for them, and under a microscope. And there is a clear implicit thought, sometimes explicit and sometimes not, that I will not be able to adapt to things that might happen. That's why I think about them all the time so I can prepare. This is the cognitive aspect. The emotional or physiological aspect is the experience of anxiety that we feel in our bodies. We start to feel pain, palpitations, irregular heartbeats, stomach pains, muscle pains, insomnia, and general problems with eating and sleeping. So the experience of anxiety has a cognitive component, which is threats, and a physiological aspect, which is the discomfort and the feeling of anxiety and fear that we feel in our bodies. And the behavioral aspect, when I describe someone who feels and thinks like this, the behavior is usually either doing too many things or avoiding them. Either he tries to verify a lot and seeks reassurance, repeats some things, and checks, or he avoids completely. So when I am, for example, afraid that I might... If we take a type of anxiety, of course, there are many types. There is generalized anxiety, which is... How do we understand the types of anxiety? The content is different. The intellectual content of threats. Generalized anxiety, as its name suggests, is general. I worry about many things: home, money, health, family. So I always think about the risks in all these areas. For example, social anxiety. The content in my mind is... Are you talking about disorders here? Yes, social anxiety. The content in my mind is the risks that might happen to me in a social context: exposure to harm, ridicule, mockery, or embarrassment. So this is what occupies my mind, and I feel the complete anxiety experience, and it governs my behavior in these contexts. So when we say, for example, avoidance, he will avoid, for example, going to invitations, abstaining, isolating himself, or doing many things, preparing for many things that are simple in the social context. For example, repeating words or greetings, or how to speak, and these are things he already knows. So, you see, when I tell you about the behavioral component, it's either too much of something or avoidance. He does too many extra things or avoids completely. So this is a description of the anxiety experience. I'd like to go through the types of anxiety disorders that exist because I want to understand. I still feel like I don't understand them well. Why? Because, for example, social anxiety disorder, I think if I ask everyone in the studio now, maybe... I mean, I go to people, and you think, "What do you want to say? How will you organize it? How will you greet them?" Especially if there's a council of fifty people, right? To avoid mistakes, how does the arrangement work? The same thing, I expect you to avoid going out, right? You avoid going out to things that socially embarrass you. Yes, the difference between this tension and having social anxiety for a while is that it's interfering with your life and causing you a lot of distress. You are very upset that you are very tense in social situations to the point that you completely avoid them and are not performing normally as expected at this stage. So the disruption is that it has started to disrupt your life, and you are very upset about this. This is the criterion for a disorder, and there's a time limit, for example, for six months in this situation, for example, because I'm going to be in front of a lot of people. Some people even get tense about eating in front of people, things like that. Yes, this is normal. But as soon as you start to feel that it's causing paralysis in your life and distress, and it becomes a worry, then sometimes we can talk about a disorder. We have, for example, a period, maybe six months is enough to diagnose the disorder and the paralysis and the anxiety that will affect you in your life. Is it outside the social scope? Outside the scope of anxiety in this type alone? Yes, anxiety as a whole, we can get tense about things like this a lot. But a disorder, for example, generalized anxiety, is that I've been distressed and worried about many scattered things for a while, and I have this anxiety experience that we described. Social anxiety is this style, that in the social aspect, for example, health anxiety or illness anxiety, I'm anxious, and my mind thinks a lot that I might have a serious illness that hasn't appeared yet. There's a style for each anxiety disorder. Health anxiety, for example, compared to social anxiety, what I worry about and think about all the time is: will I get cancer? Will I have a stroke? Do these twinges I feel mean I'll get this disease? So he becomes tense and anxious and focuses on things in his body until it causes disability in his life, he doesn't perform well, and his life areas are affected. So it's a style. Each type of anxiety has a style, and it becomes a disorder by affecting your life. Now you say it will affect your entire life outside the scope of this anxiety? Does the anxiety paralyze your life? Yes, that's the criterion I can use to measure whether I have a disorder or not. Whether I need treatment or not. Because for some people, the criterion for anxiety differs. Some have little, and some have a lot. You might be a constantly anxious person, you worry, I understand, but it doesn't affect my life. I understand what you said about outside the context of this anxiety or content. I'll give you an example of someone with social anxiety whose life has been affected. Okay, he no longer goes to job interviews when he needs a job, or he's in a job, and he can no longer meet with his superiors when this anxiety attack came. Now in his life, someone at school or university no longer gives presentations, even if he gets a lower grade, fails, and has to repeat. This effect here in social performance or when being evaluated, how did it affect him? He's no longer performing in his job or studies, right? And he's upset. And this might even affect his relationships sometimes. Someone with social anxiety gets very confused. When I was in high school, for example, I used to get anxious in some contexts. Now, even when I go out with my close friend, I feel confused and scared, and with the same feeling as when I'm in front of strangers. So he starts to get confused that it's affecting him, and it's carrying over with me sometimes. Someone with health anxiety is preoccupied with the idea that I might have an illness. You'll find him absent from work because it comes to his mind that I might need to rest. If I walk, if I exert myself, it will be bad. He's no longer performing in his job, even though, for example, health and body anxiety, he goes to hospitals a lot and spends money. Some relationships are sometimes affected because he worries and needs reassurance, and the people around him get stressed, saying, "Enough, stop." So his relationships are affected, and his self-perception, all aspects of his life. Now, if we take this anxiety in general, does anxiety differ between men and women? Generally, the expression of some emotions might be different. Women might pay more attention to their internal experience, their emotions, and feelings, and their ability to express them. Men might express... Of course, generally, in our society as a whole, psychological or emotional aspects, whether men or women, are generally expressed more physically. My stomach hurts. I feel upset. My colon or digestive system or my head is throbbing. So they start talking through their bodies. And this might relate to awareness of emotions in general and expressing them in our culture. But for men and women, the experience of anxiety that we described is the same. The expression of emotions might differ slightly. What do you mean by emotions? When we talk about anxiety disorder, we talk about an emotion, which is anxiety. We talk about this disorder being characterized by this emotion being very high, which is fear and tension reaching its peak, being dominant or controlling. But in the normal situation, we return to the normal situation. We are beings with emotions. These emotions have a function. Emotions are feelings. Their presence in our lives is very important. I want you to imagine someone who has no emotions. How difficult his life is. He doesn't feel anything. What can he do? Emotions give us signals. What should I do now? Emotions tell me what is important to me. So, for example, if we go through basic emotions, for example, the emotion of sadness. When I'm sad, the experience of sadness tells me about something valuable that I have lost. And sadness itself is useful and has a function. When I lose, for example, a relationship, an opportunity, or anything that results in a loss, and I'm sad, I'll cry. My tears often have a social function. When I cry, and someone I know sees me, "May God protect you, why are you crying?" "May God protect you." This support that comes with it helps me express the sorrow or loss of the thing. My sadness helped me adapt to what I lost. It alerts me to important things and helps me express myself. The experience of crying or weeping, people come to support me, and this helps me. The emotion of fear, for example. Fear protects you. Fear alerts you that there is danger. Pay attention, and move away. Disgust, for example, a basic emotion that tells you about things that are disgusting or might harm your health, and you stay away from them. Guilt alerts me as a signal that I haven't followed standards or have violated something related to my relationship with others, with the community I belong to. So when I feel guilty, I will usually review myself and correct the mistake, apologize, or realize that something important to me with others, I haven't followed it. The feeling of shame or disgrace alerts me that my relationship with myself and my situation, and that I haven't followed a standard that is important to me, so I feel shame and need to review this matter. The feeling of anger, for example, is a very important feeling. The energy we feel in anger makes us stop and say: "Just stop. I don't accept, and I won't let you cross this line," or "Please stop here," or "I reclaim my right," or "I demand my right." The emotion of love, for example. Love or happiness makes us connected. Imagine if your life had no feeling of love or joy. If there's no love, what wakes me up to go to work? Of course, some people have other motivations that wake them up, but generally, this makes it easier for you. If I don't feel love for others, what will make me care about them and contact them? These emotions are a very important tool. We need to understand them, know them, and know how to feel them. Knowing how to express them. So the skill of emotional awareness is very important in the normal context and in the context of mental disorders. It's something we try to work on because in mental disorders, a large part of the mental disorder is emotion, and emotion is often disordered, either increased or decreased. Okay, to deal with this situation, first, I need to know, what are emotions? How do I feel them? What are their names? And to have the ability to express them. Then organize them. So the concept of organization is that I either increase something or decrease it according to what I need in this context. So how will I have an advanced skill, which is emotional regulation, if I don't know emotions, don't understand them, and don't differentiate? And I have one word for expressing emotions: distressed, annoyed, and angry. Perhaps this point relates to the point about men's expression. Often, one expression in some contexts is: "I'm angry," but he's scared. "I'm angry," and he feels, for example, shame. "I'm angry," and he's sad. So you'll find him, for example, coming home, and he can't say, "I'm afraid of the meeting," or "The group at work, for example, is ganging up on me." "I'm angry," and he gets into a fight. So here, if there was emotional awareness, it would help him deal with his emotions well, and it would benefit him and be a prevention of disorders. So, as I told you, emotion is a very important thing in our lives, and we need to understand it. Are there tools that help us understand our emotions? The question is, what happened that we no longer understand our emotions? There's a lot of talk about this. What happened in your upbringing? When we were young, if we had a father or mother or guardian who had emotional maturity and a degree of mental health such that they could understand their emotions and help us when we were young. When a child is sad or cries, they speak the child's incomprehensible language, empathize with him, and say, "You are sad," and frown with him, becoming a mirror for him. When they become like a mirror, and the child's upbringing is always like that, they say to him, "Are you sad? Are you upset?" They give him the names of emotions and help him express them, and they don't tell him to be quiet, scold him, or hit him for it. They helped this child acquire this skill. So I have a degree of calmness, and I have this mirror that helps me understand my emotions, so it automatically becomes present. For many people, it's automatic. No one can say, "I have now reduced the feeling of sadness and increased the feeling of surprise or joy." No. But we, as specialists, can see the process. But for the person, it happens automatically. Sometimes you even regulate your emotions before they happen. For example, you know that I'm going to this meeting, and I'm going to see so-and-so, who is like this. You'll make a strategy that I won't feel this feeling. So when does this skill break down? In upbringing, and this is often what happens in many disorders. How is it acquired? Just as it was lost in a secure relationship with a mature person who knows emotions, reflects them back to you, empathizes with you, names emotions for you, and listens to you. So in the context of psychotherapy, there are many therapeutic schools that detail the skills. It becomes like training, as if you're going to a workshop to acquire them. But in reality, this content is not everything. And in the clinic, in front of this therapist, what did I feel? How did I feel things? And how was I able to experience the dark areas within me after feeling safety, containment, and listening? My skills develop like this through the relationship, then the content. This deep view of psychotherapy is acquired. If we say someone has a disorder and this skill is not present, and they are suffering, the experience of psychotherapy can correct this. If it's below the disorder level, psychotherapy books, self-help books for many therapeutic schools, are used so that I understand my emotions, apply them, and gradually acquire the skill. And if it's not in books or with a therapist, the most mature, intelligent person around you with emotional or affective skills, and you were with them, observed them, and were influenced by them, and from your experience with them, you are influenced by this. But if there's a fourth thing, which is: can I...? I mean, I am now aware that I have a problem understanding emotions. How can I improve my understanding of my emotions that can help me? The simplest thing is to go and find out, what are emotions? I believe in the aspect of going to read and understand. There are many books, and you'll find them on Google with any quick search. It's the wheel of emotions. What is it? They put about five or six basic emotions and their branches and all the synonyms in the language that express the same emotion, so you have the expressive tool and know what the emotion is like. Perhaps we know it intuitively, but believe me, there are many emotions that people don't know or don't distinguish what's happening. So, as I told you, the knowledge aspect and the practical aspect either require depth, which is the relationship, or in a very brief summary, you apply with people you are comfortable with... So it's all in the context of relationships. Okay, regarding relationships, if we return to anxiety, we said that anxiety is one of the most prevalent disorders in Saudi Arabia, and among these disorders is separation anxiety, which is the most prevalent. So why is it the most prevalent in Saudi Arabia? And why anxiety? And then we can touch upon... What is a disorder itself...? Separation anxiety is a disorder in the experience of this anxiety that we mentioned at the beginning. What kind of risks does the person focus on in their mind? Which is the content or the style of the people they love and are important to them. And when they are outside the house, or when they go out, or travel, something will happen to them, or they will have an accident, or they will get sick, or they will get tired, and they will not return to him. Separation anxiety is the first form of normal anxiety in human life. For example, in childhood up to three years, it is considered normal. When the mother leaves, the child cries. When does it become abnormal? For example, when they are of school age. Here, the child starts to be diagnosed. For example, they absolutely don't go to school. It starts to interfere with what is required of them at this stage. And this anxiety doesn't align with the actual threat or reality that nothing will happen to his mother. But you'll find him saying, "I don't want to go to class. In class, I think something happened to Mom, or the house burned down, or a thief took her." What's striking is that separation anxiety was later observed to be present in adults. For example, a mother might not want to leave the house for fear that her children might get something. Or the anxiety is related to not wanting to leave the house and not wanting to be away from loved ones because something serious will happen to them, and it will prevent him from returning to normal. So separation anxiety was observed to be present in adults. Its being number one in Saudi Arabia is very striking. Are there explanations? The matter still needs study, but this gives us an indication of how much people... That is, anxiety as a whole, from its basic roots, the person doesn't feel enough safety, and often the need for safety in his early life was not met, or there was a threat. What threatens a person's safety as a child, for example? That the mother or father doesn't respond to the child when he cries. For him, this is a terrifying experience. The one responsible for me is not responding to me. For example, the father and mother have problems in their relationship, so the child sees this as worrying. These are the ones responsible for me, and I depend on them. Of course, the child doesn't know at that time; he can't formulate it like that or express it. So I mean safety as a whole, as a need that was not met, whether physical or emotional safety. This is its seed. So when we say separation anxiety is number one in Saudi Arabia, I think we need to understand what's happening. It needs more studies. What's happening between people in their relationships? Because its style is that I lose this person or this relationship is threatened. So what's happening here? Why are people not reassured about their loved ones, and it occupies their minds? Its style is that I'm not sure if something will happen to this person, or if they will return to me or not. So there are many questions, and it's still early to know why. Okay, and the concern, sometimes parents are concerned. For example, my life will be normal, but you'll find that as soon as he leaves the house, "Did you arrive?" or "I don't know what." Is this... Yes, this is a very important part. The person who might be anxious about their loved ones, this anxiety is partly acquired. The one responsible for him is very worried about him. Part of the anxiety is that the caregivers might not be aware of the developmental needs of each stage. At a stage, he needs to be independent, but they insist, "No, life is scary. Be careful. Wear this, or eat this," or "We'll come with you," and they do many things. This in itself is worrying. So the issue isn't that you're not around. Maybe you're around too much, and overprotection is very bad, and it's linked to anxiety, overprotection, and high standards. So yes. Okay, it's clear that upbringing and parents have a high impact on the existence of these disorders. So if you give us... Yes, many people ask, "Why did I get an anxiety disorder?" And it's an important question. Some think that, for example, they came to the clinic after an event that happened in their life. This is usually a strong event that happened recently in the last few months or the last year, such as a separation, being fired from work, having a problem with someone close, a loved one being diagnosed with an illness. Then they come with any type of anxiety disorder, depending on their life story. The style of anxiety will emerge based on parts of the story. So it comes after an event, and they think, "I got sick after this. I got sick from this company. I got sick from this relationship." Yes, this event triggered your predisposition to anxiety, but there's a history of contributing factors before that. We don't see a single cause for mental disorders. Even poor upbringing or a difficult upbringing is a risk factor for developing a mental disorder or suffering. But will it necessarily lead to a disorder? It depends on the rest of your life. What are the contributing factors? What events have occurred? So the person comes with a recent stressful event, but as a specialist, when I listen to him talk, we have the current formulation of the model, the biopsychosocial model. I look at all aspects of his life. What are the factors that have accumulated and caused this disorder to appear today? These factors, if we look at the biological aspect, for example, there's a genetic component. More than one person in the family for more than one generation has more than one mental disorder. This is a risk factor. He had certain accidents during birth, for example, when he was a child. He had accidents when he was older that affected him physically. We're talking about the physical aspect. Anything that was stressful or bad happened in this aspect. The psychological aspect, but what do you mean? How does it affect...? I'll give you an example. Someone is suddenly diagnosed with an illness. This is a stress factor. An organic illness? Yes, an organic illness, for example, born with a certain disability, something in his body that makes him feel stressed. For example, the psychological aspect, in terms of personality traits. More than 50% of personality is inherited, so we can't talk much about why personality became like this. There are other aspects, but he was born with a personality, and everyone notices it, even his parents. You'll find his mother saying, "Since he was little, he's been anxious, even if there's nothing." Neuroticism is a high personality trait. This makes the risk factor for developing a mental disorder high. For example, the social aspect: family problems, insecure attachment, or an insecure relationship, or insecure bonding with a parent. The upbringing, standards, physical and psychological violence, harassment, and all these things. So, immediately, when the person comes after an event and develops a disorder, now I look at his upbringing, all these areas of his life. What happened? What has been achieved? So, usually, we will find more than one factor. So when the person asks, "Why did I get this disorder?" Some come thinking that after this relationship, or is there something wrong with my mind? Is it just my mind? Usually not. You have many things in your story that made you more vulnerable than others. We also think not just about the things we call predisposing factors, that in the early stages of his life, there were accumulated stresses, then the recent factors that triggered this, and factors that keep the illness going. For example, he has debts. This is economic pressure. For example, he's not happy in his job and works in a field he doesn't like, far from his personality. He has a relationship he's suffering in, or it's difficult to please an important relative, for example. He's consuming alcohol or drugs, or others. These are factors that keep the pressure going or might maintain an existing disorder. So I think about how all these factors in his story have come together. And I convey this knowledge to him. Okay, and on the other hand, there are factors of strength, prevention, or protection. He still has very good things that we need to look at and use in treatment. And as I listen to the factors, the complaint, or the history, I also keep an eye on what good things he has that can help him. Things that might be very simple: he's committed to the gym, he loves his job, or he has at least one supportive relationship. He has previously adapted to something very difficult and was flexible and dealt with it flexibly. He has a hobby, or he's committed to treatment, or he's enthusiastic about treatment. So I take these into consideration, that he has certain talents. So what happens in the clinic? The person who comes and says, "Why did this disorder happen to me?" As soon as you help him formulate this story with these factors, he feels relieved. "Oh, so I'm not imagining it." When you ask him, "What do you feel affected you? What is your understanding of what's happening to you?" He might say, "I'm sure the high standards in the upbringing I had. That day, when I got lost in the market, I felt like I wasn't okay afterward, and I was a child. The day I was embarrassed, and they laughed at me, and no one asked me if I was upset or not." Specific events, and most of them are in the context of relationships. So as soon as the formulation of the case or understanding happens, that it's not due to one thing, but a combination of factors that brought you here today and are suffering from this, he feels very relieved. And this understanding helps. And this is what the therapist conveys at the beginning. But don't these things happen to everyone? I mean, when you're young, you do something, people laugh at you. You might get lost. You might see your parents fighting and arguing, right? All of this is part of normal life, right? Someone might say, "We all got lost in the Haram, and we all got applauded, and we all got embarrassed in a certain situation, and people didn't defend us." Right. But you saw the idea of factors and the story, and something personal. What happened in your story? You got lost in the Haram, and you were hit in a certain situation, and things happened to you. What happened in your story, and what didn't happen in my story, protected me from the disorder, and me, no? Here are the factors, and here is the story. The psychological aspect, and in psychotherapy, it's difficult to generalize. I'm telling you these are risk factors. Pay attention to some details. But when I hear your story, I know even what you consider more essential and what affected you. For example, people might be born into a home where the father is very strict, very violent, and emotionally dry and terrifying. Most people's quality of life at a certain stage will not be good because of this relationship, and because of the father's presence, everyone has a degree of tension and discomfort, and their self-esteem is not high, and they might have emotional problems. The one who develops a disorder, come and listen to his story from the others. You'll find that it's not because we're in the same house that my experience is like yours. Where do I stand in terms of order? How did I see what happened? And how did I see the differences between us? What happened to me at school, and not to you? I was bullied at school. You weren't bullied. I'll give you examples that seem paradoxical, something strange. For example, a father is very strict and violent with all the children. One of them, for example, loved him for a certain period, and then he changed towards him. Why did the loved one get the disorder, and the others didn't? The loved one tells the story and says, "I think I lost what I had, and I lost my privilege. I was loved. What did I do wrong to become like the others again?" It's true that he's not completely satisfied with me, but I was better. So in his experience, "I lost something. I lost my status. What's wrong with me? Maybe I'm worse. I received love and lost it." So here we come to the details of the story. So what happened in the story? We come from the same environment and have the same experiences, but our experiences are not truly the same. If we take... Excuse me, I want to go back a bit. That is, I only want to take anxiety disorders. We said generalized anxiety and separation anxiety, right? Are there other types? Yes, social anxiety, health anxiety, panic attacks, and phobias. So, for example, if we go through panic attacks, and this is widespread. An important piece of information: most people with anxiety disorders don't have just one type of anxiety; more than half have a second type of anxiety, and the majority also have depression. Because if I'm very afraid, I'll necessarily be sad. Why am I afraid? Why is my life so difficult? And until when will I be like this? Sadness. Most people who come to the clinic come because they have depression. "I no longer feel the value of anything. I used to be stressed and anxious, but now I'm bored and tired. I want to change myself. I'm fed up." So he comes, and he has depression. The earlier the person comes, the better the situation. If we talk about panic attacks, these are among the most disorders. It's amazing that a complete mental disorder is in your body, it comes out in your body. That's why it's difficult for the person to understand that this is a mental disorder. My body is in an abnormal state. I have an illness. A person might suddenly get out of the car, going to enter the house on a normal day. He gets very strong palpitations, numbness, is very scared, sweats, and starts to worry. "What's happening to my body? Will I have a stroke? Am I dying now?" Panic attacks usually don't exceed three minutes. It's a very sharp and very high fear that your body is experiencing. What are panic attacks? That this happened to me once. And after these three minutes, I spent almost a month worrying, "When will this happen to me? What's wrong with me? I think about it all the time until I become distressed, until my performance in other areas of my life is not good. Neither my work nor my achievements are good, and I'm not comfortable." So the difference is that those who come say, "My body has something wrong with it." That's why it's difficult at first. It's a part of the situation being unknown. It reinforces the situation becoming worse. My body tells me, "Something is wrong." So he goes to many hospitals, goes to the emergency room, and sees most doctors in most specialties. Finally, they tell him... He usually goes to a neurologist before a psychiatrist. Finally, he goes to a therapist or psychiatrist. And what saddens me is that some people, for example, spend years suffering from panic attacks. And the attack itself, if I understood it, comprehended it, and understood the story of my life that led to these attacks today, it stops. It no longer comes. It's very easy. For example, someone comes from the second session and says, "It hasn't happened to me this week." The third and fourth sessions, completely. And it starts to decrease. This is if it comes early. For those who have been suffering for years, and usually with other types of disorders, the situation is certainly more complicated because the extent of the losses in their lives is very large. But this type of anxiety disorder, as a whole... But I'd like you to return to panic attacks. What happens, for example, in the first or second session that makes it disappear? What happens here? This type of anxiety disorder is very different in psychological education. If I understand, confirm, and comprehend with this therapist who explains to me what's happening to me? That my body... He has already done all the medical tests, and they told him, "There's nothing wrong with you." But part of this experience is very frightening. I have moments as if I'm dying. It makes him say, "Maybe the tests are wrong. They haven't discovered it yet. I'm going to die, and my time is near." And the experience of fear when my body is in a state of arousal, all my thoughts will be terrifying. A cycle that reinforces itself. So he has this attack, and he thinks, "I'm going to die." So the fear increases, and the thoughts increase that the situation will be worse, and the fear increases, and the cycle continues. What makes the difference in the sessions is that I understood how this started and how it continues. I comprehended that it's a mental disorder, and I was convinced, unlike seeing a YouTube video. I comprehended this model applies to me. Usually, for example, cognitive-behavioral therapy, we apply a model that explains how this happened to him. And he comprehends and calms down. If he understands, it decreases. Why? The core of this disorder, I'm afraid my body has something. Then, the second level, I'm convinced that my body has nothing. I'm afraid of fear itself. This fear might kill me, or I might lose my mind, or I might go crazy, or I might faint, or I might go insane. We explain to him that even these physical symptoms will not include fainting, and there's nothing about losing your mind. So there's a style, either through thoughts or behavior, through exposure, where we expose him to the experience of fear itself and say, "Sit with the fear for a while. It's not scary." So, in short, it's treating fear with fear itself, and understanding that this...

Fear is not dangerous—especially in panic attacks—and when he realizes it's not dangerous, I stop caring about it, it's okay if it comes to me, and while I'm on the highway, I won't get dizzy and nothing will happen to me, for example, it's okay if I start feeling palpitations while I'm in a meeting, nothing is happening to me. He begins to realize and realize more, either through discussion and ideas—and we deal with his ideas, which can be very frightening, by putting them in their normal context—or through behavior. Behavioral experiments: This week you are required to go, after I have explained things to you. And understand, that's it, the only thing left is, if I expose myself, for example, fear came to him that if I stood in a line while I have panic attacks, or I was on public transportation, here we come to a second type of phobia called agoraphobia—open spaces or specific closed places—it applies to open or closed places, or cars, or being in a line or a crowd. This is accompanied by many panic attacks: I am afraid of being in that place, and an attack comes and the ambulance cannot reach me. So you find him, for example, if he enters a mall, "I want to be near the doors, for example, near the door, I don't go far," or he cancels this matter. So part of the exposure, which is exposure therapy, is that we arrange an experiment with him: this week you will go, and after we have agreed on everything, you will go and tolerate the anxiety; you won't leave quickly, and you will stay for a specific time until you see that the attack came to you and things have calmed down. Here, leave. So he begins to realize that nothing happened, that's it.

So is there a difference between panic attacks and anxiety attacks? Yes, panic attacks are these, their peak is about three minutes, very strong fear and severe physical symptoms, and these are the ones I start to worry about. Anxiety attacks are something that can last a long time, hours; I am anxious and tense, like your feeling when you have an exam or a job interview or I'm going to appear on TV, a person with many thoughts and continuous anxiety for a long time, it's not acute or strong fear, but I'm not okay. And this is considered normal, or...? No, it is part of an anxiety disorder. So there is a difference here: sometimes a person, for example, has had panic attacks while he is having an anxiety attack now. It is not a panic attack; he has never had that strong one, it hasn't returned to him, but he is tense. So he says, "Is this tension I'm in a panic attack?" No, it is an anxiety attack, and you deal with it by knowing that you are in an anxiety attack. Treating anxiety as a whole is something more complex and for a longer duration, but the panic attack is this terrifying one. If it comes in the beginning, controlling it is very easy if I understand it.

Can anxiety lead to suicide? Yes, any psychological disorder is a risk factor for suicide. In general, people imagine suicide is something only the depressed or extremely sad person who has reached a stage of despair does. The experience of anxiety, when it is very high, comes with many bad feelings, and it is a very unpleasant experience. So the person reaches a stage where he hasn't hated life or despaired of it; he is exhausted from this continuous experience that has robbed him of life's meaning and taste, and he begins to feel a very great pain. In a moment of intense emotion, thinking about suicide or attempting it might be a way to escape and relieve this pain, not as a desire for death in itself, as much as "I want to stop this pain."

Okay, if we now have a good picture of anxiety, I expect people understand anxiety clearly. And the more I read to prepare for the episode, it seems you understand anxiety, until you discover in the end that the place is still difficult. Why? For example, now in one of the podcast episodes with Dr. Yasser Al-Dabbagh, he was saying that most people who meet the diagnosis of having anxiety don't actually have an anxiety disorder, but rather their personality is one of the anxious personalities. So, honestly, what's the difference? What's the difference, and how do I know? Excellent. When we talk about personality... Anxiety disorder, as we described it, is this condition that comes to the person and interferes with his life. But before that, when we talked about factors, what makes a person develop a disorder? Correct, we said a psychological side or in the formation of personality in general. The fact that you, as an anxious personality since you were young, have a nature of getting tense and worrying about things and needing arrangements, being less flexible than those around you. You notice that those around you, sometimes for example, you are sitting with a group going out for a camping trip or something, and any malfunction or glitch occurs. There is a person who gets very tense and upset; the rest, you find them, return to normal, "Come on, what will we do as an alternative?" and they start laughing and living in the moment. There is one person who is still tense, "Why did the plan fail?" or "why did what happened happen?" or upset, it takes longer and more effort to calm down and return to normal. This person might have these traits as part of his personality. We have a factor of personality. When we talk about personality, how much do I, as a normal person, as a human being, experience unpleasant emotions frequently, with intensity and for a longer time, versus tending towards balance and having emotional flexibility? There are people who have fear as part of their personality, very high. How do we start to distinguish between personality and something that has happened to you? Nature; we observe it from a long time, and it's like this. And the fact that I have this trait makes me more susceptible, with pressures, to developing a disorder. So whether I have a disorder or it's personality traits, I might need psychotherapy and I will benefit from it in managing the situation.

So in the clinic, many come: now, practically, he doesn't have a diagnosis, but does he need to come to the clinic or not? How? He knows that his quality of life, because of this trait, is a bit difficult: I worry about my arrangements, and some of my relationships are affected; any changes that happen, I need a longer time to adapt. He is not very comfortable. So he doesn't have a psychological disorder, but is he in complete mental health and comfort? That is not achieved. And the fact that he is here, understanding himself, understanding his life story, and dealing with the impact of this thing, makes it a preventive factor against developing a disorder beforehand. He has mastered, for example, the emotional things we talked about, his thoughts, and how to manage the situation?

Dr. Ahmed Al-Shayeb will be upset with you. Yes, you are telling me whether it is a personality trait or a disorder, "Come, the criterion is that the person suffers, he is suffering, and he is upset." Humans suffer, correct, they were born to suffer, I agree with you. But there are people who feel that their lives could be better. He suffers, and those around him suffer. Sometimes he doesn't meet the criteria for a disorder at this moment. Maybe he met them before and didn't get treated. So there are losses and arrangements. And no one can force anyone to come to therapy or not. And there are many, many methods, but it is one of the options.

Are there notes or signs that make me know if this is a trait or a disorder? What I mean is that you are saying that maybe someone actually has had a disorder since he was a child, right? Right. So he has been anxious since he was a child until today. And at the same time, it might be a trait; he has been anxious since he was little, but he hasn't reached the disorder. So how do I differentiate between the two cases? They often, you see, coincide, they come together. If you have the trait, you will likely develop a disorder at some point, in many cases. But sometimes, often, if it is part of the personality and no disorder has developed, you find the person is anxious and resembles the description of disorders, but he says, "I am fine, I am in control of the situation." Possibly this is his personality now, but he has dealt with the issue. On the contrary, he might have benefited; he has gained awareness and mastery over some things that made him benefit from this trait. And many do benefit from it; you find certain successes and achievements. But the core concept of the disorder started when disruption began to occur. This is the thing that differentiates it from any normal state; his life started going against what he wants.

Now we know anxiety, its disorders, traits, and some factors affecting it. What treatments are available? We have reaching the doctor or psychotherapist, but is there anything before that? And then we reach you. What do you think, before we talk about treatments, we talk about what lies behind the disorder? Something that might be obvious and people might forget, and some treatments sometimes contribute to forgetting it or remind us of it. We now understand anxiety disorders. We know the psychological disorder. Why does it occur? Often due to several factors and the person's life story. But in general, overall, what is the deep understanding of the psychological disorder? These symptoms, which are anxiety, depression, or others, are like a fever in the body. If I have an infection or an internal problem, it is considered a symptom. The psychological disorder, this apparent one, is a symptom of a deep pain, or like fundamental files common among many people, repeated, where problems occur, which then manifest, depending on the person's life story, as different disorders. The basic pain reminds us of basic human needs. The basic pain might be, or the problem, or what's behind the disorder, that this person, in short, did not feel secure enough, did not feel loved, felt like a burden, received messages from his life experience very early that he is incompetent, not good, the world is dangerous, and no one will respond to him. So it all comes back to the issue of relationships and upbringing. Correct, we said this experience might be common among many people, but the differences are in the stories. But the common thing among all those with psychological disorders is a basic pain. And I, as a child, for example... Here we will come, and maybe this talk will stir up emotions in the listener, maybe anger towards a father or mother. But let us think: the father and mother who didn't respond or weren't good, what happened in their life story? They have many basic pains and many unmet needs, generation after generation. So psychological understanding as a whole, and our understanding of disorders and the factors influencing them and the basic things or what lies behind them, I feel it cultivates compassion. I reach the conclusion that I have compassion for myself and compassion for others if I truly understand that... Let me give you an example of how we can embody this basic pain in situations. One of the important roles, for example, of parents or the father and mother: care in all aspects—psychological, physical, emotional, protection (meaning providing safety), and guidance. In many stories, these situations might occur in people who don't have a disorder, but overall, among many who have disorders, it's a common thing that, as a child, the role of protection and care wasn't fulfilled. But suddenly he is a teenager, finding parents giving him lots of instructions: "Listen to me, this is right, this is life." He begins to feel pain: "You didn't feel for me at that time, and you didn't protect me from these things that happened to me."

Situations that might represent this basic pain could be summarized as loss of love, recognition, protection, or the feeling of competence, ability, and efficacy. The child receives signals that he has... For example, a person comes home from school happy, "I got 95%." The father looks, "Your cousin got 99%." The father didn't say to him, you see, directly, "You are stupid" or "There is a problem with you." This child has a map, or a tool, or we might call it a "script" that teaches me what is happening, and I understand the world, myself, and others. The first thing I will write in this script is "I am not competent, I am not capable." Okay, if we take, for example, one of the anxiety disorders, later we come back to this script in those cumulative situations, more than one situation, which made his way of coping with it: "I have to make a huge effort, I must not make a mistake." So he tries to avoid putting himself in situations that remind him he is not competent. That script that was drawn defined himself and the situation. What happens in psychological disorders is that it becomes very rigid. I have perceptions about myself, life, and others that are rigidly negative, beliefs that are hard to shake. How do we know about them? From sensitive things in his life. As an adult, you find him, for example, sometimes to cope with this idea, the disorder... what is it? I try not to expose myself to situations that remind me of the basic pain, those experiences. The basic pain from a feeling of shame, a feeling of being less, the idea that I am not good. So I design my life so that I don't expose myself to it. For example, he enters a simple major so he doesn't make mistakes, and he can be the best in it. He doesn't expose himself to challenging situations. Then he starts to get depressed. He wants things, but "I am afraid to go for what I love, I might fail, for example, I am afraid to stand in front of people and make a mistake," etc. So here we return to the basic pain that formed an idea, and with it emotions and a stored or existing memory. This is one example.

Another example: a child is at a family gathering. One of his brothers hit him, or relatives bullied him. The father and mother didn't intervene. They were laughing, "What's wrong with you? It's fine, don't make a big deal." He got the message: "No one around you, no one will protect you. You are exposed to any harm and danger. Protect yourself. This world is dangerous, others are dangerous; they might hurt you." So this experience: first, anger at the situation, "My father and mother didn't protect me, whom I always expect to look and see what their reaction is." This situation could be relatives bullied him, one of the adults, meaning an uncle or aunt, mocked this child, and the father was present and didn't say anything. Or the adults intervened, like the grandmother. Second example: a private tutor hits me, and his father says, "Continue, keep with him." So the signal: "This world is dangerous, people can cause harm, and I am weak, and I have to make a huge effort to protect myself." So this person grows up and might put distance between himself and people. He doesn't depend on others; he needs support but doesn't seek it, expects them not to be there, and this affects his life. So the first situation shook his competence, for example, his sense of efficacy. This situation shook his need for protection or safety. A situation of love, for example, or emotional/affectionate care: a child comes crying, scared about something, or something happened, he got hurt. The father and mother silence him, "Don't talk," or just stop. Or he comes excited about something, the father is with the newspaper and refuses to engage with him. Or suddenly, he didn't do anything, and he gets hit for no reason. So he begins to feel, first, "What is my problem?" He might always imagine he is the problem. "I can't trust them, I don't feel loved or cared for, or there isn't enough affection."

We mentioned that every person has a story, and these fathers and mothers, many of them lived through many similar things. They suffer, and often they might have, for example, mental health problems. The idea is... If you allow me to challenge your idea. How? For example, you just gave three examples. The third example I want to skip because it's obvious, but the first and second, because life... I mean, you don't know. If you hear someone in parenting, they will say to you: "If you see him crying or about to fall and you go help him, you are raising him so that I am always the one who helps you; you can't depend on yourself," correct. So you find it normal if you argue with someone, "Manage your life, manage yourself." I mean, I see you, but it's okay, "Go hit him, go negotiate with him." You are children. "If you go outside, I want to leave you alone. You will fall, it's okay, fall and get up," because if I stay with you every time, that's it. Also, you gave the example: if he is crying, some people say to you: "If he cries and you go to him, you are teaching him that crying is always the solution to get anything he wants," excellent, so it's wrong. Let him cry, that's better. And so on. So now, this might cause him psychological disorders. That one says to you: "But if you..." I'm going to say to you, you are right. That's why we must understand the stages of development. There is a stage in the child's development that needs independence; how much did we help with that? And there is a stage that needs very high sensitivity in response, which is in early childhood. The psychologist Winnicott said: "What is the difference, in general, between a good enough mother or a not good enough mother, or father? It's not about making mistakes. It's not about the mistake. How do I deal with the mistake? I got angry and mocked the child, but I came to him as a child, respected him, apologized, and said, 'I'm sorry I got angry today, I was tense,' and explained. This helped..." Suddenly, my child was afraid of me or a problem occurred, and there was a disruption. How much capacity do I have to go back and repair and negotiate? This experience, you will find it influential in many people's lives. "I will never forget my father when he came and apologized to me after he hit me, and I felt I loved him more than if he hadn't made this mistake and came and apologized." Because here there is a signal of love: "I care about you, but forgive my shortcomings as a human."

This is from one side. From another side, the good enough parents, according to Winnicott, I have sensitivity to respond to the child's needs, especially in early life. I have to be very quick in responding, sensitive, and attuned to this child, completely. He needs this to be more flexible and have skills when he grows up: to tolerate frustration. At the appropriate age, according to the child's developmental abilities or cognitive aspect, I leave him space to be frustrated and for his needs not to be met in life. I give him a chance to experience this. But if I didn't do that initial sensitivity as a response to him in the first place, how will he be able to tolerate frustration later? You find him having emotional problems. So Winnicott was talking about how we don't need perfect parents attuned all the time; that's actually wrong. You are between being close and supportive, and at the right time, if we look at developmental psychology, here I leave the child his independence, and here is the side you talk about, very important. SubhanAllah, instinct speaks for itself. At a certain stage, you find the child, still small, "Yallah, he grabs things," but you find him pushing you away, "I will tie my shoes, leave me." You find him tying nonsense, not actually tying them. Good. Help him develop these skills. So at this age, when this thing becomes clear, sometimes in parents, this instinct is... "The boy became a teenager. No, sit down, do this, do that. Why? Let me be with you, teach me." I didn't take into account the developmental stages. And why did I not take them into account? Because I have excessive protective anxiety and standards as a father and mother? Yes.

There are some complexities. No, not complexities. My problem with you is the problem of parenthood. It's hard. What do we do? Yes. No, but what's harder than that is anything related to mental health? And I recognize its importance.

Okay, may I ask you a question? Ask. I am depressed after this talk. Don't you feel that part of it is very obvious? Yes? Noticeable? I'll give you an example of things that are scary in terms of obvious things we might overlook for many reasons. In past centuries in Europe and the Western world, the idea that a child needs an emotional side was not obvious or present. They sent their children to boarding schools, that's it, they lived there. For them, the child was like, "Well, he will go have his appendix removed, he will sleep in the hospital while very small, they prevent the father and mother from visiting him or staying with him. He cries and screams, that's it. The concept of you being with your child when he is sick did not exist. Boarding schools, not accompanying them in hospitals. It came to mind, 'Leave him cry, don't respond.' There was an idea he would become soft and dependent on you. Then this type of upbringing was bad. Imagine that it was not obvious that there is an emotional need in and of itself, separate from physiological needs? It didn't exist. When did it start to become clear? Imagine, relatively recently, in the 1940s with John Bowlby, a psychologist. What did he say? He was a psychoanalyst, he had a clinic in London, seeing children and mothers. Freud's theory focused on internal conflicts, etc. He felt, "No, there is something happening right now between the child and mother in reality. And there is a pattern repeating itself in a phenomenon. Something is happening between the mother and child, related to the mother's characteristics, affecting the child." Little by little, in the 1940s, 1950s approximately, he arrived at Attachment Theory. The bond. Possibly now it is a direction in many aspects that he reached the idea: we are not only social beings; we have a need for a very special type of interaction with at least one person around us. And this interaction and this bond have specific characteristics that help us grow emotionally, psychologically, and socially, and for our lives to be okay.

Before him, there were observations from doctors called something: "emotional starvation." Children were dying in orphanages after World War II. Why? They had food, we gave them everything, all their affairs were in order. They were dying of sadness. A very awe-inspiring sight. A child who doesn't interact with you, sad and miserable. Here they realized they were lacking emotion. They didn't know. So terms started like "emotional starvation" and "dying of sadness." You saw the video that might be spreading a lot on Twitter, an experiment done by a psychologist. He brought monkeys. Even animals have this type of need to a certain degree. A wire monkey mother that only provides milk from a bottle, and a second monkey covered in fur like a monkey, supposed to be soft and cuddly. They noticed the monkey goes to drink milk from the wire one and then goes to hug the second figure that doesn't provide food. It didn't link food with its secondary need. Before behavioral school, they thought the child loves the mother because of a basic biological need—fed and comforted—so he associates the mother as secondary: "She satisfied me, so I started to love her and be attached to her," not for herself. Imagine this idea was not obvious. With John Bowlby, he said: "There is a bond between mother and child that will affect the child's emotional interaction and how he deals with the world and himself." Imagine he was attacked for this idea, very strange in the 1940s. Why attacked for this thing? It wasn't obvious.

Afterwards, Mary Ainsworth did an experiment called "The Strange Situation." What was this experiment about? They enter a lab with toys. It's a lab with video, recording, or an observer. The mother and her child enter, and a stranger. This is the stranger. There are toys and normal things. They watch the child first when sitting with the mother, and a stranger, how does he behave? Then the mother leaves and leaves him for a bit, how does he behave with the stranger, the toys, and the surrounding environment? Then the mother returns, and they watch how he behaves with the mother. And here they determine the type of bond between the child and mother, and they can predict many things based on it. What did they notice? Emotionally sensitive mothers who respond to their children quickly, as we mentioned. The child left crying a bit, then might allow the stranger or interact with him, and interact with the toys, as if calming himself. As if he has flexibility. The mother returns immediately, he goes to her, is happy to see her, and resumes playing. Children whose mothers were, for example, cold or unresponsive, you find when she left and returned, it didn't matter to him. And you find his exploration of the world around him is limited. The child whose mother is unpredictable, sometimes responds, sometimes doesn't, he cries and screams, she comes and goes, returns, he is present, screaming. Did you see separation anxiety? Something that seems to often underpin most psychological disorders: an insecure bond, unlike the first calm child. So the scene, what is it in brief?

Afterwards, the extension of this legacy of John Bowlby, they realized this even in adults. This need and this bond we need from the cradle to the grave. I always have a need for this bond. What should its characteristics be? A bond often develops between me and a person I go to when I am tense and find reassurance and feel psychological support. When this person is absent, unavailable, or unresponsive, I will get tired, sad, upset, and distressed. This person, I feel comfort in the idea that he exists as a safe haven to launch from and return to, and I tell him about the world. You'll find one of your friends fits this bond, for example, or a family member, and this is excellent. When you grow up, this extension...

John Bowlby died in the 1990s. Afterwards, they realized that even among mature adults, especially in romantic relationships, there is an attachment pattern like the mother-child one, which you saw. And what your bond with your caregivers—father, mother, grandmother, or any close person—was like, will become your same style. This is part of a pattern for you: you bond with others the same way. So you find, for example, a woman got married, but "I worry, and I know he loves me and is present, but I constantly need reassurance." She often, as a child, the father, mother, or the person she had this bond with was unpredictable. For example, a person whose mother was unresponsive. So he saw the script we talked about, the script and the bond, and his idea about the world, included that it is unresponsive. So better: "You do your own business yourself." So you find him successful, independent, talented, and people see him from the outside as wonderful, but he cannot ask for support. And when he bonds with someone he loves, they don't know he loves them very much, or when they get close to him, he is not comfortable, maybe distances a bit. Because my experience with the other and my script says: "It's not very comfortable." And this is what is inside me.

So we return to the clinic topic. According to studies, the prevalence of psychological disorders in societies and the insecure bond (which then becomes a pattern) are similar. And a large percentage of those with disorders might have an insecure or secure bond. If it's secure, it will support him and be a strength point, something we can return to. People come who don't have a disorder but... in the clinic—and this is a phenomenon many specialists and doctors see—he comes only complaining about what? An insecure bond. "I can't feel secure in the relationship, I'm not comfortable." And it affects his quality of life, but he hasn't yet developed a disorder. This bond or pattern is also a symptom. It is not considered or viewed as a disorder. It is the form of relationship you are used to and which has become part of you. It is a symptom of the basic pain and the needs that weren't fully met. So here this person needs and benefits from psychotherapy. And we see many of these in the clinic. So this is in response to the things you mentioned before.

Your preambles... My problems with you are more than whether it can be treated. But is the script based on everything that happened in your life, is it fixable, or is it your fate you must live with, but we will let you cope with it? I cannot fix it? Excellent. This brings us back to the types of treatments. You asked about treatments, and we said we'd come back to them. For instance, if we talk about types of treatments, many times, most of those listening think psychotherapy is only cognitive behavioral therapy (CBT) or they call it behavioral therapy. Psychotherapy is behavioral therapy? No. There are many schools. This is one of the schools, the most widespread and used in Saudi Arabia and the world as a whole. It is considered a short-term therapy, meaning reaching up to twenty sessions, talking about six months, for example. This is possibly the maximum if we follow the protocol. In reality, people in the clinic benefit, and even according to studies, many after one year of therapy. So short-term therapies, for example, Cognitive Behavioral Therapy (CBT), this is based on a theory specific to disorders. CBT has waves. It started with behavioral therapy, then cognitive behavioral therapy, then the third wave or modern: Dialectical Behavior Therapy (DBT), Mindfulness-Based Therapy, Acceptance and Commitment Therapy (ACT). Other aspects have been added to cover deficiencies in the second wave. Other schools: The Psychoanalytic school, with many theories and derived therapies: Psychodynamic Psychotherapy, Analytic Therapy, etc. John Bowlby belongs to this same school. We have Existential or Humanistic therapy, based on existential philosophy. They have an even broader view of anxiety, which we can talk about later. Emotion-Focused Therapy (EFT). Schema Therapy. Notice many integrate CBT, Attachment Theory, and Psychoanalysis, which is the common script. They all emphasize this basic pain, but their intervention methods differ.

So regarding the script, does it change? What does CBT do? Over time, I try to make the patient realize his thoughts about himself, others, and the world, which include beliefs that are part of this disorder, maintain it, or a core part of it. We try to shake them. Shaking them is enough. Just the fact that instead of him believing or trusting in these thoughts or beliefs and it liberates his behavior, to a large extent it's enough that I shake them. If I shake them, essentially the components of the disorder start to change. If I shake the idea that "Look, you sometimes are competent, you have ability, and sometimes you might have found yourself in situations you weren't up to," for example. So when this idea is shaken, the behavior (which I was trying with huge effort) and the emotion start to ease. This is the theory: to shake one of the components, either through the idea, input through thoughts, or through behavior (do experiments that make him see in reality that his thoughts, which are tiring him, are wrong). This is the second wave. This is behavioral therapy? It's CBT. The hypothesis is to change the thoughts and rules the person lives by, which are part of the disorder: "I must behave well, or no one will love me." We change all these conditions, behaviorally or cognitively. So there is the possibility of change at the level of deep beliefs. It takes longer, depending on the disorder and its severity, but they are shaken more, and then their impact on his life decreases. And this is recovery from symptoms. They are treatments focusing on symptoms.

The modern wave of CBT, here there is an additional difference. They said: "Why focus so much on thoughts? Sometimes they don't change." They fill a gap. In some people, their thoughts don't change. So let's focus on emotions, calming the body, emotional skills, emotional regulation, mindfulness, and the values important to this person: how he focuses on them and doesn't let the content of the disorder become too central, and he must change it; he might get more absorbed in it. So here CBT says: we try to change the thoughts, transcend them, or shake them, and this is enough. So the symptoms are treated. And here there might be recovery, or improvement.

Psychoanalytic therapy and other schools have a different method, the style is completely different. It will continue for more years. And it says to you: we will return to the basic pain and deal with it, try to understand it. It benefits people depending on the cases, individuals, and their needs.

Is this Acceptance and Commitment? No. Psychoanalysis and analytic schools... We have Interpersonal Therapy, Schema Therapy, Emotion-Focused Therapy, and Existential Psychotherapy. There are many differences, but the similarities between them are also very large. Psychoanalysis or analytic schools don't necessarily say thoughts must change, but what is its bet? The relationship that will be established. It is one of the schools that focuses most on the therapeutic relationship, the relationship between the therapist and patient. Did you see the strange situation and the anxiety the person feels, and he no longer explores the world around him—the child and this missing thing with his mother? Therapy will become like a corrective experience with the therapist. It gives him the soothing he needs and some things that were missing, allowing him to grow and overcome patterns or things that were tiring him in his life.

The modern, deep, and core agreed-upon view says: did you see all these treatments we listed? The common and fundamental thing... They came and did studies on all successful therapy cases. What is common among them? There are factors related to the therapist and the patient, factors related to the relationship between us—and these are the most important—more than the content. So we come, for example, at the beginning of a person in the clinic, I am drawn to the content, and I feel, "I have mythical secrets." Then I realize the patient didn't improve much because of this new idea, education, or what I said. It seems he felt comfortable with the situation between us. So most patients, when they come and talk about the best thing that happened to them in therapy, do you know what they talk about? Something relational, like what was missing in the first place, like the basic pains. Its compensation: "I loved in therapy when the therapist validated my wounds and pain, and didn't say to me, 'Thank God you're not in Africa,' or 'Thank God you're not below the poverty line,' or 'That didn't happen to you.' No, he said, 'Your pain is understandable and justified.' I felt comfortable." Something emotional: "When the therapist smiled every time, when he opened the door for me and I left, these things affected me a lot. When I was absent and he asked about me. When I shared very sensitive things about myself and felt safe and accepted. I felt he was focused on me, empathetic towards me, listening to me very well, attentive to my details. When I felt my therapist was genuinely curious about my story and interested." These are all missing things outside: recognition, the feeling of being listened to, empathy, etc. There is also therapy based on empathy: how the person is more empathetic with himself and others helps him in his life. So now we return to the core thing among all treatments: the value of the therapeutic relationship is what paves the way for treatment.

I'll give you an example. Imagine I told you: there's a professor who has all the awesome information in psychotherapy, but he is dry with you, and might intimidate you, you get tense, right? It's even unsuitable for this profession. I will tell you: this person is warm, laughs, might joke with you, interacts with you, is comfortable, non-judgmental, and pays attention to your emotions. This is what you need more than the content. Then when does the client accept some content and benefit? After I feel comfortable with what's between us. Part of therapy, a fundamental thing, is that I don't only focus on content; I always check our relationship with the client: "How do you feel things are between us? I noticed in the last session you seemed a bit upset. Tell me, did you feel I was angry with you? Share with me what made you feel that, or what you felt." Did you see our talk about the good enough mother who repairs mistakes? As a therapist, if I make a mistake, I must apologize, not resist or justify. I say: "I'm sorry. Actually, in the last session, I might have dwelled on points and neglected an important point, which is your feeling at that moment. I'm sorry, I apologize." This helps a lot. And what happens here in this experience? Why is the therapeutic relationship so important? It corrects things and soothes. It mimics the basic human needs for attachment/bonding from the cradle to the grave. I become a source of support. And how does this person heal from the relationship? He acquires my skills. He goes outside and becomes a better listener, more empathetic, more understanding, and his relationships get better. Studies say the things that improve in people following therapy include higher income levels and better relationships. And maybe this returns us to the oldest definition of mental health by Freud: the ability to work and to love. So things become organized and calm down. This therapist becomes like a corrective experience, something I return to internally even after therapy ends.

You feel this talk is very romantic. People might find it very romantic and exaggerated. Honestly, all the facts and evidence tell us this is the most important thing. It makes us have compassion for ourselves, that the human and relational thing is what's missing and important, and it will occupy us for long periods. When we see people, for example, who have lost someone, lost a source of support, grew up, aged, and their generation isn't there—the essence is loss. They lost people, lost love, lost the support that was between us. And this is the most important thing, which every person remembers from their life experiences, no matter how difficult: "I will never forget so-and-so who listened to me and stood by me and said, 'I'm here for you,' and didn't tell me anything. He didn't advise me. He said, 'I am always here with you.'"

Does psychiatry intervene here for psychological disorders, especially anxiety? Certainly, meaning medication. Certainly, depending on the severity of symptoms. If they are acute and severe, it's possible he can't even sit and listen to you, and he needs medication, perhaps more than one type to a certain degree for intervention to occur, depending on each case and its severity. According to studies, generally if a case is severe in symptoms, medication combined with therapy is better than each alone. Therapy sessions alone might be sufficient for those with moderate symptoms, and in the long term, it's better in terms of relapse and quality of life than medication alone.

And Obsessive-Compulsive Disorder (OCD) is not classified under anxiety disorders, right? Previously, they put it in the same category in the diagnostic manual. Now it has its own category. Look, all psychological disorders include the experience of anxiety. Anxiety is called the base. Someone with psychosis has fear and anxiety. Someone with depression has anxiety. Someone with OCD has the experience of fear. And you saw when we talked about emotions, you find very high emotions like guilt, shame, and tension. OCD is more complex than just anxiety. It includes impulsive behavior. They put it in a category with disorders like trichotillomania. It's more complex than just an anxiety experience. I can't stop. Similar disorders include compulsive behavior, so its approach requires its own category. And sometimes some genes have slight differences.

Existential therapy, what is its story? I really like existential therapy. Look, it's a slightly different perspective. Existential therapists, most famous being Irvin Yalom, he is contemporary, his age now maybe ninety-two. He is one of the most prolific authors, his works are wonderful. He is a writer, novelist, and therapist. He has a model. It's not so much a theory as a model describing our experience. Irvin Yalom and existentialists say that anxiety is fundamentally an essential part of life, the experience of anxiety.

We are not talking about a disorder. What is the constant thing in life from the moment we are born? There is one very constant reality: death. We have even forgotten when we first knew about death, but it is there and it is a constant reality. All of us, in less than 100 years, will no longer be here. This is a terrifying thought that our brains are designed not to think about or deal with. That is why a scene of a coffin or a funeral shakes us deeply. The death of someone is a painful and stressful event that reminds us of this reality. So, you find a person, when someone dies or they witness a death, they start to wonder, "Where are we going? What is the meaning? Why do I want to live? Why do I do what I do?"

He says: Death is a given of existence. There will inevitably be anxiety in the background, no matter how much we resist it. The fact that time is passing is another given. Freedom. No matter what situation I am in, I always have more than one option. I have the freedom to choose what I do, who I become. I am free and I can choose this or that. So, this is a given of existence. The raw experience of existence without anything. We are not talking about something from outside it. Existence, death, there is death, and there is freedom. And with freedom comes responsibility. Responsibility means I am responsible for my decisions. If I am free, I am responsible. And this is an experience that is not the most pleasant; it is unsettling and terrifying. The additional given is meaninglessness. Of course, there are many references that tell you about meanings, but there is a high probability that there is no single, fixed meaning. This is also a disturbing experience. And the additional thing he called isolation. No matter how connected you are and how much you love others and have people in your life, you will always feel that there is a certain area inside you, a gap that cannot be filled, no matter how close you get. The existential model says: these givens are stressful. So, you see, all of them are linked to anxiety. Anxiety is fundamental to psychological disorders and suffering. When I do not adapt well to these things, when I deny death, you find me engaging in impulsive behavior and doing dangerous things as if I were exempt from death. In reality, I have not adapted to the idea. When I am not adapted to the idea that there is a gap between me and anyone else, a person, for example, jumps into relationships, tries to get close to others. Freedom and responsibility. When a person is very anxious and gives them up, they might say, "Read the Tarot for me" or "Do this for me, choose for me." They have not adapted to the givens that are part of the package of existence. When they do not adapt, emotional or psychological disorders emerge. So, when they come to the clinic... He was originally a psychoanalyst, then he branched out and developed this model. But his practice in reality is a humanistic analytical practice, like Carl Rogers. You find spontaneity, authenticity, he laughs, and shares parts of himself in the session. He considers himself a fellow traveler and a wise person rather than a therapist who is above you, who heals you, and I am better than you. I am like you. So, Irvin Yalom sees that the root of anxiety, all anxiety disorders, is our anxiety about death that we have not dealt with well. And the anxiety of death is accompanied by... my anxiety about death increases whenever I feel regret in life, that I have not lived life as I wanted. Irvin Yalom, as a human, a therapist, and an existentialist who lived a full life with all his output, shows us how he is preparing for death. He says: I have anxiety about death. I lived with it for a period of time. He has a book, perhaps from fourteen years ago, called "Staring at the Sun." Confronting the terror of death. He likened confronting our terror of death to looking at the sun. Can anyone look at the sun? It is annoying, painful, and difficult. But he encourages us on how to face the reality of death so that it leads us to live a rich life. For him, we should not treat anxiety completely, nor should we eliminate it. If I have a patient who denies their anxiety about death or eliminates it or lives as if... I need to stimulate their anxiety a little. Why? So that they live the life they want to live before time runs out. And if they live life, many theorists see that the last period, like Erik Erikson, the last stage in psychosocial development, despair versus ego integrity, is how much I feel satisfied with my life as I look back, and how much I feel I have completed or felt despair and pain that I did not do the projects that matter to me and did not live. So, existentialists see that anxiety is important. The anxiety of death, if we deal with it well, and disorders do not arise, it makes us active in our lives. I will live with those I love, I will contemplate the beauties of life, I will live the things that matter to me, and I will focus on my projects. This calms the anxiety of death when I am in that stage. And his last book, with his wife, they wrote a joint book about his wife's diagnosis of cancer and her last days. She died before the book was finished, and he completed the remaining chapters. He is practically showing us how he lived a life believing in psychiatry, therapy, and existential philosophy, and how it helps people, and through literature. He has wonderful novels. His novels are the most novels that give you the experience of psychotherapy as if you entered psychotherapy. They teach you exactly what happened. So, he showed us a life project consistent with what he advocates and what he sees in his practice. His psychotherapy books are very popular. People read them, and it strikes me when someone reads a book by Irvin Yalom on psychotherapy, and you are not a specialist, it's beautiful. His writings are wonderful, and his style is that he shares his mistakes in the clinic, sometimes he shares grave mistakes. I see a mistake, and I say, at that time he had twenty years of experience, I don't make this mistake now. How did he make it? He shares it with courage. Why? The goal when you read this section, four pages about a case he failed to treat, is that he gives you a lesson about humanity, life, essence, and the things that are overlooked. He emphasizes the therapeutic relationship. He and Rogers, and many of the theorists I mentioned, many of these schools emphasize this relationship. And recent studies on the effectiveness of therapy confirm this. Now, where do I go? Which schools do I go to? Do I have the choice, or is it... Regardless of the therapist and their philosophy of therapy? Or how do I choose, for example, this over analysis or existentialism, or whatever? If we assume that we can differentiate between medicine and... It is a great luxury to expect that these schools are available at all. Most likely, what you will find is cognitive behavioral therapy. But, for example, I do cognitive behavioral therapy, but do I only do cognitive behavioral therapy or follow the protocol as it is? I realized from experience - and this is an observation many reach - that this is not enough. So, the best is something called integrative therapy, where you have all the theoretical backgrounds in psychotherapy and you have different trainings in various types, and all of them are available. I will focus on the fact that the content itself is not the most important thing. Most likely, everyone will reach this conclusion: what is between me and the patient is the most important thing. And the content I bring at this moment is what suits you at this moment. Some people, I start with cognitive behavioral therapy right away. Others, depending on what they need. So, with each patient, you must be a different therapist, and the experience is different. But for some disorders, for example, it is famous that this therapy might be better, and it becomes a global trend. Any specialist, for example, if someone comes to me, I definitely know that this disorder needs intervention. It's not with me. I will refer them to suitable names or tell them: look for a center or clinic that offers this therapy. I have a background. What is available? But in general, availability is very limited, and these different schools are very few. You find names that can be counted on one hand, not exceeding ten, for example, in some schools, especially the more complex ones, and those with more difficult requirements, or that take a long time, or require conditions. So, most likely, you will find waves of modern cognitive behavioral therapy and cognitive behavioral therapy itself, and you will find practitioners influenced by certain backgrounds that will give the therapy its overall character. Anyone who has years of experience in the clinic will tell you after a while: I try to do integrative therapy that suits the person in front of me. May God give you good health. May God grant you good health. Thank you. Thank you. The problems of psychiatry are endless, right? What are your problems? That it differs from normal organic health. My knee was broken, I went to the doctor, and he treated it. It was clear to him exactly where the problem was. He finished treating it and knew when it would be finished. And he knew if it was healed or not. After three months, it turned out that it needed... Because he was absolutely sure that there was a slight issue, that he made a mistake in something, but he fixed it a little, and it was over. Now you are healthy, and there is nothing wrong with you. But you can't play soccer for a year. It's over for you. I don't know. It's normal for me to come to you and say: you are depressed, and someone else comes and says to me: you are anxious. It reminds me of what engineers say. Is your specialty engineering? Yes. So, glory be to God. Many people say that. No, really, it's true, right? Your words are excellent. Many people say: How can I trust, my friend? The whole experience is ambiguous and uncertain. I cannot bear it, and there are no guarantees. And how do I surrender myself? I come to a stranger in the first session, I don't know them, I tell them everything, and they decide, and all these details, and there are no tests to tell me what's wrong with me? There is nothing tangible. Not to mention that the treatment is based on talking. So, some say: we are just chatting. What are we doing? Yes, for you, the matter is completely hidden or unclear. Perhaps throughout the episode, and as we talk, I am telling you what the therapist is thinking while listening to you. Diagnosis, factors, understanding, theories, essential things, needs, and all this. For me, things are clearer because I studied them. But this psychological phenomenon is purely subjective. You are different from many people. Imagine if I applied a ruler to you like others. The experience would be very bad. For example, sometimes social sciences are blamed or criticized that even their research methods are not as rigorous as natural sciences. And they talk about this area. But imagine, for example, the best measure I can use to measure distance? The phenomenon is different. How can I apply a method to something inanimate, easy to observe and finish, to something that is a human story? The specialist is trained, and has theories, some of which contradict each other, or some of which support each other, suitable for this diversity and the intricacies of this phenomenon. Psychology is considered one of the most advanced social sciences. Psychology is one thing, and therapy is another. Psychotherapy is this part between psychiatry and clinical psychology. But in general, it is even better, perhaps in many aspects, qualitative research, or that I focus on the phenomenon. I study, for example, four or five cases phenomenologically, and they talk about themselves. I will understand the phenomenon more than taking huge numbers and removing the differences between them, and only observing the similarities. This is also misleading and incomplete. So, the phenomenon is complex and requires more complex and diverse methods. And this is frightening and does not suit many people whose thinking is: I want something tangible. But after a while, many patients come and say: What are we doing? For example, in session number ten or fifteen, they admit: I have improved. What are we doing? So, I ask them: Tell me, what do you feel? This is more important. Their feeling comes and they say: I don't know. I feel anxious. I want to hold onto something. They talk about the experience, which might even be part of their emotions: I am afraid of uncertainty. I am afraid of what we are doing. Will I lose something? Will I trust something? What will happen next? So, I calm this fear on one hand, and on the other hand, I clarify with them what changes have occurred. And if they need a theoretical understanding of it, I give them the foundations and clarify it according to the type of school or therapy. Suddenly, they calm down and say: Yes, many people come who say: What exercises are there? You saw the criticism you made about there being nothing tangible, and natural sciences compared to social sciences and others. This led to specialists within the field trying, because this bothers them, to come up with tools, exercises, methods, and ways. When you cling to this, you might overlook the essence of psychotherapy. So, these tools sometimes reassure them, and reassure me more than being useful and removing the suspicion that we are very vague. It is vague, but it is not completely chaotic. On the contrary. But as a specialist, my knowledge is certainly different from someone who doesn't know it. I can convey it. And conversely, when the experience is safe, and the therapy... I believe in the concept of not keeping everything hidden from the patient. I prefer schools or methods that encourage them to participate in this process. Let them understand what is happening. So, I will share many things with you, the aspect of psychological education along the way, with psychological support, which is the foundation. This criticism will be reduced, and the person will begin to understand, and all these things will be conveyed to them, and they will understand that this process is different from a dentist, for example, or others. Did I convince you? No, be patient for a little while. First, let's assume that your diagnosis might differ from another therapist's diagnosis. We might go to the best doctor now, and the problem is that you don't even know who the best doctor is. For example, now we will go to Professor (...) and you might completely disagree with the result he reaches and diagnoses you in ten minutes. Okay? You understand me? And he might diagnose you with narcissistic personality disorder. Excellent, because you two are unable to agree on one thing. You are both specialists. Forget about me, I am a patient. Play with me. Excellent. I will tell you about the problem of diagnoses. Yes, there are many psychological diagnoses with a low stability rate, meaning the probability that I go to five and they give the same diagnosis is weak, especially here, when it comes to severe disorders or those with a more complex nature, personality disorders, and so on. But mood and anxiety disorders have a better stability rate. Here comes the problem of diagnoses. The diagnostic manual, it tries to reassure you that we have things. And perhaps in the same way you spoke, but are disorders closed categories? Anxiety or depression, as if they are closed categories? The modern view is to understand the disorder and diagnose it as dimensions. I come here, I overlap with several disorders. I come here, I overlap with a set of disorders, and there is a method for that. That's why modern, evidence-based, transdiagnostic therapies were created. A protocol is done regardless of your diagnosis. We focus on the problems you have. We focus on what emotions are excessive. This therapy is called, for example, Unified Protocol Therapy by David Barlow. It stems from cognitive behavioral therapy and is its basis. So, the therapist who will be trained on it, diagnosis is no longer an important issue. What did David Barlow do in his research? He took a group of panic attacks, anxiety, and depression, and he did a unified protocol with them, and they all benefited, and the dropout rate from therapy was lower than with regular cognitive behavioral therapy for unified protocols that are only for panic or depression. Why? He made it chapters of therapy, like units of emotional awareness and cognitive flexibility. Instead of saying change or modify thoughts, how can I be flexible with my thoughts? So, he took the best of cognitive behavioral therapy in all its waves, the part related to emotions and the body, exposure, and cognitive flexibility, which will benefit you, whatever your excessive emotion is, and whatever your diagnosis is, because the origin is called comorbidity. The patient has more than one disorder. So, the matter of me being preoccupied with their diagnosis. We list the problems and understand what is bothering them now, and we start. What is the benefit of diagnosis in the first place? Many people deal with diagnosis as an explanation. It is not an explanation. It is the name of what you have. So, someone comes and says: Thank God, I am relieved now. Why am I sad? I have depression. This is a description of what you have. I no longer feel pleasure. I have depression. They are synonyms. Some people take it like explaining water with water, a circular explanation. I have this because I have this. It is not an explanation. People think it is an explanatory tool. It is a descriptive tool, and a name for what you have. Diagnoses were initially created why? So that when I do research, I as a specialist, and someone else does it in another country, and we come to a conference, instead of listing fourteen symptoms of depression, for example, or others, I say: depression. Instead of saying: loss of pleasure, appetite, eating, and I don't know what. I shortened the word for communication among specialists worldwide in studies, research, and conferences. So, it is an abbreviation and a scientific language. It is not primarily for therapy. It is important if it is clear. If it is not clear, there is a lot of overlap. I will focus on the essential things and work on them, regardless. And the overlaps are similar and beneficial in the aspect of medications, and so on. And even medications have a great deal of similarity. Medications are prescribed very widely. So, diagnosis, people sometimes take it as a goal and a concept that: I will be reassured when I know that what I have has a name, and I go and understand it. And for some, diagnosis can be a bad thing in their lives, where they start to pigeonhole themselves as if this is their identity. No, it is not an identity. It is a description of a state you lived for a period of time and it has passed. And it is not part of your identity. Depression requires four weeks of certain symptoms to say: I had depression. Depression, if you don't treat it, it comes in episodes. And for some, it is a pattern, meaning there is no gap between episodes, it is often acute and chronic. But it is an episode that will come to you and go. This is considered one. If you have had one, you are prone to having another more than others. It is a risk factor. But it can come and go without treatment after a year. You feel a little more recovered, but what are the losses that went with it? Treatment avoids losses, but it will go away on its own. So, why does a person then stereotype themselves with the diagnosis? These are some disadvantages of diagnosis. Now, if we take the second problem, which is the difference in diagnosis from one doctor to another, or therapist to therapist, completely differently. Now, let's assume that I am coming to you now. It is clear that you are, God willing, a genius, and I am very confident in your ability to treat. Can you definitively know that you have treated me? That is, do you definitively know that this person is now well? In the first or second session, I will ask the person in front of me, of course. This similarity is another minefield. An ideal idea. But I will ask them: What do you want to happen? So, there will be goals, often focusing on symptoms. I want the panic attacks to stop, and I want this fear I feel to lessen. I want to be able to enjoy myself. I want to go back to the club, and I want to go back to my friendships. Personal goals and goals related to symptom management, and so on. These are very easy to achieve. You will find the patient continuing, and not stopping treatment. You saw when I told you that psychological disorder is a symptom of internal pain. The symptoms are controlled. Forget about me, I can lie to you. Evaluating improvement. It's not just me, but I as a client can lie to you and tell you: I have recovered. I feel fine now. Can you know if I am lying? Or vice versa. Maybe you are fine, my friend. I know you are fine, and he says: No, I am sick. Is this verifiable from your perspective? First of all, generally, the concept of improvement is not a linear thing; it goes up and down. When do we say there has been stability? Generally, when we approach a year or ten or eleven months of follow-up with most clients, and it is observed that here they say: I have started to stabilize, and my affairs have become okay. Before, perhaps in the beginning, maybe after the third session, he said: I feel very comfortable. Does this mean it's all good? No. He won't say: Let's stop. The comfort that comes because there has been validation of certain characteristics. But you, as a therapist, when he tells me: I have improved, can you distinguish, regardless of his answer? I have criteria related to the primary complaint he came with and an evaluation of aspects of his life. But I, for example, see that he still has a problem in relationships, but he has stopped certain symptoms, anxiety, depression, and so on. But he still has a problem in communication. Does he want to solve this problem, or does he not want to solve it? If he wants to solve it, we work on it. If he doesn't... For me, for example, there has been improvement, but has there been growth? This is advanced. This is something he decides. He wants to stop now, okay, according to your goals, 80% or 95% or 90%. The decisions are his. I give recommendations. I see that yes, it might be appropriate for us to end now. Your affairs are fine, like this and that. If you need me, you can come to me later, it's okay. Or no, I see that you feel you have improved now, but I wonder if this improvement happened quickly and I am not sure if it is related to something deep, maybe to other things. So, I try to understand with him what happened. Some people improve and say: That's it, I'm done... So, here I explain the process. Will I know if he is lying? A person, for example, at the beginning of his story, when he first came to me, was not honest about many things. Is this important? Whether he is honest or not? I don't think it's very important. I deal with the pain he expresses, regardless of the facts and his inner world. It becomes clear to me later in our interaction that he is lying, or he says: I lie to everyone. I come and ask him: What did you lie to me about here between us? So, I will understand what made him lie. He might answer or he might not answer, but we will understand what is behind this that might help him. But it's not a matter of whether he is honest or a liar. What hurts him, and what pains him? And we work on it. Are there indicators that come to me... meaning, it might be... I don't want to speak as if there is a stigma on some disorders, but in some severe disorders or those related to personality, and so on, this might be included. A person suffers from lying, and there are things he is not explicit about, and there are things he uses. I deal with the phenomenon as a whole, and it has a treatment method, and I reflect this according to what is beneficial for him. So, there are indicators that yes, I might know. I have a question about existential anxiety. What is existential anxiety, anyway? I feel like many words are said without a person being aware. Are we done now? I just want to confirm. We do this before we leave. So, take your time. But existential anxiety, for example, I feel like there are words like depression. Someone comes and says to you: My friend, I feel depressed today. So, I feel, my friend, I have existential anxiety. So, what is existential anxiety? And why does a person develop existential anxiety? Existential anxiety, as the name suggests, the person starts to talk about... I don't know where to look. It's okay, take your time. They talk about the givens of existence. I have anxiety that we are going to die, and what is the meaning of life? Where are we going? What is right and wrong? I am confused to choose, for example... Sometimes it is even expressed as being confused to become, for example, a doctor or an engineer. Okay, and then what in my life? So, it might be a style of daily topics, but it more specifically relates to these givens: my freedom, my role, my responsibility, and the meaning. This is the point. For example, the content of anxiety will not be as significant as the disorders we talked about, as much as it focuses on major things. The trick is: will everyone who comes with this actually have existential anxiety, or does it involve other things? Or, like most people with depression who come and say: What is the meaning of life? But they are not concerned with the existential issue. They feel a sense of worthlessness. I am part of my condition, and I am depressed. I no longer feel pleasure or connection. So, they have lost value. So, they might ask big questions, but they are expressing internal pain more than a philosophical issue. Some people, however, come explicitly and say: These issues really bother me. So, there is a discussion about them. And here, the existential therapist, part of the foundation of existential therapy, is that you are knowledgeable about existential philosophy and all the things that Irvin Yalom, Sartre, Heidegger, and others have talked about. You then manage this philosophical dialogue with this person and see what pains them, and how they can focus, and how they can manage it beneficially. Did I answer you? If these questions come to my mind, are they questions of meaning? Now I am having a discussion with a therapist. I am not having a discussion with someone in the philosophical aspect primarily, or in the intellectual aspect. For example, if I have a problem with meaning or a problem with atheism, for example, it might fall under this. I don't know. But why shouldn't I have a discussion with someone in this field? I mean, it's a problem. It's natural to have this question: What is the meaning of life? What is the benefit of life? Why are you suffering? Right? For example, first, there is the philosophical counselor who has a clinic like a psychologist. Does it fall under...? Something between philosophy and... But they are not therapists. They are philosophical counselors. This exists. For example, Irvin Yalom, in his book "The Schopenhauer Cure," he wrote a novel. What did he do in it? Genius, something crazy. He brought a character he created, "The Schopenhauer Cure," which is Arthur Schopenhauer, the philosopher. So, this book talks about death. The novel is about a psychotherapist. The novel begins with a psychotherapist who knows he has been diagnosed with cancer and has a year to live. He starts asking himself: What should I do in this year? Then he went to his library to look for any books on psychology or psychiatry to help him face death. He found nothing. He went to Nietzsche and the concept of eternal recurrence in Nietzsche, that imagine if your life were to be repeated infinitely. This experience, of course, is imaginary. Imagine it. What is its effect on you? What is your feeling? So, he used it on himself. If my life were to be repeated infinitely, what would I change? And what would I do? He said: I will live this year like yesterday and the day before, and like the years before, a psychotherapist until the last breath. I will see my patients, and my life only, and I will live my day. And he talked about this main character – the therapist – and the therapist began to review himself, who is passionate about his work, that he is dying within a year. He reviewed the patients he failed to treat. He called one of them after twenty years of failed treatment. When he called him, he said: Hello, I have become a philosophical counselor. I treat with Schopenhauer's philosophy. You failed in my treatment, and you returned to Schopenhauer. I found everything in him, and I found in philosophy, and I am now almost a competitor to you. So, he said to him: I need some supervision from you in a certain matter to get a certain license. So, I will come to you. So, maybe we can collaborate. So, he saw his patient from a few years ago whom he failed to treat and who had become a therapist with philosophy. So, he was influenced, and the patient was influenced. It shows you these aspects. So, here is the point: just because I tell you: I am interested in existential therapy, it means I have read and have knowledge, and I personally love philosophy. So, I can help with both. You are suffering on one hand, and you have existential issues on the other hand, which I might even have, and we can discuss them. But the option of philosophy as therapy, as a standalone, is the philosophical counselor who exists outside, but not here. And you saw that school... This school is criticized, but some of its efforts are good, which is the "Life" school. Did you know it? YouTube is the author, or his works, and this project tries to use philosophy and literature to enhance emotional intelligence and for daily life, helping people. And all his books are therapy with philosophy. So, there is this aspect. The anxiety test available on the Ministry of Health website is wrong to be published, really? All of them, even those on "Labaih" and so on, these are tools... Psychotherapy, now when a patient comes to me, they talk about their subjective experience, right? We have tools called self-assessment tools. You have indeed undergone a comprehensive psychological assessment, and I have seen all aspects of your life, and I know you have an anxiety diagnosis. I use this tool to measure the severity of symptoms. It is used for those who already have anxiety. All those who do it will show anxiety. Yes, all of us have shown anxiety because they are descriptions that resemble a normal situation. If you don't have anxiety, you have undergone an assessment, and you don't have anxiety, why would I use the tool with you? I don't need it. This tool is for those who have the diagnosis. From my impression, how do we diagnose? There are very violent and strong disorders that have no tools. People think that tests mean you have reached the pinnacle, you have a miraculous tool. These tools and some theories are a bit reassuring to the practitioner. I have a tool, like an engineer's tool, a doctor's tool, and it helps and reduces anxiety and gives an aura that patients have tools and tests. Excellent. If you are confident in yourself and realize the core, I use papers or forms less. I don't need them. I need to explain to you and clarify. So, for many disorders, like personality disorders, more than one specialist has seen you and seen these criteria, so we have confirmed. We want to measure their severity or understand some details. I use these scales that were designed for clinical or research use, but they are published for the general public. Come to me, I have anxiety from the Ministry of Health. It's okay, there are infinite mistakes. No, but the ministry gives it credibility. That if the result comes out, the Ministry of Health is telling you that you are like this, you are depressed. That's why there is a problem between what? For example, these mental health departments face difficulties, such as: I am a mental health or psychology department in a hospital, and my medical director is not from the field. So, he has a wrong perception of many things we do, and he governs us with policies that are not like that. Or they misunderstand the tools. So, those who made them... And some specialists misunderstand them as well.