Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew huberman, and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. Today. My guest is dr. Paul Conte. Dr. Conte is a psychiatrist who did his training at Stanford school of medicine and then went on to be chief resident at Harvard Medical School. He now runs the Pacific Premier Group, which is a collection of psychiatrists and therapists focusing on solving.
Plex human problems, including trauma, addiction, personality, and psychiatric disorders. Today, we discuss trauma in detail and the therapeutic process in detail. For instance. We discuss. What is trauma? How do you know if you have trauma? Dr. Conte shares with us, for instance, that not every experience that we think is traumatic, as necessarily traumatic. And yet many people might have trauma without even realizing it. We also talked about the therapeutic process generally, for instance, how to, pick a therapist, how to best approach.
Roach and go through therapy and how to evaluate whether or not therapy and your relationship to the therapist is working or not. We also talked about cell therapies because we acknowledge the not everyone has access to or can afford therapy and we talked about drug therapies. For instance, antidepressants antipsychotics. We talk about alcohol cannabis ketamine and the psychedelics including psilocybin LSD, and we talked about the clinical use of MDMA and what the future of that looks like, the reason for bringing
Dr. Conte on to this podcast, is because I see him as the person who has the greatest, and most holistic view of therapy. Trauma drug therapies, talk therapies, and how self-therapy and work with others can be integrated for both healing and growing from difficult circumstances. Dr. Conte is also the author of an exceptional book entitled trauma, the invisible epidemic, how trauma works and how we can heal from it. That book describes trauma and its many features. And
Any tools, some of which we discuss on the podcast today? So whether or not you have trauma or Not, by the end of today's episode, you will have a much deeper understanding about what trauma is. In fact, I'm confident that you will gain insight into whether or not you have trauma or not, whether or not people close to you have trauma or not and the various paths to recovering and indeed growing from trauma that we can all take as you will soon. Learn. Dr. Conte is an exceptional communicator and has a unique window into the trauma and therapeutic process that. I
That all of us can benefit from before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however, part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is rokka rokka makes eyeglasses and sunglasses that are of the absolute highest quality. The company was founded by two all-americans, swimmers from Stanford and everything about Roca eyeglasses and sunglasses.
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With dr. Paul Conte, Paul. Thank you so much for being here
today. Thank you so much for having me.
I've been looking forward to this and received a ton of questions about trauma about therapy about how to assess where one is in their own arc of problems, and addressing familial issues and relationship issues, and so forth. We could just start off very basic and just get everyone oriented. Sure. How should we Define?
In trauma, we all have hard experiences. Some of them we might ruminate on more than others. But what is trauma
to make the definition relevant? I think we have to look at trauma as not owe anything negative, that happens to us, right? But something that overwhelms, our coping skills and then leaves us different as we move forward. So it changes the way that our brains function, right? And then, that change is evident in us as
As we move forward
through life.
So how do we know if we have trauma or not? I've heard before, everyone has trauma. For instance. I've heard that if we are a child or when we are a child and we request love from a parent or attention from a parent. If they dismiss us that, that's a micro trauma. It is that overstating or unfair to the real issue of trauma. Do we all have trauma? What are micro traumas? What our macro dramas?
Right, I think.
Traumas that we might categorize as disappointments, right? Or things that are negative but not deeply. Impactful I think is not it's not a helpful definition. Right? I think the helpful definition is something that rises to the magnitude of really changing Us and something that we can see both in how we behave. We can see it in mood anxiety, Behavior, sleep, physical health. So we so we can identify it and we can also see it in brain changes. So the so fact that
Becomes a more hyper Vigilant dry more Vigilant and then we can see that different parts of the brain are more active. So that definition, that definition captures how trauma, if it rises to a certain level. Like what we would say trauma that makes a post trauma syndrome, right? Leaves us different. I think is the helpful definition of trauma because it's a clinical definition, right? It's changes in us as people and we can we can map those changes to
Viable shifts in our brain function.
How do we know if we've been changed by something? And I can think back to Childhood events where some kid on the playground or in the classroom said something. I didn't like something negative about me. I think most people can do that. We have a great memory for the kid, that said something awful, or the parent or teacher, that said something awful, that really felt like it hurt us, or at least, it stopped with us. So clearly ones brain.
My brain in this example has been changed by the that event such that, I remember it. But how do we know if something has actually changed the way that we are? Because of course, we don't know how we would be otherwise,
right? That's that's difficult. Right? It's doable but it's difficult because the response. So if the trauma Rises to the level of changing our brains and and I don't just mean like we have a new memory, write it. So we can have memories of something that was - right and in that sense it changes the brain.
Because now there's something we can call to mind, but it doesn't change the functioning of the brain, right? If trauma Rises to the level of changing the functioning of our brains, then there is almost always a reflex of guilt and shame around the trauma that can lead us, and often leads us to bury it, right? To avoid it, right to to feel that. Now, there's something negative inside of me, and it's feels shameful, or it feels like no one.
What accepted? So, so what happens is, people tend to avoid looking at the change in them, which is exactly the opposite of what needs to be done. Right? The idea of in a viral pandemic, what we want to stay away from one another and isolate, right? But with a trauma epidemic, we need we need to communicate with other people. We need to communicate and put words to what's going on inside of us and and very often a person knows. I mean, I've done so much clinical work over.
At twenty years that that has focused on trauma. And a lot of the times the person knows, right? But they're not admitting it to themselves because they're afraid of it. Right? They don't know what to do. But if they start talking then they'll talk about the event or the situation could be something acute or it could be something chronic that really has been harmful to them. Right. And then they feel different afterwards like, oh after that, I started thinking differently feeling differently, but that doesn't always happen. Sometimes it's a process of
Eurasian we know through dialogue rate, whether whether it's written, or whether it's spoken of the person, sort of exploring, the changes inside of themselves, may be changes to their self talk inside changes to their thoughts, about the world and whether they can navigate safely and readily in it and, and anchors. As I talked about this, the example, I'll use it times as the example of my own life where you know, when I was much younger in my early 20s, my younger brother took his life.
By Suicide and, you know, the response of guilt and shame and and hiding all of it inside of me was was, it says very dramatic, but but I wasn't acknowledging it, right? Because I didn't know what to do about it. And I felt guilty and I felt responsible and I felt ashamed. So there was a van avoidance inside of me. And then I wasn't saying to myself. Hey before this like you thought that you could be effective and you could make your way in the world and you know, if you were a good person
And you worked hard, you could make a difference, right. And then afterwards, I thought I can't get anywhere. The the world's against me. And, you know, I I felt like all my options are all gone and you know, Zach, 24 years old, right? So, so I didn't see that the change was in me, but I was taking care of myself, poorly like it was enough going on. That was unhealthy that I couldn't avoid the realization that like, hey, I'm different now and in these ways that are automatic, you know, my reflex to, can I make my way in the world?
Can I have a good life? Can I be happy with my reflexes to that were all different and they were coming through the lens of heightened anxiety, heightened, vigilance, a sense of guilt, a sense of Shame, and a sense of not belonging in the world and and was ultimately good. And helpful people around me and my own realization and hey, things are not going. Well, right. That led me to then get some help. And to be able to talk about it and realize, like, oh my gosh, I need to face these things that are going on inside of me,
from a
Psychoanalytic psychological, and maybe even a neuroscience perspective to questions. Why do you think that? When we experience trauma?
These things that we call guilt and shame surface, you know, everything you're telling me is that in the end that's not adaptive. Why would we be built that way? That's the first question. And then the second question is, you know, how should we conceptualize, you know, guilt and shame, you know, I think we hear guilt. We hear shame. You know, how should we think about it? I mean, those emotions.
Must exist in us for some reason. But in this case, it seems like they don't serve us. Well, so maybe in that order or in reverse order, you know, what is guilt really? What is shame really? And why is it that we seem to be reflexively wired to feel guilty and feel ashamed? When that's the exact opposite of what we need to do in the case of trauma.
Right now. These are great questions, and I don't think anyone knows the answers for sure, but my
Read of all of that is that there's something adaptive that has happened in us through Evolution that now becomes maladaptive, in the way. We live in the modern world, right? So, if you think of through most of human development and people weren't living that long, right in the idea was to survive and reproduce. So, so traumatic things that happen to us, it would make sense for them to stay with us, right. So, you know, if you ate a new food and got really, really sick, so you better
Remember that, right, you know, if you see someone from the group of people, you know, a couple miles away, right? And one of those people attacks you rights, like, you better remember that? So, so the traumatic things that are severe, emblazoned in our brain are built to last, right? Things that are positive will generate some emotion inside of us, but things that are profoundly negative are much more likely to stay with us. And I think that, that was adaptive, right? When all of that was about survival, right?
Right. And I think the same thing is true with with say shame, right? So I think here, it makes sense that to talk a little bit and actually interested to hear your thoughts about this, right, that that the limbic system. Right? So the system often is called the emotion system, right in our, in our brains has actually, of course, varying function, right, and one aspect is effect. Right? So affect is aroused in us which which think the meaning then is its created in us without our choice.
So if, if we're walking down the road and someone jumps in front of us or pushes us, right, then there's a response of fear, anger, right? Heart starts beating faster, you know, more blood to the muscles. And we were getting ready to fight to write or run, right? And then we become aware of it. Right? So so, the aroused affect in US is also about survival and it has a very deep impact upon us. And shame is an aroused.
Act. So somewhere it can be raised in us without our choice, and it's very powerful. Which if you think about that is an extremely strong deterrent, right? So if you had imagined a tribe or group of people, right, that are sheltered together and, you know, someone eats half the food at night or something, right? And like, there's a very negative response, right? And that person feels shame because shame is so powerful to control Behavior, right? So, the way that trauma can change our
Reigns and and stay with us in a way that says be more Vigilant. Look at the world in a different way, act more defensively, right? And and how that links to shame and to gilts and then guilt in guilt becomes what gets called feeling technically where we relate the aroused effect to ourselves, right? So, so shame the aroused affect and guilt the next step, right? When we, when the shame gets related to self are such profound.
Ural interventions and deterrence, right? That you can see. I think how evolutionarily kind of all makes sense. If we're fighting for survival, you know, and were an elder Statesman. If we make it to 20, right? This makes sense, but it doesn't make sense in a world where we live much longer, right? We navigate in all sorts of different ways and there's so much coming at us. That can be traumatizing if you think about the news, right? I mean, how many times have I written a prescription for something that says no more news.
He actually written those prescriptions. Yes. So
glance at the news, like look at the News, 4 News, anything going on. I need to know, right? But what are people doing is looking at it and they're clicking in there clicking. And there's a, there's a sense of being like, enthralled in a very frightening way with the horrors that are in front of us, and it shows how yes trauma can come through acute things, that happen to us. Trauma can come through, chronic things, chronic denigration, whether it's
Stephon socioeconomic status, immigrant immigration status race religion, sexuality, gender identity. The these chronic traumas, right? Of being. Denigrated, by the society around, us are treated as less than can change the brain, but if I carry us experiences can too, right? And we know this is not theoretical, we know that the changes in the brain can come from vicarious experiences to, which is why people who are glued to the news and then feeling like home.
Goodness, like what is happening, over the mothers in the Ukraine, who've lost babies in the war, like the things that are so terrifying. That if we spend so much time with that, it has a similar effect. So our brains are built to change from trauma, but not in the way we experience trauma, and not in the way that we live life, in terms of the nature of living life in the duration of life in the modern world with these traumas that happen to us are often so bad for,
For us, because they change how our brain is functioning than our entire orange orientation to the world is different, and that could be for, you know, years and years and decades and decades. It brings so much misery and suffering. And at times it brings death. If you think about 100,000 overdose deaths in this country, in a year 100,000. Where is a lose? So much of that arising from? Is a person who's treated addiction very intensively over many years.
I think the well, I feel sure that the majority of addiction that I see and treat arises ultimately, the roots of it are in trauma and aren't trying to soothe something that stuck inside that the person isn't letting outside because of the guilt and shame, but it's running around in their head and there's a tormented by it. And now there's a pool for, for these drugs, or sometimes medicines to soothe. So the over the opiates that were given after a minor surgery, right? Are like, okay. Yeah, they help the pain from
the minor surgery, but what they're really helping is the pain inside, right? But that very quickly, turns into addiction danger risk and we see that over and over again and and, and not in not in a theoretical way. Like, I see that in people who have been in my practice with addiction arising from trauma who have subsequently died. So, it's sort of writ large in our existence in the modern
world. Incredible to me, that this is the way it works at what
What I mean by that, is this idea that I've heard about before. I think it was a Freudian concept of a repetition compulsion is that, you know, this is this is what boggles my mind. As I'm hearing this, something happens to us or we observed, something traumatic, and instead of acknowledging that and trying to distance from it. There seems to be a reflex of Shame and guilt in many cases and stuffing it away. And then a repetition.
In of behaviors to continue to try and stuff it away. Like you trying to pack. I don't know, recently. I was packing a home and trying to get a sleeping bag back into the bag. It seems like it's always been a mushroom out the top this kind of thing. It takes a lot of ongoing effort, and at the same time that if this thing really exists, this repetition compulsion people will return over and over again to the kinds of scenarios, or at least the kinds of emotional states that look just like the trauma or resemble it in some ways.
The question I have for you is is the repetition compulsion, a real thing. And why would we be wired that way? My understanding of this concept of the repetition compulsion is that we all want to solve our traumas and it allows us to put ourselves into micro or again macro versions of that over and over again, we get to run the experiment again and again in an attempt to solve it right in the case of taking a drug that it's clear.
You're certain drugs like opioids. It's clear how that would not allow us to deal with it. Right? It's just masking, the emotional state, but why is it for instance, that somebody who experiences sexual trauma, then places themselves into circumstances of more sexual trauma. Why is it that somebody who is in an abusive relationship, goes on to have a second and third or fourth, verbally, or physically, abusive relationship. I mean, on the face of you, just go, that makes no sense. And yet we see this over and over and over
again. Yeah.
The first thing I would say about the the validity of the repetition, compulsion concept, right? Is is a strong. Yes like it. Yes. We see that over and over. It's not necessarily in everyone. But boy it is in a lot of people who have suffered trauma. And and I think there's a very good reason on the face. On the surface of it is saying it makes no sense. But then if we think well, how does the how does our brains actually function? Right? We're sort of.
Of trained, at least in Western Society. I think to think of ourselves as logical creatures, right? That like, oh, we're logical and ultimately everything in us can just boil down to logic. And if we think about it enough, we're going to, we're going to understand how to make the right decisions, which is completely not true, right? That the, the limbic system, right? The emotion system. So to speak inside of us, always Trump's logic, right? If you think about, does it ever make sense to run into a burning building, I mean, logic says, no, right.
If someone you love is in the burning building, do people run right in, right? Because the limbic system says yes, so when logic and emotion come head-to-head, emotion wins all the time. If a motion is powerful enough, it will always win and so the limbic system is so important and the limbic system does not care about the clock or the calendar, right? And that's the answer and also to say why to the repetition compulsion. So the limbic system doesn't know like
So it's now it's today. It's met its 2022, just doesn't care at all. Right. So so how I would relate that to the repetition compulsion is, is when people are repeating, what they're trying to do is to make things, right? Right? With the idea that if we can repeat the situation and make it right. It will fix everything, right? Which makes perfect sense. If we think we'll, where is that concept coming from, right? It's coming from the
Part of the brain that wants relief from suffering of the trauma, and does not understand the clock or the calendar. So if I can solve something now, I will also solve something in the past, right? Which is why I can't tell you how many times I've sat with someone and say, we're starting to do therapy. Right? And the person will say, gosh, like I know, look, look, you just can't help me, right? I mean, you know, my last seven relationships have been abusive, right? And I'll say, back something sometime.
It's like, well, look, if you tell me that you've had seven relationships that have been abusive in different ways. I'll agree with you. I only say that because that's never what someone says, right? But I think what you're going to tell me is you've kind of had the same relationship seven times. It's not seven things. It's one, right? And that's always I don't think one time yet. It is that is failed to be the case. And that's how do you think about it? That's how we start to elucidate what's going on? So they made the light bulb.
Goes off. Like I have not had seven different abusive relationships. I have had one that I've repeated seven times and now we start getting to what's really going on. And it needs to happen that person needs to face what happened in that original abusive relationship. And it always comes down to the same sort of concepts of of the person feeling terrified. While the abuse was going on feeling, guilty feeling ashamed, feeling like, oh, they brought it on themselves. They deserve it. They don't deserve anything better.
Because the brain is trying to make sense of it, right? Or I thought I could make that. Okay, but I couldn't write and then there's more guilt and more shame and if that stuck inside of someone, like that's bundled up inside of someone, you know, like a medical abscess inside a person, you know, a walled off infection inside the body. This is the same concept in the brain. Then of course the limbic system is going to want to fix that and and it fixes it by trying to Let's recreate that situation and make it right this time and that's a minister.
One of the best examples of how the right approach of Alec. Let's look at that. Let's talk about that. Right? What's really going on there? Wait, who should feel guilty and ashamed is the person who is abused or the person who is abusing, right? And, and we can get at what's going on inside the person, and that's what changes that. And then, the eighth relationship can be entirely different than the first seven. Right? And I see that all the time. I mean this isn't esoteric or soft. Like, I see that play out clinically over and over again. And why do things get better?
Better. Because we go to the trauma and we unlock it. It's not hidden inside where it can control things. Right? We bring it to the surface and then we can take away its power.
I keep hearing in this narrative. That so much of our reflexive response to trauma both emotional and the repetition compulsion. In terms of behaviors is about some very deep attempt to change the past. Yes, and in fact in an offline conversation, I recall you saying something about this that you know,
The number of behaviors and thoughts and avoidance of behaviors and avoidance of thoughts that human beings put in to try and change. The past is, is remarkable and Erie and maladaptive. It sounds like yes. And that really stuck with me because I think we all want to feel like we're in control of our future and how we feel in the moment and to some extend, it. It works for a brief while, you know, there's this thing that happened and
Just evokes some internal arousal. And then you have to know what to do with that arousal. And I think, for many people, including myself. There's this, this fundamental question. Okay? The thought about the thing, the event or events, plural evokes. This arousal, this internal states make some people feel sleepy and exhausted, other people feel really anxious, other people, feel angry. I mean, that arousal has all these different dimensions as you as, you know, and then there's this question about
What to do with it and and I'd love to hear a maybe even just a top Contour. Prescriptive of, what do I, what does one do? I'll even just put myself in a what do I do? I've so I'm feeling upset about something. Should I feel like my options are healthy catharsis. I can tell the story feel it. I could I can pack it down all we hear that. It's bad to pack it down. But of course one has to be functional in life and deal with things and we have responsibilities.
Work and relational responsibilities Etc. We need to sleep at night. So catharsis healthy catharsis packing it down at the Other Extreme telling the story. And yet, I think a lot of people are afraid to tell the story because it's all in that telling there's a, perhaps a re-emergence of the arousal. The arousal can become greater. I mean, is that what people mean when they say things are going to get worse before they get better? I mean, so I guess the simple version of this long-winded question.
It's clear. We need to confront these things. We can't change the past by a reflexive response isn't going to do that efficiently. And so, how do we deal with arousal? How does one take what they feel inside about something shameful? What do you do with it in a moment? And does that have to be done in the presence of a skilled trained therapist, or as I'm driving to work in the morning and something comes up. I can't deal with this right now. Comes to mind. What do I do? Do I deal with it right then?
I know this is a big multi-dimensional question. But I think it's the one that a lot of people grapple with we want to deal with things. How do we deal with that? Internal
arousal? Yeah. Yeah. We so often try and change the trauma of the past, in order to control the future. And what that really adds up to is the trauma of the past, dominates our present, right? And it doesn't have to be that way. And remember, we're talking about traumas that rise.
The level of changing the brain. So as you're saying that involves re-experience, it involves hyper-vigilance increased arousal. It changes in mood States changes in anxiety, changes in sleep changes in Behavior. So these are all changes that innocent push towards dominating our present. Right? And then we're not really living in the present. Right? As we're trying to control the future. We're not going to do a great job of controlling our future. If we're not really living in the present, right? And so the
Way to come at that. It can in the moment if we're saying, okay, the moment, if I need to fall asleep, right? I might say, okay, let me try and put that out of my mind. Let me try and thought redirect so. So their short-term strategies, that can let us be functional in the context of these changes, but the answer is to go look directly at that thing. Right? Look at that, trauma. Explore that trauma. And sure that can be done with a professional. And sometimes, that's what makes sense, but not always right. Sometimes, it can be done by.
Talking to another person right writing it down. Right? Look at what's going on inside of me. That my mind is so stuck to this. Let's explore that because it's almost as if we're. We're so afraid. So often of looking at the trauma that has changed us, that will look anywhere. But at that, right. So it's like it's hidden in a closet and Will Shine the Light everywhere else, but we're not going to open that door and that's where we know people will say the same as ever heard.
Over and over. And I myself of thought this at times, like if I talk about that, I'm going to start crying and never stop, right? Or I'm going to just fall apart, right? Which is never what happens. No one ever starts crying and never stops. Right? What ends up happening, is when the person puts words to it, right? I could be in writing, could be talking to a trusted other or with a therapist, right things start to change mean, just the fact that you can talk about it. You can put words to it and other people don't recoil, right? I mean, how many times has someone said something for the first time?
Right? And, and when they're telling me about the trauma, there's such an anxious like looking like as if I'm going to be, I'm going to recoil from it, right? Meaning I'm going to recoil from them, right? And then there's a sense of surprise. If the person says well, you know, I was abused by this coach when I was a kid right or so and and there's not a okay. There's there's not a response of recoiling, you can see the change and people will say a lot like wow.
Like I'm like, I can't believe, like, you can like Kimmy, say that and be okay with it, right? I mean, so, think about what's going on inside of them, like, a, how, what is the sense of Shame as sense of, you know, this is something awful about me for people to recoil from, and it's just not true. But but they're here's where trauma is its Insidious, right? And it's pervasive, right? Because if that convinces us to continually hide it away, then how do we
Explore it like that. You know, that example of the person who says, okay. I was abused by a coach when I was a child. I mean, I'm thinking of a couple very real cases, right? People that I've taken care of and once they start talking about it, then they start talking about how, you know, they were just innocent kids, right? And like they didn't know and like they really wanted to be on the team where this coach was treating them as special and and now they can look at themselves from the outside, right? They can look at themselves like they would. Look at someone.
Else. Right. You think it's so easy for us to see what's Real and True if it's someone else, right? If you ask someone, what do you think of someone who's 10? 11 years old, who's abused and manipulated and abused by an adobe? So, oh my goodness, I feel compassion for that person. Right, but if it's us right then oh no, it's guilt and shame and we have to hide it away. And when the person starts looking at it, they consider see it from the outside and it starts to take the energy out of it right then. Well, who should feel guilty?
About that who's done something wrong. And like so now the conceptions come together, which is often a reflexive. That was my fault. Oh, I did it. I went back to it. I still stayed on the team. I went back next season, right? I let it happen again. We all the guilt and shame inside. The person gets juxtaposed like what really happened there and then they say right I was a terrified child, right? And understand it all and they can come to a place of compassion and now we are working against the guilt and shame and if the
In cries about it, and that's great. Right. I mean, crying is one of the best coping mechanisms. We have it doesn't hurt us and it, lets us grieve things again. We can't grieve if there's guilt and shame and silence. It just blocks grief, right? We have to it has to be a clean slate in a sense in order to feel sadness. And then you see that it shifts from anxiety, anger, and frustration usually directed towards the self guilt, and shame towards towards being able to process it. And being able to
Bring to bear some compassion and being able to direct the negative emotion. So to speak where they're warranted and my goodness, the changes that happen to me. It's not like it's people are miraculously cured, right? But it's remarkable. How just getting it out there and have like one hour of talking like that. Like like what we're talking about? Now can can leave a person feeling
immensely better.
It seems to me and hearing this, that there's this weird wiring that we have, because what I'm hearing is, when traumas happen to us, or we observe them. What we need to do most is to confront those And the emotions around that directly. Yes, but instead, our system defaults to guilt shame and trying to hide it. Yes, and this repetition compulsion of placing us back into things similar to those traumas or even maybe even worse. Traumas. Yeah, in an attempt to resolve.
It's like the most maladaptive. Yes, wiring diagram. I could possibly think of emotional and presumably physiological wiring diagram. Yes, and this notion of trying to change the past by doing things. Now, when the exact opposite is what's going to be beneficial also seems like yeah. Complete the whole system seems completely backwards and I'm chuckling, as I said, it's not because I'm amused it's because I'm just baffled once again at how our wiring can often not serve us. Well,
but it raises a what I think is important and interesting question, which is earlier you were talking about how, you know, people will seek out media. That's really disturbing. They'll traumatize and re-traumatize themselves on a daily basis. So that could be viewed as the repetition compulsion or the person will have the same relationship with seven different. Same abusive relationship with seven different partners in sequence.
It seems terrible and yet.
As I say this, it also is becoming clear to me how this almost seems like a poor but desperate attempt to resolve it. Yes, some way. And so the fork in the road if I understand correctly is to really get to the seed incident, really get to the thing that started at all as opposed to repeating it all. Yes.
Does that have to be done in the presence of a therapist?
Is, is there a benefit to taking a walk and thinking about these things breaking down and crying? If that's what's necessary or feeling angry? If that's what comes up. The reason I ask it this way is because
I worry, I'll just speak to my my own experience. I worry that in reactivating or touching into the emotions around something that that is itself, a form of the repetition compulsion because you're feeling it all over again, is just you're not seeking out something to evoke that feeling. So I realize this is a little bit of a circular argument. We're question, but I think it's one that I really struggle with in trying to parse all the the what I that the outcome based.
Therapies that I hear about and and the recommendations that people make, I mean, how should we conceptualize this? Something happens? Sounds like we need to deal with that thing directly. Do we need to do that with somebody else? Can we do that on our own? If we're we don't have resources and we have to do it on our own can't hire. Someone can't pay someone to work with us, right? How do we do that in a way? That isn't re-traumatizing. Ourself in a major way or in a minor way. How do we know where we are in that?
Landscape right. Again. There's a I think it's great questions. And, and I think it starts with real introspection. You know, when things are bouncing around in our minds often. It's very non productive, right? It's the same thing over and over again and that's not helpful for us. Right. So there's an idea which sometimes gets called an observing ego, right? The ability to stop and look at what's going on inside of ourselves. And it's so if we're just thinking about it and we're thinking in the same way, we sort of Innocence.
Think about it, then all we're doing is reinforcing the trauma, right? But if we can distance enough to be like, um, it's I'm interested in what's going on inside of me right now. I can think of a certain person who who really loves music and then at some point in our therapy work. I learned like she was taking long drives, but the radio wasn't on. And I was like, well, what's going on, right? And I asked and what was going on and she was running over and over again in her head. Like I'm a loser. I'm a loser, right?
And she didn't want the music on because the music would drown out what she felt, she had to say to herself. Right? And it was that like, wow, that's interesting. Right? And then her ability to observe that and to think why am I doing that when it comes into her mind? Like what does that Tres, Tew? When did I start doing that? Like I said, you know, I'm saying it for a point of exaggeration would like nobody comes out of the womb, you know, program to think I'm a loser, right? So we don't, we don't think that when we're born, right? So,
Where does that come from? Then? We can think in ways that allow us to have new thoughts, right? That we weren't having, it's not just bouncing around in our minds. And if we speak or write, they're even more mechanisms that come online in our brains, right? That are then sort of monitoring mechanisms. We think in a different way if we're using words, right? And we are better able often to bring in that observing ego, like what's going on inside of me. So so it can be very helpful to think it can be helpful.
Able to talk to someone to a trusted other, you know, friend family clergy to write to mean, these are things that can be done without expending any resources, right? And and sometimes it can make really a big difference, right? It was a wait. When did I start thinking that? And like interestingly in this case? Okay, we did it in therapy, but it became very clear what that was routed to, right? And then in the therapy, which was still relatively young, but we don't have several sessions and we weren't talking at all about what we needed to talk about.
But that's what got us to what we needed to talk about. And when did that start? And now we're in that same place of exploring that and what was the reflex to it and the sense of guilt and sense of Shame. And it's where all of that came from that just got boiled down to, I'm a loser, right? Which which this person didn't even have in their mind. Like I didn't think about myself that way, right? And it's so interesting, right? There are memories, don't in and of themselves have meaning it's like they're flat or, you know, or colorless.
Right? And and they're colored in by the emotions that we attach to them. Right? So so the idea that that certain memories now before the trauma were changed, right? By the trauma. So so I told the story sometimes a person who won an award when they were in high school that they thought was oh my gosh, I get shows, like I can do it right, and get out there that after trauma, they solve the award with a negative emotion attached to it. That was like, oh, it was given to me and I didn't deserve it and almost it was mocking. Like there's going to be the
Greatest achievement of my life and I was 17 years and take to have someone think. Like, that's not how they felt about that, at the time. It's the trauma that changed the the self-talk, the internal State going forward. And talk about miraculous in a negative way. Also change that going backward, right? And, and when we can really look at it, like, where did that come from? And we can start unraveling it, it changes. So, in those cases you often, it's helpful to have
Have a good therapist. It's not always necessary and and it certainly it's not always possible. Right? So we need other strategies and some of those I write about some of those in the book of how can we sort of get at trauma without those formalized mechanisms. And sometimes if is the symptoms are significant enough like it. We really do need to talk to somebody professional who can who can help us get to the root of the trauma and there's so many times. That's the answer to what's going on with people, you know, people I've seen about
Residential stays, I'm not exaggerating this for mental health, reasons for substance reasons, and no one's ever taken a trauma history. And then, when you take a trauma history, so well, that's obviously where this is all coming from, right? Like that's when the drug use started shortly thereafter, the negative self-talk and negative feelings that led to the drug use. Then you go after the trauma and, and you can change things. Whereas trying to change things without looking introspecting talking about the trauma. I think, of course, was
futile.
Do you think that people can start to have - fantasies? I mean, you mentioned this woman who would take these long drives to berate herself. I'm not familiar with that. But I'll give a little bit of personal disclosure here. I've felt several times in my life that I will start to create a narrative about something that truly hasn't happened about something terrible. That somebody is going to do. Yes, that's going to upset me. Yes, and for the longest time I want
I might doing this and I have a couple ideas about why one is that I was attempting to just avoid thinking about other things. It's just, you know, anger is such a, an attractive, emotional force, and it's an attractant at, it's not attracted. We don't like it. And yet, oftentimes, anger is a great way to replace feeling some something else. Yes, feeling sad, or having to come up, or to do work, or to do something useful, so that it has this kind of a lie.
Like gravitational force to it. That was one idea. The other idea was in imagining kind of worst outcomes, then actually, that relationship were could actually seem a lot better in reality. It's almost like creating this - contrast. Yes. It's like, oh well, then it's not that bad. And and then the third possibility is I have no idea why but it seemed like a reflex and I spent some time thinking about. I can't say I've resolved it completely, but why would somebody have a narrative? A
Narrative when driving, or when walking of I'm just gonna spend some time and think about how terrible this thing is going to turn out or how someone's going to upset me or harm me or how terrible I am. It seems again like maladaptive thinking maladaptive wiring and yet I have to assume that it serves some
purpose. Yeah. Yeah. Yeah. I think there are three factors there and they're all bad and I think you spoke to at least two of them right there. They I think speak. So
Lee to how Insidious trauma is and how these are real brain changes inside of us, so I would say the three factors punishment avoidance and control, right? So so the trauma inside of us, that makes a guilt and shame so often so often leads to a desire to punish oneself, right? And the idea that, oh, that was my fault or I deserve that. Well, what do we do? If something is someone's fault and someone
Now deserves punishment, right? I mean, we punish them, right? We send them to jail. We give them a fine, right? We punish them as. So, what what we do is punish ourselves. Right? We, if we tell ourselves, we're loser, or this awful thing is going to happen, right? Then part of what we're doing is saying to ourselves. See right? You deserve that you're not going to have anything better, right? It's a - it's a very negative way that the brain tries to make us in a sense do better by hurting us more for the things that we couldn't and shouldn't have been able to warn.
Expect it to be to control in the first place, right? The second is distraction. As you said, anger, that kind of fantasy can distract us from from affect feeling and emotion that can be much more - you know, anger. It can be more gratifying than, certainly, than guilt or shame, although guilt or shame conserve a punishment purpose, but if anger is directed also towards ourselves, right? Then it can serve punishment to so punishment, avoidance, and the sense of control that if you think ahead,
Add to something awful that you're imagining is going to happen. Well, maybe that will let you avoid it, right. I mean, you can see the brain here since really confused. I mean, part of the brain wants to punish part of the brain doesn't want to think about it at all, and part of the brain wants to make it better. And and then how all of that resolves, if we're not aware that, hey this is in the context of our brains being deeply, impacted by trauma. So, what's going on here is all maladaptive, right? Because he's - fantasies of the future.
ER, they may help us feel better about something in the present, but they don't help us make anything better. They don't help us make anything better. So this is the kind of the sequela. This is where trauma and all this reflexive stuff that happens after trauma. Ultimately lead us. And you can see how we get lost, how I've seen over and over again in my own life in the lives of other people, how man we get stuck in those situations and that's why
I see people. Sometimes this has been going on for 30 years, 40 years, right? And it's just been going on over and over and over again because there's no natural end to any of this, right? Unless we look at it in a different way that we have knowledge and information. Like, whoa. This isn't the way it has to be. Let me bring a novel perspective to this. It doesn't change on its own.
I'm struck by your statement that these thoughts or behaviors can make us feel better, but they
they don't actually make anything better in that way. It this mode of imagining terrible outcomes starts to immediately seem like taking opioids. It you know it you feel better in the moment, but it doesn't actually make anything better and it right probably makes things worse. Yes, and and just as question of how how much worse and and in what direction?
Yes,
and so I just wanted to just pause on that on that concept because I think that concept of
Makes us feel better, but doesn't make anything better. I think answers an earlier question about the this, what seems to be a totally maladaptive wiring diagram, you know, we need to confront the thing but we don't want to go into the repetition compulsion. So there's a, there's a, it's a, it's a knife edge there to navigate through trauma. Yes.
Working with a very skilled clinician. Like yourself, I think, is the ideal circumstance for for people? And of course, there are people who can't access support from somebody, for whatever reason you've talked about journaling. Hmm. Yes. As a useful tool. Could you maybe you highlight some of the other things that people can do on their own? And then I'd also like to talk about what makes for a good therapist. What should people look for for those that are seeking
In therapy, especially nowadays. When a lot of therapy is being done remotely. But let's just start with the the let's just call them self generated or zero cost sorts of things journaling, being the first and then what are some of the others and and what kind of structure would you recommend someone put around journaling, carry a journal around all day and jot things down as they come up or sit down and spend an hour writing in complete sentences. For
instance. Yeah, if I could add something to what you just said, but before the question right there that
We have these short-term coping mechanisms in us, right? And in a way, it makes sense, right? We find ourselves in just terrible situations, you know, then a short-term coping mechanism can get us through them. Right? So our brains are built that way and that's part of survival to, right? And whether now in the modern world, whether it's its food, its drugs, it's X, its alcohol, right? Or its negative thoughts, right? This is short-term, soothing even the negative.
To the angry short-term soothing at the expense of long-term change, right? And that's where, you know, addictive Pathways can come into play. And, and that's where again, our, how we're built evolutionarily for survival, doesn't help us, you know, in the way humans have evolved, and we haven't lived this way throughout your 99.9, something percent of human history, right? So so we're not adapted to this. So I want to just make a point of saying that about the short-term soothing at the
Us of any love long-term change, you know, and then the, the question you had asked about journaling or what can we do? That's outside of professional. I think the Hallmark of it has to be bringing new eyes to it. Right? Like thinking about self with a curiosity. Instead of just a simple automaticity or repetition. Right? Look at why am I thinking about this? When did this start? Why is this in me? Right that? It's that, that whether it's words or
We're writing that so important. So I think for journaling, it depends on the person, you know, I mean, we don't want somebody carrying around a journal all day, if then there's a compulsion to I need to write about everything that's going on in my mind, right? Like that might be good too. Okay, right. A little bit at night, right? Or someone who might think you know, sometimes this really comes into my mind in a strong way and it could be unpredictable. Right? I want to have the, the journal with me. So that thing is back in my mind. Now, you know, let me write about it, right? Because then putting words to it and then being able to read those words.
That's right. And when people read even do a little bit of journaling, and they read like, Oh, I thought again about how much herbal person who can't have a good life, because because I was in such a bad car accident, or because that person attacked me or because when I was in school, I was bullied because I look different than everyone else, right? Or I acted different for everyone else. Wow, you note actually see that written out. It's, you know, it's a little bit of that.
It's a little bit of that like when you're saying it to someone as if it were someone else, right? Because now there's enough distance from it. Like, I'm looking at the words. I wrote, right? That we get some distance and we can start to integrate some of the not just the compassion, but integrating compassion and logic right there. Like, okay, I feel a sense of compassion. Oh, wait, what does this mean? What really happened here? Right, and gosh, I did start thinking differently. After that. I started to. That's where this came from, right? That's why I'm saying this, it's those
Kind of Revelations that we can have through again the written or spoken word. And I think it get that involves a trusted other, you know, or writing. And I think those are ways we can do this where we bring some di Nuovo perspective to something that often has been bouncing around inside of us and it's amazing to me that you can see such intelligent empathically attuned. People who've had the same thing running over and over again in their
For years, and it just points out that our brains. Don't automatically say, hey, wait a second. You know, I've been spinning wheels here for a long, long time. Like, was there another way to look at this? We need something from the outside which can just be knowledge. Right. Which is why I think what we're doing here or reason I wrote the book that I wrote was was like apprehending this like amazing surprise to me, right? Which is a wow Alex, um, huge percentage of everything I'm treating is
Rooted in trauma and the opacity of trauma, right? Which is why we don't see that. Oh, the depression, the panic attacks, the life change the addiction, the know, the maladaptive choices. Like, oh, this is all coming from trauma because it hides itself in that, in that opacity. So, we need a DI Nuovo perspective, if we're doing it on our own, and we need that if we're doing it in therapy, which might link like, finding the right therapist, right, which is also part of your question.
Yeah. I definitely want to know about how do
Assassin. Find the right therapist before we cover that. However, something came up in the course of your answer. I can immediately relate to this idea that, you know, certain behaviors are really maladaptive and are stuffing things down or avoiding. The topic is problematic, and bringing a curiosity, and an introspection. Almost a third personing of the experience that we've had in order to try and address it from it.
Through a, from a new truly from A New Perspective. It occurred to me as we were discussing this, however, that some people and yes, maybe I'm talking a little bit about my own experience. We have a sense of our own identity and are and how people view us in our ability to be functional in the world in ways that we like effective at work or a good brother or a good mother or father human being in the world. We have relationships. And I think that one thing that I have heard
And maybe I've experienced is that sometimes those maladaptive thoughts or behaviors the things that generate a kind of a repetition of anger or of arousal or activation or sadness that we have some internal process where we funnel that into a functionality in the world. So we I'll give a more concrete example. So in thinking about things that have upset me in the past and in imagining bad outcomes in the future, there's a certain name.
Eternal state of arousal that comes about and for many years, I was able to use that not to feel angry but rather to work, an extra, three hours a day or two pack my schedule with work and social engagement. So I could show up in a way that I, you know, hopefully was a very good brother to my sister, for instance. So, in a way, it was a, it was a transformation of something negative inside of me into a functionality in the world. That was actually very rewarding and beneficial.
Yes.
And yet in describing it I can immediately see how it would be wonderful if I could Source from something else. And yet I you can imagine and I can imagine how one would be reluctant maybe even terrified of giving up that Source. It's a fuel. Yes, and I think knowing some of the traumas of other people and their reluctance to work through those. Obviously. I'm not a therapist since this over and over again, that one's positive identity.
Can often be linked to something difficult in their past and so people are reluctant to give up this fuel? Yeah, because it's in that sense. It's functional. The only thing that allowed me to kind of start to address this and why I'm still so curious about this because I don't think I've worked through this process. Completely again, a little more self-disclosure. There is that I was told that these words, just imagine how much better it would be if you could.
Horse from a different fuel of fuel that felt better, right? Maybe it was the on the it was on this, this sentence. It was, maybe you could actually be much more effective. Yes. Maybe you could be 10 times the better brother. Yeah, maybe you could have 10 times more Insider work capacity, Etc. So it's on that hint of a promise that at least I was inspired to start looking into these things and reading about trauma in your book and elsewhere and start to
about this. So again, I realize this is a long-winded question in a somewhat complex idea, but I think or I hope that people will be able to resonate with this idea that sometimes we want to stay attached to the this short-term soothing that the punishment distraction or control, because it evokes this arousal and then we can apply that arousal.
Yes. Yes. I think what you're describing Maps. I think clinically to what gets called sublimation. So there's something - inside of us, but we sort of transfer, that energy, we transfer that into
Something that is adaptive or that is positive. So the idea of the anger, right? I think of that thing, and it makes anger in me. I channel that into harder work, right? Or I channel that into like I'm going to go be nicer to my brother, some write something like that and and there's validity to that right? And and but being can become like self-justifying if a person thinks well, let's look at what this is doing for me, right? I wouldn't work as hard without it right now. We start to become attached to the trauma. Whereas I think what you had said,
Is absolutely true. That just because we can sublimate some of the negative effect feeling emotion that comes from trauma into something productive. Doesn't mean that that's best, right. We know, we can get to our destination by taking a very circuitous route, right? We might waste an hour getting there, but we get there. That doesn't mean that that's best. And it also doesn't look at all the negative right in this example, the wasted fuel the wasted time, right? We get somewhere, but we
Not optimizing and I have yet to see one person who who has addressed the trauma and become less functional, right? It's always either, they're just as functional, but they're happier, right? Or more functional because as you said like just because we may be able to sublimate. Well, maybe what's going on? Will be 10 times better. Right? If if we if we weren't sublimating because the sublimation limits us, write it limits our perspective, to only what we can see and do through the lens of the
Trauma, and that is never better than the alternative.
Thank you for that. Yeah. You're welcome. Yeah, let's discuss how 1/4 should go about, finding a really good therapist. Typically, this in my experience. This is done by Word of Mouth. You know, there's this person you might want to work with them. They're really great. What are some of the characteristics that one should look for? And should we take into account?
Whether or not we are a person who, you know, for instance, I've heard this from from listeners. Although I'm clear. I'm definitely not talking about myself here in cloaking something. Some people would say, you know, I want to work with the somatic therapist because I've actually heard someone say I think in feels they, you know, I feel stuff in my body. So I want to work with someone who can really acknowledge that or someone else will say, you know, I want to work with somebody who has this orientation or that orientation or is
Open to my particular lifestyle or isn't going to tell me that I have to leave my relationship. You know, I feel like people already show up to the question of who to work with, with all these, you know, things internally some of which are voiced and some of which aren't. So I'd love for you to talk about maybe some of the core features of a really good therapist and then how to look for a therapist. And also how to think about oneself in looking for a therapist because of these kind of
predispositions, right? Well, there's a lot of data.
Out this over over the years that if you look at what are the top 10 important factors to find in a therapist just repeat Rapport 10 times, right? I mean, that's the key and if you think about that, that's pretty amazing, right? Because therapeutic modalities can be so different, right? And I think, what what that's telling us is in way something very obvious, right? Like what is report me like, you know, it's somebody's paying attention, right? It's trust. It's a back-and-forth. It's it's like, yeah, even though I'm doing,
I'm doing something difficult. I'm doing it with someone who's really helping me. Someone who's in it with me. Right. Someone who's really paying attention wants me to be better. That's indispensable. I mean, it's just indispensable and I write in the book. Is someone a therapy is not making eye contact or this is the way they do it, right? And you know, you got to fit into the box of the way they do it. That is not going to be helpful. And and then what I what I think about that is the different modalities, it doesn't actually tell us that. Oh the modalities are relevant. I think that's not true.
I think that good therapists are not pigeon-holed by a certain modality. They may come at the world largely through a psychodynamic or CBT or a DBT lens, who uses lots of different ways to do therapy. But when you really talk to those people, really good experience therapist. It's all coming through the vehicle of the Rapport, but they're practically shifting to what the person needs, you know, I don't understand the idea that like I just do this, right?
Right. I don't do that and when people are pigeon-holed that way I don't think they help their patients very well. Right. We have to be diverse enough to say, hey, I want all the arrows in the quiver, right? And and even though there might be one that I favor, and that's the lens. I see things through. No, I can be versatile. I can shift, I can adapt to what this person needs and I think if you have that, you've gotta, if you have that, you've got a winning
combination. Great. So people should perhaps try a few therapists and maybe have a session or two or three to see if
The Rapport feels like it's taking root. Is that? Yeah, I have that,
right? Yeah, and I think that's why we're to mouth is important, right? If someone you trust tells you, hey, this is a good person that says a lot. Right already makes the pretest probability is quite high. But yes, it's interesting to see when people have a therapist, or they called her insurance and are assigned a therapist this thought that like, oh, that's the person I have to have now and it's like, no, you should look at that like anyone, you know, you'd be interviewing right for, you know, for a job, right?
But you got to bring again the right set of thoughts to that. It's to be helped, right? Which is like I want someone who has rapport with me. I don't want someone who's going to make it easy, right? Who's like, well, it's gosh, it's kind of pleasant because then that means we're not talking about the difficult things. Right? So if one brings like, I know, this isn't going to be easy. I got to talk about difficult things, right? Even if one doesn't recognize I got to talk about the trauma in me, right? But to go to therapy thinking, no, it's I mean, sometimes it's enjoyable but a lot of times, right? It's not right, it's hard.
You can be excruciating, we can cry during it. But this a right that that's how I'm going to be helped. And I want someone who's going to do that with me. You know, who's really looking at what's going on inside of me? How do we help me? And I can feel sort of the robustness of that, if one brings that approach and then looks at the therapist through that lens. You're you're very likely to then move on from someone who's not a good choice, right. And really stick with someone who is even though that doesn't mean it's always a pleasant and enjoyable. I mean it has to not
Not be that
sometimes right? Maybe we could drill a little deeper into the mechanics of therapy. I put out a few questions to audience asking what they want to know about therapy and it was amazing. I hundreds, if not thousands of responses saying, how should I show up to therapy? So, for instance, should people take a 5-minute meditative drop in before, or should they just show up cold and let it emerge during therapy. Is it a good idea to take notes or to not take?
Notes and then post therapy, how should clients patients as they're sometimes called one or the other. I never know which, how should they process that information? Should they take some designated time afterwards and, you know, an Ideal World, take a 30-minute walk afterwards and think about the material, or should they set it aside and come back to it. Of course, there are constraints work and family Etc. But, you know, we there's a lot of knowledge out there about how to best show up to a workout warm up for 5-10 minutes.
Minutes. Then do this etcetera. And then the cool down. I mean here we're talking about hard psychological work aimed at bettering oneself. So to my knowledge, I've not ever seen this information. Anywhere. Be very useful to hear your thoughts on this. Yeah.
Well, not trying to duck the question, but but I think it varies so much by person. So if you think about the first part of your question, I think was how to show up if therapy, right? And I think the answer would be whatever, lets you be fully present when you're in therapy. Now, for some
Well, this is going to be how I show up early. You know, I said, I call myself a meditate a little bit. I mean that's how them their present right for other people. They used to be able to show up walking to the room. They can stop another present, right? Who's whatever works for that person so that they're really they're their thoughts. Their energy is really in what's going on and the same thing applies on the other end. No, there are people who are really well served by, you're going for a walk, if they can or sitting quietly after therapy kind of putting that in order, right? Otherwise
Wise, they lose some of it writer like some of the aha's, right? Ortho. That's an interesting thought that they really need to put it in order. Maybe that involves taking some notes during therapy. Right for other people. They need to do the exact opposite. They need to like leave nothing about that at all and then they can reflect on it later and learned from it. So, you know, we're so different. The human beings is such a diversity in us that that if there's no hard answer to that because like being present when it's happening and then being able to sort
Consolidate and and retain. What's been gained is most important that I think we have to figure that out person by person. Mean I try and do that in the work of like, what serving this person best and sometimes we feel, sometimes it involves and sometimes we talk about it, but it varies so much.
If someone were thinking about embarking on therapy or more therapy to address trauma or just general issues of Life. What is the frequency that you recommend? I could imagine to extreme models. One is okay.
I'm going to finally tackle. This trauma. I'm going to do therapy three times a week, but for a shorter period of time, you know, six months, you know, over and out versus this open-ended model of once a week. Typically for as long as it takes.
Right, right. I think that also varies and I work with people in varied ways from someone who's doing well. And like, we meet for a half hour every six months, right? To doing week long.
Early sessions to spending three intense days with someone in a row, right? So I think as far as like kind of guiding principles what I have found in my own life because I value my own therapy be tremendously. So I found in my own life and in my own clinical work that if it's less than once a week and it's hard for us to retain really, you know, we spend a lot of time kind of catching up.
Yup. Okay, what's happened? Let's get back to the place. We were at before, right? Which is why I think if we're really going to get somewhere. We're not just trying to maintain something right then I think once a week for an hour is really kind of the minimum, right? But more intensive work. It's like the more intense it is it's not linear rights an exponential gain. Like we do a lot of intensive work right where someone will come and do 30 clinical hours with us over the course of a week. So five or
Different clinicians, 30, clinical hours. And we found that the benefits of doing that are immense. It's like I say years worth of therapy Consolidated and you think. Well, 30 hours. Let's say, you know, we go almost every week. Maybe that's 45 or 50 hours, but 30 hours with that kind of intensity is worth by 60 hours, you know, done in a different way because then it's in Us in an active way, right? It's in the therapist in an active way becomes.
Very, very Dynamic. So I think turning up the intensity if there's something that we really need to process, absolutely make sense. And I do that in my own life, is something now is like, whoa, It's really something is really distressing me and it's linking into prior trauma and I can see what's going on in me. And I start that ruminative thoughts, you know, with negativity, like I got to go more, right? Because I got to do that processing. So I can get to the place that I am, which is not that something to trauma has no impact on me, right? Is that the impact is much less than?
Was before the therapy and that I most often more often than not have an ability to see when it's now intruding into my thoughts. And it's taking me away from like what I really think and believe or being able to draw logic and emotion together and make good decisions turning up, the intensity. Then absolutely makes sense.
This very deep intensive work of 30 hours in a week. What brings somebody to some the type of work that sort.
Art, is it a suicide risk or in a severe addiction situation? I mean, how does one gauge, how much therapy they ought to be doing? And should it always be on the therapist to decide that frequency. What would bring someone to a situation of five therapist and 30 hours a week in one week? Right?
Right. Yeah. It's usually, a person who is really distressed by something, you know, whether that's
It's so negatively impacting their life or life or sometimes a person comes to realization. I just can't take this anymore writer. I'm sick of the cyclical depression. I can't got to stop having panic things. Like I need help, right? But it's usually some you know, crisis point with the idea of crisis in the meaning of okay, something comes to a head and after it things are going to be different right now, total crisis and things going to be negative afterwards, but a point where then that cognitive flexibility comes to the fore of like way I need to do something.
Different, right? So that that's often what brings us, you know, sometimes it's other people pointing it out door is somebody's had an intervention somewhere or yes, that person has been hospitalized after a suicide attempt, or they've gone back to rehab again for the third, or fourth time in their life is really in danger. Sometimes, it's that and sometimes it's a person realizing. Yeah. I just want to, I want to look at myself when I understand myself better, you know, I know that what's going on in me isn't as good as it can be right. So so I think people
Come to it for all sorts of different ways. And I think yes, I think a lot of times it would be the therapist to say, it looks more worried, you know, more intensive work or can make a difference, but I think the person also needs to, you know, take ownership right of their own therapy and see if I don't feel helped enough. Well, I have to think about that, right? And talk to the therapist about that because it may be it may be that therapist isn't a match, right? Or maybe you talk to the therapist and the therapist can change his, or her approach, right? Or maybe talk to the therapist.
Stand, increase the frequency, right? But the idea is that to be aware of it. Right? And if one's needs, aren't being met to acknowledge that, right? Because people can get into a rhythm of therapy where it's really not helping them. Right? But they either feel sort of nihilistic about it. Like, I'll know better and I'm going to therapy, right? Or sometimes there's a sense that while I'm in therapy, so, I'm kind of checking that box of doing something for myself, but it's not really getting me anywhere. And then the part of the brain that's controlled by the guilt and shame and avoidance.
That's a great idea. Right? So again, this ability to observe ourselves and like what's going on in my being helped in the way. I do, I feel helped right? Am I in some ways? Even even, like, happy that I'm not feeling help because I don't have to face this thing. I don't want to face, right? Or am I too afraid to say, I need more help. I do. We really need to look at ourselves. And this is where the insurance systems often are very difficult because it's hard. Sometimes for person to say, I need more therapy because that may not be possible. Right? So, so there are sort of -
factors in the world around us. But ultimately I think the answer to the question comes down to observing ourselves and taking ownership of like what's going on in Us and how we're feeling and and feeling that that commitment to sell for to self care to say, I need to go change this
and for those that maybe don't have the means or insurance or access to do. Even one day a week therapy in the journaling model. Could one perhaps take an entire day as
Awful as it might seem to do a lot of journaling and thinking and walking, you know, to a self-generated intensive. Do you think there's utility to that
mean there could be? But again, it depends by person because they're, there could also be something negative about that if it's someone who's not at the point, not ready for that, right? I mean, we don't come at, you know, we don't come directly at the trauma immediately at least most of the time, we don't do that, right? And and we often don't explore it in depth like this idea.
That oh, that person now has to go through every second of the trauma is actually not true. I mean, sometimes it is but that's that's not the common situation race. More often that person has to acknowledge like the example of like I was sexually abused and if they acknowledge that and to and say, okay like gosh, what is that done to me? That doesn't mean well, let's parse out every moment of like how that was and the terror of that so that can lead people to a worse place, right? So, so I think the idea of
Biting off small pieces. So to speak where a person is writing, right? Or is talking, but I think if one is writing, it is good to communicate with another write, another trusted person. And if there's not someone in one's personal life and their clergy members, even if one isn't a affiliated with an organized religion, you can probably go places and get a clergy to want to help you. Right? I mean, there are people out there who want to help other people. So they say what if someone has no one I mean, almost never do we have no one here, right? Because
Could probably go find someone but we need to cut. Take that in pieces. So there's some risk. They trying to do the Intensive thing, you know, on ones own. And and that's where I would put in. If, if a person is having suicidal thoughts, or even thoughts of death of, not wanting to be alive. I don't deserve to be alive mean, these are warning signs for really getting help. So there are some signs that say, Hey, don't try and do that on your own, right? Go to go, try and find a resource and it's, you know, things that get to that level of severity, of an often, a person knows.
That I mean, am I in a place where I know? I'm not healthy and I'm, I'm having, you know, kind of scary thoughts then, then we need that. That's a person who really shouldn't be doing that on
their own. Great. Thank you for that. You're welcome. So we've been talking a lot about talking and now I'd like to talk a little bit about chemistry. Yes. Drugs. Yes. So maybe first we could talk prescription drugs, you're a psychiatrist. So you're approved to and presumably do prescribed medication where
Appropriate and this is a vast landscape. Of course, we've got ADHD. I should just tell you, I get more questions about ADHD and the drugs related to ADHD and dopamine than any other topic, any other topic. So there's ADHD. There's OCD. There's depression. There's antidepressants, and so forth. Is there some way that we can wrap our arms around all of that? As a way of wading into this, this drug question and
Just address, you know, how does one decide when medication is useful? Because in the end the dissection tool that the psychiatrist or a therapist has is language and at some point one has to make an assessment about dopamine or serotonin or whether or not a given drug would help and most therapies. I believe don't involve putting someone in a brain scanner and to my knowledge. There still is not a very good blood test to assess. Oh, is this person's dopamine low or high? Correct me if I'm wrong. And ultimately that
But and I know there are companies out there. So I'm not trying to undermine those companies. But if I happen to do that in the statement, if you take a blood test and find that your serotonin metabolites are low. My understanding is it's possible that you are too low in serotonin in the brain, but that's a very indirect window into what's really going on. So, how did how does that? How do you think about prescription drugs in the context of treating trauma and other and other conditions? And then maybe we'll drill into some of the more specific
conditions. Sure.
The first comment that right there aren't test for these things and I think the test for metabolites mean things are so different, you know, by the time what we're talking about has been metabolized, you know often to some very significant extent left the brain now, it's in the peripheral blood that we really don't learn from that. And I think that we tend to over utilize medicines in this country because we have a Health Care system that often that. So, based on throughput that we want to polish the hood. When there's a
Woman the engine, right? So we over utilize medicines often as an endpoint. Right? All we're going to make that person is depression better with an antidepressant. Well, I mean maybe right. But most of the time it's for the person's depression to really get better and stay better. They need to unravel. What's driving the depression. Right? Right. So the first step is I think there are two steps to it, right? The first assessment step is is there a diagnosis that that the vast majority of the time?
I'm, if not, sometimes all the time, really worn some medicine. So they're bipolar disorder OCD add right? These are diagnosis that we understand more about them. And what's going on in the brain and how medicines can treat or stabilize them, which doesn't mean the medicine is necessarily. It's not a substitute for therapy. Right? But sometimes the medicine and therapy can go hand in hand over OCD, for example, warrants therapy, but it almost not always but it almost always
Warrants medicine to so that you can ease the systems that are making the rigidity and the repetition in the brain. So, so the first kind of Branch Point can be, what is the diagnosis? What is the level of severity? Right? And I think that's very, very important where I think it's a little more. Maybe even interesting is using medicines to help the person engage in the therapy as productively as possible. And, and here's where I think we're so limited.
Edited by how we categorize medicines. And this sort of pharmaceutical Insurance driven medical system. We have that I think throws us off and tremendous way. So you think about how medicines are categorized? So antidepressants in the vast majority of people who are helped by antidepressants. They're not, they don't have clinically severe depression, right? Those medicines. Create more distress tolerance in us, right? And if you think about,
How helpful that can be if you're going to go now, you're going to do something difficult or you're going to bring that trauma or this stressors to the surface and going to process, and you're going to try and make life change. If we can make more distress tolerance in us. That can be so, so much better, right? And think about the category of medicines that are called antipsychotics, which really puts people off, right? But, but most of the prescriptions for antipsychotics are not for psychosis, right? And their ways, in which low dosing of some of those
Those medicines can help intervene in - Pathways right in Pathways that are about distress and, you know, sending out those tendrils of neurons, that are about hyper-vigilance and avoidance, right in our brain. And we can often get it that. And if you can improve someone's distress tolerance, and you can use medicines that take away. What clinically is rumination, right? Not a, not the standard meaning of that word, but the clinical meaning of it, where their distress centers in our brain.
Letters overactive. And then we get stuck in these maladaptive - Pathways where we think about something over and over and over again, with no real chance of solving it, because that's not what's going on inside of us. So medicines can help that, but we have to have some flexibility around their conception and the modern medical system of the 15-minute visits, you know, to a psychiatrist that are that are weeks apart. I mean, I don't understand how how that goes. Well right in the vast majority of times.
I think it doesn't go well because it's not enough time to do the therapy giving generate the understanding. So then medicines get thrown at the person. This is how we use. I think approximately five times as much medicine. I think across the board. I say the Dutch population, right? They mingle Y is five times more is a lot more medicine, right? And you know, they have a Health Care system and a cultural system that to the best of my understanding is more rooted in taking responsibility for oneself, right? So if a person,
Zenon cholesterol is high rate. The first order of business is he could take better care of yourself, right? Like, this person really needs to lose some weight exercise more. They didn't know. Not just jumping to like, let me give you a medicine and you know, and shift you through the healthcare system and out the other side of the door, right? And the same thing is true in mental health, you know, and I'm not trying to be critical to the psychiatrist. The nurse practitioners are people who are practicing in that way because oftentimes there is no choice, right?
They're working in a healthcare system that the standard is is is highly space or spaced apart. 15-minute visits What alternative is there? Right? But to look at okay, I'm going to use medicines because I don't have another tool to bring to bear. So I think the Health Care system and its focus on throughput and it's short-term talk about we talk about short-term response, right? There are short-term soothing at the expense of long-term health, and I think that is the metaphor for that applies to
Health Care System, right? Where if we if we are going to try and treat a symptom in the short term. We're going to do it in a 15-minute visit that we're going to do it in a way that maybe it soothes the symptom, maybe it doesn't but it does not get at the problem. We need to invest more resources to get at the problem. And I think that's where a sort of protest, you know, if people as a society, we see look we don't like the way our Healthcare is going like we need more focus on what the actual problems are that. Yes, we would spend more.
More money, you know, do treating people and taking care of people because it's more human time, but ultimately about less suffering less death, right? And ultimately more productivity. I think as an economy, we would save so much money. If we spend money on the human aspects of mental health care because people would be more functional, they're spending less time in the hospital right there. They're more productive, when they're working. There's less entry into the criminal criminal justice system. So I think medicines
Overused in part for systemic reasons in large part for systemic reasons. And also, for some of these categorisation reasons though, that person meets some technical criteria for depression. We got to give them this medicine instead of really thinking what's going on in this person, and I see this over and over again. I see someone is on seven medicines and on seven medicines to treat, seven different symptoms and other have side effects from all those seven medicines, maybe two of them are to treat the side effects from the other five, right? And that's bad.
Right, and if you really get at what's going on in them, now, they're doing much better and maybe they're on two medicines. Right? So, I don't know if that's a helpful answer
to that is it's a very helpful answer. I mean, I think at least in the Spheres that I run these days, I hear a lot of negative statements about antidepressants. I think, you know, I'm old enough to remember the book, listening to Prozac, and I remember when Prozac and, and it's and things like it first started showing up in the excitement and then
Nowadays, I hear more about the problems with all these drugs, you know, and maybe that's just because I have arms in the both the scientific but also in the kind of Wellness Community, where people think a lot about behavioral change. Fortunately, I think that's it that they do that. But of course, these drugs, as you mentioned can have enormous utility as well. I'd like to just pick up on one theme that I haven't heard a lot about anywhere else, which is the short term versus the long-term use of these drugs. Because I could imagine, you know, someone feeling like they're finally going to tackle.
Something that's been inside them for a long time either because there's really struggling or because they're just done with not working it through and and they decide to start a medication that would give them higher levels of distress tolerance for a short while. I mean, is there anything to say that someone couldn't take up properly prescribed medication for a week or for the first three months of the work and then know that they can come off.
It because I think that the black and white model of, okay, you're either gonna start this drug and stay on it forever or be taking some drugs forever, or you're not going to take anything. I mean, that just seems to life, doesn't does life have to work that way. Right? Is there is there a short-term use that can be effective?
Yeah. Absolutely. Yes, as in American Medicine, we are so much better at starting medicines than we are at taking them away. Right? And part of that, I think is driven by the such a strong presence of the pharmaceutical.
Street and the pharmaceutical industry, pharmaceutical industry. Does a lot of, very good things, right? But, you know, there's such thing as too much of a good thing, right? And then, as a society, when something seems positive, this I think also is human nature. We can over invest in it, right? So you think about when Prozac and those kinds of medicines came out, they were safer medicines, they're billed as antidepressants. And the thought was, well, they're going to fix depression, right? And it's not how that works. Right? So if we look at them,
As tools right then we can deploy them sometimes for the longer term because sometimes that's necessary. But absolutely for the shorter-term mean absolutely if we thought of Prozac and those kind of medicines not as oh, they're antidepressants. We said look, what they do is they they seem to make there be more serotonin in certain circuits that are important for mood regulation anxiety, regulation distress tolerance. So those medicines can really help
If they're very severely depressed and we wanted to, to get to get them feeling better. They can also help someone if they could eat neat, use more distress, tolerance in a discrete period of time, right? When we think about them that way, we think about them as tools that we could apply for short-term or long-term. We don't see them as fixes, right? And we don't see them as then substitutes for the human to human work. That needs to be done. I mean, I've, you know, been as so in my training at times in Health Care Systems,
Yes, and I've seen in many other circumstances that look at medicines as answers. And this idea that, oh, that person is a an alert time. They'll be a number, right? Right. In the number, is the diagnosis, and that number gets this medicine. And like, I'm not sure we could be more misguided than that, and that's what leads to adding medicines adding medicines, is not working. Of course, it's not working, you know, because no one's really paying attention to what's going on. So, add more medicines and then medicines for the medicines and we know this is true, we do.
We know this is true, but we haven't had the wherewithal as a society to say like with a lot of things in society to say. Hey like this isn't okay, right? I mean, we need more the give these people who are trying to help us, they need more latitude to help us. So we need more human to human contact to get it. What's really going on? And yes, that's an investment of time and energy and money in the short term, and sometimes that's money from the system's, right? But if we do that, my goodness, look at the look at the payoff of that.
At
what is your thought about, anxiety, and ADHD as separate phenomena in terms of medication. Again, ADHD. Is that the thing that seems to come up most in questions? I can't tell you the number of especially students. But also young working professionals and even people who are, you know, outside those categories who are interested in or taking Ritalin.
Adderall modafinil are modafinil or Vyvanse because they seem to struggle focusing without it or and I don't know because I'm not one of those individuals or because they seem to just like how well they can focus when they do take those compounds. And so my understanding is these compounds mainly increase dopaminergic Transmission in the brain. Also adrenaline epinephrine in the brain. So they're more or less stimulants. They look a lot like the least chemically they look a lot like cocaine and amphetamine.
Oh, they're they're not quite cocaine and amphetamine. So should we be concerned about this? Is this a different sort of epidemic can these drugs be used to train the brain to focus and then people can withdraw from these drugs. I mean, I think this is a huge topic and one that may be warrants its own episode entirely. But as long as we're on the topic, what are your thoughts about medication for
ADHD? Sure, medication for ADHD can be extremely effective and the studies show show us that
They show us that if there is ADD, then medication for ADD is very very helpful. And that's true in youths. It seems to be true. If adults have adult ADHD or add like we kind of know that's true. But all attention deficit is not attention deficit disorder, right? And there we go to the reflexive 15-minute visits, throw medicines at things, right. Attention deficit can come from many, many places.
Aces. And one of them is anxiety, right there. There's so many other reasons, depression, affects attention, poor, sleep affects attention. Poor diet can affect attention stress in life can affect attention. So, and certainly trauma. And the thing, the, the problems that trauma spins off can affect the tension. So, you know, this is really the, this is a really the truth that while teaching once about medicines and pharmacology. I was frustrated about how the answer to everything was like what?
And we use, what medicine do we use as opposed to? Like this is just one piece of the puzzle. And I told an anecdote, which I think it was a clinical anecdote. Like, what do you think is going on? And I think that if I told that to enter middle school, students, just I mean, they would probably say you just told the story of a person with a rock
in their shoe,
which is what I the story that I was actually telling, right? But several people I was talking to their Physicians right at add. All right. It's like, know that.
Another person steps down the rock hurts and they're not able to maintain attention. Right? Like that's what's going on. But we're so programmed to think about medicines and inappropriate use of add medicines. As you said, there's dopaminergic impact there is epinephrine norepinephrine. Impact were affecting what are called. Prefrontal Alpha 2 receptors that, like really need to be helped if there's real add. But if there isn't, that is not a good thing to do, which is why it is quite fascinating that when people
Have ADD, they tolerate generally stimulants very well without the other problems that can come of stimulants. And and I don't know, we don't claim to know why that is but we see that phenomenon, but when people are being treated for ADD and they don't have ADD which sometimes they know they don't have ADD but the stimulants make them function better. So they go to somebody and get the stimulants. That's that's not a good thing to do because stimulants when they're not needed overtime. They do affect our physical function. They
Affect our judgment, right? There are a lot of negative things that come from that they can affect the vigilance inside of us. So, so yes, it's a valid diagnosis but it gets made. When it's not present very often, which we see with a lot of diagnosis that you can throw medicine at, we see the same thing with bipolar disorder true. Bipolar disorder is extremely important to utilize medicines effectively. But how many people are diagnosed with bipolar disorder? Who have they absolutely don't have bipolar disorder, but
It's a, it could be a catch-all diagnosis because there's in a sense, something to do for it in quotes. Right? And you can throw medicine addict, right? So, I mean, what do we expect, right? If we have, if we have a health care System where you 15-minute visits with your psychiatrist, of course, we're going to throw medicines at everything and then the training paradigms are going to look at it through that lens and then very often. Again. I give you example of seeing somebody on seven medicines mean the first thought I have is how many of those medicines are actually counterproductive and
And a lot of the time, it's not like oh every now and then one is counterproductive know. That's the case. That's the case, a lot of the time and again I come back to if we're not putting thought into it. What other result would we expect?
Thank you for that answer. I am very curious what constitutes negative effects of stimulant. So if somebody's taking Adderall or Ritalin, in order to work longer hours or Focus because they have attention deficit, but not necessarily ADHD. And again, I'm not recommending. Anyone do this. I've just heard the numbers that have come back at least from surveys and discussions with colleagues at Stanford and elsewhere other college campuses. It upwards of 75 percent of college students use semi-regularly.
These drugs off, not by prescription, just to study and to learn. Yes. I can imagine sleep issues because people because these are stimulants what sorts of other issues can they create for people problems that you
create? I mean, I think a touchstone maybe for that's running through our conversation, right? Is prioritizing the short-term benefit over solving a long-term problem, right? Which we might say is a human tendency and we see it across the topics that we're discussing so-so.
Short term use of stimulants. Your people are more alert. They can stay awake more. They can study more intensely and longer. Okay, there's some short-term benefit of that over there. Even there there can be problems right there, but we can we can say, let's just say for sake of argument that in the short term. There's something to be gained by doing that, right? But oh my goodness, there's so much. That is, there's so much risk to that. Right? And how many times have I seen someone who they're doing that, and they're just doing that to study, right? And now,
Addicted to the amphetamines and their behavior changes and they don't know it. Talk about shifting. Our brain towards a more defensive, you know, sort of suspicious outward look, you know view of the world that we see a lot of that. So we see judgement impairment. We see heightened levels of anxiety. We see more impulsivity in decision making and and sometimes we can get to the point of seeing Frank psychosis now, that's not common. But if I seen
Young people who've done exactly what you're describing right there, using the using Adderall, or using Ritalin to study, and then I see them when they're coming into the hospital. You screaming about how someone's trying to hurt them boy, then it's the worst case scenario, but it shows like that's where that can go. And how much is there between the, oh, I'm just using it to study and that severe, you know, outcome that is actually quite negative for a person and might change how they think about that friendship or that relationship, right? A lot.
- happens when we change our brains without an ability to see like what is it actually doing to us? So, which is part of my whole theme about trauma, right? It changes our brains and we don't know it, right. Well, the same can be. The same is often true of amphetamines used inappropriately. It shifts our brain and and we don't realize that we're a little bit more impulsive in our decision. Making a little bit less trusting. These are significant negative things that if we don't know, it person will just say I'm, I'm just using it to study music.
Get to work more. That's not. No, that's not without its high level of
risk.
What are you thoughts on cannabis? I've said it many times on this podcast before. I'll say get I feel fortunate that I've never really been attracted to alcohol or drugs of any kind in in so much so that if all the alcohol and all the marijuana and all the cocaine amphetamine disappeared, I I wouldn't notice any change in my life, right? And I feel lucky in that way because I know a lot of people feel an attraction to these things as almost a gravitational force from their
Just drink it. They just feel I once heard it described in this. I think it was an Augustine Burrows book dry, where he was an alcoholic. He said that the first drink, he had, it felt like this magic Elixir that that meshed with the physiology of his blood in the most seamless way. And as I was reading this, I thought, oh my goodness. First of all, that's the most foreign experience for me in terms of alcohol and second. Gosh, that must be terrible and you can. But at the same time, you could really understand why someone would be drawn to that. So can
Nowadays is legal or decriminalized in many areas of the u.s., A lot of people seem to use the argument. It's not, it's better than drinking or they only do it for sleep or anxiety management. I'm not looking to demonize or support the the Cannabis. So, what are your thoughts about cannabis for anxiety management depression, and maybe even for ADHD for that matter?
Sure if I could make it an alcohol comment.
Write the number of times. I've seen alcohol, like having been a good idea for coping with something approaches zero. Like the alcohol for coping is just never good. And there's an additional risk factor that there are certain genetic profiles where people respond strongly to alcohol. Like as you're saying, it's not just oh there's a little bit of short-term relief of distress, but there's a sort of euphoric response and those genetics. We don't understand them completely. They seem to be
In northern European populations more prevalent as you head, West in northern Europe. So we understand that where risk factors are demographically, but we can't pinpoint that for any one person. And there's a tremendous risk of that when a person responds. So, strongly to alcohol or habituate scoping to alcohol, cannabis is a little bit of a different story. I mean, how I have seen that play out again. This isn't coming from any expertise around the neuro, the neuropharmacology of it, like houses.
Really working in the brain. It comes from an observation that what it seems to do is to narrow our attentional perspective, right? So it's why people will say, well, they want to, they want to use cannabis before watching a movie with friends or something. Right? And and think, okay. I think why people are doing that is because a cognitive Spectrum Narrows. And then, instead of worrying about that thing at work or that relationship. If you want, can just be present right for for a Gates out, other attentional intrusions, right? So,
In some ways. I mean, I've absolutely seen it be helpful to people. I mean, it's been legalized in Oregon, which is where my I spent a lot of my time and it's not where all of my practice is. But what I have seen is it is at times helpful, save around sleep, right? Because a person can gate out other intrusive thoughts and they can just relax and go to sleep, but there can be another side of that to that at higher levels of distress at higher levels of tension. What it can do is narrow the focus of cognition to the
Thing that is - right. So so the idea that Oleg this is a treatment for depression anxiety. Trauma is not true. Right? Can it be helpful under certain circumstances? I think the answer to that is. Yes. I mean, I know the answer to that is. Yes, because I've seen it play out clinically that way, but it can also be harmful to so there. Again, like anything that has any power power to influence our brains. We want to be thoughtful and careful about it. I mean, do I think that it's safer than alcohol?
Tsamina Mina Qui. So clearly see that. Does that mean it was just uniformly? Safe? No, right. So we want to be respectful of anything that can change how our brain is working. And I think that includes certainly includes alcohol and I think it certainly includes cannabis to.
I'd love to talk about psychedelics for two reasons. One there seems to be a tremendous amount of interest in psychedelics as a therapeutic clinical tool. I know there's also recreational use analogous.
Preface all this by saying that my stance is we absolutely know for sure that these are controlled substances. They're illegal to possess sell or use in most of the country. There are few areas where they are decriminalized and psychedelics has a broad category, of course, and we can touch on some of the different different ones, but
Whereas five years or so five years ago or so. I was truly afraid to say the word psychedelics in any kind of public venue their Laboratories at Stanford working on ketamine psilocybin and MDMA. Mostly in animal models. There's terrific work going on at Johns Hopkins school of medicine and Matthew, Johnson's lab and others. Looking at the clinical applications, mainly of, high-dose psilocybin and LSD. There's the maps trials with MDMA. So nowadays.
It's safe for an academic, like me, to say, the word psychedelics. And I'm, I'd love to approach this question of psychedelics from a place of true exploration and curiosity. But with the preface that we're talking about this in the, in a legal clinical setting and the legality is something that's now in process. I don't think it's completed, but that's my understanding, but there are trials there are, you can go to clinicaltrials.gov and put in MDMA and you
See a bunch of clinical trials that are happening in the recruiting subjects. So I think it's safe to have the conversation now and I'd love your thoughts about psychedelics. Maybe we could start with psilocybin and LSD. As a broad category of drugs that at least my understanding is they touch on mainly the serotonin system, some specific receptor activation and modulation tend to change Notions of space and time. Adjust internal State and we would start there and then maybe
Venture into some of the other one. So what are your thoughts on these drugs? For therapeutic potential? Also potential hazards Etc.
Yeah. I think if we look at the true psychedelic, so psilocybin and LSD, because ketamine and MDMA their different categories of medicine there, these sort of Novel tools to bring to bear, but if we start with psilocybin LSD, true psychedelics, I think why it is why they have gained so much momentum over the last several years.
Is because the data coming from the labs, in the academic centers is so powerfully positive. And as someone who's I'm interested in anything that's potentially helpful. Right? And I want to learn and understand that because a lot of things that are potentially helpful, you know, you go and look at the data and you see that that's not helpful other. That's harmful. I think what we have seen with psychedelics is that they're so helpful, right? And and the trials are bearing that out and of course.
These are used in professional hands and with the right kind of guidance to extremely powerful tools, but used in the right way by someone, who knows how to utilize them in the right set and setting can have an immense positive impact. And that's why I think that the thought is there across people and more and more people feel comfortable saying it and talking about it mean, we're in the state of Oregon. Now where, where the thought is were moving towards legalization of psilocybin early in 2023.
And it's part of the new data, right? And how it meshes with the older data, right? How it meshes with data from the 60s and 70s that showed such a strong powerful impact of these medicines. And I have a whole set of thoughts about what's happening there and they're just their conjectures, right? But but my read of, you know, as best I can try and understand the neuroscience and and the clinical applicability in the changes is
You know what happens is we see less communication less chatter in the outer parts of the brain, right in the outer parts of the cortex. And I think that as human beings, we sort of glorify the parts of the brain that only we have, I mean, certainly in my growing up. What did I learn? Even if you think about, like learning about the brain in high school, right? And learn that like, wow, we're great as humans because we have language and other animals don't and we can use tools and like, aren't we? So,
Great. Because we have this part of the brain that other animals don't and it lets us function, right? Okay, there's some truth to that, right? That, that, that we can do things, others can't do, but we we get lost often in the outer parts of the cortex, which I think are about survival. Right? So we come back to the things you and I talked about early on of like, why are these trauma mechanisms in US? Writes, like so much of what's going on in our brains, is about survival. And I think,
Living, so to speak in the cortex, right? In the outer part of the brain is consistent with a focus on Survival. So if you think that's where languages, that's where vision is, that's where executive function is. So planning and tackle the task execution. So, so much of that is about making our way in the world around us. So we tend to glorify that I think, well, that's in a sense where our existence is, right. And I believe, that is not true, right? And again, can I say that for sure? One, of course.
Right, but my read of 20 years of doing clinical work and thinking about all sorts of medicines and, and thinking about the psychedelics with a, in a lot of depth. I think that what they do is they take us out of the cortex, right? Because that's where we run into these problems. That's where we bounce things over and over again that the distress centers deep in our brain and the brain stem kind of alai, with the outer parts of the cortex and they say, right? We're in distress. We want to stay alive, you know, often a lot of us have had
Trauma that makes these changes in the brain and then we're thinking all the time. Like, what would I do, if, if there were a war? What would I do? If there's Civil War, someone bombs us all? I do, if the economy collapses, right? What will I do if somebody gets sick, we're thinking all this future projection that is all coming from a place of fear, right? It's all coming from a desire to think about things and control the future with this part of the brain. That is so uniquely human, right? And I think when we take the neurotransmission,
Out of those places, right? And we set it in a part of the brain and say the insular cortex, right? The parts of the brain that are sort of in the middle, right? Which I think I believe is where our humanness really is. So the psychedelics make there be less chatter communication, these other parts of the brain and then we become seated in the part of the brain that I believe is most about our experience of true, humanness, which is why when you read about people who have
Audiences. And I've heard about them, people talk to me about this. Right? And they've utilized it, they talk with me. So whether it's someone telling me their story, or it's coming from research data, you know, it's why people can sort of see with Clarity that, oh, that trauma like I think, is not my fault, really. We feel a sense of compassion for ourselves. We relieve ourselves release ourselves from guilt. And he said, why is this so helpful to people? And I think it's because it can do what we are trying to get at it.
Good therapy, but it can really catalyze that by just putting a person in that part of the brain that can see it for what it is. Without all that chatter in the cortex about, I gotta think it's your father. You won't avoid it again and that makes the repetition compulsion. How do I think ahead to the next thing that might happen? And what else, bad might happen. We don't get anywhere doing that and I think where we get somewhere is when we seed ourselves deeper in the brain, which I think we do if we're like, doing really good therapy and we're you know, we're in the Deep parts of
The brain. But these these psychedelics the medicinal value I believe is putting us in that part of the brain where person can really find truth. And that's why I think that it's come so far in these few years because I think that is very clinically evident. And I think we're going to see more and more the value of that and how what the psychedelics do can become? I believe a heuristic for understanding like, wait, how our brains really?
And what are the parts that really matter to our experience of being human? It's those parts of the brain, right? The Deep parts of the brain, the insular, cortex and the and the areas around it. That's a light up. When a person has an experience of spiritual ecstasy or an experience of connection with another person, right? We kind of have these Telltale markers that something is going on there. That's very important and very special. And I think we're more attracted to the outer parts of the brain and Parkers are easier to.
Study right. Mean as you know better than I do, we started studying the brain through lesion studies, right? Because it is easier to see if a person got hurt in this part of the brain or had a stroke in that part of the brain, what changes? So we look at the cortex because one it's easier to study and we tend to glorify it and I think that has been misguided and I think that we're learning how about how that's been misguided through the study of these novel, modalities from Western perspectives, but of course, they've been used for
Long, long time in other cultures, but novel from our perspective.
Yeah. I'm fascinated by this idea that the, in these middle brain structures is where our Humanity lies. And, as you said, I also wonder whether or not other animals experience life more from that orientation with less chatter, we can only guess what, you know that dog lover and, and being in the presence of animals that seem to just be present in what's happening in their media.
An environment, not too much.
It is summation. Essentially you're talking about is sentience as important and extensions is extremely important. Very and if we're going to overvalue say language, then I think we undervalue sentience, right which is why I think we tend to undervalue animals, right? And and there's suffering was in. Well, they're not saying anything about it's right and you know, they're not writing about it. So okay, it's easy to ignore and we think about getting the hubris of that right though because we can think and talk and write like we must be feeling more.
Then then species that don't do that. I mean, I think I think that is so true and that we're going to understand more about sentience and other species and how that's at the core of existence and my hope would be that we value more humans and animals right through the evolution of that
understanding.
The hallucinations that accompany psychedelics like LSD and psilocybin, how such an attractive Force to them as a concept and, and as an experience. And so, I think most often, when people hear hallucinogens, they think and psychedelics. They think about hallucinating right. Makes sense, why they would. But what's so interesting to me is nothing in your answer about psychedelics psilocybin and LSD focused on hallucinations.
A say, it was more about feeling States, accessing a feeling stayed to our relation to an event, or to a person, or to oneself. Maybe even, I caught hints of maybe even empathy for oneself for the first time. None of that had to do with it seeing seeing sounds or hearing colors. And, you know, those kind of cliche statements about hallucination. So I am aware of Laboratories one at University of California, Davis in particular, but a few others that are trying to generate
Variants of psychedelics that lack. The hallucinogenic properties, but maintain these other properties as therapeutic tools. And as I say that, I realized that people in the Psychedelic Community are probably thinking oh that's horrible. That's a the dismantling of the core thing. But the simple question is, do you think the hallucinations are valuable for
anything? And I think we're really getting into the it to the philosophical, right? The ontological, right? There's this sort of fun, too.
To understand being right? And I don't claim to know the answer to that. I think that at times, it seems like the hallucinations have a metaphorical or a symbolic way of being helpful, right? Because people will come to understand things that that they hold dear and true after the experience, right? That, that often not always come through the lens of of the hallucinations.
So are the hallucinations necessary, are those hallucinations, sometimes important, sometimes not, you think we don't understand that and I think we want to be respectful of the, of sort of mystery of that. But what I think is fascinating, is anything about like substance abuse? And what that means is one aspect of that. Is that a person as experiences thoughts conceptions of self and the world with the substance that without the substance. They know are wrong, right? People talk about, you know, liquid courage, right. And OG, I feel
About myself. And I feel courageous could have had a couple of drinks. Now, when I, and I after that, I feel like normal about myself and that was false. Right? And, and we see that, like, that's part of what substance intoxication means, right? But what we see with the Psychedelic medicines, is something that's incredibly different, right? That people are having experiences that are Saudi linked from our normal experience of reality. And then when they come in a sense back online with, with, in a normal cognitive way.
They realize like wow, I'm applying all those mechanisms of trying to understand truth and to that and what I see is that it's true and wow, it's true. Like I mean hear that all the time which tells me hey, something different is going on there. And of course, these are powerful tools. So misused like very bad things can happen, but you think about the clinical utility? And what does it mean that so many people change for the healthier or even change their lives after an experience? Because it's so
Like oh now I understand something. That's true. And it's not something bizarre is like I wasn't responsible for being raped that time or, you know, I, you know, I'm not less than even though my sexuality, or my gender identity is different from some silly binary concept, right? Like people kind of can often get it and they feel differently about themselves and guilt and shame are impacted. So I think we're likely to see that they are powerful. Anti trauma mechanisms again, used clinically in the right hands, and and I think that we're also going to see that
a heuristic for understanding our brain that goes against what I see as some of the reflexive hubris of well, the outer parts must be the best because that's what makes us human and other animals. Don't have it and we're better because we're human. I mean, it makes no sense. You
know, I'd like to talk about MDMA and I'll preface this by saying, I was a participant actually technically, I'm still a participant in a clinical trial. So I have experience of doing it twice at the trial, involves three separate dosing of this.
I was reluctant to do it outside of a clinical trial most because I was a where there can be some cardiac effects and I like the idea of there being a clinician on hand and I'll just say that I found the experience has to be profound beneficial and very different from one one session to the next. The first one felt a whole collection of of ideas and relational.
Things came up that felt very powerful and transformative and I do think that I learned there, I exported a number of things. My particular experience isn't relevant here. But the second time I expected it to be the same way and it was very mellow and relaxing and was, it was deeply tied to kind of Notions of acceptance. So there weren't all these Revelations and wow, new insights. It was very much about sort of grounding into a kind of a calmer state. So I
The personal experience of benefiting from these in ways that I think still benefit me and was very struck by the power of MDMA and my very crude understanding of the pharmacology and the state that is being under MDMA is that it encourages or increases dopaminergic transmission, but also serotonergic transmission, which is to my knowledge at kind of a rare State for the brain to be in that typically it's more of a seesaw of dopaminergic drive towards external goals or more Sarah.
Turner, Jake drive towards you, no more plasticity or comfort, with what one already has. And so with both those systems Amplified the only way I can describe it subjectively is that it everything sort of funneled back in and it was almost like a pursuit of inner landscape and I can only imagine what it would be like in the context of doing this with somebody else. Also taking MDMA. I have no idea what that's like. That's my report of the experience. I know that these
And can vary. What are your thoughts about that? The chemistry and the what sorts of states do you think MDMA is creating that can explain why? It's a useful therapeutic tool in some cases? And what sorts of cases, those might be
sure. Sure to clarify. I think part of what we're starting with is like, this is very different than the psychedelics right which are ceding our Consciousness in these deep centers of the brain, right? Whereas what MDMA is doing is sort of
Of flooding with positive neurotransmitters, right? In certain parts of the brain. And I think what that creates is a greater permissiveness inside to entertain or approach different things, right? So the, so I think where we see it's tremendous, I read of the data is around potentially, and, and we're seeing in some of the trials, right? Tremendous benefit for trauma, right? And you think about what we're talking about earlier? How this reflexive guilt shame hyper-vigilance avoidance, right?
And when these systems are flooded with these neurotransmitters, it's more permissive to sort of, think about that. Right? And to think about that without again, all the chatter of that your fault, or you're never going to get anywhere because of that, or, you know, what that means right there. They can kind of go away. And then we can think about it in a way that isn't through the lens of fear. Right? And I think that's the power there. Is that there is permissive of approaching something contemplating something, you know, a different Novelties. We talked about
Di Nuovo approach and I think that's also why the experience can vary because you could also see how if you're not thinking about something, right? So there's not a clinical guidance to it. You could, you could be in a state where like, I just feel good. Right? And I'm thinking about good things and like that can feel good. Right? But it, but that's not necessarily problem solving, right? So the clinical guidance says, hey, let's take that state and do something with it. Right? Let's now that you're in this state. Let's say,
Hey, let's make hay. While the sun is shining, right? You're in a state where we can look at things that are traumatic, right? We can approach them from a de novo perspective. And I think it's part. I think that explains why you had these different experiences from one to the other because your brain is just in a state, that's conducive to something, right, but if there's not the, the mechanism to have that thing happen, like conducive to something therapeutic, then you might go there on your own or you might just be in a state, we have a sense of well-being, and, and you sit with that
witch.
Seems like a waste to me. I mean, this is what I tell people when they ask about MDMA, as I said, at least from my experience that the potential Hazard there is that in that very high dopaminergic serotonergic State. There were moments where I felt like I could get excited about anyone specific concept that I might even just think about, for instance, you know, water and how nourishing it is. And really just go down the path of water and the world and all the water and you can you know, you're in a
State that is very prone to suggestion. Yes, internal suggestion. And so the guidance turned out the guidance from the clinician turned out to be immensely valuable in allowing me to go into my own head for a bits of time. But then also to resurface and share and exchange in a way that to I'm trying really get something out of it. That was useful in that I could export because, of course, water is wonderful, but I'm not really interested in growing my relationship to water and I really felt like and I could understand for the I never went to Raves or
Growing up. I never did MDMA recreationally, but I understood for the first time how people could get really attached to an environment and feel connected to things? Because I think with all that serotonin you just feel connected to everything around you. So I think it's
a slippery slope there
and and I don't know what the future of the clinical use of MDMA looks like. But I would hope that whoever's thinking about, I'm guiding these sessions is really thinking carefully also about evolving, the practice to help people, really move through in a
Anyway, so they can leave with something
valuable. Yes, 100 percent and 100 percent. These are such powerful tools and if they're powerful tools and we're using them without respect for that right without clinical guidance. We incur risk, right? I mean, you know, getting obsessed with water. Well on it probably isn't going to hurt you, right? But if someone is out using it around other people, what one can feel positively about or become sort of Obsessed? In a short-term about can be very
They can be a lot of risk to that. So I think it anchors back to these are very powerful tools. We're coming to understand them much, much more, and we're coming to understand that they have immense potential to be helpful to us, but I think and hope that that only also increases our respect for those modalities and what can come, what - can happen. If we're not
respectful. It's going to be very interesting to see where all of this goes in the next few years. Not just in, or
Reagan. But elsewhere. It's one way or another. It's happening. It seems to have a momentum that is not going to stop. So very exciting area to be sure. I agree. I have a question about language in your book. You talk about how we need to be careful about the use of language around trauma and maybe problem solving, and problem, describing in general, you know, on at one extreme. You hear that your brain and your body hear every word you say, and
You know, we have to be so careful with language and that actually frightened me for a number of years because I would hear that and I thought, gosh, if I just think that something is bad. Now, it's going to hurt me worse which itself is part of that whole, you know, packing down of an issue, very hard to avoid thoughts without distraction. So that's one extreme on the other hand. You know, I, I can say, I can tell somebody I love them with a tone of hatred.
I can tell somebody I hate them with a tone of love. Yes. So, how should we think about language in parsing trauma? And in your book, you talk about you give some cautionary notes about talking about depression trauma and PTSD in terms that might diminish their real severity in some cases. And and I was really struck by that. So maybe just touch on you know, how should we talk about these things in a way? That doesn't diminish them for ourselves or for
They're people and at the same time honors, the fact that there's a lot of trauma out there and there's a lot of depression out there and we need to talk about
it. Yeah, I think this is a very complicated and in many ways convoluted topic. I think it's wonderful that we have language but boy language leads us astray often to do you think about how we help people Define words, like what someone says the word was? It does a person, know what that word means you, what? Nuance are they taking from it? That we see
Have to be very careful what we're saying and what we're communicating. And I think this doesn't mean because, you know, there's a sort of phenomenon now where people are trying to control language. I think too much. Like you can't say anything that someone else might find her fully have to refer to people in ways. They choose to be referred to even if those are ways that others don't understand or ways. They themselves have decided or ways that might be psychologically or clinically unhelpful. So, I think the over control of language is,
Not good, but I think the specificity of language of what are we trying to say? How are we defining it? Or even the word trauma? Right? We're talking about traumas. We wanted to find what that means. Right? It doesn't just mean like or anything kind of - right? Because then that dilutes it down to meaning nothing, right. It also doesn't just mean, you know, injury and combat, right? Like, we have to talk about what that is. So I think anchoring it to something that rises to the magnitude of overwhelming are coping skills and changing us like then at least,
East. I Define it that way and I can communicate that to you and we can understand we're talking about, right? I think that another aspect of language while again, we need this middle ground and I don't think that it is okay for the over control of language to shut down expression, but we also have to acknowledge. You know, how we're so much less distance from each other, through social media and I think social media can do very very good. Things is hopefully we're doing now, right? But it can also be
Used to harm people from a distance, right? And how much hatefulness is there out there that I think comes from anger and frustration in people getting back to trauma. Right? But people just want to be angry and it's not really issues if they're talking about but then there's a target of that anger and you know, people feel beleaguered by that and though the words that people use sometimes are so awful. That someone reading that look if you're into demographic, that's being targeted, right? And you're reading that
Mean, how does a person? Not feel you not feel beset, upon vulnerable, right? And then I think that also fuels, you know, things like we just had this terrible shooting in Buffalo, right? Like justi hate-motivated, right? And I think that because that kind of language becomes very real to people who may take it in it fuels their hate, and then they do something to enact it, which, of course, creates greater feeling vote, fear and vulnerability. And I think there was some Civility and decorum, that was in our
Not that long ago, right. I mean, you know, I'm in my early 50s. I'm not that old, right, but I remember a time when when in political discourse, a people were civil to one another right now. So much. It means not all of it. Right? But there's an acceptance of things that are just bombastic. Write this, it's a circus Sideshow. Sometimes of of people being just angry and aggressive and and it's not really linked to anything of those allegedly linked to something, but then other people's anger can attach to it.
And it's not about what it's about, but it's about allying with the anger. And and I think that there is so much damage that comes from that and I think you should we have should it be? Okay? That people sometimes are talking communicating using language in ways that would like get us suspended from middle school, right? Ways. I don't want my eight-year-old to see. I mean, is that really okay, or do we need to take a stand for the rational, use of language? I don't want my you
Of language, be over controlled by someone who thinks they sort of understand better. Then the rest of us how to communicate with us. Okay. I don't want that with stereotypically, a sort of idea of the left side, right, at least in our society. But I also don't want language. You can be so angry and so aggressive that it is perpetuating or spreading vulnerability and that it facilitates trauma, and, and I think we could set standards as a society where we say.
I don't want anybody in power who's going to behave that way? Right? I don't care if their whole agenda is like make Paul Conte's life better. I'm still not going to vote for you. Right? If you're behaving towards others in a way that's denigrating, you're behaving in a way that I feel essentially ashamed of right. And, and I feel that a lot. I see the politics, you know, I see things. Play out snot always political, of course, not always political, but I see things play out and I think, oh my gosh, I feel embarrassed like we're somehow okay, with this wood doesn't matter which side of the political.
It's coming too and I think that's an indicator that what we're doing is really hurtful to us. People become more angry. They attach to the anger people, feel more beleaguer. There's more divisions between us and it seems more and more like, well, we can only really identify with people who are just like us and like, what does that really mean? That the divisions that it creates between us and and that, you know, that promotes so many negative things, right? I mean, think about ways in which it promotes White
Emma. See right as just one example, right? And we've seen that play out that this is really bad for us and we've got to look at that. I mean if we don't look at that, I don't think it's always something is going to happen. Like something is happening. Right? It's happening
now. Yeah, and I'm it really to my mind. It really seeps down into the soil of everything that we're talking about on all sides. Yes. People are activated. People are upset about one thing or the other, right?
No one is immune from upset regardless of political affiliation, and everybody seems to be upset nowadays. And, as I was hearing, you talk about this, I feel a lot of resonance with what you said and I also hoping you run for office,
so I don't think I have the gumption for that but that but thank
you for all that would be wonderful. Thank you. I'd like to talk about a concept of taking care of oneself. This comes up in the book.
This is something. We talked a lot about on this podcast. I mean, I think people have heard me blab, endlessly, and I'll probably go into the grave telling people to get sunlight in their eyes when they can and to try and get proper sleep and to have a few tools for reducing their anxiety in real time. And, and on, and on and on, you know, we hear about this concept of taking care of oneself, and I think at a surface level, it can sound a little bit light, you know. Take care. Take care. Take good care.
You know, we but to me it's a deep and Powerful concept and I was very happy to see it in your book and also to learn a lot of ideas about what that really looks like because whether or not somebody is in the early stages of considering whether or not they have trauma or is in the Deep stages of working that through or has made it through the tunnel, some distance taking one care of oneself as an ongoing process.
I'd love for you to just describe what taking care of oneself. Means to you as a clinician and of course the practices and things that you encourage people to do, but but how we should, how should we think about taking care of oneself? Because on one extreme you could imagine a massages or treats vacations and chefs For Hire that take care of everything for ourselves. And On The Other Extreme. You could say, you know, it leaning into life in a way that
You're paying attention to small things while working very, very hard. So, it's such a big concept. But how do you think about taking care of oneself? How should I take care of myself? How should people take care of themselves?
Sure. I see here. What I think is a very fascinating dichotomy, right? That in some ways. I think about how complex our brains are right, how complex our psyches, our unconscious minds are. There's so much complexity there, but on the other hand psychological Concepts that are
Consistent with health are often. Very simple, right? Was You, by which I don't mean light, right, but, but, but simple straightforward, right? And I think self-care is absolutely one of them. I mean, how much is talk about how to take care of oneself that just skips over the basics that are necessary as a building block for all out. So it doesn't matter how many chefs are Vacations or whatever a person has, if the basics of self-care aren't squared away. And it's not a lie concept to say like Luke, are you sleeping?
Enough. Right? Are you eating? Well, are you getting natural light? Are you interacting with people who are good to interact with? Right? Are you accepting negative interactions in your life? Are you living in circumstances that make you feel okay or not? They're very, very basic premises. But so often we're not looking at them at, all, right, we're not looking at them at all because we tend to skip over them and we tend to skip over them either because
again, in some automatic way that sometimes is, trauma driven or we're not going to look at that. Right? And often not taken care of ourselves. Can have the punishment distraction, right? There's so much that can come into that or our sense of power is is tied to not taking care of ourselves mean, I'll give you. An example is I tend to for whatever reason do reasonably well with very poor self-care, right? And like that was very adaptive when I was into medical training, right? And I'm like, okay I can
Need a lot today. I cannot eat, right? I can sleep two hours. I can sleep eight. Right? I mean, overall that's not good and it hasn't been good for me as I've aged, but then I realized something like I'm doing all these things that make myself healthier, but like what, I ignore that right. And why am I ignoring? That was a key question? Why am I ignoring it? Because somewhere inside of me is it was and still to some extent. Is this idea that my ability to be really functional right to generate success in the world, around me is tied to my ability to do.
That right, that all fight. But if I stopped doing that and now I'm like I'm eating and sleeping regularly. Then I'm going to lose some Edge and so so, you know, even I think about this all the time but I realized, hey, I'm also, I'm not doing it inside, you know, and, and I think it's really grounding to the basics that really helped us of like what are the basics of what I'm doing and not doing in my life. Diet exercise, sleep, people circumstances, leisure activities and mean sunlight. And I think immensely important
And dramatically
undervalued. I want to thank you for that. And I want to thank you for today's discussion. I found it to be incredibly informative and I know our listeners will also. I also want to thank you for the work you do. I mean, you obviously run an incredibly robust clinical practice that I'm aware that you're constantly trying to improve even though it's operating at the highest levels already. And I really, the reason why you're here today is because I I've done a while.
Wide and deep search for people in these areas and there are so few who have the background in medical training and Physiology in the psychoanalytic and psychiatric realm and also have a grounding toward the future, you know, what's coming and who can encapsulate, so many different orientations and bring them together into a coherent piece. So I really thank you. Yeah. And for your book.
Is incredible. I will go on record saying. I think this is the definitive book on trauma, and I really encourage people to read it and will continue to encourage people to read it at so many valuable takeaways and insights and tools. They're so on behalf of the listeners and myself. Thank you so much for joining us today.
You're very welcome, and I take that to heart and I'm very appreciative of being here. So you're very welcome. And thank you
as well. Thank you. Thank you for joining me.
Me for my discussion with dr. Paul Conti. I also highly recommend that you explore his new book, which is trauma the invisible epidemic, how trauma works and how we can heal from it. It's an exceptional resource both for those that have trauma and those that don't have trauma or those that suspect they might have trauma. Again. It's a deep dive into what trauma is and offers many simple tools that anyone can apply with a therapist or not in order to heal from trauma. And if you'd like to learn more about dr.
Auntie and the work he does directly with patients. Please check out his website. Pacific Premier group.com. We've also provided a link to both the book and Pacific Premier group.com in the show. No captions. If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific. Zero cost way to support us. In addition, please subscribe to the podcast on both Spotify, and apple and on both Spotify and apple. You can also leave us up to a five star review on YouTube. You can leave us comments or suggestions.
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Improving Focus for managing anxiety and for many other aspects of mental health, physical health, and performance for that reason the huberman Lab podcast has partnered with Momentis supplements because first off, they are of the very highest quality. They also ship internationally which many other supplement companies do not. And we wanted to have a One-Stop location where people could find and access the supplements that are discussed on the huberman, Lab podcast. So if you go to live, momentous.com huberman, you will.
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On the huberman Lab podcast. We also have a newsletter called the neural network newsletter, where we offer distilled information. So list of protocols and key. Takeaways from podcast episodes. If you want to sign up for the newsletter, all it requires is your email. Please know that we do not share your email with anybody. We have a very clear privacy policy. You can find all that by going to huberman lab.com. There's a menu there where you can sign up for the neural network newsletter. You can also immediately get access to some example newsletters. So you know, what the
Newsletter is all about. So, thank you once again for joining me, for my discussion with dr. Paul conti, and last, but certainly not least. Thank you for your interest in science.
