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