The Off-Label Podcast

In Part 2 of our anxiety series, we’re going deeper, breaking down what anxiety actually is, what’s happening in your brain and body, and how medications fit into the picture.If you’ve ever wondered why anxiety feels so physical (racing heart, nausea, chest tightness, dizziness), this episode explains the physiology behind it in a way that actually makes sense. We walk through the anxiety response, including the role of the nervous system, fight-or-flight, and why your brain sometimes sounds the alarm when nothing is actually wrong.We also talk about anxiety medications—what they do, how they work, and common misconceptions people have about them. As mental health providers, we share real-world insight into when medications can be helpful and what to expect if you’re considering them.Whether you deal with generalized anxiety, panic attacks, or chronic overthinking, this episode will help you understand your symptoms in a way that feels less confusing and a lot less scary.Because once you understand what your anxiety is doing, it becomes a lot easier to work with it instead of against it.

Welcome to Part 1 of our anxiety series where we’re making anxiety a little less scary and a lot more relatable.In this episode, we introduce the Catastrophe Scale, a funny but insightful way to understand how anxiety turns small moments into full-blown spirals. From unread texts to awkward social interactions, we rate everyday situations from mild concern to complete mental chaos.Along the way, we break down why anxious thoughts escalate so quickly and how to start catching yourself before you hit a level 10 spiral.If you struggle with overthinking, social anxiety, or constantly expecting the worst-case scenario, this episode will help you feel seen (and maybe laugh at your brain a little too).Because sometimes your brain is dramatic… and it’s okay to call it out.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BC with special guest Amber Herpfer, BA, MSWiWe’re wrapping up our Mental Health Spring Cleaning series with the step that actually creates change.In Spring Cleaning Pt. 4, we break down the final piece of CBT: changing your thoughts. Using our simple framework, check it, challenge it, change it, we show you how to reframe negative thinking patterns and shift your mindset in a realistic, sustainable way.We’re also joined by our intern Amber, who helps us tie together everything we’ve covered in this series. From identifying thought patterns to challenging them and finally learning how to replace them, we work through the CBT process giving you some real tools to take home with you.In this episode, you’ll learn:How to reframe negative or distorted thoughtsWhat “changing your thoughts” actually looks like in real lifeWhy reframing isn’t toxic positivity (and what to do instead)How to start building healthier thinking patternsIf you struggle with overthinking, anxiety, or self-doubt, this episode gives you practical tools you can start using immediately.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BCYour thoughts feel true—but what if they’re not?In Spring Cleaning Pt. 3 of our Mental Health series, we’re breaking down cognitive distortions - the automatic thinking patterns that can fuel anxiety, overthinking, and self-doubt.As mental health providers, we see these patterns all the time and, chances are, you’re experiencing them too without even realizing it. From mind reading to catastrophizing, we explain how these thoughts show up in real life and why your brain is so quick to believe them.This episode will help you:Identify common cognitive distortionsUnderstand why your brain jumps to worst-case scenariosStart separating thoughts from factsWe also address overthinking, anxiety spirals, and how to tell if a thought is actually true.✨ Not every thought deserves your trust—and this episode will show you why.

In this episode of The Off-Label Podcast, we’re continuing our Mental Health Spring Cleaning series by diving deeper into Cognitive Behavioral Therapy (CBT) and the first step to changing your thoughts: awareness.If you’ve ever struggled with overthinking, anxiety, or negative thought spirals, this episode is for you. Most of the thoughts that drive stress and self-doubt happen automatically, and if you don’t notice them, you can’t change them.We break down how to identify automatic thoughts, why your brain jumps to worst-case scenarios, and how to start catching the mental “clutter” that’s been running in the background. Using real-life examples (and a little humor), we make CBT practical, relatable, and actually doable in your day-to-day life.In this episode, we cover:What automatic thoughts are and why they matterWhy overthinking feels uncontrollableHow to start noticing negative thought patternsSimple CBT techniques to build awarenessHow your thoughts impact anxiety, mood, and behaviorWhether you’re new to therapy concepts or already working on your mental health, this episode will help you take the first step toward a clearer, calmer mind.Don’t forget to follow, rate, and share with a friend who could use a little mental spring cleaning.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BCIn this bonus episode, we’re coming to you hot off the heels of the Psychotherapy Networker Symposium in Washington, DC! We’re breaking down our biggest takeaways, favorite moments, and the sessions that left a lasting impact on how we think about therapy, trauma, and real-world mental health work.We dive into powerful presentations from Britt Rathbone, LCSW-C, ACSW, BCD, CGP on Dialectical Behavior Therapy (DBT), Nadine Burke Harris, MD, MPH, FAAP on Adverse Childhood Experiences (ACEs), and Bessel van der Kolk, MD, author of The Body Keeps the Score, who led an engaging and thought-provoking discussion on trauma and healing. We also highlight insights from Terri Cole, MSW, LCSW on high-functioning codependency and boundaries.Beyond the sessions, we reflect on how attending a major mental health conference reignited our passion, challenged us to grow, and inspired us to show up more fully in our own community and clinical work. And of course, we share some of our funniest and most chaotic moments navigating DC along the way.If you’re a therapist, mental health professional, or just someone interested in trauma, therapy techniques, and personal growth, this episode is packed with insight, inspiration, and real talk.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BCSpring cleaning isn’t just for your house — sometimes your brain needs it too.In this episode of the Off-Label Podcast, we’re talking about mental health spring cleaning and the thoughts we keep holding onto that might need to go. You know the ones: “I should be further along by now,” “Everyone is judging me,” “If I rest I’m being lazy,” and the classic mental junk drawer of overthinking, guilt, and negative self-talk.As a psychiatric nurse practitioner and a licensed clinical social worker, we break down the common thought patterns that contribute to anxiety, burnout, people-pleasing, and perfectionism, and talk about how to start letting some of that mental clutter go.We also explore why our brains hang onto unhelpful beliefs, how cognitive distortions show up in everyday life, and a few practical ways to challenge the thoughts that keep us stuck.If you’ve ever felt overwhelmed by overthinking, comparison, or the pressure to have everything figured out, this episode is your reminder that sometimes the healthiest thing you can do is clean out the mental junk drawer.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BCWe played a game called “Horrible Therapist”… and it sparked a deeper conversation about something a lot of people quietly wonder:How do you know if your therapist is actually good?In this episode of The Off-Label Podcast, we break down:• Red flags in therapy• Green flags in therapy• What good therapy should feel like• How to know if therapy is working• How to tell if your therapist is the right fitTherapy should feel collaborative, safe, and grounded in real clinical skill — not awkward, dismissive, or performative. We talk about the difference between discomfort that leads to growth and discomfort that signals something isn’t right.If you’ve ever wondered, “Is this normal in therapy?” this episode is for you.As always, this podcast is for educational purposes only and is not a substitute for individualized therapy or medical advice.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BCIn this episode of The Off-Label Podcast, we talk about how to cope when the news feels overwhelming and the world feels heavy.From constant headlines and social media updates to global crises and political tension, many people are experiencing increased anxiety, stress, and emotional exhaustion. We break down why our brains are wired to react so strongly to negative news — and what you can actually do about it.We cover:​ How doomscrolling can get the best of you• Signs you’re experiencing news-related anxiety• How to set healthy boundaries with media consumption• Therapy tools to manage overwhelm and uncertainty• Staying informed without sacrificing your mental healthIf you’ve been feeling anxious, helpless, angry, or emotionally drained by current events, this episode offers grounded, research-based strategies to help you stay steady in unstable times.This conversation is educational and not a substitute for therapy, but we hope you walk away thinking: “I’ve never thought of it like that.”

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BC with special guest Amber Herpfer, BA, MSWiIn this Ask the Amandas episode, two mental health professionals answer some of the most common questions people have about therapy, mental health, and emotional wellbeing. Licensed clinicians Amanda and Amanda discuss what therapy actually looks like, how to support someone who is resistant to seeking help, and how mental health shows up in everyday life.This mental health Q&A explores the connection between ADHD, CPTSD, and childhood trauma, what it means when therapy “gets worse before it gets better,” and how mental health professionals set work-life boundaries to prevent burnout. The Amandas also share their personal paths into the mental health field and what a good mental health day looks like for them.This episode is for anyone curious about therapy, navigating anxiety or burnout, supporting a loved one, or wanting a clearer understanding of how mental health care really works.Topics covered include: • How to support someone resistant to therapy • ADHD, CPTSD, and childhood trauma • Explaining therapy and mental health work to others • Burnout and boundaries for helping professionals • What progress in therapy actually looks likeIf you’ve ever wondered whether therapy is right for you, or how to talk about mental health more openly, this episode offers practical insight and reassurance.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BCIn this episode of The Off Label Podcast, licensed mental health professionals explore burnout, motivation, and the all-or-nothing thinking that keeps so many people stuck. If you’ve ever told yourself, “I’ll start when I feel more motivated,” this conversation gently challenges that idea.We break down what motivation actually is, why it’s unreliable as a driver of change, and how common cognitive distortions—especially all-or-nothing thinking—quietly sabotage progress. Drawing from CBT concepts and real-life experience, we talk about why doing things imperfectly is often healthier and more sustainable than waiting to do them “right.”This episode also explores radical acceptance, recalibrating rigid goals, being gentler with yourself during burnout, and learning to recognize progress even when it feels small. We discuss how lowering the bar on purpose can help you rebuild momentum without turning self-improvement into pressure.This conversation is for anyone navigating burnout, struggling with motivation, feeling overwhelmed by expectations, or trying to make meaningful changes without burning out in the process.Topics include: • Burnout and emotional exhaustion • Motivation myths and why willpower fails • All-or-nothing thinking and CBT distortions • Radical acceptance and self-compassion • Making progress without perfectionSlightly better still counts — and sometimes, that’s more than enough.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-B with special guest Travis MitchellSnowed in and feeling… a lot? ❄️ In this cozy, slightly chaotic episode, we’re joined by Chef BoyarTravis to talk about the emotional wintry mix that shows up when life slows down. From restlessness and low mood to comfort, connection, and unexpected moments of warmth, we explore what it’s like to be stuck—and why there’s no “right” way to feel about it. No toxic positivity, no pressure to make the most of it—just real talk about meeting yourself where you are.

What if therapy didn’t always have to feel heavy, intense, or serious?In this episode, we lean into play. We’re talking about why fun, humor, and games aren’t just allowed in therapy—they’re often used on purpose. From silly “getting to know you” questions to creative ways therapists help people feel more comfortable, we explore how play lowers pressure, builds connection, and helps people open up in ways talking alone sometimes can’t.This isn’t a therapy session, and we’re not analyzing anyone—but we are pulling back the curtain on how therapists use lighthearted tools intentionally, especially with kids (and yes, adults too).No homework. No pressure. Just vibes—with a point.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BC Starting psychiatric medication can bring up a lot of questions, hope, and uncertainty. In this episode, we talk through what medication is designed to help with, how prescribers think about treatment, and how medication fits into the bigger picture of mental health care.We explore common fears around psych meds — including worries about feeling numb or “not like yourself” — and clarify what the actual goal of medication usually is: reducing intensity, creating stability, and helping you feel better without taking anything away.This is a grounded, stigma-free conversation between a therapist and a mental health prescriber about using medication thoughtfully, realistically, and collaboratively. Whether you’re considering medication, already taking it, or just trying to make sense of how psychiatry works, this episode offers reassurance, clarity, and a gentle approach to psychiatric medication.

Hosted by Amanda Smith, MA, MSW, LCSW and Amanda Mitchell, DNP, APRN, PMHNP-BC Thinking about therapy but feeling nervous to start? You don’t have to share everything all at once.If you’re therapy curious but hesitant, anxious, or unsure what to expect, this episode is a gentle, pressure-free place to begin.In this episode, we break down what starting therapy is really like, why anxiety before your first session is completely normal, and how good therapy is designed to move at your pace without rushing into trauma or uncomfortable conversations.We talk about: • therapy anxiety and fear of opening up • what actually happens in early therapy sessions • why you’re allowed to go at your own pace • how therapists prioritize safety, choice, and consentIf you’ve been wondering “Should I try therapy?” or “What if I’m not ready?” this episode will help you feel more informed, grounded, and in control of the process.Topics: what to expect in therapy, first therapy session, therapy anxiety, starting therapy, trauma, mental health

Hosts: Amanda Smith, MA, MSW, LCSWAmanda Mitchell, DNP, APRN, PMHNP-BC The Off-Label Podcast is a mental health podcast about therapy, psychiatry, and what it really means to take care of your mental health in real life.Too often, conversations about mental health happen in silos. You hear therapy advice in one place, medication information somewhere else, and real life struggles somewhere entirely different. But healing does not happen in silos, and neither do we.Hosted by a licensed therapist and a psychiatric mental health provider, we explore mental health from multiple angles including therapy, medication, psychology, neuroscience, and lived experience. We talk openly about anxiety, depression, burnout, relationships, boundaries, trauma, identity, and the everyday stressors that shape emotional well being.If you have ever felt overwhelmed by conflicting mental health advice online, unsure whether therapy or medication is right for you, or confused about where psychology ends and psychiatry begins, you are not alone.On The Off-Label Podcast, we explore the gray areas of mental health. The nuanced, complex, not one size fits all parts of healing. We break down common therapy concepts such as CBT and cognitive distortions, discuss how psychiatric medications actually work, and have honest conversations about what growth looks like outside of social media soundbites.This is not about fixing you. It is about helping you better understand yourself, think critically about mental health, and feel less alone in the process.Whether you are therapy curious, actively in therapy, considering medication, or simply interested in psychology and personal growth, you are in the right place.Welcome to The Off-Label Podcast.