WEBVTT 1 00:00:00.200 --> 00:00:04.040 Oh hey, it's that little green wispy weed sprouting from 2 00:00:04.040 --> 00:00:06.879 a crack in the sidewalk alley. Ward back with a 3 00:00:06.960 --> 00:00:13.240 hopefully hopeful episode of Ologies Traumatology. What is trauma? Who 4 00:00:13.279 --> 00:00:17.320 gets PTSD? And what steps large and small can you 5 00:00:17.359 --> 00:00:20.399 take to heal a heart in a brain? So WHOA 6 00:00:20.719 --> 00:00:23.559 is a good one? I got goosebumps both recording and 7 00:00:23.679 --> 00:00:26.960 writing it up. But first thanks are always in order 8 00:00:27.000 --> 00:00:29.160 every week to the many folks who are making this 9 00:00:29.239 --> 00:00:33.520 podcast a reality, from an idea million years ago to 10 00:00:33.560 --> 00:00:35.759 a weekly thing I get to put together. So thanks 11 00:00:35.759 --> 00:00:38.759 to everyone on Patreon dot com slash Ologies for tossing 12 00:00:38.799 --> 00:00:41.280 in as little as twenty five cents an episode to 13 00:00:41.439 --> 00:00:44.920 submit your questions and to join that party. Also, thank 14 00:00:44.960 --> 00:00:49.840 you to anyone supporting Ologies Merch by sporting Ologies Merch. 15 00:00:49.880 --> 00:00:52.960 It's available at ologiesmarch dot com. There's also a link 16 00:00:53.000 --> 00:00:55.119 in the show notes. And thank you to all the 17 00:00:55.159 --> 00:00:59.520 folks who have rated and subscribed, which keeps Ologies up 18 00:00:59.560 --> 00:01:02.799 among those science giants in the podcast charts. Thank you 19 00:01:02.840 --> 00:01:04.599 so much for that, and also to everyone who leaves 20 00:01:04.640 --> 00:01:07.280 a review for me to read, like for example, this 21 00:01:07.319 --> 00:01:10.159 one by Jersey Dork, who says I was most touched 22 00:01:10.200 --> 00:01:13.159 by the field trip La Natural History Museum episode. Ali 23 00:01:13.239 --> 00:01:15.200 shares her passion and love for the museum, and you 24 00:01:15.200 --> 00:01:17.840 can feel how happy she was to have changed her 25 00:01:17.879 --> 00:01:20.079 career like this. She takes a minute toward the end 26 00:01:20.120 --> 00:01:23.120 to encourage all listeners to chase what you are passionate about. 27 00:01:23.159 --> 00:01:24.920 And I really took that to heart, and I'm now 28 00:01:24.959 --> 00:01:28.319 taking steps to start a wedding dress brand. So congratulations, 29 00:01:28.400 --> 00:01:31.120 Jersey Dork. That made me just giddy for you, if 30 00:01:31.519 --> 00:01:35.400 I do say so myself. Hey, get it, neverone, Okay, 31 00:01:35.439 --> 00:01:38.719 Traumatology very much a noun, very much a word. It's 32 00:01:38.760 --> 00:01:42.599 a discipline. But in researching this intro, I've found out 33 00:01:42.640 --> 00:01:47.040 there are two kinds. What there's medical traumatology, which is 34 00:01:47.480 --> 00:01:52.079 surgical wound healing, like after accidents or major injuries. And then, 35 00:01:52.120 --> 00:01:56.480 of course there's psychological traumatology that researches and helps treat 36 00:01:56.480 --> 00:02:00.400 people who have witnessed or experienced distress. So traumatology either 37 00:02:00.400 --> 00:02:04.280 one comes from the Greek trauma that means wound or injury, 38 00:02:04.359 --> 00:02:07.439 and the root for that word just fun side note 39 00:02:07.680 --> 00:02:11.520 meant to rub or twist or pierce in the way 40 00:02:11.560 --> 00:02:15.599 that one would have an old creepy weapon, so trauma. 41 00:02:15.680 --> 00:02:18.280 You know what. After a series of episodes about toads 42 00:02:18.479 --> 00:02:20.719 and crickets, I just thought we should have a little 43 00:02:20.759 --> 00:02:24.919 gander at our squishy but strong human minds. And I 44 00:02:25.039 --> 00:02:28.439 was chatting with wonderful person and boyfriend, Jared Sleeper, who 45 00:02:28.479 --> 00:02:31.080 helps editologies and he's the host of the mental health 46 00:02:31.120 --> 00:02:34.039 podcast Make Good, Bad Brain. And he suggested a friend 47 00:02:34.039 --> 00:02:36.879 of his, and less than twenty four hours later I 48 00:02:37.000 --> 00:02:40.240 was headed to this doctor's cute, cozy home. There was 49 00:02:40.280 --> 00:02:43.479 a diploma on the bookcase, the smell of some freshly 50 00:02:43.520 --> 00:02:46.680 lit incense. He has beard and tattoos. He looks like 51 00:02:46.719 --> 00:02:50.080 someone who would open like a vintage motorcycle shop. But 52 00:02:50.159 --> 00:02:53.560 he's like a surprise, I'm a traumatologist. So he got 53 00:02:53.599 --> 00:02:56.199 a cup of coffee. We settled into some big comfy 54 00:02:56.240 --> 00:02:59.639 chairs to talk shop about clinical bummers, but how to 55 00:02:59.680 --> 00:03:02.680 help your brain cope with maybe what life has dealt you. 56 00:03:02.879 --> 00:03:06.520 So this traumatologist has studied the role of mindfulness and 57 00:03:06.599 --> 00:03:11.560 meditation and its efficacy and limits in trauma therapy and 58 00:03:11.680 --> 00:03:14.639 other mental health symptoms and disorders. So he's taught a 59 00:03:14.759 --> 00:03:18.840 Mindfulness for Practitioners workshop in a psychiatric clinic, has worked 60 00:03:18.840 --> 00:03:23.879 on research for improving acceptance, integration, and health among LGBTQ 61 00:03:24.039 --> 00:03:30.479 plus service members, reducing suicidality among LGBTQ plus youth, and 62 00:03:30.719 --> 00:03:36.120 done extensive research on examining mindfulness and therapies for military veterans. 63 00:03:36.479 --> 00:03:38.759 He's a cool dude. He's also a member of the 64 00:03:38.840 --> 00:03:42.439 Association for Behavioral and Cognitive Therapies. He's a member of 65 00:03:42.479 --> 00:03:46.680 the Cognitive Behavioral Therapy Society of Southern California. He's also 66 00:03:46.960 --> 00:03:50.039 part of the National Association of Social Workers. And I 67 00:03:50.120 --> 00:03:53.319 love this chat because it's very obvious that his mind 68 00:03:53.520 --> 00:03:57.000 cares about other minds, but also his mind is just 69 00:03:57.039 --> 00:04:00.800 a bucket of responsible information on the topic. So this 70 00:04:00.879 --> 00:04:04.479 episode maybe not the most hilarious of the ologies, but 71 00:04:04.560 --> 00:04:07.520 I think it's incredibly important for all of us. So 72 00:04:07.599 --> 00:04:11.240 we talked about how trauma affects the brain, what trauma is, 73 00:04:11.680 --> 00:04:14.879 what percentage of folks will have lasting effects after a 74 00:04:14.919 --> 00:04:18.439 traumatic event, how clinicians help their patients get over some 75 00:04:18.800 --> 00:04:25.000 distressing memories. We also touched on PTSD, EMDR, cbt CBD, 76 00:04:25.439 --> 00:04:30.279 pe CPT, and more So, take a deep breath, don't 77 00:04:30.279 --> 00:04:34.079 forget to exhale, and learn about distressing with your friendly 78 00:04:34.160 --> 00:04:37.519 neighborhood traumatologist, doctor Nicholas Barr. 79 00:04:55.839 --> 00:04:57.279 So, I'm Nick Barr. 80 00:04:57.519 --> 00:05:01.040 Doctor Nicholas Bar, doctor Nicholas Bar. Yeah, how long have 81 00:05:01.120 --> 00:05:01.759 you been a doctor? 82 00:05:03.560 --> 00:05:07.399 Let's see my decrease right there. I think that was 83 00:05:08.000 --> 00:05:12.000 last summer. Yeah, so, oh god, Actually I think it 84 00:05:12.040 --> 00:05:16.160 defended my dissertation like a year ago last week, so 85 00:05:16.199 --> 00:05:17.519 a year about a year. 86 00:05:17.839 --> 00:05:21.759 Congratulation, thanks, yeah, And what was your dissertation on? 87 00:05:22.519 --> 00:05:27.519 So basically I looked at the role of mindfulness across 88 00:05:27.600 --> 00:05:32.040 kind of the trajectory of military veterans combat related experiences. 89 00:05:32.120 --> 00:05:35.120 So my first study just was like a head to 90 00:05:35.120 --> 00:05:38.920 head comparison of trait mindfulness and combat experience as predictors 91 00:05:38.959 --> 00:05:43.199 of PTSD and depression. And then I looked at how 92 00:05:44.040 --> 00:05:48.680 mindfulness and PTSD and depression predicted mental health stigma, internalized 93 00:05:48.680 --> 00:05:51.000 mental health stigma, because we know that's one of the 94 00:05:51.040 --> 00:05:55.120 core barriers to veterans' service use behavior, like getting mental 95 00:05:55.160 --> 00:05:55.920 health services. 96 00:05:56.120 --> 00:05:59.160 So Nick says that combat is what's called a linear 97 00:05:59.279 --> 00:06:03.439 predictor of PTSD. So the more war zone firefights a 98 00:06:03.480 --> 00:06:06.319 person may have experienced and the more intense they were, 99 00:06:06.560 --> 00:06:10.800 the stronger their probability of developing post traumatic stress disorder, 100 00:06:10.959 --> 00:06:14.519 which is our good buddy we casually call PTSD. Nick's 101 00:06:14.519 --> 00:06:18.279 research also found that the stronger a veteran stigma about 102 00:06:18.319 --> 00:06:22.120 mental illness, the stronger their PTSD symptoms tended to be. 103 00:06:23.240 --> 00:06:27.279 Nick's research also looked at trait mindfulness and its association 104 00:06:27.360 --> 00:06:31.639 with PTSD, So could mindfulness help veterans with the body 105 00:06:31.680 --> 00:06:34.879 and mind's response to stress. Also, if you don't know 106 00:06:35.040 --> 00:06:38.160 what trait mindfulness is, you're in a really good company. 107 00:06:38.319 --> 00:06:40.680 And what is trait mindfulness exactly? 108 00:06:40.800 --> 00:06:43.040 Basically when we talk about mindfulness and kind of the 109 00:06:43.079 --> 00:06:47.279 Western from the Western sort of behavioral health psych perspective, 110 00:06:47.360 --> 00:06:51.560 it's the ability to pay attention on purpose to present 111 00:06:51.600 --> 00:06:56.120 moment phenomenon without judgment or elaboration, so without like ruminating 112 00:06:56.279 --> 00:07:01.879 or avoiding basically that content, so things like thoughts, feelings, 113 00:07:01.879 --> 00:07:06.879 behavioral urges. And that's like an okay definition from the 114 00:07:06.920 --> 00:07:11.759 perspective of like measuring it with scales, you know, self 115 00:07:11.800 --> 00:07:14.000 report scales. But there are a lot of problems with 116 00:07:14.279 --> 00:07:16.839 measuring mindfulness in that way, Like from the kind of 117 00:07:16.839 --> 00:07:19.399 Buddhist perspective, which is what mindfulness grew out of and 118 00:07:19.439 --> 00:07:23.519 that's sort of where I my undergraduate degrees in religion, 119 00:07:23.560 --> 00:07:26.639 and my focus was Buddhism. You really miss a lot 120 00:07:26.920 --> 00:07:29.560 when you define mindfulness in that way. I mean, in 121 00:07:29.560 --> 00:07:34.959 the Buddhist sort of perspective, it's a much more holistic 122 00:07:35.240 --> 00:07:40.600 orientation towards your life and life experience. And you know, 123 00:07:40.600 --> 00:07:43.240 we probably aren't capturing that level of nuance with like 124 00:07:43.279 --> 00:07:46.920 a twenty four item questionnaire. But then there are other 125 00:07:47.040 --> 00:07:50.160 researchers who sort of triangulate on the concept by looking 126 00:07:50.319 --> 00:07:55.079 by taking objective measures of attention, so like measuring attention 127 00:07:55.199 --> 00:07:57.439 control and impulsivity. 128 00:07:56.920 --> 00:08:00.319 And is a lot of that trait mindfulness? Is some 129 00:08:00.399 --> 00:08:03.480 of that just executive function? Is that frontal lobe stuff? 130 00:08:03.759 --> 00:08:05.839 Is that innate or is it situational? 131 00:08:06.800 --> 00:08:09.800 Well so, yeah, great question, thank you. Yeah. The brain 132 00:08:09.879 --> 00:08:17.240 regions that would correspond to better mindfulness, you know, in 133 00:08:17.319 --> 00:08:19.959 terms of what we see in like fMRI results, Yeah, 134 00:08:20.040 --> 00:08:23.839 would be prefrontal cortex and then the HPA axis, which 135 00:08:23.879 --> 00:08:26.199 is I'm not a neuroscientist, but you know it's just 136 00:08:27.800 --> 00:08:31.519 which is like your hypothalamic pituitary adrenal axis, which kind 137 00:08:31.560 --> 00:08:34.200 of regulates like fear and memory. So there's one kind 138 00:08:34.240 --> 00:08:38.120 of famous study where a bunch of very accomplished meditators, 139 00:08:38.120 --> 00:08:41.360 you know, ten thousand hours plus meditation experience. So monks 140 00:08:41.960 --> 00:08:44.720 were asked to look at disturbing images, so you know, 141 00:08:44.840 --> 00:08:47.440 like horrible pictures like babies with tumors on their faces 142 00:08:47.480 --> 00:08:51.759 and things like that while practicing a loving Kindness meditation, 143 00:08:52.919 --> 00:08:56.200 and they showed a lot of prefrontal cortex activation, whereas 144 00:08:56.240 --> 00:08:59.519 people who were non meditators showed a lot of amigdala activation, 145 00:08:59.679 --> 00:09:02.639 so revulsion, fear, distress. 146 00:09:03.159 --> 00:09:05.600 So for more on this, you can see the two 147 00:09:05.639 --> 00:09:08.799 part Theorology episode in which we get to know our 148 00:09:08.840 --> 00:09:13.399 brains a little screaming almond of terror the amygdala. Also, 149 00:09:13.480 --> 00:09:16.399 I went to look for that specific study, but there 150 00:09:16.559 --> 00:09:18.919 had been several like it, so I added some of 151 00:09:18.960 --> 00:09:22.200 the details that Nick mentioned and came up with some 152 00:09:22.240 --> 00:09:25.519 research papers about pediatric facial tumors, which was not what 153 00:09:25.559 --> 00:09:28.159 I was intending. But moving on, So, there have been 154 00:09:28.440 --> 00:09:32.919 multiple studies looking at the brains of meditators, and some 155 00:09:33.080 --> 00:09:35.240 have been thrown a little bit of shade just because 156 00:09:35.240 --> 00:09:39.759 the principal investigator was a close personal pal of His Holiness, 157 00:09:39.919 --> 00:09:42.919 the Dalai Lama, so people thought perhaps they were biased, 158 00:09:43.200 --> 00:09:45.120 but that doctor was like, you're going to tell a 159 00:09:45.120 --> 00:09:49.279 cardiologist not to exercise? Come on. Nick himself is very, 160 00:09:49.360 --> 00:09:52.399 very committed and focused on evidence based research, and I 161 00:09:52.480 --> 00:09:56.559 found his PhD dissertation in it. Nick thanks his friends, 162 00:09:56.720 --> 00:10:00.000 who he says have put up with my predictable response 163 00:10:00.200 --> 00:10:03.120 to even the most trivial claims with okay, but where's 164 00:10:03.120 --> 00:10:05.279 the evidence. So yeah, he's a data dude. 165 00:10:05.399 --> 00:10:10.159 And yeah, that will make you better at your executive functions. 166 00:10:10.799 --> 00:10:15.639 We see that. Actually, a colleague of mine years ago 167 00:10:15.799 --> 00:10:18.919 in the same PhD program, did a study looking at 168 00:10:18.919 --> 00:10:22.759 a mindfulness based intervention with individuals with schizophrenia, and she 169 00:10:23.120 --> 00:10:27.480 found improvements in executive functioning following her intervention. So yeah, 170 00:10:27.679 --> 00:10:29.200 there's there are linkages there. 171 00:10:29.799 --> 00:10:32.360 So let's trace his path all the way from his 172 00:10:32.639 --> 00:10:36.720 pre academic beginnings. He got a BA in comparative religion 173 00:10:36.840 --> 00:10:40.960 at Columbia University. He studied mindfulness in India, did some 174 00:10:41.039 --> 00:10:43.840 teaching in LAOS, and got a master's in social work 175 00:10:43.879 --> 00:10:47.080 at UCLA and a PhD at USC where he's now 176 00:10:47.120 --> 00:10:49.720 also doing some post doc work. So can you tell 177 00:10:49.720 --> 00:10:52.480 me kind of what brought you to be interested in 178 00:10:53.000 --> 00:10:55.440 kind of a religious background? How that led to Trauma. 179 00:10:55.840 --> 00:10:58.679 I had a weird, like early interest in Buddhism. I think, 180 00:10:58.720 --> 00:11:01.320 like my my did a bunch of work in Japan 181 00:11:01.360 --> 00:11:03.559 growing up through all these books on Zen. I didn't 182 00:11:03.559 --> 00:11:06.039 study Zeen, but through all these books on Zen, and 183 00:11:06.039 --> 00:11:09.399 I would like look at them, you know, and just 184 00:11:09.799 --> 00:11:14.360 remember having this kind of weird fascination with them as 185 00:11:14.399 --> 00:11:17.200 a kid. And then when I went to college, I 186 00:11:17.240 --> 00:11:19.600 went to Columbia and the head of the religion department 187 00:11:19.600 --> 00:11:21.639 at the time was this guy, Robert Thurman, who was 188 00:11:21.759 --> 00:11:25.480 like the first Western monk ordained by the Dalai Lama. 189 00:11:25.600 --> 00:11:31.240 He's like this very charismatic, sort of interesting storyteller, and 190 00:11:31.279 --> 00:11:34.240 I totally was like, you know, hook line and sinker 191 00:11:34.279 --> 00:11:34.759 into it. 192 00:11:34.960 --> 00:11:37.000 I was curious what this guy was all about. And 193 00:11:37.039 --> 00:11:40.159 I looked him up and his face seemed hauntingly familiar. 194 00:11:40.240 --> 00:11:42.559 And then I read his bio and he's also Uma 195 00:11:42.639 --> 00:11:48.240 Thurman's dad. Also, Uma Thurman's mom was LSD advocate Timothy 196 00:11:48.320 --> 00:11:50.679 Leary's ex wife. Did you know that? Okay, I'm getting 197 00:11:50.679 --> 00:11:54.120 off track here. Anyway, Nick attended a lecture by Thurman, 198 00:11:54.240 --> 00:11:58.080 who's a Buddhist author and academic, and he was enthralled. 199 00:11:58.279 --> 00:11:59.840 So then I just started taking a bunch of the 200 00:12:00.159 --> 00:12:02.639 courses and I ended up studying abroad at this place 201 00:12:02.639 --> 00:12:05.399 called the Institute of Buddhist Dialectics, which is a kind 202 00:12:05.440 --> 00:12:09.879 of the monastic training college that's attached to the Di 203 00:12:10.080 --> 00:12:14.919 Lama's sort of temple compound in northern India from Dharmsala. Yeah, 204 00:12:15.000 --> 00:12:17.480 so so then I, you know, I was like learning 205 00:12:17.519 --> 00:12:23.840 from a guchet amnk Tibetan Buddhist philosophy. My father had 206 00:12:23.879 --> 00:12:27.960 just died, so I was like totally, yeah, I was 207 00:12:28.240 --> 00:12:30.960 not doing well, wasn't coping that well. So I sort 208 00:12:30.960 --> 00:12:33.000 of yeah, thanks. It was a long time ago at 209 00:12:33.039 --> 00:12:36.000 this point, but yeah, I appreciate it. So so I 210 00:12:36.039 --> 00:12:39.159 think all of that sort of led to my interest 211 00:12:39.559 --> 00:12:44.840 in Buddhism and how that intersects with trauma and coping 212 00:12:44.879 --> 00:12:48.480 with trauma. I don't think I was not traumatized in 213 00:12:48.519 --> 00:12:50.440 the DSM sense of the word. I mean I had 214 00:12:50.480 --> 00:12:53.200 not undergone a trauma. I was just like fucked up 215 00:12:53.200 --> 00:12:57.159 and disturbed and upset, you know, not coping well. I'd 216 00:12:57.159 --> 00:13:00.960 had a pretty like you know, sheltered life, I think, 217 00:13:01.320 --> 00:13:04.200 and so I just hadn't dealt with something like that, 218 00:13:06.799 --> 00:13:09.840 but yeah, so it just it helped me, I mean 219 00:13:09.960 --> 00:13:14.720 doing and I was doing like a formal meditation practice 220 00:13:14.960 --> 00:13:17.039 every day for a long time, you know, in this 221 00:13:17.120 --> 00:13:22.080 sort of monastic training context, and I just noticed that 222 00:13:22.120 --> 00:13:26.200 I was really much better able to handle my thoughts 223 00:13:26.200 --> 00:13:28.679 and feelings. I mean, I was like totally naive. I 224 00:13:28.679 --> 00:13:30.440 was like, huh, I wonder if anyone's ever thought about 225 00:13:30.440 --> 00:13:33.200 this before, like could we use this to help us 226 00:13:33.240 --> 00:13:35.600 with trauma? Of course, like people have been you know, 227 00:13:35.879 --> 00:13:39.799 doing this in a really rigorous way since like the 228 00:13:39.879 --> 00:13:45.360 nineteen eighties or maybe before even, but you know, naively, 229 00:13:45.440 --> 00:13:47.759 I was like, oh, this could be like my contribution. 230 00:13:49.759 --> 00:13:52.720 Oh god. And so I ended up doing some like 231 00:13:52.799 --> 00:13:56.759 teaching and development work in Laos, which is a Buddhist country, 232 00:13:57.440 --> 00:14:00.440 and I was just interested, like, you know, they were 233 00:14:00.480 --> 00:14:02.440 kind of developing from the ground up at that point. 234 00:14:02.440 --> 00:14:05.480 They didn't have a public health system really or like 235 00:14:05.840 --> 00:14:09.519 a mental health infrastructure really at all. Again, you know, 236 00:14:09.639 --> 00:14:11.600 naively and with a lot of hubers, I was like, oh, 237 00:14:11.639 --> 00:14:13.799 I bet I'd be a good therapist because like I'm 238 00:14:13.840 --> 00:14:17.840 pretty even keeled and this stuff doesn't freak me out, 239 00:14:17.840 --> 00:14:19.480 so maybe I should just go be a therapist. So 240 00:14:19.519 --> 00:14:23.279 I applied to a master's in social program. While I 241 00:14:23.320 --> 00:14:25.600 was there, I took the Jerry in Bangkok and then 242 00:14:25.759 --> 00:14:28.679 came back and got my master's at UCLA. 243 00:14:28.759 --> 00:14:30.720 I think that's a good self selection. Though. If you're 244 00:14:30.759 --> 00:14:32.480 like I can listen to people's problems and not get 245 00:14:32.480 --> 00:14:34.759 freaked out, I think that's good because there are plenty 246 00:14:34.759 --> 00:14:36.840 of problems that I'd be like, I'm growing more than 247 00:14:36.879 --> 00:14:41.279 you are. I'm at this A tier two is probably okay, 248 00:14:41.320 --> 00:14:44.159 but just in the fetal position, they're like. 249 00:14:44.159 --> 00:14:46.159 Yeah, they're not good. Yeah, right, you don't want to 250 00:14:46.200 --> 00:14:46.440 do that. 251 00:14:47.399 --> 00:14:50.200 But what was it like also as a as a Westerner, 252 00:14:50.679 --> 00:14:54.399 as a white dude, to go to countries and learn 253 00:14:54.600 --> 00:14:58.200 Where did you find that that was pretty rare or 254 00:14:58.240 --> 00:14:59.879 was it pretty common? Or how are you received? 255 00:15:00.799 --> 00:15:03.200 I mean, white privilege follows you everywhere in my experience, 256 00:15:03.240 --> 00:15:07.360 so like, yeah, I definitely had it in Southeast Asia too. 257 00:15:07.720 --> 00:15:10.320 So Nick says he lived in Laos for three years 258 00:15:10.360 --> 00:15:13.799 and formed relationships and friendships and became part of the community. 259 00:15:13.840 --> 00:15:17.879 And one thing that struck him was the multi generational living, 260 00:15:18.159 --> 00:15:21.519 so a household with grandparents and kids and uncles and 261 00:15:21.559 --> 00:15:23.679 aunts and brothers, and sisters. And he said in the 262 00:15:23.679 --> 00:15:25.679 three years he lived there, he could count on one 263 00:15:25.720 --> 00:15:28.360 hand the number of times he saw baby crying. There's 264 00:15:28.399 --> 00:15:31.000 just always someone holding the baby, tending to the kiddos. 265 00:15:31.320 --> 00:15:33.559 And it felt so different from life in the US, 266 00:15:33.759 --> 00:15:36.039 where I guess we got a lot of crime babies. 267 00:15:36.399 --> 00:15:39.519 How is it as someone who you know has a 268 00:15:39.639 --> 00:15:42.720 kind of a background in the US but studied abroad 269 00:15:42.799 --> 00:15:46.000 in so many different cultures, Why do you think Westerners 270 00:15:46.039 --> 00:15:50.759 are so bad at mindfulness and meditation? Why are we 271 00:15:50.840 --> 00:15:53.399 resistant to it? Why are we maybe ignorant of it? 272 00:15:53.720 --> 00:15:55.720 Yeah, I mean it's a good question. We talk about 273 00:15:55.759 --> 00:15:58.240 trade mindfulness, right, so there's the idea that there's some 274 00:15:58.519 --> 00:16:00.360 level of the trade and everybody. But I think like 275 00:16:00.399 --> 00:16:03.799 physical exercise is a good analogy. Everybody has some level 276 00:16:03.879 --> 00:16:08.240 of physical fitness, right, and it's going to be like 277 00:16:08.360 --> 00:16:12.320 in a bell curve probably, so like it's a normalized trait. 278 00:16:12.399 --> 00:16:16.159 So some people are just going to be more fit 279 00:16:16.320 --> 00:16:19.840 than others as a result of kind of their genetics 280 00:16:19.879 --> 00:16:23.919 and their behaviors, right, that interaction. And I think it's 281 00:16:23.919 --> 00:16:27.600 the same with my poments, Like some people are more 282 00:16:27.720 --> 00:16:31.120 just naturally attuned to that style of kind of cognitive 283 00:16:32.039 --> 00:16:36.919 management than others. But it's a malleable trait, so you 284 00:16:36.960 --> 00:16:39.039 can get better with practice in the same way that 285 00:16:39.080 --> 00:16:40.720 you will be able to do more push ups if 286 00:16:40.720 --> 00:16:42.399 you do them every day, or run farther if you 287 00:16:42.440 --> 00:16:45.919 do that every day. So you know, again, this is 288 00:16:45.919 --> 00:16:49.399 like beyond I think the science. But just my personal 289 00:16:49.519 --> 00:16:54.320 view is that we're in a culture that doesn't reward that, 290 00:16:54.679 --> 00:16:58.559 you know, because we're in the attention economy and like 291 00:16:58.720 --> 00:17:00.960 really smart people are trying to figure out how to 292 00:17:01.000 --> 00:17:05.319 consume more of your attention with shorter and shorter you know, 293 00:17:05.519 --> 00:17:08.839 bits of stimulus, and so we're literally practicing the opposite 294 00:17:08.839 --> 00:17:10.680 of mindfulness every day. I mean, when you get an 295 00:17:10.680 --> 00:17:12.480 email and feel like you have to respond to it 296 00:17:12.519 --> 00:17:17.000 in a minute, that's the opposite of mindfulness. So I 297 00:17:17.039 --> 00:17:20.960 just think we're culturally conditioned not to practice those skills. 298 00:17:21.079 --> 00:17:22.799 But I guess the short answers, I think our culture 299 00:17:22.799 --> 00:17:25.519 doesn't value mindfulness, even if we say we do. 300 00:17:26.119 --> 00:17:28.839 And when it came to trauma, how did you become 301 00:17:28.960 --> 00:17:32.240 a traumatologist? Like, at what point did you really zero 302 00:17:32.359 --> 00:17:32.799 in on that? 303 00:17:34.359 --> 00:17:39.000 You know, Yeah, it's a good question. Again, I guess, well, 304 00:17:39.759 --> 00:17:44.160 so my like clinical training, My first internship when I 305 00:17:44.240 --> 00:17:47.720 was doing my masters was at the VA here in 306 00:17:47.759 --> 00:17:52.000 West Lay and the impatient psychiatric unit. And so when 307 00:17:52.000 --> 00:17:53.880 you're in an impatient unit, you don't get to do 308 00:17:53.920 --> 00:17:57.119 a lot of therapy because people are like acutely ill. 309 00:17:57.160 --> 00:17:59.279 And the kind of goal of those units, for better 310 00:17:59.359 --> 00:18:01.720 or worse, it is like get people to calm down, 311 00:18:02.200 --> 00:18:05.000 and then you figure out where to discharge them and 312 00:18:05.519 --> 00:18:08.359 get them, you know, engaged in their services. I think 313 00:18:08.400 --> 00:18:10.839 some people get are freaked out by that, you know, 314 00:18:10.880 --> 00:18:13.599 because it's it's outside the bounds of your normal experience 315 00:18:13.599 --> 00:18:17.400 to see somebody who's floridly psychotic and like loud. I 316 00:18:17.400 --> 00:18:19.079 mean that it just freaks a lot of people out. 317 00:18:19.079 --> 00:18:22.599 But to me it didn't, and so I was like, oh, 318 00:18:22.640 --> 00:18:28.240 this is interesting. And then my kind of second training 319 00:18:29.039 --> 00:18:33.480 placement was at Harbor UCLA, which is an a county 320 00:18:33.599 --> 00:18:38.319 directly operated adult mental health clinic, and the everybody has 321 00:18:39.200 --> 00:18:42.599 almost everybody there had some kind of traumatic experience. May 322 00:18:42.640 --> 00:18:45.119 not have been there presenting problem, but it informed what 323 00:18:45.160 --> 00:18:49.039 was going on often and I learned how to do 324 00:18:49.119 --> 00:18:51.400 the one what's still now one of the gold standard 325 00:18:51.920 --> 00:18:55.160 PTSD treatments, which is called prolonged exposure. And I just 326 00:18:55.400 --> 00:19:00.839 loved that treatment because so it's an exposure protocol. It's 327 00:19:00.920 --> 00:19:06.119 essentially kind of the goal again is the gold standard, 328 00:19:06.279 --> 00:19:11.079 Like PTSD treatments are prolonged exposure, this thing called CPT, 329 00:19:11.240 --> 00:19:14.720 which is cognitive processing therapy. And then some people also 330 00:19:14.799 --> 00:19:18.359 consider EMDR to be one of those treatments, which I'm 331 00:19:18.400 --> 00:19:19.200 not trained in. 332 00:19:19.680 --> 00:19:23.640 So yes, exposure is a leading treatment to trauma therapy. 333 00:19:23.680 --> 00:19:25.960 And we'll talk about em DR later, but right now, 334 00:19:26.160 --> 00:19:30.400 suit up for some PE which is prolonged exposure. And 335 00:19:30.440 --> 00:19:33.839 from the sound of it, it might get just as sweaty, okay. 336 00:19:33.559 --> 00:19:36.359 But what it is essentially is getting the after doing 337 00:19:36.400 --> 00:19:39.559 a lot of informed consent and explaining you know, what 338 00:19:39.599 --> 00:19:43.480 the treatment is and what the roles are, and really 339 00:19:43.960 --> 00:19:46.119 laying out in detail what the roadmap is going to be. 340 00:19:46.200 --> 00:19:50.319 Like Basically, what you do is have the person develop 341 00:19:50.359 --> 00:19:56.079 a list of their most and least distressing experiences. So 342 00:19:56.759 --> 00:19:59.200 you know, you would start with something low like I 343 00:19:59.240 --> 00:20:03.039 don't know, like let's say the person had been like 344 00:20:03.200 --> 00:20:05.839 attacked in the parking lot of their grocery store at night, 345 00:20:05.960 --> 00:20:09.920 for example, So low on your list of SuDS, which 346 00:20:09.960 --> 00:20:12.480 is subjective units of distress. This list, it would be 347 00:20:12.599 --> 00:20:18.519 like thinking about in detail going to the grocery store, 348 00:20:18.519 --> 00:20:20.839 and that might put you at like a twenty out 349 00:20:20.839 --> 00:20:23.119 of one hundred, one hundred being the trauma event itself, 350 00:20:23.160 --> 00:20:25.519 like the worst thing it's ever happened, and then ninety 351 00:20:25.599 --> 00:20:27.839 might be going to that same parking lot at that 352 00:20:27.960 --> 00:20:31.240 same time alone. That might be like high on the 353 00:20:31.279 --> 00:20:33.359 list of SuDS. So you develop that list, and then 354 00:20:33.400 --> 00:20:37.839 the person recounts to you in detail their worst traumatic 355 00:20:37.920 --> 00:20:42.480 experience and you record that and they do it over 356 00:20:42.519 --> 00:20:46.160 and over for thirty or so minutes, and you're checking 357 00:20:46.160 --> 00:20:49.359 in and you know, but you're not. And you also, 358 00:20:49.400 --> 00:20:53.400 before doing that, you teach relaxation skills, like you know, 359 00:20:53.880 --> 00:20:57.799 progressive muscle relaxation, deep breathing, things that physiologically relax the body, 360 00:20:58.200 --> 00:21:01.240 and you have them narrate that experience again and again 361 00:21:01.279 --> 00:21:03.680 and again. Like usually in the beginning it's like five 362 00:21:03.720 --> 00:21:07.839 minutes because there are disturbances of memory gaps in the memory. 363 00:21:07.920 --> 00:21:10.160 Person wants to get through it. It's it's upsetting. Then 364 00:21:10.200 --> 00:21:13.000 you're like great now again. So you don't do a 365 00:21:13.039 --> 00:21:15.359 lot of like kind of traditional talk therapy while the 366 00:21:15.400 --> 00:21:18.920 person is relating their experience, and it's very distressing for people. 367 00:21:19.039 --> 00:21:21.640 I mean, imagine someone has been trying to not think 368 00:21:21.680 --> 00:21:24.480 about this experience for however long and now they're like 369 00:21:24.559 --> 00:21:27.359 giving you the most detail they can about it. Yeah. 370 00:21:27.359 --> 00:21:28.960 I just literally got goosebums. 371 00:21:29.000 --> 00:21:32.119 Yeah, it's terrifying and people, I mean people really become 372 00:21:32.319 --> 00:21:35.319 upset in the session. I mean people are crying, you know, 373 00:21:35.559 --> 00:21:37.359 like they don't want to do it. And then they 374 00:21:37.359 --> 00:21:39.920 would listen to the tape afterwards and you know, do 375 00:21:40.039 --> 00:21:42.319 some of that, like some of what we call in 376 00:21:42.440 --> 00:21:45.720 vivo practice where they would approach some of the stressors 377 00:21:45.720 --> 00:21:48.200 on that SuDS list and then you know, do relaxation 378 00:21:48.279 --> 00:21:53.680 afterwards this process and what happens is people habituate to 379 00:21:53.920 --> 00:21:57.279 their distress. So, you know, an analogy, you'd be like 380 00:21:57.319 --> 00:21:59.440 watching a horror movie. If you watch the scariest movie 381 00:21:59.480 --> 00:22:01.680 you've ever seen, but every time the worst scene comes on, 382 00:22:02.079 --> 00:22:04.920 you cover your eyes and look away. The hundredth time 383 00:22:04.960 --> 00:22:07.880 you watch it, it's still going to be terrifying. But 384 00:22:07.920 --> 00:22:10.319 if you force yourself to watch it again and again 385 00:22:10.400 --> 00:22:13.000 and again and again and again, well the hundredth time 386 00:22:13.039 --> 00:22:15.480 you watch it, it's not going to be pleasant, but 387 00:22:15.519 --> 00:22:18.359 it's not going to be horrifying to you because you've 388 00:22:18.359 --> 00:22:22.480 habituated to that experience. 389 00:22:23.079 --> 00:22:25.440 I went to add an audio clip from the Exorcist 390 00:22:25.519 --> 00:22:27.079 and I started to google it and then I was 391 00:22:27.119 --> 00:22:29.839 like no, no, no, and I chickened out. So point taken, 392 00:22:30.039 --> 00:22:30.599 doctor Nick. 393 00:22:30.839 --> 00:22:36.559 But that's kind of the Yeah, underpinning of most trauma 394 00:22:36.599 --> 00:22:40.400 treatments is this idea of habituation to distress. 395 00:22:40.799 --> 00:22:43.440 When you're talking trauma, what exactly is trauma? I know 396 00:22:43.480 --> 00:22:45.880 that that's so subjective, And when you're talking about people 397 00:22:45.880 --> 00:22:49.759 who are in active firefights where people many people at 398 00:22:49.799 --> 00:22:52.720 once are trying to kill them, Yeah, and their closest 399 00:22:53.599 --> 00:22:56.720 friends are dying around them. It doesn't get a whole 400 00:22:56.720 --> 00:22:58.920 lot worse than that. And I know that having studied 401 00:22:58.920 --> 00:23:02.319