Speaker 1: Oh hey, it's that little green wispy weed sprouting from
Speaker 1: a crack in the sidewalk alley. Ward back with a
Speaker 1: hopefully hopeful episode of Ologies Traumatology. What is trauma? Who
Speaker 1: gets PTSD? And what steps large and small can you
Speaker 1: take to heal a heart in a brain? So WHOA
Speaker 1: is a good one? I got goosebumps both recording and
Speaker 1: writing it up. But first thanks are always in order
Speaker 1: every week to the many folks who are making this
Speaker 1: podcast a reality, from an idea million years ago to
Speaker 1: a weekly thing I get to put together. So thanks
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Speaker 1: in as little as twenty five cents an episode to
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Speaker 1: you to anyone supporting Ologies Merch by sporting Ologies Merch.
Speaker 1: It's available at ologiesmarch dot com. There's also a link
Speaker 1: in the show notes. And thank you to all the
Speaker 1: folks who have rated and subscribed, which keeps Ologies up
Speaker 1: among those science giants in the podcast charts. Thank you
Speaker 1: so much for that, and also to everyone who leaves
Speaker 1: a review for me to read, like for example, this
Speaker 1: one by Jersey Dork, who says I was most touched
Speaker 1: by the field trip La Natural History Museum episode. Ali
Speaker 1: shares her passion and love for the museum, and you
Speaker 1: can feel how happy she was to have changed her
Speaker 1: career like this. She takes a minute toward the end
Speaker 1: to encourage all listeners to chase what you are passionate about.
Speaker 1: And I really took that to heart, and I'm now
Speaker 1: taking steps to start a wedding dress brand. So congratulations,
Speaker 1: Jersey Dork. That made me just giddy for you, if
Speaker 1: I do say so myself. Hey, get it, neverone, Okay,
Speaker 1: Traumatology very much a noun, very much a word. It's
Speaker 1: a discipline. But in researching this intro, I've found out
Speaker 1: there are two kinds. What there's medical traumatology, which is
Speaker 1: surgical wound healing, like after accidents or major injuries. And then,
Speaker 1: of course there's psychological traumatology that researches and helps treat
Speaker 1: people who have witnessed or experienced distress. So traumatology either
Speaker 1: one comes from the Greek trauma that means wound or injury,
Speaker 1: and the root for that word just fun side note
Speaker 1: meant to rub or twist or pierce in the way
Speaker 1: that one would have an old creepy weapon, so trauma.
Speaker 1: You know what. After a series of episodes about toads
Speaker 1: and crickets, I just thought we should have a little
Speaker 1: gander at our squishy but strong human minds. And I
Speaker 1: was chatting with wonderful person and boyfriend, Jared Sleeper, who
Speaker 1: helps editologies and he's the host of the mental health
Speaker 1: podcast Make Good, Bad Brain. And he suggested a friend
Speaker 1: of his, and less than twenty four hours later I
Speaker 1: was headed to this doctor's cute, cozy home. There was
Speaker 1: a diploma on the bookcase, the smell of some freshly
Speaker 1: lit incense. He has beard and tattoos. He looks like
Speaker 1: someone who would open like a vintage motorcycle shop. But
Speaker 1: he's like a surprise, I'm a traumatologist. So he got
Speaker 1: a cup of coffee. We settled into some big comfy
Speaker 1: chairs to talk shop about clinical bummers, but how to
Speaker 1: help your brain cope with maybe what life has dealt you.
Speaker 1: So this traumatologist has studied the role of mindfulness and
Speaker 1: meditation and its efficacy and limits in trauma therapy and
Speaker 1: other mental health symptoms and disorders. So he's taught a
Speaker 1: Mindfulness for Practitioners workshop in a psychiatric clinic, has worked
Speaker 1: on research for improving acceptance, integration, and health among LGBTQ
Speaker 1: plus service members, reducing suicidality among LGBTQ plus youth, and
Speaker 1: done extensive research on examining mindfulness and therapies for military veterans.
Speaker 1: He's a cool dude. He's also a member of the
Speaker 1: Association for Behavioral and Cognitive Therapies. He's a member of
Speaker 1: the Cognitive Behavioral Therapy Society of Southern California. He's also
Speaker 1: part of the National Association of Social Workers. And I
Speaker 1: love this chat because it's very obvious that his mind
Speaker 1: cares about other minds, but also his mind is just
Speaker 1: a bucket of responsible information on the topic. So this
Speaker 1: episode maybe not the most hilarious of the ologies, but
Speaker 1: I think it's incredibly important for all of us. So
Speaker 1: we talked about how trauma affects the brain, what trauma is,
Speaker 1: what percentage of folks will have lasting effects after a
Speaker 1: traumatic event, how clinicians help their patients get over some
Speaker 1: distressing memories. We also touched on PTSD, EMDR, cbt CBD,
Speaker 1: pe CPT, and more So, take a deep breath, don't
Speaker 1: forget to exhale, and learn about distressing with your friendly
Speaker 1: neighborhood traumatologist, doctor Nicholas Barr.
Speaker 2: So, I'm Nick Barr.
Speaker 1: Doctor Nicholas Bar, doctor Nicholas Bar. Yeah, how long have
Speaker 1: you been a doctor?
Speaker 2: Let's see my decrease right there. I think that was
Speaker 2: last summer. Yeah, so, oh god, Actually I think it
Speaker 2: defended my dissertation like a year ago last week, so
Speaker 2: a year about a year.
Speaker 1: Congratulation, thanks, yeah, And what was your dissertation on?
Speaker 2: So basically I looked at the role of mindfulness across
Speaker 2: kind of the trajectory of military veterans combat related experiences.
Speaker 2: So my first study just was like a head to
Speaker 2: head comparison of trait mindfulness and combat experience as predictors
Speaker 2: of PTSD and depression. And then I looked at how
Speaker 2: mindfulness and PTSD and depression predicted mental health stigma, internalized
Speaker 2: mental health stigma, because we know that's one of the
Speaker 2: core barriers to veterans' service use behavior, like getting mental
Speaker 2: health services.
Speaker 1: So Nick says that combat is what's called a linear
Speaker 1: predictor of PTSD. So the more war zone firefights a
Speaker 1: person may have experienced and the more intense they were,
Speaker 1: the stronger their probability of developing post traumatic stress disorder,
Speaker 1: which is our good buddy we casually call PTSD. Nick's
Speaker 1: research also found that the stronger a veteran stigma about
Speaker 1: mental illness, the stronger their PTSD symptoms tended to be.
Speaker 1: Nick's research also looked at trait mindfulness and its association
Speaker 1: with PTSD, So could mindfulness help veterans with the body
Speaker 1: and mind's response to stress. Also, if you don't know
Speaker 1: what trait mindfulness is, you're in a really good company.
Speaker 1: And what is trait mindfulness exactly?
Speaker 2: Basically when we talk about mindfulness and kind of the
Speaker 2: Western from the Western sort of behavioral health psych perspective,
Speaker 2: it's the ability to pay attention on purpose to present
Speaker 2: moment phenomenon without judgment or elaboration, so without like ruminating
Speaker 2: or avoiding basically that content, so things like thoughts, feelings,
Speaker 2: behavioral urges. And that's like an okay definition from the
Speaker 2: perspective of like measuring it with scales, you know, self
Speaker 2: report scales. But there are a lot of problems with
Speaker 2: measuring mindfulness in that way, Like from the kind of
Speaker 2: Buddhist perspective, which is what mindfulness grew out of and
Speaker 2: that's sort of where I my undergraduate degrees in religion,
Speaker 2: and my focus was Buddhism. You really miss a lot
Speaker 2: when you define mindfulness in that way. I mean, in
Speaker 2: the Buddhist sort of perspective, it's a much more holistic
Speaker 2: orientation towards your life and life experience. And you know,
Speaker 2: we probably aren't capturing that level of nuance with like
Speaker 2: a twenty four item questionnaire. But then there are other
Speaker 2: researchers who sort of triangulate on the concept by looking
Speaker 2: by taking objective measures of attention, so like measuring attention
Speaker 2: control and impulsivity.
Speaker 1: And is a lot of that trait mindfulness? Is some
Speaker 1: of that just executive function? Is that frontal lobe stuff?
Speaker 1: Is that innate or is it situational?
Speaker 2: Well so, yeah, great question, thank you. Yeah. The brain
Speaker 2: regions that would correspond to better mindfulness, you know, in
Speaker 2: terms of what we see in like fMRI results, Yeah,
Speaker 2: would be prefrontal cortex and then the HPA axis, which
Speaker 2: is I'm not a neuroscientist, but you know it's just
Speaker 2: which is like your hypothalamic pituitary adrenal axis, which kind
Speaker 2: of regulates like fear and memory. So there's one kind
Speaker 2: of famous study where a bunch of very accomplished meditators,
Speaker 2: you know, ten thousand hours plus meditation experience. So monks
Speaker 2: were asked to look at disturbing images, so you know,
Speaker 2: like horrible pictures like babies with tumors on their faces
Speaker 2: and things like that while practicing a loving Kindness meditation,
Speaker 2: and they showed a lot of prefrontal cortex activation, whereas
Speaker 2: people who were non meditators showed a lot of amigdala activation,
Speaker 2: so revulsion, fear, distress.
Speaker 1: So for more on this, you can see the two
Speaker 1: part Theorology episode in which we get to know our
Speaker 1: brains a little screaming almond of terror the amygdala. Also,
Speaker 1: I went to look for that specific study, but there
Speaker 1: had been several like it, so I added some of
Speaker 1: the details that Nick mentioned and came up with some
Speaker 1: research papers about pediatric facial tumors, which was not what
Speaker 1: I was intending. But moving on, So, there have been
Speaker 1: multiple studies looking at the brains of meditators, and some
Speaker 1: have been thrown a little bit of shade just because
Speaker 1: the principal investigator was a close personal pal of His Holiness,
Speaker 1: the Dalai Lama, so people thought perhaps they were biased,
Speaker 1: but that doctor was like, you're going to tell a
Speaker 1: cardiologist not to exercise? Come on. Nick himself is very,
Speaker 1: very committed and focused on evidence based research, and I
Speaker 1: found his PhD dissertation in it. Nick thanks his friends,
Speaker 1: who he says have put up with my predictable response
Speaker 1: to even the most trivial claims with okay, but where's
Speaker 1: the evidence. So yeah, he's a data dude.
Speaker 2: And yeah, that will make you better at your executive functions.
Speaker 2: We see that. Actually, a colleague of mine years ago
Speaker 2: in the same PhD program, did a study looking at
Speaker 2: a mindfulness based intervention with individuals with schizophrenia, and she
Speaker 2: found improvements in executive functioning following her intervention. So yeah,
Speaker 2: there's there are linkages there.
Speaker 1: So let's trace his path all the way from his
Speaker 1: pre academic beginnings. He got a BA in comparative religion
Speaker 1: at Columbia University. He studied mindfulness in India, did some
Speaker 1: teaching in LAOS, and got a master's in social work
Speaker 1: at UCLA and a PhD at USC where he's now
Speaker 1: also doing some post doc work. So can you tell
Speaker 1: me kind of what brought you to be interested in
Speaker 1: kind of a religious background? How that led to Trauma.
Speaker 2: I had a weird, like early interest in Buddhism. I think,
Speaker 2: like my my did a bunch of work in Japan
Speaker 2: growing up through all these books on Zen. I didn't
Speaker 2: study Zeen, but through all these books on Zen, and
Speaker 2: I would like look at them, you know, and just
Speaker 2: remember having this kind of weird fascination with them as
Speaker 2: a kid. And then when I went to college, I
Speaker 2: went to Columbia and the head of the religion department
Speaker 2: at the time was this guy, Robert Thurman, who was
Speaker 2: like the first Western monk ordained by the Dalai Lama.
Speaker 2: He's like this very charismatic, sort of interesting storyteller, and
Speaker 2: I totally was like, you know, hook line and sinker
Speaker 2: into it.
Speaker 1: I was curious what this guy was all about. And
Speaker 1: I looked him up and his face seemed hauntingly familiar.
Speaker 1: And then I read his bio and he's also Uma
Speaker 1: Thurman's dad. Also, Uma Thurman's mom was LSD advocate Timothy
Speaker 1: Leary's ex wife. Did you know that? Okay, I'm getting
Speaker 1: off track here. Anyway, Nick attended a lecture by Thurman,
Speaker 1: who's a Buddhist author and academic, and he was enthralled.
Speaker 2: So then I just started taking a bunch of the
Speaker 2: courses and I ended up studying abroad at this place
Speaker 2: called the Institute of Buddhist Dialectics, which is a kind
Speaker 2: of the monastic training college that's attached to the Di
Speaker 2: Lama's sort of temple compound in northern India from Dharmsala. Yeah,
Speaker 2: so so then I, you know, I was like learning
Speaker 2: from a guchet amnk Tibetan Buddhist philosophy. My father had
Speaker 2: just died, so I was like totally, yeah, I was
Speaker 2: not doing well, wasn't coping that well. So I sort
Speaker 2: of yeah, thanks. It was a long time ago at
Speaker 2: this point, but yeah, I appreciate it. So so I
Speaker 2: think all of that sort of led to my interest
Speaker 2: in Buddhism and how that intersects with trauma and coping
Speaker 2: with trauma. I don't think I was not traumatized in
Speaker 2: the DSM sense of the word. I mean I had
Speaker 2: not undergone a trauma. I was just like fucked up
Speaker 2: and disturbed and upset, you know, not coping well. I'd
Speaker 2: had a pretty like you know, sheltered life, I think,
Speaker 2: and so I just hadn't dealt with something like that,
Speaker 2: but yeah, so it just it helped me, I mean
Speaker 2: doing and I was doing like a formal meditation practice
Speaker 2: every day for a long time, you know, in this
Speaker 2: sort of monastic training context, and I just noticed that
Speaker 2: I was really much better able to handle my thoughts
Speaker 2: and feelings. I mean, I was like totally naive. I
Speaker 2: was like, huh, I wonder if anyone's ever thought about
Speaker 2: this before, like could we use this to help us
Speaker 2: with trauma? Of course, like people have been you know,
Speaker 2: doing this in a really rigorous way since like the
Speaker 2: nineteen eighties or maybe before even, but you know, naively,
Speaker 2: I was like, oh, this could be like my contribution.
Speaker 2: Oh god. And so I ended up doing some like
Speaker 2: teaching and development work in Laos, which is a Buddhist country,
Speaker 2: and I was just interested, like, you know, they were
Speaker 2: kind of developing from the ground up at that point.
Speaker 2: They didn't have a public health system really or like
Speaker 2: a mental health infrastructure really at all. Again, you know,
Speaker 2: naively and with a lot of hubers, I was like, oh,
Speaker 2: I bet I'd be a good therapist because like I'm
Speaker 2: pretty even keeled and this stuff doesn't freak me out,
Speaker 2: so maybe I should just go be a therapist. So
Speaker 2: I applied to a master's in social program. While I
Speaker 2: was there, I took the Jerry in Bangkok and then
Speaker 2: came back and got my master's at UCLA.
Speaker 1: I think that's a good self selection. Though. If you're
Speaker 1: like I can listen to people's problems and not get
Speaker 1: freaked out, I think that's good because there are plenty
Speaker 1: of problems that I'd be like, I'm growing more than
Speaker 1: you are. I'm at this A tier two is probably okay,
Speaker 1: but just in the fetal position, they're like.
Speaker 2: Yeah, they're not good. Yeah, right, you don't want to
Speaker 2: do that.
Speaker 1: But what was it like also as a as a Westerner,
Speaker 1: as a white dude, to go to countries and learn
Speaker 1: Where did you find that that was pretty rare or
Speaker 1: was it pretty common? Or how are you received?
Speaker 2: I mean, white privilege follows you everywhere in my experience,
Speaker 2: so like, yeah, I definitely had it in Southeast Asia too.
Speaker 1: So Nick says he lived in Laos for three years
Speaker 1: and formed relationships and friendships and became part of the community.
Speaker 1: And one thing that struck him was the multi generational living,
Speaker 1: so a household with grandparents and kids and uncles and
Speaker 1: aunts and brothers, and sisters. And he said in the
Speaker 1: three years he lived there, he could count on one
Speaker 1: hand the number of times he saw baby crying. There's
Speaker 1: just always someone holding the baby, tending to the kiddos.
Speaker 1: And it felt so different from life in the US,
Speaker 1: where I guess we got a lot of crime babies.
Speaker 1: How is it as someone who you know has a
Speaker 1: kind of a background in the US but studied abroad
Speaker 1: in so many different cultures, Why do you think Westerners
Speaker 1: are so bad at mindfulness and meditation? Why are we
Speaker 1: resistant to it? Why are we maybe ignorant of it?
Speaker 2: Yeah, I mean it's a good question. We talk about
Speaker 2: trade mindfulness, right, so there's the idea that there's some
Speaker 2: level of the trade and everybody. But I think like
Speaker 2: physical exercise is a good analogy. Everybody has some level
Speaker 2: of physical fitness, right, and it's going to be like
Speaker 2: in a bell curve probably, so like it's a normalized trait.
Speaker 2: So some people are just going to be more fit
Speaker 2: than others as a result of kind of their genetics
Speaker 2: and their behaviors, right, that interaction. And I think it's
Speaker 2: the same with my poments, Like some people are more
Speaker 2: just naturally attuned to that style of kind of cognitive
Speaker 2: management than others. But it's a malleable trait, so you
Speaker 2: can get better with practice in the same way that
Speaker 2: you will be able to do more push ups if
Speaker 2: you do them every day, or run farther if you
Speaker 2: do that every day. So you know, again, this is
Speaker 2: like beyond I think the science. But just my personal
Speaker 2: view is that we're in a culture that doesn't reward that,
Speaker 2: you know, because we're in the attention economy and like
Speaker 2: really smart people are trying to figure out how to
Speaker 2: consume more of your attention with shorter and shorter you know,
Speaker 2: bits of stimulus, and so we're literally practicing the opposite
Speaker 2: of mindfulness every day. I mean, when you get an
Speaker 2: email and feel like you have to respond to it
Speaker 2: in a minute, that's the opposite of mindfulness. So I
Speaker 2: just think we're culturally conditioned not to practice those skills.
Speaker 2: But I guess the short answers, I think our culture
Speaker 2: doesn't value mindfulness, even if we say we do.
Speaker 1: And when it came to trauma, how did you become
Speaker 1: a traumatologist? Like, at what point did you really zero
Speaker 1: in on that?
Speaker 2: You know, Yeah, it's a good question. Again, I guess, well,
Speaker 2: so my like clinical training, My first internship when I
Speaker 2: was doing my masters was at the VA here in
Speaker 2: West Lay and the impatient psychiatric unit. And so when
Speaker 2: you're in an impatient unit, you don't get to do
Speaker 2: a lot of therapy because people are like acutely ill.
Speaker 2: And the kind of goal of those units, for better
Speaker 2: or worse, it is like get people to calm down,
Speaker 2: and then you figure out where to discharge them and
Speaker 2: get them, you know, engaged in their services. I think
Speaker 2: some people get are freaked out by that, you know,
Speaker 2: because it's it's outside the bounds of your normal experience
Speaker 2: to see somebody who's floridly psychotic and like loud. I
Speaker 2: mean that it just freaks a lot of people out.
Speaker 2: But to me it didn't, and so I was like, oh,
Speaker 2: this is interesting. And then my kind of second training
Speaker 2: placement was at Harbor UCLA, which is an a county
Speaker 2: directly operated adult mental health clinic, and the everybody has
Speaker 2: almost everybody there had some kind of traumatic experience. May
Speaker 2: not have been there presenting problem, but it informed what
Speaker 2: was going on often and I learned how to do
Speaker 2: the one what's still now one of the gold standard
Speaker 2: PTSD treatments, which is called prolonged exposure. And I just
Speaker 2: loved that treatment because so it's an exposure protocol. It's
Speaker 2: essentially kind of the goal again is the gold standard,
Speaker 2: Like PTSD treatments are prolonged exposure, this thing called CPT,
Speaker 2: which is cognitive processing therapy. And then some people also
Speaker 2: consider EMDR to be one of those treatments, which I'm
Speaker 2: not trained in.
Speaker 1: So yes, exposure is a leading treatment to trauma therapy.
Speaker 1: And we'll talk about em DR later, but right now,
Speaker 1: suit up for some PE which is prolonged exposure. And
Speaker 1: from the sound of it, it might get just as sweaty, okay.
Speaker 2: But what it is essentially is getting the after doing
Speaker 2: a lot of informed consent and explaining you know, what
Speaker 2: the treatment is and what the roles are, and really
Speaker 2: laying out in detail what the roadmap is going to be.
Speaker 2: Like Basically, what you do is have the person develop
Speaker 2: a list of their most and least distressing experiences. So
Speaker 2: you know, you would start with something low like I
Speaker 2: don't know, like let's say the person had been like
Speaker 2: attacked in the parking lot of their grocery store at night,
Speaker 2: for example, So low on your list of SuDS, which
Speaker 2: is subjective units of distress. This list, it would be
Speaker 2: like thinking about in detail going to the grocery store,
Speaker 2: and that might put you at like a twenty out
Speaker 2: of one hundred, one hundred being the trauma event itself,
Speaker 2: like the worst thing it's ever happened, and then ninety
Speaker 2: might be going to that same parking lot at that
Speaker 2: same time alone. That might be like high on the
Speaker 2: list of SuDS. So you develop that list, and then
Speaker 2: the person recounts to you in detail their worst traumatic
Speaker 2: experience and you record that and they do it over
Speaker 2: and over for thirty or so minutes, and you're checking
Speaker 2: in and you know, but you're not. And you also,
Speaker 2: before doing that, you teach relaxation skills, like you know,
Speaker 2: progressive muscle relaxation, deep breathing, things that physiologically relax the body,
Speaker 2: and you have them narrate that experience again and again
Speaker 2: and again. Like usually in the beginning it's like five
Speaker 2: minutes because there are disturbances of memory gaps in the memory.
Speaker 2: Person wants to get through it. It's it's upsetting. Then
Speaker 2: you're like great now again. So you don't do a
Speaker 2: lot of like kind of traditional talk therapy while the
Speaker 2: person is relating their experience, and it's very distressing for people.
Speaker 2: I mean, imagine someone has been trying to not think
Speaker 2: about this experience for however long and now they're like
Speaker 2: giving you the most detail they can about it. Yeah.
Speaker 1: I just literally got goosebums.
Speaker 2: Yeah, it's terrifying and people, I mean people really become
Speaker 2: upset in the session. I mean people are crying, you know,
Speaker 2: like they don't want to do it. And then they
Speaker 2: would listen to the tape afterwards and you know, do
Speaker 2: some of that, like some of what we call in
Speaker 2: vivo practice where they would approach some of the stressors
Speaker 2: on that SuDS list and then you know, do relaxation
Speaker 2: afterwards this process and what happens is people habituate to
Speaker 2: their distress. So, you know, an analogy, you'd be like
Speaker 2: watching a horror movie. If you watch the scariest movie
Speaker 2: you've ever seen, but every time the worst scene comes on,
Speaker 2: you cover your eyes and look away. The hundredth time
Speaker 2: you watch it, it's still going to be terrifying. But
Speaker 2: if you force yourself to watch it again and again
Speaker 2: and again and again and again, well the hundredth time
Speaker 2: you watch it, it's not going to be pleasant, but
Speaker 2: it's not going to be horrifying to you because you've
Speaker 2: habituated to that experience.
Speaker 1: I went to add an audio clip from the Exorcist
Speaker 1: and I started to google it and then I was
Speaker 1: like no, no, no, and I chickened out. So point taken,
Speaker 1: doctor Nick.
Speaker 2: But that's kind of the Yeah, underpinning of most trauma
Speaker 2: treatments is this idea of habituation to distress.
Speaker 1: When you're talking trauma, what exactly is trauma? I know
Speaker 1: that that's so subjective, And when you're talking about people
Speaker 1: who are in active firefights where people many people at
Speaker 1: once are trying to kill them, Yeah, and their closest
Speaker 1: friends are dying around them. It doesn't get a whole
Speaker 1: lot worse than that. And I know that having studied
Speaker 1: in LAOS too, I'm sure that you saw people who
Speaker 1: had been through a lot of that too, I mean,
Speaker 1: having done some work there. But how do you quantify
Speaker 1: what trauma is?
Speaker 2: Yeah? So it's a really good question. I mean, you
Speaker 2: know there's the DSM definition, which is essentially, you know,
Speaker 2: there are like four symptom clusters which are re experiencing
Speaker 2: a voidantce arousal like physiological arousal and cognitive and emotional
Speaker 2: symptoms like kind of numbing.
Speaker 1: Nick says that between two versions of the Diagnostic and
Speaker 1: Statistical Manual of Mental Disorders aka the DSM, the parameters
Speaker 1: of PTSD changed. And I look this up and they
Speaker 1: added involuntary to intrusive, distressing recollections of the event, And
Speaker 1: instead of the kind of vague symptom of having a
Speaker 1: sense of a foreshortened future, they now say persistent and
Speaker 1: exaggerated negative beliefs or expectations about oneself, others, or the world,
Speaker 1: and a persistent inability to experience positive emotions. So what
Speaker 1: else has changed?
Speaker 2: So it used to be like you have to experience
Speaker 2: something that made you feel like you were going to die,
Speaker 2: and now it's you could experience it makes you feel
Speaker 2: like you're gonna die. You could hear about it in
Speaker 2: a lot of detail firsthand, not on TV is a stipulation,
Speaker 2: but you know, you could hear about that happening to
Speaker 2: a friend or family member, or if in the course
Speaker 2: of your work you're exposed to the details of horrible
Speaker 2: things a lot like police officers who are you know,
Speaker 2: having to like search for child predators and are exposed
Speaker 2: to like child pornography and things like that. You know,
Speaker 2: they are also covered under that criteria. A so the
Speaker 2: definitions are still evolving. I mean, that's the current DSM criteria.
Speaker 2: But you know, PTSD wasn't added til the to the
Speaker 2: DSM until the seventies by a group of Vietnam veterans
Speaker 2: who advocated for its inclusion, even though we know people
Speaker 2: have been experiencing PTSD symptoms since the first human being
Speaker 2: did something terrible to the second human being, you know,
Speaker 2: and it was called shell shock for a while, was yeah,
Speaker 2: soldier's hard shell shock. I mean, it's been called different things,
Speaker 2: and some of the symptoms have been different, but there's
Speaker 2: kind of this underlying I think, you know, disturbance in
Speaker 2: fear and memory and some brain regions associated with those things.
Speaker 2: Although now we have this this you know, kind of
Speaker 2: more emergent field of inquiry which is looking at something
Speaker 2: called moral injury, which can look like PTSD, but is
Speaker 2: more related to people's experience of betraying values, like either
Speaker 2: they've betrayed their own values or someone important has betrayed
Speaker 2: shared values, and the symptoms kind of follow from that
Speaker 2: more than like this fear processing problem.
Speaker 1: So quick as I Moral injury is a term that
Speaker 1: arose to describe what soldier's experience when they, in the
Speaker 1: course of service, do things that otherwise contradict their values.
Speaker 1: But in reading further about it, I found one article
Speaker 1: by Simon in Talbot and Wendy Dean about how physicians
Speaker 1: and healthcare providers suffer not just from burnout but from
Speaker 1: moral injury because the US healthcare system doesn't allow them
Speaker 1: to provide services that they want to anyway, Be nice
Speaker 1: to your nurses and doctors and veterans and your psychologists
Speaker 1: and neuroscientists who write the manuals about this stuff.
Speaker 2: So I mean, but yeah, that's kind of a rough
Speaker 2: overview of the DSM. But really, I think you know,
Speaker 2: you don't need to have been in a firefight to
Speaker 2: have experienced a trauma. It's really when you have an
Speaker 2: overwhelming sense of fear, shame, yeah, terror, helplessness that is
Speaker 2: beyond your capacity to regulate, and that experience causes problems
Speaker 2: and your ability to remember and process fear.
Speaker 1: How do you know if maybe something you went through,
Speaker 1: either emotionally or physically, has caused PTSD, How do you
Speaker 1: know if it's interfering to that to that extent.
Speaker 2: Yeah, so that's a good question too. So all the
Speaker 2: DSM diagnosis carry this requirement that it caught that they
Speaker 2: the symptoms you're experiencing have to cause problems in your life,
Speaker 2: so you know, they have to be interfering with your
Speaker 2: ability to Usually it's like the two core domains, right,
Speaker 2: like work and relationships, So they have to be interfering
Speaker 2: with those core domains.
Speaker 1: Okay, hold on to your butts because this next fact
Speaker 1: truly surprise me.
Speaker 2: So it's possible that someone could and in fact, most
Speaker 2: people who experience trauma don't develop PTSD. What really, by
Speaker 2: far most the prevalence in the national population is like
Speaker 2: seven percent, and in veterans it's like between you know,
Speaker 2: eleven and thirty percent, depending on what kind of population
Speaker 2: we're looking at. But even if you take thirty percent,
Speaker 2: I mean, seventy percent of people don't develop PTSD, and
Speaker 2: presumably some of them are experiencing traumas. But you know,
Speaker 2: it's also possible to have negative experiences cause you problems
Speaker 2: even though you don't have full blown DSM five criteria PTSD.
Speaker 2: I mean, we know from the literature that that's the case.
Speaker 2: I would encourage people to consult with a professional. They can, like,
Speaker 2: you know, go to therapy, like people, everybody should go
Speaker 2: to therapy. So go to therapy if you can. But yeah,
Speaker 2: if you feel like there's this memory of something that
Speaker 2: happened to you that's causing you a lot of problems
Speaker 2: and you're experiencing a lot of distress having nightmares, you know,
Speaker 2: you can't relax. It's intruding on your day to day life.
Speaker 1: Okay, So more on access to therapy later in this episode,
Speaker 1: trust all, pod Dad, we're going to go over some
Speaker 1: resources for y'all.
Speaker 2: Probably worth talking to somebody about it, you know.
Speaker 1: And are there any myths about PTSD or how it's
Speaker 1: handled kind of pop culturally that you cringe out that
Speaker 1: you wish you could dispell.
Speaker 2: Well, I mean, I just think we use the word
Speaker 2: too loosely. I mean it's there's like a balance, right.
Speaker 2: I certainly don't think that, you know, we should. It's
Speaker 2: not helpful for anyone to think, like, oh, what I
Speaker 2: went through isn't as bad as like being shot at
Speaker 2: for a nine month combat deployment, So like I should
Speaker 2: just shut the fuck up, Like, no, that doesn't help anybody,
Speaker 2: It doesn't help you. It doesn't help people in your life.
Speaker 2: At the same time, I think we do over use
Speaker 2: the word a lot, and we'll be like, oh, that
Speaker 2: exam traumatized me, you know, and and you know that's
Speaker 2: I think that's just how we use the word now.
Speaker 2: But I think we just have to be careful about that,
Speaker 2: you know, not fragilizing ourselves and at the same time
Speaker 2: being really honest about when we are having problems.
Speaker 1: So does Nick have any festering flim flam he wants
Speaker 1: to debunk. Let's bust a couple of myths.
Speaker 2: One myth that I hear a lot, and I hear
Speaker 2: this from a lot of veterans, so I think I
Speaker 2: should just mention it is that, you know, most veterans
Speaker 2: are doing great. Most veterans do not have PTSD. Most
Speaker 2: most veterans cope really well. In fact, there's this thing
Speaker 2: called the healthy soldier effect, which suggests that in general,
Speaker 2: military veterans are better able to cope with difficulties than
Speaker 2: the civilian population because they're very highly trained and they're
Speaker 2: self selecting. You know, we don't have a draft, So
Speaker 2: most veterans are doing well. There's like this myth of
Speaker 2: the sick like fucked up veteran and that does not
Speaker 2: reflect a large popul the larger population of veterans. So
Speaker 2: I think it's important to say that at the same time,
Speaker 2: we do have this subset of veterans who really need help,
Speaker 2: and we can do a much better job in getting
Speaker 2: them help, and we're not doing a great job right now.
Speaker 2: So you know, both those things are true at the
Speaker 2: same time.
Speaker 1: So another nugget of flim flammery Nick says not in
Speaker 1: those words, is that there is a misperception that PTSD
Speaker 1: and trauma treatment is just a done deal. We know
Speaker 1: what we need to know. And he says, boy howdie,
Speaker 1: that is not the case, and we need much more
Speaker 1: research into some new ways to treat PTSD. Even of
Speaker 1: the veterans who seek and get good therapies like prolonged exposure,
Speaker 1: a lot of them still meet criteria for PTSD after
Speaker 1: they complete the treatment. So Nick thinks mindfulness is promising,
Speaker 1: but there's a lot of debate in the field about
Speaker 1: how effective mindfulness based interventions are for PTSD. And remember
Speaker 1: he's an evidence loving data nerd. In all he says,
Speaker 1: we need more research, we need more treatments.
Speaker 2: I think there's also some evidence that there could be
Speaker 2: like a propilactic effect to do in mindfulness practice. So
Speaker 2: if you do do a lot of mindfulness and you
Speaker 2: have an adverse experience, there's probably a bit of a
Speaker 2: protective effect against developing PTSD. So I think it's worth doing.
Speaker 2: But to get to your question, I would say it's
Speaker 2: really about what it's like exercise, what you like to
Speaker 2: do and whatever. It's easier for you to keep on
Speaker 2: dooing consistently is probably the best thing, So that might
Speaker 2: be like an app. Some people love that. If it
Speaker 2: makes it easier for you to do the practice, you
Speaker 2: should do that. Other people want to be in like
Speaker 2: a group, you know, they might go to, like a
Speaker 2: meditation group. I know there are a lot of those
Speaker 2: in LA. If that makes it easier for you to
Speaker 2: do the mindfulness practice, you should do that. So it's
Speaker 2: other people don't like to do that. They just want
Speaker 2: to practice on their own. They want to just do
Speaker 2: like a breath stabilization. I mean, there's so many resources.
Speaker 2: You can have someone guide you through a meditation on
Speaker 2: YouTube and any accent that you want, you know, male, female,
Speaker 2: So yeah, yeah, So it really is about what works
Speaker 2: best for you.
Speaker 1: So just in terms of apps, just side note to
Speaker 1: say I've been using Calm and I really love it,
Speaker 1: and they are sponsors of the show, not this episode
Speaker 1: in particular, but I just want to say I generally
Speaker 1: prefer it, just saying they're not having an ad this episode.
Speaker 1: But if you do want to try them for seven
Speaker 1: days for free, you can Calm dot com. If you
Speaker 1: decide to get a yearly subscription, you can get twenty
Speaker 1: five percent off using calm slash ologies if you want to,
Speaker 1: so very least there's a free trial. Now, what if
Speaker 1: apps are just not for.
Speaker 2: You people are more interested in like a Buddhist you know,
Speaker 2: like adhering a little more closely to like a traditional
Speaker 2: Buddhist perspective. There's a great book called What the Buddha
Speaker 2: Taught by wall Polo Rahula, which is like a free pdf.
Speaker 2: Now that's like a great place to start. That's really
Speaker 2: I think, what's what's easiest for you? Like, not everybody
Speaker 2: needs to go do CrossFit, you know, so not everyone
Speaker 2: needs to go do like a ten day meditation retreat.
Speaker 2: If you like that and that helps you do it,
Speaker 2: you know, if you prefer to like do the equivalent
Speaker 2: of taking a walk around the block, which is maybe
Speaker 2: just like sitting down and doing some deep breathing for
Speaker 2: five minutes on your setting your funnel arm in the morning.
Speaker 2: Do that. That's great.
Speaker 1: So whatever you do is the best.
Speaker 2: Yeah, whatever you can keep doing is the best.
Speaker 1: Yeah, exactly, that's so good to know. Yeah. I'm not
Speaker 1: going to run an iron man me either.
Speaker 2: That's wrong with those people.
Speaker 1: Obviously, thing is wrong with people who go hard. But
Speaker 1: just FYI, if you're wondering what is an iron man,
Speaker 1: it's two point four miles swimming, one hundred and twelve
Speaker 1: miles biking, and then you just top it off with
Speaker 1: a marathon for dessert, all in one day. It takes
Speaker 1: like ten hours. A lot of people don't even stop
Speaker 1: to potty, and I respect that so much, but it
Speaker 1: sounds more terrifying than watching The Exorcist on a Jumbo tron.
Speaker 1: Do you have friends in your life that come to
Speaker 1: you san yo, Nick, whatever, it's me, I had this
Speaker 1: really bad thing happened. What do I do?
Speaker 2: I mean, I don't do like I wouldn't do therapy
Speaker 2: with my friends, you know, but I don't think that's
Speaker 2: a good idea. Even though everyone in a clinical graduate
Speaker 2: program absolutely does do that. In the beginning, everyone does it,
Speaker 2: and everyone realizes this is a terrible idea.
Speaker 1: It's diagnosing everyone in your.
Speaker 2: Yeah, and yourself. Yeah. I have a lot of conversations
Speaker 2: with friends who are like, hey, you know I'm having
Speaker 2: this problem. Can you give me a suggestion about what
Speaker 2: I might want to try? Yeah?
Speaker 1: For sure. Can I ask you some Patreon questions?
Speaker 2: Of course?
Speaker 1: Yeah.
Speaker 2: Please.
Speaker 1: I have a stack of several several pages.
Speaker 2: Yeah, bring them up.
Speaker 1: Okay, he is down. But before your Patreon questions, a
Speaker 1: few words from sponsors. I like so much. Also, they
Speaker 1: make it possible for us to donate to a charity
Speaker 1: every week of the ologists choosing, and this week Nick
Speaker 1: picked National Military Family Association founded in the Vietnam War
Speaker 1: era by military spouses, and they are the go to
Speaker 1: source for members of Congress and politicians when they want
Speaker 1: to understand the issues facing military families. So they provide
Speaker 1: support for veterans, their kids, their families. More info is
Speaker 1: at Militaryfamily dot org. And this episode comes out on
Speaker 1: the heels of Memorial Day in the US and May
Speaker 1: is Military Appreciation Month. So a sincere thank you to
Speaker 1: everyone who has served and to their families for the
Speaker 1: sacrifices and thanks to the following sponsors who made that
Speaker 1: donation possible. Okay, back to your questions. So this is
Speaker 1: from Shannon my trauma question. If someone grows up with
Speaker 1: a parent with major PTSD and feels like there's definitely
Speaker 1: transferred trauma, what would your advice be to both treat
Speaker 1: that and help break the cycle going forward for their
Speaker 1: own children.
Speaker 2: Yeah, that's a great question. I'm a huge I'm a
Speaker 2: huge advocate for competent professional treatment. So I would go
Speaker 2: and see a therapist who is trained in PTSD treatment
Speaker 2: and they should tell you what modalities they're trained in.
Speaker 2: We know that there's intergenerational transmission of trauma. I mean
Speaker 2: not all the time, but you know that's certainly a
Speaker 2: real phenomenon.
Speaker 1: Okay, quick aside. I did a little digging on this
Speaker 1: and it's fascinating. So there are so many studies on
Speaker 1: this topic dating back thirty or forty years studying the
Speaker 1: offspring of survivors of the Holocaust and in one World
Speaker 1: Psychiatry paper titled Intergenerational Transmission of Trauma effects Putative role
Speaker 1: of epigenetic mechanisms. First off, I did have to look
Speaker 1: up putative and it means like reputed. And this study
Speaker 1: reports that psychologists were noticing that children of survivors were
Speaker 1: having issues with overidentification with a parent. There were self
Speaker 1: esteem impairments because they would just minimize their own life
Speaker 1: troubles in comparison to the parent trauma, which totally makes sense.
Speaker 1: There is a tendency toward catastrophizing and worry anxiety, nightmares,
Speaker 1: there's hypervigilance of dangers and some difficulties in interpersonal relationships.
Speaker 1: So was this epigenetic where genes altered because of the trauma,
Speaker 1: And of course this can extend to so many populations
Speaker 1: from victims of colonization and slavery and genocide all over
Speaker 1: the globe. Researchers also looked at how maternal stress can
Speaker 1: affect the HPA stress handling in the womb, and also
Speaker 1: how parental care changes the way our genes are expressed.
Speaker 1: Now this is a big one. How does parental care
Speaker 1: change the way our genes work? There was one study
Speaker 1: in the nineteen eighties that just blue scientists a fuck away.
Speaker 1: They just lost it over this. So they separated mother
Speaker 1: rats with their newborns and then reintroduce them. Some of
Speaker 1: the pups in adulthood showed these altered responses to stress,
Speaker 1: and it turns out it wasn't the separation but the
Speaker 1: way that the mom rats welcomed them back, So more
Speaker 1: licking and grooming as a little, tiny baby rodent was
Speaker 1: shown to buffer some of the negative effects of the
Speaker 1: trauma for the lifetime of the baby rat. Now is
Speaker 1: this true for humans? Scientists note these things are really
Speaker 1: hard to test and study in humans because of so
Speaker 1: many factors, and also as adults, our exposure and our
Speaker 1: responses to stress change us all the time anyway, which
Speaker 1: is a fact that white and my eyes and made
Speaker 1: me rethink some of my life stressors. Okay, so what
Speaker 1: if you feel impacted from a parent or a relative,
Speaker 1: or a partner's trauma or trauma experience.
Speaker 2: I think one of the good things about our kind
Speaker 2: of contemporary information saturated societies that you can look up
Speaker 2: a lot of quality information. So I would look up
Speaker 2: like National Center for PTSD has a lot of really
Speaker 2: valuable information. They will link you to lists of providers,
Speaker 2: they will link you to which treatments are effective, they
Speaker 2: talk about symptoms, So yeah, I would do that. I
Speaker 2: also think like in terms of breaking that cycle. Second
Speaker 2: part of the question. I mean again, I'm like an
Speaker 2: advocate for mindfulness. So I do think it's worth trying
Speaker 2: some of that just because not necessarily that it's going
Speaker 2: to treat the person's trauma, but that it gives you
Speaker 2: some space in between your urges and your actions. And
Speaker 2: so if you're gonna respond, you know, if you're especially
Speaker 2: if there's another person, if you're going to respond in
Speaker 2: this way that is kind of driven by your own
Speaker 2: emotional urgency, but that isn't really consistent with your values.
Speaker 2: Doing mindfulness practice will give you a minute to or
Speaker 2: some space to notice that urge and then make a
Speaker 2: determination about whether the behavior, maybe it's a parenting behavior
Speaker 2: that you're going to do, is consistent with your kind
Speaker 2: of larger overall set of values. So that might be
Speaker 2: like another thing to do. But treatment, and so I
Speaker 2: really think it's critical that people who are having some
Speaker 2: of these problems try to go and get treated. There's
Speaker 2: no reason to keep suffering.
Speaker 1: Other than money, I guess fuck, other than money.
Speaker 2: Yeah, there is pretty good treatment for like if you
Speaker 2: don't have any money, Like actually La County Mental Health
Speaker 2: there's some excellent clinicians and then there's really good treatment
Speaker 2: for people who have a lot of money. You know,
Speaker 2: you can just pay out a pocket, but it's really
Speaker 2: hard if you're in the middle to get access. Yeah,
Speaker 2: that's that's absolutely the case.
Speaker 1: How do you feel about those apps where you can
Speaker 1: kind of text a therapist.
Speaker 2: I am not up on the research in terms of
Speaker 2: their effectiveness. I imagine that there probably aren't great studies
Speaker 2: yet because it's so new. Look if it's working, if
Speaker 2: it's helpful and it's working, that's good. I think one
Speaker 2: issue though, is especially around trauma. If you have PTSD,
Speaker 2: talk therapy is like traditional kind of sit on the couch,
Speaker 2: what's wrong? Talk therapy isn't effective. We know it's not
Speaker 2: really yeah, so, and in fact, I think it can
Speaker 2: be unethical to do treatment with people where you're not
Speaker 2: actually treating the underlying problem. You're just the stress relief
Speaker 2: valve so that you know, they come in once a week,
Speaker 2: they blow off enough stress so that they can kind
Speaker 2: of hang on with their fingernails for the rest of
Speaker 2: the week until they come see you again. That's, in
Speaker 2: to mind mind, not responsible or ethical. I mean, therapy
Speaker 2: should be about learning the tools so that you can
Speaker 2: overcome the problems that you're having, and you can do
Speaker 2: that in many cases with PTSD. So you know, if
Speaker 2: you've been seeing the same therapist or texting with the
Speaker 2: same therapists for like a couple of months, three four,
Speaker 2: five months, your problem is PTSD and you haven't gotten
Speaker 2: any better, you need to see another therapist because that's
Speaker 2: it's not working. You know, if you feel as if
Speaker 2: something is working, your symptoms are getting better, you're not
Speaker 2: having those functional problems like in work and relationships, then
Speaker 2: that's probably yeah good, I'll maybe keep doing that. If
Speaker 2: you've been trying something for a while and your symptoms
Speaker 2: are not getting better and it's not kind of an
Speaker 2: evidence based treatment, then I would look for something else.
Speaker 2: You know.
Speaker 1: Gtfl Man had something.
Speaker 2: Yeah new, Yeah, exactly.
Speaker 1: Laura Evans wants to know what are some of the
Speaker 1: main differences between EMDR therapy and other forms of therapy
Speaker 1: like CBD, CBT.
Speaker 2: Yeah, not CVD, although that's promising as real.
Speaker 1: Okay, quick aside because an EMDR question was also asked
Speaker 1: by Mewmew and Bowie, Michelle Minert, Jenny Huntley, Erica Smith,
Speaker 1: and Ashley Hamer. But before we get to the EMDR
Speaker 1: and CBT. Let's real quick go over to the other
Speaker 1: therapies like CBD. Now, this is found in cannabis and
Speaker 1: not the THHC elements that make the Tobacci wacky. But
Speaker 1: a ton of papers have been published on cannabinoids, starting
Speaker 1: with Rodent models in two thousand and eight and then
Speaker 1: go into human trials four years later. And this one
Speaker 1: Front Neuroscience Journal article from twenty eighteen said, as observed
Speaker 1: in Rodent's recent studies have confirmed the ability of CBD
Speaker 1: to alter important aspects of adversive memories in humans and
Speaker 1: promote significant improvements in the symptomatology of PTSD. Also note,
Speaker 1: over use or abuse of cannabis, like the THHD part,
Speaker 1: has been correlated to folks suffering from PTSD, possibly from
Speaker 1: self medication. So if you're going to consider it as
Speaker 1: a therapy, do some research and talk to doc please,
Speaker 1: and thank you, love Dad. Now, as long as we're
Speaker 1: speaking in acronyms about experimental drugs, what about MDMA or
Speaker 1: the buttoned up lab name for ecstasy or molly that
Speaker 1: your roommate's cousin tries to score before going to a
Speaker 1: rave carnival in the desert. Well, it's being researched as
Speaker 1: a possible PTSD therapy if it's administered by therapists and doctors.
Speaker 1: Some folks say in two sessions two weeks apart is best,
Speaker 1: and some brain imaging studies have shown it may be
Speaker 1: able to help reduce activity in the amygdala to help
Speaker 1: overcome the reliving of the traumatic memories. But if you're
Speaker 1: going to consider it as a therapy, do some research.
Speaker 1: Talk to a doc please, and thank you, love Dad. Okay,
Speaker 1: EMDR is EMDR effective only for certain types of issues?
Speaker 1: How do you know what type of therapy will work
Speaker 1: for you? So EMDR CBT, and is CPT also another one?
Speaker 2: Have so many Yeah, a lot of acronyms. Yes, this
Speaker 2: is a big question. So okay, I would say so
Speaker 2: CBT cognitive behavioral therapy is like a giant umbrella, and
Speaker 2: underneath CBT cognitive behavioral therapy a lot of different treatments fall.
Speaker 2: So EMDR, which is I movement, desensitization and reprocessing. I believe.
Speaker 2: So again, I'm not trained in EMDR, but basically what
Speaker 2: EMDR is is like I'm not certified to do EMDR.
Speaker 2: I am to do pronged exposure and cognitive behavior therapy.
Speaker 2: But my understanding of EMDR is that there is a
Speaker 2: pairing of your kind of talking about the experience with
Speaker 2: this bilateral stimulation, which is like you know, either visually
Speaker 2: someone moving a finger back and forth or like a
Speaker 2: sound in the ear. And I think the hypothesis is
Speaker 2: that by engaging the brain and processing that other stimulation,
Speaker 2: you take some of the emotional balance away from narrating
Speaker 2: the trauma experience.
Speaker 1: EMDR bye. The BYE was discovered in nineteen eighty seven
Speaker 1: by now psychotherapist doctor Francine Shapiro, when by chance she
Speaker 1: was walking through a park. She was hella bummed. She's like, ough,
Speaker 1: this hurts. And then she noticed that when she glanced
Speaker 1: rapidly back and forth, maybe there was a squirrel, a bird,
Speaker 1: I'm not sure. Her troubling thoughts seemed to subside. She
Speaker 1: was like, hot dog, I'm gonna go get a PhD
Speaker 1: about this. So to see more research on it, there
Speaker 1: is plenty. Go to nih dot gov the page for
Speaker 1: the National Institutes of Health and you can just tippity
Speaker 1: tappity EMDR and a whole boatload of studies come up. Now, Nick,
Speaker 1: who's a stickler for evidence, has an in mind.
Speaker 2: Now, it's not clear that EMDR without the bilateral stimulation
Speaker 2: is better than EMDR with it, so you know, that's
Speaker 2: kind of an interesting finding. But if you have someone
Speaker 2: who's trained in EMDR and you are doing EMDR and
Speaker 2: you are getting better, awesome, I would keep doing that.
Speaker 2: The difference with the with like cognitive processing Therapy CPT
Speaker 2: and problemed exposure is that those two are explicitly exposure
Speaker 2: based protocols, and EMDR doesn't call itself an exposure based
Speaker 2: protocol even though I think it is. I mean, if
Speaker 2: you're talking about your trauma experience, that's exposure. But prommed
Speaker 2: exposure and CPT are explicitly exposure based protocols, and the
Speaker 2: mechanism of action at work there is exposure. Again, it's
Speaker 2: really about what's more, what you're more amenable to trying,
Speaker 2: Like the one that you are going to complete is
Speaker 2: the one that you should do. You know, there's a
Speaker 2: lot of dropout in PE, So dropouts.
Speaker 1: In PE can be common, not unlike when everybody happened
Speaker 1: to be sick on the day we had to run
Speaker 1: the mile. But Nick says pe prolonged exposure dropout may
Speaker 1: be high because the recall is just so distressing at first,
Speaker 1: and others might not like the cognitive behavioral therapy because
Speaker 1: there's some homework involved. So in order for to work
Speaker 1: for you, the type of therapy should be a good fit.
Speaker 1: You can't hate it.
Speaker 2: I think it's important to ask the therapist what they're
Speaker 2: trained in, what they think the issue is, and what
Speaker 2: the treatment plan is. And if they can't answer those questions,
Speaker 2: I don't think that's a great person to see. I mean,
Speaker 2: you know, but there are a lot of paths to
Speaker 2: the garden. You know, a lot of different modalities can work.
Speaker 2: If it's trauma specific, I would focus more on those
Speaker 2: trauma specific interventions. But again it's really about what works.
Speaker 2: I mean, like equine therapy is emerging as like an
Speaker 2: effective trauma treatment, you know. I know this guy who
Speaker 2: runs motorcycle trips through the Horn of Africa for veterans
Speaker 2: with PTSD and they seem to So, you know, a
Speaker 2: lot of this stuff is probably not scalable for like
Speaker 2: a community you know, mental health clinic or like a
Speaker 2: national sort of system of clinics. I would work your
Speaker 2: way down from the things that are most well studied. Yeah,
Speaker 2: until you find something that's effective.
Speaker 1: How do you know if you've got a good therapist?
Speaker 1: How do you find a good therapist? And how do
Speaker 1: you know if you don't like your therapist or you
Speaker 1: don't like that it's not your problem?
Speaker 2: Yeah, well it might be. I mean, it might be
Speaker 2: your problem if you've tried like fifteen therapists.
Speaker 1: I had a therapist too. You read my astrological chart
Speaker 1: made me take a polaroid with both of her poodles.
Speaker 1: It's true. She told me that I wasn't married yet
Speaker 1: because something about a house in Pluto, and I was like, eh,
Speaker 1: but I like your weird poodles. I was like, all right, lady,
Speaker 1: did that work for you?
Speaker 2: No?
Speaker 1: And I kind of broke up with her overtext, and
Speaker 1: she just texted me back, okay.
Speaker 2: Yeah, like ouch. I mean that sounds like you handled
Speaker 2: that well. But who knows, maybe that is like helpful
Speaker 2: for someone. I mean, I don't know, Well, yeah, probably not.
Speaker 2: I mean, look, I think you know, therapist is like
Speaker 2: a provider, like a doctor, So like a physician or
Speaker 2: a primary yeah, primary healthcare doctor. I think you should
Speaker 2: probably interview a couple. I mean, there are those baseline questions,
Speaker 2: like what modalities are you trained in, what is the
Speaker 2: treatment plan for this disorder? Have you treated people with
Speaker 2: these problems before? If it's like, oh, treatment plan, I
Speaker 2: don't really do that, I kind of feel it out. Well,
Speaker 2: I don't know about that. You know, it's probably good
Speaker 2: to go maybe like once or twice. But if someone's
Speaker 2: really off putting you just don't like their personal style,
Speaker 2: that's okay. You know, find someone who you do like.
Speaker 2: I mean, in all the kind of like big effectiveness
Speaker 2: meta analyzes for different types of therapy, the factor that
Speaker 2: explains the most variance in outcome is the relationship with
Speaker 2: the therapist. This is like an often cited fact. So
Speaker 2: we're finding so regardless of what the modality is, if
Speaker 2: you don't feel like your relationship with the therapist is strong,
Speaker 2: it's unlikely you're going to have good outcomes.
Speaker 1: What if you're a dick and that's why you're going
Speaker 1: to therapy though.
Speaker 2: Yeah, and that's the case. Some people are dicks. Yeah,
Speaker 2: So if you're a dick and you are, no therapies
Speaker 2: are working, and you know it's like you think, man,
Speaker 2: I'm just I keep on, like I feel trapped in
Speaker 2: like my set of behavioral responses. You know, it might
Speaker 2: be worth going and getting like a really good assessment
Speaker 2: to try to figure out and you want to change that, right,
Speaker 2: if you're interested in changing.
Speaker 1: Right, some people don't want to change.
Speaker 2: Some people don't know. Some pop don't want to change,
Speaker 2: and hey, do your thing. Yeah, the world needs people
Speaker 2: like that too. I guess right.
Speaker 1: They're like, I'm making a lot of money this way.
Speaker 2: Yeah, right, I'm CEO. So you deal with it a
Speaker 2: bunch of different.
Speaker 1: People looking at you. Rachel Polifka, V CJ. Shower, Graham Tattersall,
Speaker 1: and Todd McLaren asked that they've heard that certain games,
Speaker 1: particularly Tetris I covered on one episode, distract the mind
Speaker 1: after a trauma and can make a big difference in recovery.
Speaker 1: Have you ever seen that in any veterans?
Speaker 2: Like, no, but this, I'm gonna look us up after
Speaker 2: we stop. Yeah Tetris Wow, I mean I don't know,
Speaker 2: I have not seen that.
Speaker 1: But how does trauma imprint itself? Like, if you distract
Speaker 1: yourself right after a trauma, will it imprint differently?
Speaker 2: Well, so this is a good question. So we know that,
Speaker 2: like early intervention is really important, but the type of
Speaker 2: early intervention matters. So there was this program that was
Speaker 2: like critical incident debriefing something like that. It was called
Speaker 2: which was like this, immediately following the trauma experience, they
Speaker 2: had the person debrief about it, and the evidence showed
Speaker 2: that made people worse. Oh yeah, so it it matters
Speaker 2: what type of treatment people do. So let's say you know,
Speaker 2: you have like a pretty stable life, your family life,
Speaker 2: your home life is healthy and good. You don't have
Speaker 2: a lot of negative experiences, you know, beyond the realm
Speaker 2: of the norm. And then you have like a single trauma,
Speaker 2: your odds of recovery are very good. Someone who has
Speaker 2: multiple sequential traumas, including like early childhood trauma, especially like
Speaker 2: early childhood sexual abuse, we know that's some of the
Speaker 2: most predictive of later problems PTSD, depression, anxiety.
Speaker 1: So quick aside. This, of course, can be greatly affected
Speaker 1: by socioeconomic and also some cultural factors. Clearly, and studies
Speaker 1: have shown that women and other marginalized genders are twice
Speaker 1: as likely to have PTSD at some point in their
Speaker 1: lives as men, and as a woman who has been
Speaker 1: mugged by guys with knives. I get this, but privilege
Speaker 1: also plays in yet again, of course, and in America,
Speaker 1: black people experience the highest prevalence of PTSD, but all
Speaker 1: minority groups were less likely to seek treatment for PTSD
Speaker 1: than white people because barriers to therapy could be everything
Speaker 1: from social stigma, cost to time off of work. And
Speaker 1: there's more on that later in the episode. But now
Speaker 1: getting back to video game studies, just type in Tetris
Speaker 1: to the nih dot gov website. I swear a whole
Speaker 1: budget reading.
Speaker 2: Yeah, I'm not aware of this, like of the kind
Speaker 2: of Tetris. Although that's cool, I'm interested in that. Yeah,
Speaker 2: I'm gonna hop on Google scholar. But but yeah, again,
Speaker 2: I think, you know, because I am an empiricist, I
Speaker 2: do think that it's best to just start with the
Speaker 2: things that are most well studied, you know, I think
Speaker 2: in general that's like a good default. But you know,
Speaker 2: just because something has been studied doesn't mean it doesn't work.
Speaker 2: Like there are now these kind of emergent virtual reality
Speaker 2: kind of exposure based protocols. Those seem to be very promising.
Speaker 1: Oh wow. Yeah, so if you had a bad experience
Speaker 1: with a spider, you just go into a VR and
Speaker 1: spider Town and you're over it.
Speaker 2: Spider Town. Yeah, I mean that would be like flooding
Speaker 2: right where you like expose yourself to like the stimulus.
Speaker 2: That's not great for everybody, but that's again of an
Speaker 2: exposure based method. I mean, look, it's not going to
Speaker 2: hurt to play tetris. That's that I cannot imagine what
Speaker 2: the downside of that would be, you know, So especially
Speaker 2: things that are very low risk, like yeah, try it,
Speaker 2: why not? We also know that there's some there's some
Speaker 2: studies to show that, like pharmacological intervention right after trauma
Speaker 2: can blunt some of the memory encoding, so those things
Speaker 2: can be useful.
Speaker 1: Nick reminds us that he's not a psychiatrist, but explains.
Speaker 2: So, the two like neurotransmitters that are most closely tied
Speaker 2: to trauma are cortisol and norbin ephron. They're kind of
Speaker 2: like fight or flight neurotransmitters. But again, like you know,
Speaker 2: the brain of someone who's experienced a lot of childhood trauma,
Speaker 2: the way that they respond to him process those neurotransmitters
Speaker 2: is going to look different from the brain of somebody
Speaker 2: who had a trauma as a relatively healthy adult, you know.
Speaker 1: And looking this up, I found a study saying that
Speaker 1: cortisol and nourepinephrine levels were affected, and that these and
Speaker 1: a host of other changes in biology are likely the
Speaker 1: causes of more depression, substance use disorders, and medical issues
Speaker 1: like GI problems and immune system issues, also obesity and
Speaker 1: heart disease. So if you experienced any childhood trauma, there
Speaker 1: are so many reasons you deserve to heal and get
Speaker 1: some help to work through it. So a big hug
Speaker 1: goes out to the next patron, Julia who asked. Julie
Speaker 1: W said, I found out a couple years ago that
Speaker 1: a friend of my dad's who's now dead, sexually assaulted
Speaker 1: me when I was two to four years old. I
Speaker 1: have no recollection of this happening. She essentially says, is
Speaker 1: it possible that these traumatic experiences, remembered or not, along
Speaker 1: with other circumstances, could have contributed to twenty five years
Speaker 1: of depression and anxiety.
Speaker 2: It's certainly possible. Yeah. Yeah, So to kind of back
Speaker 2: up a little bit for that first part, some people will, yeah,
Speaker 2: they'll come in and say, you know, I know this
Speaker 2: thing happened to me, but I just don't remember it.
Speaker 2: And that's kind of especially at that age. It's part
Speaker 2: of the bodies like natural repertoire body and brains. Natural
Speaker 2: repertoire of protective mechanisms is to like try to not
Speaker 2: remember horrible things, and that's okay. You know, if you
Speaker 2: don't remember something horrible that happened to you, that's okay,
Speaker 2: that that might be good, you know. And so I
Speaker 2: don't think it's a good idea to try to recover
Speaker 2: those memories, you know, if it's now, if you're coming
Speaker 2: in and it's like, this thing happened to me, and
Speaker 2: just the knowledge of that it's not provoking symptoms of PTSD,
Speaker 2: but the knowledge of that really fucking bothers me. That's
Speaker 2: a problem in and of itself to work on, you know,
Speaker 2: So that could be something absolutely to work on. We
Speaker 2: also know that that trauma is really embodied. I mean,
Speaker 2: I think one of the deficits and the more cognitively
Speaker 2: oriented treatment in the cognitively oriented treatment protocols for trauma
Speaker 2: but everything else too, is that they neglect physiology you
Speaker 2: a lot. And so like doing relaxation practices, doing deep breathing,
Speaker 2: progressive muscle relaxation, getting into the body, noticing where in
Speaker 2: the body you experience emotion. It's really critical and I think,
Speaker 2: especially for some people, like that's what they need more
Speaker 2: than like, Okay, I'm having this thought that's maladaptive. How
Speaker 2: do I collect evidence to adjust it? You know, some
Speaker 2: people don't want to do that, and it's not as
Speaker 2: useful for them. So I think it's certainly possible that
Speaker 2: events that you don't explicitly remember can have an impact
Speaker 2: and be experienced in different ways, like physiologically in terms
Speaker 2: of mood and emotion.
Speaker 1: Quick aside. So the next day I got a text
Speaker 1: from Nick, who wanted to add an afterthought. He said,
Speaker 1: I was reflecting on some of your patron's questions about
Speaker 1: what someone can do if they are reluctant to seek
Speaker 1: treatment but want to do some work on their own,
Speaker 1: he said. He mentioned physiological relaxation techniques and medication, which
Speaker 1: he says, I definitely think are a good idea, but
Speaker 1: wanted to add that getting good sleep, eating in a
Speaker 1: bat balanced and healthy way, avoiding alcohol and mood, altering
Speaker 1: non prescribed drugs, and scheduling some exercise and social interaction
Speaker 1: are also really helpful in facilitating well being and recovery. It's,
Speaker 1: of course tough to do those things consistently, but they
Speaker 1: can make a big difference. Thank you, doctor Nick for that.
Speaker 1: I should say, when I myself, I'm at my most
Speaker 1: balanced and happy, I do this thing called rem REM,
Speaker 1: and I should do it every single day of my life.
Speaker 1: I make this little weekly chart with the days on
Speaker 1: one side and then four columns on the other axis,
Speaker 1: and the rem REM stands for reading, exercise, meditation, and
Speaker 1: REM good sleep, And I try to hit each of
Speaker 1: those every day, even if it's just five minutes of
Speaker 1: like very tired burpies in the living room and five
Speaker 1: minutes of meditation and reading one page in a book
Speaker 1: and just trying to go to bed with the lights off.
Speaker 1: And right now I'm just gonna have a one on
Speaker 1: one really quick with myself. Eli Ward, Hi, it's me.
Speaker 1: Can you please do that again? Yeah, I'll get on it, ok.
Speaker 1: Thanks y.
Speaker 2: Yes.
Speaker 1: Helen Bubbawash asks I am an indigenous person. People talk
Speaker 1: about intergenerational trauma experienced by indigenous people. What causes trauma
Speaker 1: to be intergenerational? And Jenny Hay says yes.
Speaker 2: This, Yeah, so that's a great question too. So, I
Speaker 2: mean we think about groups that have been discriminated against, marginalized,
Speaker 2: and not only like discriminated against and marginalized, but we're
Speaker 2: the victims of violence, like you know, at higher rates. Well,
Speaker 2: you know, even if you personally didn't experience violence, but
Speaker 2: like let's say you're growing up with mom and dad
Speaker 2: in the house. Right, if mom and dad experienced violence
Speaker 2: and they have symptoms of trauma, which might include the
Speaker 2: beliefs like the world isn't safe and I'm not safe,
Speaker 2: and they're acting on those beliefs that the world isn't
Speaker 2: safe and I'm not safe and my kids aren't safe. Well,
Speaker 2: you are going to learn from that example, even if
Speaker 2: they're not ever saying that you, but their behaviors are
Speaker 2: demonstrating that point of view for good reason, because it's accurate. Well,
Speaker 2: you might incorporate that those views into your own behaviors, right,
Speaker 2: and feel unsafe. Which again, if you know, we're talking
Speaker 2: about trauma as like a kind of a disruption in
Speaker 2: the way that we process fear and memory, Well you
Speaker 2: can see that that it might kind of create those
Speaker 2: conditions in the brain of the person who has not
Speaker 2: directly experienced a trauma, but whose experience has been conditioned
Speaker 2: by these views that the world isn't safe and that
Speaker 2: they can't trust what's going on. They can't trust the world.
Speaker 2: So I think in that way we can start to
Speaker 2: see how how the experiences of trauma can be passed
Speaker 2: down generationally. You know, just also in the in terms
Speaker 2: of the way people process emotion. Right, if you have
Speaker 2: untreated trauma symptoms, and it's like, well, when disturbing emotions
Speaker 2: come up, my strategies avoid that, which makes a lot
Speaker 2: of sense. Who wants to experience distress? Right, So then
Speaker 2: you kind of learned that emotional coping style too. Al
Speaker 2: something bad comes up, avoid fuck the lements of mail.
Speaker 2: And we know that avoidance is one of the things
Speaker 2: that sustains PTSD symptoms. Right, If you avoid dramatic memories
Speaker 2: and emotions associated with the trauma, it perpetuates that cycle
Speaker 2: of experience. So if you're learning all those strategies and
Speaker 2: incorporating those beliefs as you grow up, that kind of
Speaker 2: can account for what we talk about when we say
Speaker 2: intergenerational transmission of trauma. That's the bad news. The good news, though,
Speaker 2: is that those are learned behaviors, and so you can
Speaker 2: learn other behaviors, so you can stop practicing those behaviors
Speaker 2: when you practice and rehearse different skills and behaviors, you
Speaker 2: acquire those faster than the ones you kind of passively absorb.
Speaker 1: So in pre plotting skills and coping, and you may
Speaker 1: be able to respond to emotional situations with less sweating
Speaker 1: and less frazzle, more calm, a little more chill. Your
Speaker 1: brain's like been there, survive that. Your brain essentially turns
Speaker 1: into like Kurt Russell wearing sunglasses in a nineteen eighties film,
Speaker 1: He's Cool. Absolutely, see yeah, does it form a neural pathway?
Speaker 2: Yes, yeah, absolutely, yeah, Like all behaviors, thoughts, feelings, urges,
Speaker 2: emotions are reflections of brain processes. Like that's what true
Speaker 2: empiricists would say. Anytime you learn a new pattern of behavior,
Speaker 2: you are changing and creating new neural pathways. Actually, you know,
Speaker 2: evidence shows that the effects of depression medications are immediated
Speaker 2: by what's called neurogenesis, which is the creation of new
Speaker 2: neurons in the brain. Changed behaviors are mediated by changing
Speaker 2: brain processes and brain structures. So yeah, absolutely, by doing
Speaker 2: new things, by rehearsing new ways of responding to distress,
Speaker 2: you are creating new pathways in the brain. Huh.
Speaker 1: That's interesting, that's very that's very optimistic.
Speaker 2: Yeah, totally. Yeah, Yeah, people are incredible resilient and the
Speaker 2: brain is too.
Speaker 1: And Jenny Hay also asks, can you speak about the
Speaker 1: different ways that trauma manifests in different people, like dissociation ADHD, OCD,
Speaker 1: eating disorders.
Speaker 2: Yeah, so, like the kind of DSM criteria point to this.
Speaker 2: These these kind of set of symptoms that are related
Speaker 2: to trauma, right, the re experiencing, avoidance, physiological arousal, cognitive numbing,
Speaker 2: those are the symptoms that really describe PTSD. But certainly
Speaker 2: there are other issues that people can have that can
Speaker 2: be informed by their experiences, including trauma experiences. So I
Speaker 2: wouldn't say there's no evidence to suggest that like ADHD
Speaker 2: is as a result of trauma. I don't think there's
Speaker 2: like a cause a link there. So disordered eating behavior
Speaker 2: can definitely manifest in the context of trauma. Many of
Speaker 2: the trauma patients I worked with also had disordered eating behaviors. Yeah,
Speaker 2: so that was very common OCD. I think, like true,
Speaker 2: OCD tends to be very organic in the brain. So
Speaker 2: is it possible that people could use that kind of
Speaker 2: compulsive behaviors could arise in relationship to traumatic experiences?
Speaker 1: Yeah?
Speaker 2: Absolutely, So if your problem is like I, you know,
Speaker 2: I'm binging and purging, for example, I would try to
Speaker 2: treat that problem first. And in the context of treating
Speaker 2: that problem, if trauma emerges, if it's like, yeah, every
Speaker 2: time I think about this thing that happened to me,
Speaker 2: I want to binge and purge. Okay, well, now we
Speaker 2: have this like explicit linkage that's emerged, you know, and
Speaker 2: we can work on that pathway because that's a pathway
Speaker 2: to behavioral pathway. It's a pathway in the brain.
Speaker 1: It's so weird to think that you have these little
Speaker 1: trails you've carved out in your brain. Totally going to
Speaker 1: go on this trail I've been on before, and you're like, damn,
Speaker 1: I kind of make a new trail.
Speaker 2: That's such a great example. And I actually use that analogy.
Speaker 2: And so here's like to kind of develop that analogy
Speaker 2: further is if you are it's like a freeway, it's
Speaker 2: a freeway with no traffic. Right, Let's say there's this
Speaker 2: linkage every time you remember this person or this thing
Speaker 2: that happened, it makes you want to engage in X behavior.
Speaker 1: Okay, so right now, think about a thing that freaks
Speaker 1: you out and then maybe not so great behavior you
Speaker 1: used to cope.
Speaker 2: Yeah, you getting on a freeway. Well, that is like
Speaker 2: a freeway in your brain. It's so well rehearsed because
Speaker 2: you practice it many, many times. But when you start
Speaker 2: to practice an alternative behavior like this is I know,
Speaker 2: this is like a very reductionist and simplistic. It's absolutely
Speaker 2: not this easy. But let's say, for example, you had
Speaker 2: that memory, you observe the urge to engage in a
Speaker 2: target behavior, a problem behavior, and then you're like, Okay,
Speaker 2: you know what I'm gonna do instead is I'm going
Speaker 2: to do ten cycles of deep breathing five seconds in,
Speaker 2: five seconds out, and then I'm going to see what
Speaker 2: my urge is afterwards. If you do that, you are
Speaker 2: to use our roads analogy, you're kind of bushwhacking a
Speaker 2: tiny trail through the jungle.
Speaker 1: That's a lot.
Speaker 2: You have this super highway of your old behavior and
Speaker 2: now this tiny trail that you've kind of bushwacked for
Speaker 2: the jungle with this alternative behavior. But the more you
Speaker 2: practice that alternative behavior, the wider and smoother that new
Speaker 2: trail gets, and the more overgrown that old highway gets,
Speaker 2: and eventually that old highway will return to the jungle,
Speaker 2: and you'll have this new behavioral pathway that you practice
Speaker 2: and rehearse over time. Boy, getting off the freeway makes
Speaker 2: you realize how important love is. So I think it's
Speaker 2: a really good analogy. But yeah, I mean to kind
Speaker 2: of pull back a little bit and answer this question
Speaker 2: from like a clinical perspective. It's possible that trauma can
Speaker 2: play a role in the constellation of causes and conditions
Speaker 2: that lead to contemporary problem behaviors. Absolutely, I think people
Speaker 2: should avail themselves of the best evidence that we have
Speaker 2: right now, and that is, we have particular treatments that
Speaker 2: the evidence suggests work best for particular disorders and so
Speaker 2: or particular problems. And so I think it really makes
Speaker 2: sense to find someone who's experienced and trained in treating
Speaker 2: whatever the problem is that you're having and try that first,
Speaker 2: and if it doesn't work, then we can again work
Speaker 2: our way down. You know.
Speaker 1: So, if you're feeling like you're struggling, get some help
Speaker 1: if you can. It doesn't mean there's anything wrong with you.
Speaker 1: It just means you're human. You deserve to heal. Now,
Speaker 1: we all know that a huge block to therapy is
Speaker 1: just cost. I get that so hard. I put out
Speaker 1: a tweet over the weekend asking folks how much cost
Speaker 1: plays into their access to therapy, and out of fifteen
Speaker 1: hundred responders, ninety three percent of you said cost was
Speaker 1: a huge block. So I asked if anyone wanted to
Speaker 1: share any tips, and here are some resources. Okay, I
Speaker 1: mentioned the site in the Addictionology episode, but Open Path
Speaker 1: Collective dot org is a wonderful site. It helps match
Speaker 1: you with therapists who provide low cost talk therapy to
Speaker 1: people who are uninsured or underinsured for between thirty to
Speaker 1: sixty dollars per session, and it costs a one time
Speaker 1: forty nine dollars fee to join, and then you're in
Speaker 1: for life. If you have insurance or can afford therapy
Speaker 1: but just aren't sure where to look for someone, try
Speaker 1: their sister site being seen dot org. Or there's a
Speaker 1: directory at Psychology Today that's really helpful. You can ask
Speaker 1: a therapist about sliding scale fees and they can adjust
Speaker 1: their prices depending on what you can afford. And if
Speaker 1: you're in a bad place and that just seems overwhelming,
Speaker 1: see if you can enlist a friend or relative to
Speaker 1: just help sit down and make some phone calls with
Speaker 1: you and line up some appointments or some interviews over
Speaker 1: the phone. Sometimes just getting a buddy to encourage you
Speaker 1: and get you started can make all the difference. Now
Speaker 1: some other options. There are apps that provide lower cost
Speaker 1: text or videotherapy. There's Larker, There's Better Help, there's talk Space.
Speaker 1: There's even seven cups, which is free and just staffed
Speaker 1: with the volunteers who are just active listeners. Though it
Speaker 1: can connect to you with a database of therapists if
Speaker 1: you need one. Now, if you have help insurance through work,
Speaker 1: you can ask about flexible spending accounts to allocate some
Speaker 1: toward therapy, or you can ask HR if there's any
Speaker 1: free crisis counseling for employees. Some larger companies will offer this.
Speaker 1: And when I was a newspaper reporter, it's so stressed out.
Speaker 1: I took advantage of this and got a few free
Speaker 1: therapy sessions, which was super helpful and in part convinced
Speaker 1: me to quit my job. There. Thank you when Listener
Speaker 1: said that for military families, military one source has been
Speaker 1: super helpful for her and her family. Also look into
Speaker 1: counseling centers or universities that have graduate student counselors who
Speaker 1: are therapists who are heavily supervised. So it's kind of
Speaker 1: like getting that therapist and then several of their teachers
Speaker 1: in one who kind of go over your case and
Speaker 1: give some advice. Now, feel free to interview the doctors
Speaker 1: or therapists over the phone. First, ask what their methods are,
Speaker 1: what kind of issues they treat, and Twitter user Nerdy
Speaker 1: Zebra chimed in to say that neurodiverse folks like anyone
Speaker 1: on the autism spectrum or with ADHD, should ask if
Speaker 1: the therapist has experienced treating similar patients, because tech therapy
Speaker 1: can have really different approaches. And they also say I
Speaker 1: should mention that depression and PTSD can be considered disabling
Speaker 1: and there are vocational rehab departments and even medicaid that
Speaker 1: might be able to help. And as for a prescriptions,
Speaker 1: a few folks on Twitter mentioned good rx is having
Speaker 1: good deals on prescription medication. Okay, this is along aside,
Speaker 1: And at this point I also apologized to Nick for
Speaker 1: hanging out in his living room for so long and
Speaker 1: preppering him with so many questions.
Speaker 2: Seriously, this is like really like fun and nice for me.
Speaker 1: So Christy Stewart wants to know how often do trauma
Speaker 1: victims display symptoms of echoism. I just learned about this term,
Speaker 1: and it's really fascinating that we recently came up with
Speaker 1: this term. I don't know what this term means.
Speaker 2: I don't either.
Speaker 1: Okay, I'll look it up. Okay, look this up and
Speaker 1: who boy? Okay, wow, real quick. Echoism is when a
Speaker 1: person has a fear of seeming narcissistic, and they tend
Speaker 1: to be warm hearted but afraid of becoming a burden,
Speaker 1: and they have a hard time just voicing their preferences.
Speaker 1: I did not know there was a word for this.
Speaker 1: And Shannon Feltis and Bonnie Dutch, the wonderful sisters who
Speaker 1: help with all the ologies merch, have a saying about
Speaker 1: shying away from praise. Whenever someone compliments them, they respond,
Speaker 1: you are that. To the point that they have finally
Speaker 1: put out their own podcast. They're so hilarious and so
Speaker 1: charming and warm and weird and so fucking funny and
Speaker 1: their title you are that. So they just posted episode
Speaker 1: zero literally yesterday. It just went up. You should be
Speaker 1: able to find it on Spotify today. It should be
Speaker 1: on iTunes literally any second. So just go and subscribe
Speaker 1: right now. You will love them again. Their podcast is
Speaker 1: called You Are That. I'll put a link in the
Speaker 1: show notes. You Are That? Okay? Sound a wis echoism? Yeah?
Speaker 1: I don't know. Amy Greenan asks if someone has been
Speaker 1: through multiple traumatic instances of abuse in the distance past,
Speaker 1: in the distant past, but won't get profession I'll have
Speaker 1: to deal with the lasting emotional mental effects. Is there
Speaker 1: something they can do on their own to help themselves
Speaker 1: through it? Asking for a cherished someone who would never
Speaker 1: ask for themselves.
Speaker 2: Yeah, man, it's really tricky. I mean, well, okay, so
Speaker 2: here here, Here's what I would say, is that, first
Speaker 2: of all, I think, yeah, it can be real. I
Speaker 2: totally understand why people would not want to go deal
Speaker 2: with this with a professional, because who wants to re experience,
Speaker 2: talk about, investigate and relive the most painful things that
Speaker 2: have ever happened to them.
Speaker 1: It's just I prefer not to.
Speaker 2: I mean, it's really it's a big ask, you know.
Speaker 2: So I totally understand people not wanting to like excavate
Speaker 2: all that stuff. I would, you know, and if telling
Speaker 2: people to do things got them to do it, then
Speaker 2: there'd be like, no problems in the world, right, So yeah,
Speaker 2: you know, if you have done your best to try
Speaker 2: to invite this person to get help and they just
Speaker 2: really don't want to do it, you know, I think
Speaker 2: you're going to jeopardize a relationship if you keep pushing them.
Speaker 2: So what I would say is just very broadly, one
Speaker 2: way that can help improve symptoms is for people to
Speaker 2: get more comfortable with distress. I know that's kind of
Speaker 2: an oxymoron, but basically to do a couple of things.
Speaker 2: One is to develop the skills to engage with and
Speaker 2: experience emotions that are painful, because that leads to the
Speaker 2: knowledge that this is not going to overwhelm me, that
Speaker 2: I'm not going to open the door to this stuff
Speaker 2: and be totally overwhelmed and never recover. It leads to
Speaker 2: the understanding that actually, this stuff is really painful. These
Speaker 2: memories are painful, these emotions are painful, but I'm able
Speaker 2: to tolerate them. Even though I might be crying, i
Speaker 2: might be in a lot of pain, I'm able to
Speaker 2: tolerate them, collect myself and go forward. So that is
Speaker 2: like the real kind of holy grail of trauma treatment
Speaker 2: is to develop that's those skills to tolerate distressing emotions
Speaker 2: and develop the knowledge that even though you have these
Speaker 2: distressing emotions, you're capable of dealing with them, which people are.
Speaker 2: It's just very hard to do that, So you know,
Speaker 2: I think what I would start with is physiological relaxation
Speaker 2: exercises like progressive muscle relaxation and deep breathing, and you can,
Speaker 2: like we were saying, with meditation, you can have like
Speaker 2: any accent and any gender lead you through progressive muscle
Speaker 2: relaxation on YouTube. So if you want to have like
Speaker 2: an Australian guy take you through progressive muscle relaxation.
Speaker 1: Feeling your muscles as they become soft and relaxed.
Speaker 2: You can do that. There are five minutes scripts or
Speaker 2: twenty five minute scripts. I would do that. I would
Speaker 2: like do yoga, I would do massage. I would start
Speaker 2: in the body so that people have confidence I can
Speaker 2: relax my body if I get overwhelmed. I would start there,
Speaker 2: and then I might think about doing some meditation, some
Speaker 2: mindfulness practice, because that will bring up inevitably, it will
Speaker 2: what you will see surfacing in the mind, distressing thoughts
Speaker 2: and emotions. But I don't think you should start there
Speaker 2: if you can't relax your body. So I'd start again
Speaker 2: first physiological relaxation, then maybe moving into mindfulness where now
Speaker 2: you have confidence, you can relax yourself and you're making
Speaker 2: a little space for these things to come up in
Speaker 2: the mind. And then I would be doing things that
Speaker 2: build confidence, like you know, doing things physically that allow
Speaker 2: you to build some confidence depending on what the traumas are.
Speaker 2: There seems to be like some evidence to suggest that
Speaker 2: like martial arts training can be helpful, especially for women
Speaker 2: experienced sexual assault. But again, you have to do that
Speaker 2: with people who are where you feel safe and confident,
Speaker 2: Like you can't go to some idiot mcdojo who's you know,
Speaker 2: untrained and unsafe and who knows. Like maybe after doing that,
Speaker 2: the person's like, you know what, this is good. I
Speaker 2: feel a little bit more control and mastery. And now
Speaker 2: maybe I am willing to now that I've done this
Speaker 2: a little bit on my own, maybe now I am
Speaker 2: willing to try to talk to a professional, or maybe not.
Speaker 2: Maybe this is enough.
Speaker 1: Yeah, you know, that's great advice. Neither rome nor confidence
Speaker 1: is built in a day. So just keep stacking those bricks,
Speaker 1: keep digging out those latrines. Little by little. It's going
Speaker 1: to make a difference. Megan McLean asks, can you talk
Speaker 1: a little bit on how animals, like pets, therapy animals. Look,
Speaker 1: you get a fish tag, et cetera, can help people
Speaker 1: who've experienced trauma. How does it help long and short term?
Speaker 2: Yeah, so I'm not again like this is a little
Speaker 2: outside of my area of expertise, but yeah, there seems
Speaker 2: to be some evidence that like petting dogs results in
Speaker 2: the release of a a bunch of beneficial neurotransmitters like
Speaker 2: dopamine and uh ox. Yeah. Yeah, but I know, like
Speaker 2: there's a big program to provide emotional support animals to veterans.
Speaker 2: And I mean, these animals are like incredible. They can
Speaker 2: like nudge They're so perceptive that they can like nudge
Speaker 2: you when you're having a panic attack, encourage you to
Speaker 2: take a medication or try a practice. I haven't seen
Speaker 2: any negative I haven't heard of any negative effects. But
Speaker 2: beyond that, I'm not. Yeah, it's a little outside.
Speaker 1: My Whenever I pet a dog, I'm so much happier.
Speaker 2: Yeah, I know for me, that's the case.
Speaker 1: I'm so happy right now. Is this what happens in
Speaker 1: a dog?
Speaker 2: Yeah? Totally?
Speaker 1: Okay, quick look up and there are nearly seventy studies
Speaker 1: published on h AI human animal interactions, or as I
Speaker 1: like to pronounce.
Speaker 2: It, Hi Hi Hi.
Speaker 1: Now some benefits of having interactions with animals. I'm going
Speaker 1: to list them off as fast as I can. Social attention,
Speaker 1: social behavior benefits, interpersonal interactions, and mood dress related parameters
Speaker 1: such as cortisol, heart rate, and blood pressure. Self reported
Speaker 1: fear and anxiety goes down. Mental and physical health improves,
Speaker 1: especially cardiovascular diseases, improvement of immune system functioning and pain management.
Speaker 1: Increased trustworthiness of and trust toward other persons, reduced aggression,
Speaker 1: enhanced empathy, and improved learning. What's happening here? How are
Speaker 1: pets making us so happy? Well, your brain likes to
Speaker 1: release a feel good chemical around them called oxytocin, and
Speaker 1: it promotes bonding and happiness. So if you're bummed, maybe
Speaker 1: adopt a critter. I myself am leaving almonds outside and
Speaker 1: checking them constantly to see if a crow wants to
Speaker 1: be my friend, and I think that counts as interaction. Okay,
Speaker 1: let's get negative real quick. Last questions I always ask
Speaker 1: is what's one thing about your job that sucks? What
Speaker 1: is the worst thing about your job.
Speaker 2: Man, what's the worst thing? I really like my job? Honestly,
Speaker 2: there's gotta be something that sucks. Yeah, well, I mean
Speaker 2: like getting manuscripts and grants rejected sucks. Cleaning data sucks. Yeah,
Speaker 2: I hate cleaning data.
Speaker 1: That's the cleaning data.
Speaker 2: Well, when you collect data from people, you know, like
Speaker 2: you imagine just like a giant spreadsheet of all these things.
Speaker 2: You have to convert that into a usable format. So
Speaker 2: you have to like go through and recode variables so
Speaker 2: that they're scored correctly. You have to just if you're
Speaker 2: like me, go through with a fine toothcomb manually and
Speaker 2: make sure that there are no glaring errors. Yeah, just
Speaker 2: turning like a raw data set into a usable data set.
Speaker 2: It just takes a ton of work.
Speaker 1: You know, Like, are there any jams you listen to
Speaker 1: when you're like I got a data crunch.
Speaker 2: I do like to listen to music when I'm doing that.
Speaker 2: Things with no words, though I listen will you know,
Speaker 2: like the words will or words in a language I
Speaker 2: don't speak. That would be okay you But nothing America,
Speaker 2: Yeah nothing.
Speaker 1: Yeah, problems is not going to.
Speaker 2: Work right, Yeah, Like dub reggae is a good it
Speaker 2: is good because it's kind of like it's pretty chill
Speaker 2: and there's not a lot of lyrics. That's like good
Speaker 2: data cleaning music.
Speaker 1: That's a good jam.
Speaker 2: Yeah.
Speaker 1: And then the thing that you love the most about
Speaker 1: your job. I know that's going to be difficult.
Speaker 2: Honestly, it's not that hard like the So right now,
Speaker 2: I'm uh have a intervention that a colleague and I developed,
Speaker 2: which is a mindfulness and yoga based intervention for youth
Speaker 2: experiencing homelessness, for whom trauma is ubiquitous. I mean it's like,
Speaker 2: you know, it's one of the prime drivers of youth
Speaker 2: homelessness or use leaving home and youth are at very
Speaker 2: high risk for experiencing trauma when they're on the street
Speaker 2: as well for a variety of reasons. So we just
Speaker 2: like piloted this intervention. We have, you know, some good results,
Speaker 2: our first main effects paid or just accepted for publication.
Speaker 2: So that's all great, but I just you know, the
Speaker 2: best thing is just hearing from people who who have
Speaker 2: benefited from the work. I mean, that's why we do it,
Speaker 2: you know. I mean nobody I don't think gets into
Speaker 2: this so that they can trade their papers around with
Speaker 2: fifteen other academics like you want it. You want your
Speaker 2: work to have an impact on people's lives. So that's
Speaker 2: far and away the most you know, we're not in
Speaker 2: it for the money. Unfortunately, that's far and away the
Speaker 2: most important thing. That's the best part. Seeing people like
Speaker 2: get better, their lives get better. That's I think. You know,
Speaker 2: that didn't happen, I would wouldn't want to keep doing this,
Speaker 2: you know.
Speaker 1: Yeah, I guess it's cool to watch new pathways get
Speaker 1: formed and freeways overgrown.
Speaker 2: And yeah, yeah, totally, that's it is cool. Yeah, I mean,
Speaker 2: it's just you know, it does remind you of how
Speaker 2: strong and resilient people are. You know, people are really extraordinary.
Speaker 1: So yeah, I guess we don't really give ourselves enough
Speaker 1: credit for that.
Speaker 2: No, no, we don't. I think, you know, especially in
Speaker 2: our like contemporary culture, I don't think we give ourselves
Speaker 2: enough credit.
Speaker 1: That we're just stronger than we realize. It's just a
Speaker 1: matter of practice in a lot of ways.
Speaker 2: Yeah, I mean, even if you have the negative you like,
Speaker 2: I just finished watching Fleabag the second season, and there's
Speaker 2: oh my god, it's so good. Okay, she's incredible, But
Speaker 2: there's one scene where she's like, yeah, except most people
Speaker 2: have people are shit and then someone and like, I
Speaker 2: think we all have that thought a lot too, you know,
Speaker 2: and we get cut off in traffic enough. But then
Speaker 2: the person says to her, yeah, but they're all we've
Speaker 2: got great too. Yeah, so I think, yeah that I
Speaker 2: like that awesome. I mean, people really are all we've got.
Speaker 2: So you know, it's nice one you see see them
Speaker 2: feeling better. Thank you so much for no thank you,
Speaker 2: Oh my god. No, it's my pleasure.
Speaker 1: So ask smart data nerds, stupid questions and it just
Speaker 1: might help your brain. So to learn more about doctor
Speaker 1: Nicholas bar you can find him on Twitter now at
Speaker 1: doctor Nicholas bar two Ours one doctor Nicholas bar One.
Speaker 1: I'm going to link that in the show notes. He
Speaker 1: is brand new to Twitter. I was his second follower ever.
Speaker 1: I just followed him. So show him some love, say hi,
Speaker 1: ask questions. Doctor Nicholas bar One now. Ologies is on
Speaker 1: Twitter and Instagram at Ologies. You can say hi. You
Speaker 1: can tag your merch photos Ologies merch or any artwork
Speaker 1: Ologies art. I love to see it and repost it.
Speaker 1: I'm on Twitter and Instagram at ali Ward. Merch is
Speaker 1: available at ologiesmerch dot com. Thank you to sisters Shannon
Speaker 1: Feltis and Bonnie Dutch for managing that, and do check
Speaker 1: out their brand new podcast, You Are That. I think
Speaker 1: you will fall in love with them. They are wonderful.
Speaker 1: Links to sponsors and charities are in the show notes
Speaker 1: and if you'd like to check those out, and some
Speaker 1: more links to research those are all up at aliward
Speaker 1: dot com, slash ologies slash Traumatology. Thank you to Aaron
Speaker 1: Talbert and Hannah Lippo, you wonderful beings for admitting the
Speaker 1: ologies podcast Facebook group. And thank you to listener JSG Snaege.
Speaker 2: I'm not quite sure.
Speaker 1: How to pronounce it. It's a lot of consonants, but
Speaker 1: they left a review saying that they like the show
Speaker 1: but found the recent boofology met toad remark in poor taste,
Speaker 1: and I totally agree with you, and I'm so sorry.
Speaker 1: In the moment, it seemed like a dig against perpetrators,
Speaker 1: kind of likening them to these gross wordy toads. But
Speaker 1: toads deserve better, and very much victims deserve better. And
Speaker 1: my position is a woman who's experienced sexual harassment doesn't
Speaker 1: give me a pass to make light of it. So
Speaker 1: I'm snipping that comment out of the episode and re
Speaker 1: uploading it because I don't want to risk bumming anyone
Speaker 1: else out. So thank you for letting me know, thanks
Speaker 1: for the heads up in honesty and perspective, and thanks
Speaker 1: for listening. Also, happy, happy belated birthday to my dear
Speaker 1: friend Sarah Basco, who I'm lucky to have known since
Speaker 1: we were twelve. You are a wonderful person and will
Speaker 1: forever be the beach master of my heart. Thank you
Speaker 1: to the very handsome Jared Sleeper of the podcast My Good,
Speaker 1: Bad Brain and the martial arts podcast Fight Stuff for
Speaker 1: the Nick connection and for the assistant editing and for
Speaker 1: some research help. And of course huge thanks to editor
Speaker 1: Stephen Ray Morris, who hosts the per cast about kitties
Speaker 1: and see Jurassic Righte about Dinosaurs, for stitching this all
Speaker 1: together every week and saving my brain. The theme song
Speaker 1: was written and performed by Nick Thorburn of the band Islands,
Speaker 1: And if you listen to the end of the show,
Speaker 1: you know I tell you a secret, And this week
Speaker 1: I'll give you a pro tip. When you're not sure
Speaker 1: if you can handle doing any exercise because you don't
Speaker 1: want to go outside and put on shoes. There's this
Speaker 1: app called tabatas Stopwatch Pro, and it's very handy for
Speaker 1: when you want to do like four minutes of burpies
Speaker 1: or jump rope, and it's like forty seconds on and
Speaker 1: ten seconds off and forty seconds on whatever, and then
Speaker 1: this robot voice kind of lovingly barks at you. Exercise, rest, exercise,
Speaker 1: and it's helpful and it's a great way to just
Speaker 1: get blood to your brain. So take care of your
Speaker 1: wonderful brains because you and they both deserve it. We'rmine pacodermatology,
Speaker 1: hombiology or do zoology, lithology, technology, meteorologyology, napology, seriology, pology,