Microtherapeutics

Where where are we falling short and and where are the spaces that need to be filled? And what I love about my conversation with Dr Boston is there are so many solutions that she gives and the science to back it up. And y'all are going to get something for free. So don't you fast forward this little intro. I'm gonna give it to you right now and we'll get into you'll hear in the episode more about what

it is that Dr Vosson works on. But she is the chief medical officer of a company called Real And again, you're about to get something free, so keep listening. It's a mental health care company that's building a new therapy model. Through a monthly membership, Real provides care to members that they're able to access anonymously on their own terms, at a price that is more affordable than other therapeutic approaches.

Through modernized therapist designed programs, they're improving the quality of mental health care and making it accessible to more people, especially the nearly of people that are left out of the current traditional one to one therapy systems. So right now there is a code you will get a free month of membership on a monthly membership offering valid through May thirty one. Okay, so you've got a month. The steps to redeem it are go to join dash real

dot com. Select Join Now at the top, select the monthly option, and proceed to their member info at the paywall, where it asks you to input your credit card. There will be a selection for a coupon code promo and you will enter anxiety bites. Click and complete, and now you have one month of a free monthly membership to Reel and you can download the app to continue member on boarding and ultimately picking a pathway to get started. And so you may ask, well, what is this real?

What are you talking about? You'll see when you go to the website. But basically what Dr Vasson does she leads something at Stanford University called brain Storm and it's a lab. So the Stanford Lab for Mental Health Innovation otherwise known as Brainstorm, focuses on trying to solve the mental health crisis through entrepreneurship. Right, So basically, there's a really depressing statistic that over the course of a lifetime,

fifty of Americans will have a diagnosable mental health disorder. However, if we optimized all the therapists in the United States, we'd only have enough therapists to treat seven percent of the American population. Again, despite the fact that of Americans will have a diagnosable mental health disorder. So sometimes people

need solutions. And what Nina's student, one of her students from her Brainstorm lab did was that that that's what they do with the the Stanford Brainstorm Lab is they come up with ways that young people can become entrepreneurs in ways that help people with mental health. So one of her or students is now the CEO and founder

of Real which is one solution to mental health. And what Dr Voston works on with a lot of online companies like Pinterest, or TikTok is something known as micro therapeutics, which is a tool kit of exercises that are based in cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy translated into two or three minute things that you can do online for free and actually feel better in

just a few minutes. It's it's a compassionate experience. That is the opposite of when you log onto a website and something pops up and tries to sell you something, or you see a negative comment. It's literally the opposite. It's it's information that kind of just comes to you and it gives you things you can do right in

that moment. Because, as I learned from Dr Boston, the average person who suddenly feels a symptom of anxiety or any kind of mental health issue, it takes up for some eleven years before they decide to set foot into a therapist office. So imagine, you know, and that was my story as well as Dr boston stories. It took

almost a decade to go get help. And so imagine if in that time, uh that you know, imagine if in those ten years you have little tools along the way to help you in the moment with your symptoms. It would certainly alleviate all of the things we do that are you know, not great choices to alleviate our anxiety, right over, eating drugs, alcohol, maybe even just you know, taking our anger out on other people, sleeping all day whatever. It is just maladaptive behaviors that you know, we do

because we're self soothing, we're self medicating. We don't know how to fix this, and you know, imagine doing things that help here and there on the way to your journey to finally walk in the door of a therapist office. And so I just found this conversation today so fascinating. I learned so much that although it seems like everybody is having mental health issues and it seems overwhelming, how are we going to get everyone this help? It is possible.

And I love the idea that people are going to college and learning about ways to become an entrepreneur, not so they can sell us more lotions and and leggings, but so that they can find a way that that mental health solutions can be integrated into our you know, we're already online life. So again I hope you will sign up for the free offer for a month of real and again all of that will be in the show notes, so you can just click there and get

on it. So again, today I talked to Dr Boston about the fact that she is someone that had anxiety and still has anxiety and depression as she still is this, you know, brilliant doctor. It happens to the best of us. And we talked a little bit about, you know, our COVID habits and what she's doing to make changes. She explains the biopsycho social model that is how we diagnose and treat anxiety, and she just has a lot of

great facts about what actually helps alleviate our anxiety. And again there's no magic pill, and you're going to hear a lot of the same things that you've heard in other episodes about mindfulness and sleep and exercises because that stuff works. But what I love the Dr of Boston does she will actually write things like that on a prescription ban. Anyway, let me just let me just start the episode. You don't need to hear me describe what

we talked about. Let's just go there now. Well, let me let me of course brief you on again who I'm chatting with. Dr Nina Vasston is the chief medical officer of Real, a mental health care company building a new therapy model. Outside of her work at Real, she is a psychiatrist and professor at Stanford, where she is the founder and executive director of Brainstorm, the Stanford Lab

for Mental Health Innovation. She has served as a healthcare advisor to the United Nations, the World Health Organization, and the Obama and Biden presidential campaigns. Dr Vasson earned an a b in Government from Harvard College, graduating as one of Glamor magazine's top ten college women, m D from Harvard Medical School, NBA from Stanford Graduate School of Business, and completed psychiatry residency at the Stanford School of Medicine, where she was Chief Resident. Oh my god, Uh, I mean,

I think she's pretty qualified to tell us what to do. Me. On the other hand, I got a Bachelor of Arts in modern dance. So so don't take don't take my word on anything. Just just let's just listen to Dr Boston. Okay, Dr Vosson, thank you for doing the show. And you know, everyone just heard in the intro your credentials and how um acclaimed and brilliant you are. But you're still a human and I would love to hear your experience with anxiety past and present. You know, how did it manifest

in your life, how did you cope? What what does it look like on the day to day Now, First of all, thank you Jeds so much for having me and and let me take a step back, thank you for having this podcast. Thank you for talking about mental help with so many people. It's incredibly you know, important, and I just really appreciate the platform that that you created here. Oh thanks, It is the joy of my life. I could do this all day. So it's really easy to do because I love it. I love that. I

absolutely love that. And to answer your question, so actually on my LinkedIn, the very first thing that I share before any credential, before any title, is UM, that is my now twenty plus history with both anxiety and depression, and going back, I think starting in as a teenage Jeer, I had pretty bad social anxiety as well as general anxiety,

both kind of emotional and physical manifestations of that. And just to give you some examples, UM, I was a math nerd in your growing up and one of the things I remember is before any math competition, I would get like nausea, upset stomach, have to go to the bathroom multiple times in the morning. We we go to like other other schools and like I go to their their bathrooms like for like twenty minutes before the competitions

would start. Had no idea what that meant. Oh, it took like ten years to finally figure out we know why that was always happening and that this was a pattern. And you know, sweaty palms, those were sort of the physical manifestations I would get pretty regularly before before things like that have stake sorts of things in particular. And then in terms of social anxiety, you know, getting really really nervous before but before kind of any type of

social event. But moreover, you know, worrying that people were judging me and um anything that I would say, uh, be thinking so much about how are people going to you know, perceive what what that is that I'm saying. And uh so that that was one of the second thing. And I think, you know, as a teenager, of both were the things that definitely manifested. As time has gone on. Um, luckily,

I think that both of those have certainly gotten better. However, I do still struggle with anxiety today, um, you know, twenty years later, and I think different manifestations of it. Um. It shows up in certainly in various forms. And one of the these I think is really important to understand about anxiety is that one is on a spectrum, you know, from zero to a hundred, if you will, and throughout

our lifetimes that that will change. And even in what I'm standing, like, the flavor of anxiety can change for someone and as different you know, life stressors come and go, Um, things get better and worse and so um. You know.

For me, I think that I've been in treatment now for I guess probably about ten years, um, meaning both both medications and various forms of therapy, as well as some of the things I hope we talked up today, um you know, doing things like um, gratitude, mindfulness, journaling, exercise, so many, so many of the kind of things that we talked about now is lifestyle and wellness and well being, and um, they've all you know, I would say that every kind of every type of treatment out there has

definitely helped me a little in different ways. Um. And but but nothing also has been like a quick fix or a cure. Uh. Yeah, that one one more thing I'll share about that is that UM, I think most recently, certainly I I didn't even, I think, appreciate the extent

of my anxiety until COVID started. And I think a lot of people have had similar experiences where maybe their anxiety was kind of under the radar, and then with COVID they like you know, became an overwhelming thing or have been something that they dealt with for a long time, it reached absolute new heights where for some people that was crippling. They's hard to have panic attacks. UM. For me, I think what I realized was one, uh, really a

lack of self care. This is very very common that doctors, while we tell our patients to do all these things for them so for them, we do not do it ourselves. And that was something that was really big for me. But in the in the context of that, UM, really I think having when I was anxious, UM, for me, what that meant was often turning to food UM and and at times also also like having a couple of

extra glasses of wine, you know. And I think that both of those kind of overeating over drinking are things that are you know, very very common sort of self you know self medicating if you will, for anxiety and and so those are things I actually stopped drinking UM and I'm now I'm actually right now learning how to deal with my anxiety and triggers. I said, I'm not having that extra cookie or you know, calling pizza delivery at ten pm. UM. But it's something I've stopping with

real for a long time. And I think now what I realize is it's tart. I'm trying to accept it, realize I will struggle with it and that's okay, And let me get the right tools so that I can, um make things a little bit better on a daily basis. And just relating to that really quick, just so people can hear how anxiety is so sneaky. Um. I've had generalized anxiety order panic disorder undiagnosed since I was probably eight, diagnosed at age forty seven now, and it moves around,

it changes. I feel like some things are completely mastered. And so what was interesting is because I had such a good handle on anxious feelings, panic attack symptoms and even rumination, I didn't suffer that in the pandemic. However, I did start. Oh, I'll just have a couple of drinks every night. Oh, I'll just order food at ten at night when I should just go to bed. But I wasn't feeling anything I could identify. I didn't feel nerves, I didn't feel the onset of panic. I didn't even

feel sadness. I felt nothing. And now I know that all those coping mechanisms were anxiety. And what it doesn't actually frighten me. I'm just being verbose. But what is interesting to note is that unlike all beings IDEA had in my life, and I thought I was handling the pandemic so well because I wasn't panicking, is oh, I didn't even know how to identify it. It was so it didn't have any symptoms. Honestly, I just had the the the bad solutions, you know. And I think that's

a little frightening. I guess it is frightening. It is. You're absolutely right. It is frightening because especially when we're aware of certain things, and we can tell our emotions have changed, you know, and we know what to look for when that goes away, and there's nothing that you can sense is very frightening. And in this case, I think what you saw was a change in your behavior but it was difficult to associate that behavior with anxiety

because those same triggers that you had before weren't coming up, right. Um, And so I think that exactly what you dealt with, Jen is what I mean meant, like, you know, millions of people in our country and and certainly around the world experienced over the last few years with you know, and we saw that we saw like you know, weight gain increased, the amount of substances that people have been consuming has increased. And so these are very very common

and the easiest accessible things that we know. That kind of sued us, right and so, um incredibly incredibly common. And I think that um, as we move forward, the more we can become aware of what are these things that we do and how do we cope? Um, that that will that benefit all of us because exactly like you said, it's like, oh, I didn't realize that's what it was. This question just came to me. It maybe

less of a question than a comment. It's so hard because being a teenager, our hormones are going crazy, We're experiencing so many things for the first time. We don't have any life experience to draw, and of course we're going to have anxiety, So it's really hard to tell what's situational, you know what I'm a teenager and what's Oh, I might have an anxiety disorder and this will probably

continue into my twenties and thirties. Do you think it's more of the way like sort of what the teen mager does to cope is what causes it to become an anxiety disorder or not? One. I think that's a great it's a great question one because it's like, how do we know for ourselves what's normal and what's not?

And you know, I speak around around the country to big groups of people, especially now a lot of employers, will you know, we'll talk to large companies everything, And actually, one of the most common questions I get, jen is is kind of I think one of the things you're referred to is how do I know if this is normal or something that's actually a disorder? Wherein any to seek help? And so I think, even as a teenager, one big important way to distinguish that is how much

does it affect in your life? In the sense that if we think about anxiety, is it you know, I get a little nervous before the s A T S or but you know, Oh there's a cute guy, and my palms get sweaty, you know, as he's trying to talk to me. That's what happens to me. But but um, you know, I think thinking about that versus I'm so anxious that I'm only sleeping three hours at night or

you know, I I my grades dropped. You know, I used to be as straight a student and now I'm getting sees because I can't focus right, that type of a change where you're not taking care of yourself, like the goals you have in life for yourself, for sports, for relationships, for school, like those are all changing. That's I think the best way to see are you able to cope and live the life you want to or is this issue getting in the way. Um. So that's

the first part of that. The second part what I'm hearing you is saying is like, how do we know what? You know? Why really is anxiety? Why does anxiety occur? And what are the things that happen in childhood that can lead to it being a bigger issue as an adult versus not? And what that I think it's ays to is the biopsychosocial model of e mentally list in particular of anxiety. UM, I'll pause, There is that something

we should talk about? Yeah, biopsychosocial on my list. Well, let's go there now, and then I want to get into your um, you know, your academic laboratory and you're you know, concept of technology and entrepreneurship. But but let's get into biopsychosocial. So that's a new thing I'm hearing, and I know the concept is not new, But UM, I've heard you saying a lot in my research, and I would love for you to explain what do you mean when you say that? And how does that? How

does how does that help you help people? Absolutely, So when we say biopsychosocial, what that refers to is the way that we think about why any mental health condition, whether that's anxiety, depression, trauma, obsessive compulsive disorder, why it occurs, why it manifest in the first place, as well as then actually it gives us a framework for how to then treat deep these conditions. So let me explain what

that means. So when we say biopsychosocial, what that means is that the reason anxiety occurs is actually this combination

of biological, psychological, and social factors. Biologically, that means like things like our genetics, right, like if mom or dad was anxious, there's a much higher likelihood that you're going to be anxious because this stuff gets passed on in the d n A. From the psychological perspective, that means how do you talk to yourself and cope with stressors and um that you know what, what's what's your dialogue with yourself? That's the kind of psychological what's your resilience

like a component? I think the social component is actually one of the most fascinating. And when we say social, that's a mix of I would say two big things. One is historical, meaning what was your childhood like? You know, if we think about, for example, now all the kids who grew up throughout COVID, this will be a part of their life for you know, for their entire life, and how will that manifest as you know, as things continue?

And so did you grow up in a household that was very supportive, encouraging, did you grow up, you know, in the midst of war, or have immense trauma where you bullied as a child. All those very much significantly lead to what anxiety can look like, not only as a child but also as an adult. And then secondly

we have environment. And so I think the biggest way to think about the environment just let's think about the last two years and how everyone's life has changed, and where the environment that we're living in because of all these literally like you know, changes to what our home looks like, what work looks like, what our relationships look like, all of that, uh increases what you know, in this case, it increases anxiety. Um And so all of those together

actually help us conceptualize why anxiety occurs. Now, what last thing will add about that, I think that's really important and makes is also what I think in a lot of ways, what makes mental health fascinating and frustrating, maybe compared to some other areas of medicine, is that in other areas of medicine, we have a blood test or you know, you can get an X ray or m r I and you can really see exactly what they are, or like you have the number telling you what level

things are in terms of figuring out the severity of disease. The issue with mental health is that, um, one, you know, we don't have that, but moreover, we don't really know right now, how like what percentage of my anxiety versus your anxiety is biological versus psychological versus social. We can get a full history and kind of make some guesses like, oh, you know, my mom also has anxiety, so that certainly means it's probably and my brother has anxieties. There's probably

a family component. How big is that, We're not quite sure. Hopefully in the future will start to have more information to get this, but right now we don't. UM. So I think really what we should take from this is recognizing, you know, it's not the kind of old school ways that people thought about why someone has mental illness. Nothing that was your fault. It's nothing that like quote someone did. Um. It is a very real biological part. But and and

also medical station car environment. My listeners have part of me say this a million times. But the first time I went to get medication for depression was you know, early twenties. I don't believe I suffered from depression too much anymore, but the doctor, you know, was very kind and normalized it in fifteen minutes just by looking at me.

Explained that I had a chemical imbalance. And I was so confused because I literally thought I was going to get a blood test or have electrodes put in my head, and I just didn't understand, Like, how can you say chemical but you didn't do anything, you know, And so I'm learning now that that's kind of like, uh, it's not a myth per se, because I know that chemicals are involved, but it would you say that it was

just sort of like they named it badly. I think, yes, it's that bad marketing is what I would say that that and what that is is so you know, at the biological level, what we know is that, for example, with anxiety and depression, the level of the neurotransmitters things like sarah tonin dopamine uh nor an efferent the levels that we have in our brain are different. And so you and I who have anxiety, who who you know have also done with depression, we have different levels compared

to someone who doesn't. And moreover, the medications for example ssr I selective serotonin re uptake inhibitors, medications like UM, sertraline of lu ox of tine, pro pro prosagne, medications like that UM. What they do is they block the debt the breakdown of the serotonin, so that leads to an increase of serotonin in our brain. Um, and that's what's trying to do because maybe you and I either make less or we break it down quicker. And so the point of the medication is to increase the amount

of that in our body. So technically, yes, at that level there is a quote chemical imbalance, but I completely agree, like it's not the right way to talk about it or think about it, and um, there there's a much more kind of maybe eloquent or or kind and really educational way to explain that so people don't feel like I have wrong chemicals in my body or grain. You know.

I had a psychiatrist used to say, we're gonna have to play scientists, and I found out for me, I do better with the UM drugs that are less the serotonin reuptake inhibitors, but better with the dopamine increasing you know, UM SMRI s. I think they're called right, Yeah, that's that's exactly right. And I yeah, and and um, I think that that's that's also something that I think can

be frustrating. And I say that it's because I think that one something that's been important to me is actually trying to educate folks so much about these medications, and you know, one thing that happens is for a lot of people, the first medication might not be the right medication, and it is a little bit of trial and error. And I can imagine going to a doctorate and being like, we're going to experiment what but but the reality is that you know that not only actually is the case

for psychiatric medications, for a lot of other medications. It is the same thing. We are not sure I like allergy medication, which allergy medication is going to work really well for you. We're not exactly sure from the get go. But that's why oftentimes we have to try a few and it is important to you know, work with your doctor to to see what's working, what's not working when other side effects so bad that they outweigh the positive effects.

And one thing that's really hard about these medications is that you feel the negative side effects before you feel the positive um and that makes it really frustrating at times. But it is really important to give it a try because you know, I certainly seem both for myself as a patient as well as for you know, hundreds of of my own patients, how medication can just give people's lives back to them. We'll be right back. So the

biopsychosocial Am I wrong in saying that? It sounds like the social aspect is sort of a newer discovery, or maybe not a newer discovery, but a newer has more gravitas, like people are taking it more seriously. I think that's absolutely right. People are now taking it more seriously and

recognizing just how much and how complex it is. For example, only now I think we're recognizing how like early childhood traumas or as I said, you know, things like bullying can make a tremendous impact later on down the line

in ways that we really didn't appreciate before. And so one, there's a lot of research now being done on you know, things from the past that help us see how it links to things in our present um as well as then recognizing that, you know, as I said, it's it's relationships, it's what work looks like, it's what family life looks like, it's in all these sorts of aspects of environment. So

that that's definitely that's definitely becoming the bigger thing. But I what I actually think is really exciting about that is that it gives us so many more opportunities for intervention and rather for treatment. So you know, it's not just the when we think about biopsychosocial you know, as I said, it's not just why disease occurs, but it's how then we can treat. So what means is that, you know, we can treat with medication biologically, we can

treat with therapy psychologically. But then when it comes to environment there's so many different types of treatments that help from the environmental perspective, everything from working on your relationships with your parents or with your spouse, exercise, mindfulness, meditation, journaling, gratitude like so the dozens and dozens of things. And I find that really exciting, and I hope I find that that gives hope to people that it isn't just a pills help. But it isn't just a pill that's

the only answer. There are many many others that help improve anxiety and moreover, can build up a lifetime of resilience for you. Absolutely well, that brings me to your work. So you have an academic laboratory called Brainstorm, and on the website it says transforming mental health through technology and entrepreneurship, which then leads us to another project that you're involved with called Real which I've mentioned in the interest. So I don't I don't know. I I'm just so fascinated

by that. I was like, I've never had anybody I've never liked to like, you're the only person doing this. It's so exciting. How did you come up with mental health and entrepreneurship like hand in hand. Yeah. Absolutely, I it's been such a such a passion really almost in the past decade or so, and I would absolutely like

to to share that. And let me start with you know, in mental health and in psychiatry, one of the things that we talk about, it's sort of big, like a catchphrase for for the field for for years and years and years, is meet people where they are. And you know, it's something that we say figuratively around you know, whether you were just getting diagnosed or you're not sure if you want to take medication. You know, the way that you need to talk to people is seeing where they

are right now and and really approaching discussions that way. Now, if we think about that from the figurative perspective, that's what that means. If we think about from the very list, So what just to take a step back as I think about how solve mental health is a problem, right, how to make things better? Two billion people around the world, first of all, have a diagnosable brain or behavioral health disorder.

And I seem diagnosable with with that inflection, because what that means is that you know, you meet X number of criteria for depressional for anxiety. But what that also means is that let's say you're four out of eight you meet what if you meet three out of eight? Okay, you might not be diagnosable, but you're still really anxious, right, and you would still absolutely benefit from treatment, and you're

still really struggling because that so. So I said that because you know, I think when we talk about statistics, the official diagnosa is important, but it's also just important to think about life, right and like the whole spectrum. Um So, so when you have a problem that big where it's billions of people around the world, um And I think the other thing, you know, you mentioned your

mom and sister having anxiety. When anyone has anxiety, it's not just the person myself who struggles, is their loved one as well, right, like, and so it's really really something that goes much broader. So when you have a problem of that um magnitude and also urgency, especially in the US now you know, drug overdoses are the number one leading cause of death for the last few years for Americans ages eighteen to point five, right, Like, it is killing our generation of people. Um that is both

prices and you know, and magnitude. So what are we gonna do about it? Right? And and that's to go back ten years. I was when I was you know, in in medical school and just getting into psychiatry. Um. That that's kind of what I was thinking about. And at that time it was the first time, you know, as as physicians, we treat one person at a time every you know, ten minutes, fifteen minutes, one hour. That's that's kind of what the traditional medical model looks like.

My own background had really been actually in the nonprofit sector. I did a lot of work with the American Cancer Society as a child, and when as a teenager, I launched a network for a team volunteers for American to Society. And it's always been really interested in communities and the much bigger picture scale, like things like how is policy impact millions of the people at a time, What are these things that we can do to reach like entire populations.

And so you know, in medicine, the idea of this kind of one by one when you think that, Okay, in a week, how many people can I touch? Forty hundred UM certainly like critically important and the foundation of our current medical system. And and you know, my father's a on collegist who does that. I have so much

deep respect and admiration for that. And yet at the same time, for myself, as someone who was kind of always interested in that bigger picture UM sort of thing, Uh, became really fascinated because and just to go back in medical school, that's the first time that people started to think about how they use technology UM from the consumer side, like things that could help if you had diabetes or

high blood pressure, things like that. So it's it's been out there for other diseases, had been very slow to get to mental health. So that makes sense. So that idea of UM, let's train a bunch of entrepreneurial types to handle these diseases. Right without even realizing it, I can see that it's been out there. It's out there,

and it's mental health. Yeah, it sounds so new to me. Yeah, right, you know, but I think you're right, and it's the idea is, how do we think about all these new ways to address mental health not just seem like see a therapist and I'll throw out one statistic. What we know is that, you know, most people want to think

about mental health, they think about therapy. If we optimize all therapists in the country to treat Americans, we would only have enough therapists to treat seven percent of the population. Oh my god, seven percent. Now the problem there is that over the course of a lifetime, fifty percent of Americans will have a diagnosed while mental health disorder. So yeah, clear, clear,

you know, imbalanced there. And so we absolutely you know, one on one care, traditional medicine, clinical work, com medicine important. We will never be able to solve the problem unless we think about other ways that we can reach people. And that is where technology comes in. So I'm set

at the beginning to meet people where they are. And to me, what was really fascinating is recognizing, Okay, like if you think from a literal perspective, where are people And back in the day, that meant like community medicine. People who would go in bans to you know, two different communities and work with the home of population or go go out there to folks and reach them in you know, in their homes or even the doctor with the you know, whould knock on doors and and and

see boats. Today where are people? They're all online and we all spend you know, like the number of hours especially like teenagers and kids and young adults that online

is really really big. And so given that we are like kind of living our lives online and it's this whole new world that we're living in, if we can address mental health online both thinking about it's this whole new community that we're living in, how do we keep people safe and make it uh environment that's mental health friendly as well as think about the online worlds as ways to deliver and provide mental health you know, therapeutic

services education that that is a tremendous opportunity to reach people in ways that you know, is low cost, scales can be you know, and and just gets to you. And in particular because of stigma, it's so hard to go out and be proactive and even figure out that I have something I need to go to find a doctor or get this information. If we can get this to people as they're already on Pinterest or TikTok or Instagram. That allows us to really have a tremendous way of

reaching people. And so that that's actually exactly what we do at Stanford Brainstorm. The biggest part of it is we work with companies like Pinterest and TikTok. I'll also work with organizations like but to Pop, Shu Core Foundation, with Kevin Love Foundation, groups like that that are really trying to think about how do we leverage technology to reach populations and also through platforms like like these online platforms.

So to take it back, let's say, Um, you know you're talking with someone at Pinterest, what exactly would you be asking of them? Is that the right way to put it, that is perfect questions. So if we go back about three years we were speaking with pinterests and what Pinterest realized as they were looking at what people were looking for when they came to Pinterest. Most people come for things like wedding planning or interior design or

searching for recipes. It turned out that the fourth most common category of search terms was actually related to mental health. That was really really surprising because it's not a place that you kind of just think, oh, and let me go sort of for mental health information there, right, And they really realized, yeah, and they really realized, like what

can we do about it? Like how can we change the whole experience people have so that it feels safe and warm and welcoming to talk about mental health online? But moreover that you get tools and resources, you know, and now we're talking about so much like fake news and misinformation, how do we actually help people get top quality information that we know comes from doctors and is evidence based, like you know, not like really the best types of treatments. And that that's actually how the whole

thing began. And so they're kind of four categories of things that we worked with them with. The first thing that we did was what we created what we call microwth therapeutics, And so basically, what now if you go to Pinterest and you type in I'm stressed or what do I do for depression? And these were some of the types of search terms that people were looking for before I'm going to do it while I'm talking to you. Yeah, yeah, yeah, So go go to pints and type in depression for example,

or stress or anxiety. Now what happens is you get a whole pop up and it's a separate pop up and importantly it does not link to your home feed, meaning we're not tracking your UM search or anything. You know, it's it's it's all private information. So it's very applical in that way. YU and you get you get to pop up basically that saides you know, it looks like you're you're maybe struggling with something. How can we help you? I just got it. Yeah, So so it shows me.

You know, people have their little memes and they're cute little UM charts. But then there's a little thing in blue that says, if you're feeling sadder stressed, here are some resources, and then you can click take a look, and it takes you to a separate thing UM suicide Prevention Lifeline. But then these little things too minute things you can listen to refocus your attention except your emotions. This is fantastic, that's exactly so those two many things.

So it's basically all we called the micro therapeutics, and it's a whole like toolkit of exercises based in common behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy. These are the same therapies that we would use with patients one on one and right and you know over the course of weeks or months that we would do with patients.

At of what we did was we translated it into a two minute, three minute thing exercise that you can do on pinterest thinking about what is the best scientific evidence tell us that you can uh how to think the best of these different things, and what can you actually do online without a doctor in the convenience of your home, such that the minute you type in stress or depression you can get something and actually feel a

little bit better ingesting units. I love this, Yeah, I love this because you know, if someone is typing in stress depression and they might see a quote or I mean, which is great, but you so rarely online see something pop up and interrupt you that wants to help you rather than sell you something or you know, no, you're absolutely right, and that's act to something that's really important. And I'm so like appreciative, Like the CEO of Ben

silvermanut Pinterest like has the best values. When we were working with him, he said, adamantly, you know this is not something I want to have ads. This is not at all something that I want to like, you know, be related to bringing in more money. This is completely just something I want to help people. So they're no ads with this or anything. And it's complete, it's free, right, So like think about you know the cost of mental health care so so difficult. It's this is a horde

percent free. You go type you get these resources, you can access it at any time. Um. And I think what's really important here is, you know what the problem with mental health. You know, the average amount of time from first having a symptom of mental illness to seeking medical attention in the US is eleven years. Yeah, seven years, seven years. But my mind to mind too, imagine lighting out eleven years with you know, I think I am

having a heart attack, you know, exactly exactly. And so having resources like this that are so easy to access and free means, you know, even if you have a little inkling I might be depressed or anxious, if you can go and actually get some sort of help, um, that that's really important to get started. And moreover, you know, the way all these diseases progress is in those early stages.

They're they're small. You have mild disease early on, and it gets worse as things go along, and so things like this, especially if you reach people early, can make a tremendous difference actually, and I think that's really, really, really valuable. So so that was one big set is just how do we get more of these things online? And that's actually what I hope all other platforms start doing as well, so you know, you're you, you're able

to get this sort of information. UM. The second big thing though, is uh, the actually term for this whole thing that we created on pinters is called compassionate search.

And the idea is how do we actually change the user experience for when you're online so that instead of feeling like something that into your point is like toxic or you know, like the Facebook UM whistleblower who you know talked about eating disorders and how the more time people spend online, especially kids, we see that rates of self harm, suicidal ideation increase, body body eating disorder, eating

disorders and body image issues get worse. How do we actually create a compassionate experience And so in addition to providing these resources, UM, the other thing we did is

actually change things about the user experience. So one example is UM with autofill like when you you know you're type, you're searching for something, if it's something that's dangerous, like related to self harm, it actually won't auto fill in the way that you're searching for like you know, for me, like a navy re velvet couch, it might all right film,

but in this case it won't. And moreover, it won't push things to you like you know, if you start to type something then in your inbox you might start to get a lot of other Navy blue couches. Nothing that like that would hume if it's something that we

think is concerning. The third thing we did was actually work with the engineers to change the algorithms um and so what they were able to do there is actually by educating them and explaining what is harmful content, the context of harmful content for who is it harmful, we're actually able to decrease the amount of self harm content

by a eight percent in about six months. Wow. And kanyex is so important too, because like a kind of side example is if you report someone on Twitter that's harassing you, unless they say these five words, it's not harassment. So it's it sounds so exciting that you're there is an ability to apply context too social media. You're absolutely right, and it's also very cultural to write, you know, like the work we did. We it was in English and eventually spread to I think so hard spread to nine

other countries. But you can think that something that's bullying or harassment or or harmful in the US compared to in another country. They're tremendous issues there. Based on your age, based on your you know, your background, based on your gender, all of those context is really important. We'll continue the interview on the flip side of a quick message from

our sponsors. You were telling me about a student of yours that started a company that you're very much an involved with real and I would love to hear more about them. Absolutely So I have to say a lot of my favorite students my part times million, so Arie Eli Sefira. So with my lab. In addition to you know, working with companies, I teach courses on how to start a company and mental health UM and at students for

teaching these courses. And the very first time I taught this course was I guess around five or six years ago there was a rock Star UM it's actually graduate student course that taught at the d School and we have a lot of business school students and engineering school students and law school students. There was this rock star senior undergrad who was studying computer science and math whose name was Arielli Sepia and Um, and she came to

the class really impressive background. She had been interested in mental health after one of her close friends had attempted suicide and it just really, you know, tremendously moved her and she was just really thinking not only how did this happen, but what can be done about it? And looked was really just this incredible student and someone who wanted to have taken all sorts of information and learn as much about mental health as she could. So she

went all across the world. Actually she went to the UK and Um studied at the what's called the one of the most innovative in patient facilities around mental health. She worked with IDEO trying to understand how do we redesign mental health facilities and think about what the patient care experience looks like. UM, and it's so much stuff to try to understand more about mental health. And that's actually what we did in the classes really help people

understand the nuances of mental health. You know, a lot of companies out there as well as folks who are doing anything to try to now make an impact in mental health usually have personal experience, their own experience or

the experience of a friend. And what is really important, especially on my perspective this clinician, is understanding like the breath of experiences, because if you're going to create something, you really need to understand what is it like for entire populations and what are these things that come up so that when you're building, you can you know, we talked about like putting the user first, not like thinking what's right for the hospital or the clinician, but how

do we actually start with the patient and what the patient needs and create a solution from their perspective? And that was that was really critical to you know, what we teach them, of course, and and what exactly I think, what what Ariela has done? Um and uh And so we met in the course and she graduated and uh, what went on to City Block Health, which is a company based out of New York that works with the Medicaid population. Uh And and you know tried multiple things.

You actually thought about becoming a therapist um and then realized that she didn't want to come a therapy. She really wanted to change the system and that's what led to her starting REEL And that's where she started with with how do we actually start con scratched, Like what does what does system redesign look like? And what do we need to offer people to a really impact mental health in that way? And so you know, we we

would we kind of continue this mentor vntie relationship. We would talk, you know, talk on the phone and stuff. And basically over the last three years. I started off the first time she she quit her job to try to start this company. She called me get said, I think I'm gonna do this. I was like, yes, you know, like a gun gun post work you all the way um and and little by little, you know, start off as an advisor and I guess within a year, the you know, was was thrilled to join her as the

chief medical officer of real UM. And that's what we're doing, is we're now we're working together as for former professor's student. Now that you know she she is my CEO and my boss now and that's which is I love it and and that's what we're doing. We're trying, we're trying to build a new therapy model. And it's been I have to say, it's been really tremendous seeing UM for

grow and how the whole company has grown. We're now over the UM you know, fifty employees, you know, the thousands and thousands of members and what to me has been really impressive. Actually, I'll say one more thing about Ariella is as we think about mental health, it's not just how do we change this system? I've actually gone a step further. It's how do we, you know, change the way that mental health looks, you know, across really like even more broadly than that, to thinking about like

what does it look for employee? Like what does it look like for employees? And I think that actually, especially now as we think about COVID, the number of employers I've spoken with were realizing my employees are really really suffering. What do I do about it? That is one of the biggest opportunity points that we have to make change in mental health as adults. The majority of our time we actually spend in the workplace, and that's actually something

that we've done. It real is you know, in addition to creating this product that we get out there to our members, UM we've actually looked to see how do we change the workplace and make it more mental health friendly. That starts with things like we have one our breaks throughout the week of just let's take a pause. We actually have what we call mental health break where one week every quarter, the whole company get off. And this is different from our PTO of time off. Literally the

entire gets off. And it's whatever I tell people that they're like, you know, I start doing your company yesterday. But the thing is, like, what we know from COVID

is that people didn't take vacation. And what we also know is that just like when we sleep, the importance of why sleep is so important to every human being, it's important to take time off of work because it allows us to spend time with family, to rejuvenate, to master other hobbies, and you know, spend time in nature and all these things that are so tremendously important for well being. Um, what we're actually trialing now, just as it literally started two weeks ago, is we're testing out

the four day work week. This entire quarter, our whole company is trying the four day work week, and we're gonna we did the data. We we took surveys before, and we're gonna take surveys after and try to really just study to see how that has it made a difference, How has it made a difference, to to understand what are other things that we can do because the end of the day, at one of the things that's most fascinating to me about mental health is there is no

one solution, right. It's not just one medication, it's not just one type of therapy. It's policy, it's economics. It's changing the workplace, it's delivering treatments like real it's changing the way that we talk to each other. It's having a podcast called Anxiety by that changes the way that our society talks about and thinks about and gets to laugh about mental health. All of those that's what needs

to change if you think about it. I mean, I know not every school system works this way, but you know, growing up, you have the summers off and you reinvent yourself, right, and you come back a whole new person. And you know, I think we can do that. You wanted to reinvent ourselves quite as much as we did when we're still developing kids and teenagers. But I'm just I just mean, like you get a week off, you get such perspective, right, you just feel like yourself again. And I love this

as opposed to the old school. Um, we're gonna take a week and we're gonna go on a group trip and team build and you know, climb trees. It's like, I don't want to spend it with people from like team building, and I think that essent should be as because honestly, if you take care of the individual, you'll probably have an easier time relating with others at work

and working well with others. Like it sounds like that your student who's now your boss is um is solving, is one person solving the problem or you know, helping to solve the problem of only seven percent of the world would be able to see a therapist. So now like you're saying, they can get smaller doses of help, and it's not online therapy, it's it's all kinds of things. It's almost you know, it's like you and I were talking about we waited, you know, a decade to go

get help. It's not even that like, oh, if only we've gotten help sooner, but if only we've had little things along the way to learn to cope, maybe we wouldn't have gotten into some bad habits you know that made our anxiety worse or whatnot. So I this is what I love about it. That is so beautiful. I will record that and share that with so many people. You are absolutely right. And also on is that this

happening pretty sententistic. Is actually for the US, it's much worse when we pay worldwide and even like for I was like, it's worse. Uh, it's why it's worse In one one example in Ethiopia, literally the ratio of psychiatrists to people is one in a million, God right, So so worldwide, you know, much of much much worse. Um. So you know when we when we need to do more. At the same time, I think that what you said is, um,

you know, you absolutely nailed it. And what we're doing it real is thinking about, you know, when what can we offer people? Because you're You're right, it's not when we think about behavior change. Behavior change is tremendously difficult. At the same time, it is all these little things, right like when we think about what we need to do to help with anxiety. The biggest things I'll tell you when I tell people I write prescriptions off and

actually not just for medication. Oh yes, I'm wanted to ask you about this and so excited. Yes, yes, I'll tell you what I've prescriptions for. I write prescriptions for. And these are the things actually that have the most scientific evidence for making an impact and xiety across the board, whether you're severe or mild, or have just a little bit or and no matter who you are, it's things like mindfulness meditation. I'll actually give you, I'll give you,

I'll give you ten my top ten ten list. That's right here we go, mindful mindfulness meditation with deep breathing, sleep, gratitude, nutrition, substances meaning like alcohol, drugs, the Meryl CBT products, things like that, exercise. Wait, I'll decrease the substances. Substance, that's a weird doctor wy decreasing, decreasing substances, decreasing to tobacco use, decreasing alcohol use as as much as possible or or none zero to none or or non done too little

um uh. Nature, community and connection, giving an altruism um sexual pleasure actual are actually our chief therapy for for real Rachel Hoffman has for PhD and sex therapy, which one makes our company like the most live company to work at work at and is great, you know, water pooler conversation is fantastic. Um, But we to also know that, you know, sexual pleasure doesn't meense things for making anxiety better. So those are my top ten um and tave the

best for last. But all of those, right, all of the nothing is new, right, none of those you're like, oh, I've never heard of that before, right, Like, but they're hard and the simplest things are offered to do. And that's actually also why I write a prescription, because what I've seen is that there's something about you know, the patient doctor relationship for a lot of people is very sacred. And while we know, you know, we all know, I know I probably shouldn't be eating nutella out of a jar,

but I do that at times. Is it the best thing for me? It feels like it is. It probably isn't, I get that, right. But but at the end of the day, you know, whether it's around you know, health and exercise and nutrition or gratitude, mindfulness, taking out time and nature, um, all of these things we know it to be true, but it's still really hard to make these little changes. And at the end of the day, it. Actually, it's not like doing these big grand gestures that makes

the biggest difference. It's doing small little things for example, like you know, actually have to tell you something. Um. I even for myself when I go to the gym, just in the last two weeks, I've been telling myself, hey, even if you don't have an hour, try to get on the elliptical or try to run even for twenty or thirty minutes. Yeah, I'm not doing the best workout ever. But but what I've really but you know, the consistency and having getting there every day. Consistency is what leads

to you know, what your life looks like. All those little behaviors make a big difference. And then the prescriptions. Actually, there are two things that I've noticed make a big difference. One is, as I said, just it's almost like when you get it, you take it so much more seriously when it's coming as a prescription. The other things I've noticed I've noticed this actually specifically for women, is that I think it's almost like it gives you permission to

take care of yourself. And so for so many women, you know, there's the sense that we take care of everyone else, but not ourselves, and I actually remember and that self care can sounds so indulgent, like we're not saying, like, go to a spa every day. We're just saying, you know, drink some water, that you're exactly right, you're exactly right. And I think that the prescription gives them that permission

for self care. I remember having a patient who felt so guilty about taking time out, even like a few minutes to go for a walk. And I literally wrote this prescription thirty minutes in nature, um, you know, three times a week, and I gave it to her and she said that she came back the next week and started crying and saying that she showed it to her husband and that having that prescription it felt like that

pass that I can go do this for myself. And how she noted her anxiety got so much better by being able to be out in nature and walk her dog and everything, and so little things like that I just think make a really big difference. And it's important for all of us to think about what are these little things, um it might seem with all these things out there, and let me just maybe say say kind

of one one final way way to think about it. Yeah, I know a lot of people, even you know some of my best friends in medicine, they're like, does mindfulness really make a difference? You know? And then the reality is is, like you know, every day they're great scientific studies that come out and and tell us it does. I think at the at the end of the day, not everything will work for everyone, but most of these things actually will work for most of us, and so

it's really important to find what works for you. You know, even when we say mindfulness and deep breathing, there are like fifty forms of mindfulness and deep breathing. It can be diaphragmatic breathing, it can be prayer, it can be you know, just doing like guided meditation, and those are

quite different. Just like for exercise, if you're ombi eliptical or growing across fit or or playing soccer, those are all very different, right, So finding what works for you, UM that that that's really important and giving herself that commission. Have you heard this expression? My friend is in a a and she told me this, and I love it. It's um none are too dumb for recovery, but some are too smart. Yes, I have heard that. I absolutely

love that. Yes I do gratitude list every day, and I was telling someone about it and they're like, but I don't feel grateful. I go, I don't feel anything when I make the list. I just write a list of things I'm mentally aware that I am glad I have in my life. And then now I have a notebook. So whenever I'm telling myself lies, which is how my anxiety starts, I get to look through my gratitude journal and be like, oh, wow, like I had a friend this day that said this to me, and this day

I felt good about my body or whatever. I get to see proof that I actually don't believe the things I'm thinking. That's all I do it for. I think you're you're absolutely right and yeah and actually sure. One of the things that's most fascinating to me is I I do love the science behind it. Mindfulness, meditation, that the deep breathing. What we actually know now because people have done the science and you know, they actually can

tell when we look at the basic cellular level. What we see is that when people do mindfulness and deep breathing, there literally are chemical changes at the cellular level that lead to the cell living longer. Basically, it leads to a decrease in the enzyme that breaks down the DNA of cells, and as a result of that, the cell lives longer. And as a result of that, that's why we know there's a link between doing mindfulness, meditation, and

deep breathing and longevity and length of life. So like literally taking a few deep breaths today leads to you living longer. Like that is mind blowing to me, because, like you said, like sometimes I feel something, sometimes I don't, but like the actually it does cause like those chemical changes. But the thing is, we don't feel chemical changes in

our selves right right. Well, it's yeah, it's not having a glass of wine where you're like, oh I feel that right away, you know, it's it's it's just experiential. It's over time. You look back and go, oh, I didn't make a total mess in my life this last year because I wasn't stuffing my feelings down or you

know whatever. Then that's the other thing I was going to say at the beginning is it must be so hard to diagnose people because and it totally you know, people come in and they're like, okay, so I have the worst anxiety ever, and there's no test for it, and it's like, I know, you think that's the symptom. Is like you think, you know, you can't jump into someone else's body and feel what their anxiety feels like. But I know we all think ours is the worst.

You know. Yep, you're absolutely right. You're absolutely right, and ultimately, you know, all these changes that we're trying to make, Like you were staying with the Gratitude Journal, you might not feel it in the moment, but like when you take a medication, you don't necessarily feel that like the minute you take it, right, some of these things it will.

You might not notice it in the moment, but then you might reflect back in like a month and say, actually, you know, maybe I do it a little bit better, or it is that combination of seeing like a month's worth of gratitude that makes me feel differently. And at the end of the day, I know, as someone who just always starts with the science for me, you know, all those ten things I mentioned, those are all, as I said, again, the most scientifically back things that we had.

When we know that all these studies show that like, oh, we've done it on thousands of people and we literally see that it absolutely makes a significant difference. That's something for me gives me a little or little a lot of confidence that even if I don't feel it at the end of the day, like I know that it's doing something good and that that helpful lot too. It's like,

maybe that's the faith in science component. Well, it's true, and you're always framing those things is like not science because they're not pills or um, you know, cognitive behavioral therapy. But right, they're based in science, Like the success of them is based in scientific studies or else, you know, why would you recommend them? Um? So it's so true. It's framing it for the perfectionist or the type of like, no, this is as science c as CBT, and I love

looking at it that way. Anxiety Bites will be right back after a quick little message from one of our sponsors. Okay, so this was something I've heard you say that you know when this goes back to what we were talking about earlier with this this chemical amalanced notion that the discovery that serotonin levels are connected to gut health. Now, how new is this discovery and what does that mean exactly? What should we do with this knowledge? Us? Everyday people

absolutely great great question. So what we know about serotonin is it helps modulate your mood. And we were talking earlier about s s r I serotonin such and serotonin reuptake inhibitors, one of the most common or the most common psychiatric medication. That's what they target. Um. What's really interesting about this is there is actually more serotonin in your gut then there is in your brain. And so just to take a step back, so if we think

about serotonin, basically there's serotonin in both places. It's the same molecule, but it's made from different cells. So in the brain it's made from these neuronal cells that are called the raphite neuron, versus in your gut it's made by endocrine immune and gut neuron cells. But they both produce saratonin. However, they function differently in each location based on what the brain needs and what the gut needs.

But at the end of the day, what's important to realize here is that what it means is that there is this connection between the brain and the gut. And people are talking about that like mind body or gut brain connections acts, these things like that, And just to give an example, like how to think about what is this connection. How does this show up? I'll give you

two examples. One is that when people start taking these medications this SSR eyes, one of the first side effects they will have is actually having some nausea or gas or intestinal upset. And you know you mentioned earlier about how uh you know the side effects maybe their differ for a short amount of time, but don't last forever.

This is actually one of the most common things because usually for a lot of people, not everyone, for a lot of people, they'll have like three or four days of this nausea, upset stomach, but then it completely goes away. And the reason we think why that happens is because as the medication, basically, what the medication trying to do is increase the amount of serotonin. What it's not able to do is just increase the serotonin in your brain.

Because the medication you swallow it, and it works throughout your entire body. It's not sophisticated enough to just target the serotonin in your brain, got it. But and so as a result, it also increases the serotonin in your gut. And because there's more serotonin in your gut than in your brain, you end up having these in you know, changes in the serotonin levels in your gut, and so your guts like, hey, what's going on. Something is different,

and so that's why you actually feel noxious. That's amazing. So it's it's really doing its job. It's not some signed fact because it's some imperfect medication. It's actually doing its job. And it just doesn't mean to do it as much in your stomach, but your stomach will get used to it. Is that basically what happens. I think that that's it's a good way to think about it. That like the stomach. You know, the change is making

of the stomach. It's not for what we know now, it's not hurting or helping necessarily anything related to the gut function. What it's really we're trying to get it to do is help those levels in the brain. Um. But that's like what that relationship is. And and to go a step further, the other thing is we know

that there's a huge link between gut issues diseases. Even like irritable bowel syndrome, for example, is more common among people who have anxiety and depression, Meaning issues and diseases that come up in the gut. There's a higher correlation when folks have you know, biological issues with with their their braining is and anxiety depression. So you know, I muself talked about how I would get these you know, I would have nausea and stuff before these these math

topic titians. That's actually kind of what we like that that was it's like, UM that you know, having physically having anxiety but also having you know, kind of other symptoms as well. And that because we know that there's this gut brain access and so UM studies have shown that there are certain types of gut bacteria that are associated with diseases like anxiety and depression, as well as

diseases like autism and schizophrenia. And there's a lot of emerging research now that's trying to figure out exactly what this means. It's it is early, it's early research, UM, and what's really important is what we're trying to figure out. We know that these can there are these connections. What we're then trying to figure out is okay, based on that, how do we use that information to figure out how we can prevent disease, how we can treat disease better.

It's a very exciting area and I think you know there's more more to come. Certainly it's interest an area follow um. But that's why even you like a lot of people talk about probiotics and why probiotics and the gut microbio can help with your anxiety. That that's why things like that are really interesting. So if someone has ABS, does it mean that their stomach doesn't have enough serotonin just in a very basic way that that Yeah, that

that's actually different. It's more that ib S is a separate condition that is related when so their likelihood if someone has anxiety, there's higher correlation of having yes and anxiety. Um, So that the different different councules, but they kind of often go hand in hand. So if someone is not on any kind of S s R I and they don't take medication, but they have anxiety, just one of the things in their tool kit could be taking a probiotic just to have their gut health be O you know, optimize.

That's exactly right, And I think it just as you said, you know, I think more and more. It's a fascinating area of research, and every every six months, I'm sure there will be something that comes out where we learn more about what we can do with our gut that will help our anxiety more and more. I even loved we know now that like there's certain foods that can increase and decrease anxiety and dean um like you know that salmon is good and nuts are good, and decreasing

processed foods and sugar like you know. All we were seeing so many relationships between what we ingest and our mood and anxiety, and similarly we're learning more about our gut and the same. Lastly, I will ask you and I've had very different opinions on this podcast, are we, as everyone keeps saying, in a mental health crisis in this country. I have heard everything from no, it's always been there, but we just see it because of social media. Um, yes,

everybody has some undiagnosed anxiety disorder. Um that just got worse with the pandemic. And then I've heard, no, it's not a mental health that year not everyone has a diagnosable anxiety disorder, but it's chronic stress and we're not meant for that. We're meant for acute stress. So what's your take on what's going on currently? I mean, what is your opinion? Is this a mental health crisis we're

in or is it is it more nuanced? Yeah, I usally we absolutely are and I certainly I think it depends how how do you define crisis or when we say that is that everyone is certain populations. But here's why I think absolutely it is not. And here's why. First, you know, I would say that both are true. You know both we are in a crisis and we have a chronic stress issue. Or maybe it's like all of the above, right, like you know, it's answer E on

the on the standardizing on the standardsize dies exam. Um, here's here's the issue. So even before COVID, we were in a crisis. And just to give you some of the statistics, on example, substance use sort of drug overdoses were the leading cause of death for Americans eighteen to forty five. That has only gotten worse. Despite the fact that you know, both the Trump administration and the Binding administration have put millions and millions of dollars, if not

even billions of dollars into tackling the opioid epidemic. From all sorts of perspectives, those numbers only got worse. Okay, And so again it was a problem before the pandemic made it worse, but it was still a problem, right,

and the problem loneliness. We were in the midst of the loneliness epidemic where everyone from elderly folks who like some who never see anyone for weeks at a time, all the way through, you know, all of the two teenagers who we are seeing changes in the UH in when teenagers hit certain social milestones and their growth and development because of all the kind of they spend online, that their ability to make relationships and form relationships in the way that you and I did growing up because

we did not have our devices with us, you know, seven that we were able to do. This current generation is not able to do in the same way. And we're seeing seeing very real changes in the way that they form relationships and and in their own you know, kind of growth, growth and development. Just just two examples their loneliness and and substantius the suicide rates have increase in suicide rates were increasing in teenagers even before the pandemic.

Since the pandemic has gotten worse. Was even more interesting and and concerning is how these rates have gotten worse for those who are already most marginalized. Sorry about that, All good, All good, I'm just getting an alert, I wanted alert. I'm in Brooklyn. I'm getting a wanted alert for the guy that did the subway shooting. UM a daylight. I think this alert is coming in. But okay, sorry, but that well, there you go. There's a real life

I'm gonna keep that in the podcast. Is a real life My phone just stared at me that there's a shooter on the loose. I mean, you know, adding to our mental health crisis? Is this kind of stress? You're absolutely right, Yeah, I'm sorry, no, but no, but not

is the example, right? But because actually know that was a perfect example, because to get at the point that there are all these other things going on and then something that that happens, right, and so even if you're able to get by, then you reached the threshold and

you're at another level. And I think that you know, so when I was I was talking right before the before the alert um and how you know and how and how tragic um, But that you know before the alert um that what's really concerning, even most concerning is as for example, when since the pandemic started, the levels of depression, anxiety, substance use, trauma have in some case

some cases doubled in certain populations even like quadrupled. And what specifically we see is that those who were already most marginalized, both because of their ability to get resources the way that they engage with the healthcare system, those are the populations for whom the rates have increased them most, so specifically in women in the black and Latin X populations, in UML, the LGBTQ populations, right and so for one, just example, were for kids were teenagers were saying that

suicide rates for girls increased by about fifty percent over the first of pandemic for boys for for four percent, four versus fifty percent. So that what that gets that is what that's what what what do we do about it? Right? Like?

And I think that's what we always need to be thinking about, is there are so many things that need to get done and so so on one, you know, I think all of those statistics show that, you know, when it comes to mental health, there are spectrum of issues, right There is anxiety, there's depression, there's trauma, there's self harm, there's there's a substance use, like all of these things and all and there's all these numbers are getting worse,

and they're getting worse for the people who are already the most disadvantaged. That makes sense. That makes sense, right, because it's like, already things are hard and then it's hard to get help. And I think what all that leads to is number one, UM, I want to actually sort of end on on a hopeful note, is that Number one. I think what I'd like to actually shape

the conversation around is treatment. And and let me go back one step to say that throughout the pandemic, what myself and I think all colleagues in the field have felt like is the silver lining from the mental health perspective has been the tremendous increase in people talking about mental health. The absolutely like the improvement in stigma and the way that mental health has changed, um in terms of who's talking about how they're talking about it has

increased so much. It's where I thought it would be like five or ten years from now. And it's everything from the news media and the number of articles and stories out there about mental health. There literally now every day there's like a front page story or a big story on something like to mental health. It's it's it's

in your world, right The entertainment world. Um, one of my best friends is an emergency room position, like brilliant, trained at Harvard at Stanford, and she actually works with her name is Jennifer, and she has this company called med Consults for Page, Stage, and Screen, and she works with writers who are working on scripts and how to make them more medically accurate. And there's the emergency room position. Yeah,

it's it's really it's really really cool. Actually she's an emergency room position and so a lot of her work, you know, in the past, had been how do we, you know, get get this word right, or when someone is having a surgery or an accent, how do we make sure it shows up correctly. What you told me is like over the last couple of years, the number of scripts that get to her around mental health where people want to have mental health storylines, has like gone

up tremendously, UM. And I think that's amazing because the more that the media is talking about this and really presenting these issues with much more like more reality based. Um. It really that that's what leads to all this culture change and gets people getting to the doctor earlier than eleven years. And you know, like that that all of that is so important. So that's this little religning, is that stigma's gotten better. We're talking about it so much better.

I think the next big step is it needs to

be around treatment. It's not just that we're talking about it and saying, hey, I had this too, but that all of that needs to lead to everyone seeking how do I get better as early as possible, and that we're making it safe and supportive, that parents and children, that school, that employers are creating time for people to take a month off or to you know, get proactive help, that that that that they're able to you know, to get and not interfere with Where all of these are

really really important. Um And I think that what's amazing is that no matter who you are who's listening to this podcast, there is actually probably some way, based on what you're doing, that you can make an impact in this.

You know, if if you're again, I'll just go back, like Jen, the fact that you've created this podcast, What that does, How that changes the dialogue, How that changes who even recognizes this is an issue, and that whether it means they themselves recognized earlier now that they have

something and they can get help tremendously important. Whether they realize, oh, they actually work in a field that they can maybe make some change, Like they work in HR and they can change the benefits that the that their company gives people. That is huge. That is huge. Maybe they're a teacher and they want to change the way that they talked about invited their kids. That would be life changing for an entire generation, you know. So there's so many things

that can be done. And um and I think that I like end on that level of hope it real We say celebrate therapy. We want to celebrate the experience and champion and make you proud of the fact that you got help and that you're getting help. You just gotta be super pumped up. I hope you're feeling as pumped up as I am about the future. And I'm going to get into our takeaways today. There's so many. I love it. I love it when a guest just

downloads information into my brain and don't forget. If you go to join dash reel dot com j O I N dash r e a l dot com, select to join now at the top. Once you get to the paywall, you are going to select the coupon code and the promo and enter anxiety Bites all caps, all one word, and Anxiety Bites again. You can just go to the show notes, follow along and get your free month. And here are the takeaways from this episode. Now, don't forget. Please send me an email Anxiety Bites Weekly at gmail

dot com. Let me know what you've learned from listening to the show. If you have any hot tips of your own that you have come up with that help your anxiety, please share it with me. I'll share it with our listeners and if you have any questions, it could be answered on an upcoming listener email episode. So please do that again. Anxiety Bites Weekly at gmail dot com would love that. All right, let's get into the

takeaways from this episode. The first thing that Dr Vaston has on her LinkedIn bio before any credential, is her twenty year history with anxiety and depression due to COVID, many people whose anxiety was under the radar, they came overwhelming or reached new heights. Many people turned to overeating and alcohol in order to self medicate. So this sounds like you. It's normal. Even Dr Vasson herself did this. Dr Vasson has accepted that she may struggle daily with anxiety,

and that's okay. She's got the right tools and is making things a little bit better for herself on a daily basis. Sometimes we can have a change in our behavior due to our anxiety, even though we didn't feel any of our usual anxiety triggers that led to the change in behavior. If you're a teenager, how do you know if you're super intense feelings your anxiety is something normal because you know you're a teenager and you've got all those hormones, or if this is going to be

a disorder. The first thing you need to do is distinguish how much are these feelings and sensations affecting your life? Is your sleep disturbed, have your grades dropped? Are you having trouble focusing? Or are you able to cope and live the life you want? Or is the anxiety getting in the way? Why does anxiety even occur in some

people in the first place. What's known as the biopsychosocial model in anxiety is a threefold explanation that helps to understand why it manifests in the first place and gives a framework for how to treat mental health conditions. So biosocho biosoco biopsychosocial, all one word means that the reason for anxiety is a combination of biological, psychological, and social factors. The biological is our genetics, like did family members have anxiety?

It's passed down in our d n A. The psychological means how do you talk to yourself? How do you cope with stressors? The social component is a mix of historical what was your childhood like, was your household growing up supportive? Where you bullied? And the second component to social is our environment what's going on currently in our home life, our work life, or our relationships. The issue with mental health right now is that we don't have a way to measure, you know, say, like the way

you could measure other diseases using a blood test. There's no way to measure what percentage of our anxiety is biological versus psychological versus social. We can get a full history verbally from a patient and from there make some educated guesses. But with this biopsychosocial model, the old way of thinking about mental illness is over. Nothing is your fault and it's nothing someone did. Anxiety has a very real biological part, and it's also a manifestation of our

current environment. In regards to taking medication for anxiety, it does take a bit of trial and error. For example, even with allergy medication, doctors aren't sure from the get go what will work for patients. There is serotonin in our brain and in our gut, and a lot of antidepressant hills are what's known as ss R eyes, and one of the side effects of these antidepressants can be stomach upset for the first week or two because it's affecting the serotonin level in your gut, but it should

eventually subside again. Trial and error with any kind of medication. With any mental health medication, you will feel the negative side effects before you feel the positive ones. But if you stick with it, medication can absolutely give people back their lives who need it. The social aspect of the biopsychosocial model is being taken more seriously these days, as people recognize whoops, why is my phone ringing that this

whole thing is complex. We can appreciate now how early childhood traumas or things like bullying can make a big impact later on down the line, and this gives therapists and doctors more opportunities for treatment There are so many different types of anxiety treatments that help from an environmental perspective, from working on relationships with people, exercising, mindfulness, meditation, journaling, gratitude, and so much more. Two billion people around the world

have a diagnosable mental, brain or behavioral health disorder. But even people who don't meet all of the criteria for a mental health diagnosis may still struggle with anxiety and could absolutely benefit from some kind of treatment. If we optimized all of the therapists in the United States, we would only have enough therapists to treat seven percent of the American population, despite the fact that over the course of a lifetime, fifty percent of Americans will have a

diagnosable mental health disorder. The average amount of time from someone first having a symptom of mental illness to seeking medical attention in the United States is eleven years. Dr Vauson's lab at Stanford Brainstorm, the Stanford Lab for Mental Health Innovation, focuses on trying to solve the mental health crisis through entrepreneurship. We won't be able to solve the problem of getting people mental health care unless we think about other ways to reach people, which is where technology

comes in. Dr Vowson's goal is to help foster entrepreneurs who find ways to address mental health online, as well as think about online worlds as ways to deliver and provide mental health therapeutic services and education to reach people in ways that is low cost and just gets right

to you. One example of how Brainstorm has changed things online has been working with a company like Pinterest to get their users tools and resources that comes from doctors and is evidence space treatment from mental health known as

micro therapeutics. Micro Therapeutics is a whole tool kit of exercises based in cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy translated into two or three minute things that you can do online and actually feel a little bit better in just a few minutes. It's a compassionate experience.

Dr Vosson's former student, Ariella Sophia, is now the founder and CEO of Real and Real is a website and community that is a team of innovators, clinicians, and technologists on a mission to not just normalize mental health care, but celebrate it. They integrate empathy, creativity, and design to build a progressive mental health care experience while also improving the quality of care itself. Dr Vawson is the chief medical Officer. There is no one solution to mental health.

It's not just one medication or one type of therapy. It's also policy and economics, and it's also about changing the workplace, and it's about changing the way we talk to each other. Dr Vauson's top ten prescriptions that she actually will write on a prescription pad for patients for

treating anxiety. Mindfulness, meditation with deep breathing, sleep, gratitude, nutrition, reducing substance use like alcohol, drugs, tobacco, to use as little as possible, zero to none or none to little, exercise, nature, community and connecting, giving and altruism and sexual pleasure. It's not about big, grand gestures that help alleviate anxiety. It's doing small things and doing them regularly. And there is scientific evidence that things like journaling and getting outside actually

help our brain. Studies have shown that mindfulness and deep breathing bring about chemical changes at the cellular level that lead to a cell living longer, which means that there's a link between mindfulness, meditation, and deep breathing and longevity. The length of your life all right, and if you want to read these takeaways, you can always go to my website, Jen Kirkman dot com and then click anxiety Bites again. That link will also be in the show notes.

Thank you so much for listening and remember anxiety Bites, but You're in control. For more podcasts from My heart Radio, visit the I heart Radio app, Apple podcast, or wherever you listen to your favorite shows.