1 00:00:00,440 --> 00:00:03,960 Welcome to sheep Resisted, I'm your host Sadie Sutton, a 19 2 00:00:03,960 --> 00:00:06,440 year old from the Bay Area studying psychology at the 3 00:00:06,440 --> 00:00:10,000 University of Pennsylvania. Sheep resisted is the teen 4 00:00:10,000 --> 00:00:12,880 mental health podcast made for teenagers by a teen. 5 00:00:13,360 --> 00:00:16,120 In each episode I'll bring you authentic, accessible and 6 00:00:16,120 --> 00:00:19,400 relatable conversations about every aspect of mental Wellness 7 00:00:19,960 --> 00:00:22,000 you can expect. Evidence based teen approved 8 00:00:22,000 --> 00:00:26,040 resources, coping skills including lots of DBT insights 9 00:00:26,080 --> 00:00:28,680 and education, and each piece of content you consume. 10 00:00:29,360 --> 00:00:32,479 She Persisted offers you a safe space to feel validated and 11 00:00:32,479 --> 00:00:35,160 understood in your struggle while encouraging you to take 12 00:00:35,160 --> 00:00:37,520 ownership of your journey and build your life worth living. 13 00:00:37,840 --> 00:00:41,720 So let's dive in. This week on She Persisted. 14 00:00:42,400 --> 00:00:45,360 I like to think about this as needs not being met. 15 00:00:45,640 --> 00:00:47,800 You know, there's universal needs that we need, we need to 16 00:00:48,080 --> 00:00:50,320 love, we need to be loved. We need to have a sense of 17 00:00:50,320 --> 00:00:52,000 respect. We need boundaries and we need 18 00:00:52,000 --> 00:00:54,120 space. We need meaning in our lives. 19 00:00:54,480 --> 00:00:57,960 And if something's gotten in the way of us being able to meet 20 00:00:57,960 --> 00:01:00,440 those needs, depression's going to come up and tell us about 21 00:01:00,440 --> 00:01:02,960 that, and it's going to try to tell us that at least it might 22 00:01:02,960 --> 00:01:04,760 not be so obvious what it's trying to tell us. 23 00:01:05,040 --> 00:01:07,360 Hello, hello and welcome to She Persisted. 24 00:01:07,360 --> 00:01:10,080 If this is your first episode, so happy you're here. 25 00:01:10,080 --> 00:01:13,080 We have a great one today. If you're a returning listener, 26 00:01:13,080 --> 00:01:15,600 I'm so glad you're back. I really hope you enjoyed the 27 00:01:15,600 --> 00:01:18,800 episode. We have a very exciting guest 28 00:01:18,800 --> 00:01:22,000 today that I actually met at ADAA, which is the Anxiety and 29 00:01:22,000 --> 00:01:24,000 Depression Association of America. 30 00:01:24,000 --> 00:01:26,640 It was in my first psychology conference and I presented a. 31 00:01:26,640 --> 00:01:28,200 Poster which was really exciting. 32 00:01:28,200 --> 00:01:31,480 With my lab and attended a bunch of different talks about 33 00:01:31,480 --> 00:01:33,560 different topics related to mental health. 34 00:01:33,640 --> 00:01:35,520 There was a training on validation. 35 00:01:35,520 --> 00:01:38,600 There was this talk about research on how we talk about 36 00:01:38,600 --> 00:01:40,880 mental illness and specifically depression. 37 00:01:40,880 --> 00:01:44,120 There is ones about ethics and clinical practice. 38 00:01:44,160 --> 00:01:47,640 Exposing clinicians to what exposure therapy was like, which 39 00:01:47,640 --> 00:01:51,080 actually one of my favorite doctors, Blaze Aguirre from 40 00:01:51,080 --> 00:01:53,360 Three E, spoke at that one, which is so fun. 41 00:01:53,360 --> 00:01:56,080 We got to do a little reunion. But all this to. 42 00:01:56,080 --> 00:02:00,360 Say I learned a lot and was really inspired from a podcast 43 00:02:00,360 --> 00:02:04,000 and academic perspective. And after hearing this panel, I 44 00:02:04,000 --> 00:02:06,800 was like, I absolutely need to have this clinician on the 45 00:02:06,800 --> 00:02:10,440 podcast because it is so relevant to the idea of the 46 00:02:10,440 --> 00:02:13,120 podcast as a whole, which is all about talking about mental 47 00:02:13,120 --> 00:02:14,800 health. And so I of course want to make 48 00:02:14,800 --> 00:02:17,200 sure that I'm doing that in an effective way. 49 00:02:17,560 --> 00:02:20,920 And also I think for you guys listening, you're obviously very 50 00:02:20,920 --> 00:02:23,720 aware of your mental health. You want to be intentional, you 51 00:02:23,720 --> 00:02:26,280 want to be effective. You want to give yourself the 52 00:02:26,280 --> 00:02:29,520 best chance possible when it comes to recovery and building 53 00:02:29,520 --> 00:02:31,360 your life worth living. And so I just thought this was 54 00:02:31,360 --> 00:02:35,240 so on the nose and relevant and would create such an incredible 55 00:02:35,240 --> 00:02:37,520 conversation. So our guest today is Hans 56 00:02:37,520 --> 00:02:39,160 Schroeder. He is a clinical assistant 57 00:02:39,160 --> 00:02:41,800 professor of psychiatry at the University of Michigan. 58 00:02:41,800 --> 00:02:45,280 And his research is on the beliefs and messages about 59 00:02:45,280 --> 00:02:47,520 mental health and the impacts that those have. 60 00:02:47,880 --> 00:02:51,760 So as a clinical psychologist, he works both on the research 61 00:02:51,760 --> 00:02:54,800 side of things like I just mentioned, but he also works in 62 00:02:54,960 --> 00:02:57,680 practice. So he does exposure, he does 63 00:02:57,680 --> 00:03:00,760 group therapy with clients. And so this was just a really 64 00:03:00,760 --> 00:03:02,600 well-rounded, incredible conversation. 65 00:03:03,160 --> 00:03:06,480 But how do we talk about depression to give people hope 66 00:03:06,560 --> 00:03:10,160 and help them feel seen and validated, while also 67 00:03:10,160 --> 00:03:13,800 encouraging growth and giving them the best chance at recovery 68 00:03:13,800 --> 00:03:17,520 and engagement in therapy? And so we talked about things 69 00:03:17,520 --> 00:03:19,200 like the chemical imbalance theory. 70 00:03:19,600 --> 00:03:22,480 We talked about the school of thought, the depression is a 71 00:03:22,480 --> 00:03:26,080 signal that something is going wrong in your life and that it's 72 00:03:26,080 --> 00:03:28,400 telling you that something needs to be adjusted or fixed and 73 00:03:28,400 --> 00:03:30,160 there's a need that's not being met. 74 00:03:30,280 --> 00:03:33,320 We talked about identifying with mental illness diagnosis that 75 00:03:33,320 --> 00:03:35,360 I'm sure a bunch of you can relate to. 76 00:03:35,360 --> 00:03:37,200 And then we. Also talked about how we can 77 00:03:37,200 --> 00:03:42,760 validate while also encouraging agency and accountability in 78 00:03:42,760 --> 00:03:44,960 mental health. This was a really incredible and 79 00:03:44,960 --> 00:03:47,040 cool conversation. I absolutely loved it. 80 00:03:47,040 --> 00:03:49,480 I know you guys will as well and if you. 81 00:03:49,600 --> 00:03:52,560 I have thoughts, definitely DM me, e-mail me all the things. 82 00:03:52,560 --> 00:03:55,440 I can't wait to hear them. And this interest is getting 83 00:03:55,440 --> 00:03:58,040 long, so let's just dive in. Well, thank you so much for 84 00:03:58,040 --> 00:03:59,520 joining me today. And she persisted. 85 00:03:59,520 --> 00:04:01,560 I'm so excited to have you on the podcast. 86 00:04:01,560 --> 00:04:04,680 I got to hear you speak at ADAA, which was so fun. 87 00:04:04,680 --> 00:04:08,040 And I immediately was like, more people need to hear about this 88 00:04:08,040 --> 00:04:10,760 and understand the implications of your research. 89 00:04:10,800 --> 00:04:12,400 So I'm so excited to have you here today. 90 00:04:12,840 --> 00:04:14,520 Oh, I'm so excited to be here, Sadie. 91 00:04:14,520 --> 00:04:16,800 Thanks so much for having me. Of course. 92 00:04:17,279 --> 00:04:20,640 So to start with, people that are not deeply invested in the 93 00:04:20,640 --> 00:04:23,440 psychology world and are not paying attention to all the 94 00:04:23,440 --> 00:04:26,480 research that's coming out regularly, can you give a little 95 00:04:26,480 --> 00:04:30,160 bit of some background on your career and how you got to these 96 00:04:30,160 --> 00:04:34,520 specific research interests and the specific area of study? 97 00:04:34,920 --> 00:04:37,400 Sure. So I'm a clinical psychologist 98 00:04:37,400 --> 00:04:39,080 and I work in. It's kind of confusing. 99 00:04:39,080 --> 00:04:41,960 I work in a psychiatry department at the University of 100 00:04:41,960 --> 00:04:43,200 Michigan, but I'm a psychologist. 101 00:04:43,200 --> 00:04:47,000 So I see people for therapy. I provide talk therapy, I do 102 00:04:47,000 --> 00:04:51,280 cognitive behavioral therapy. And my research focuses on how 103 00:04:51,360 --> 00:04:54,360 essentially how people think and talk about mental health with a 104 00:04:54,400 --> 00:04:56,920 particular focus right now on depression, how people talk 105 00:04:56,920 --> 00:04:59,880 about depression. And I got interested in this in 106 00:04:59,880 --> 00:05:03,320 undergrad, actually at Michigan State, learning about fixed and 107 00:05:03,320 --> 00:05:04,920 growth mindsets. I don't know if you've ever 108 00:05:04,920 --> 00:05:07,560 heard of that. It's Carol Dweck at Stanford. 109 00:05:07,560 --> 00:05:10,480 She studied like, do you think people can change their 110 00:05:10,480 --> 00:05:12,680 personalities or, or their intelligence? 111 00:05:12,720 --> 00:05:16,840 And it turns out that if we talk about attributes like 112 00:05:16,840 --> 00:05:20,480 intelligence or personality in genetic language, like you're 113 00:05:20,480 --> 00:05:22,200 born with it, that's pretty much all you've got. 114 00:05:22,520 --> 00:05:25,200 People tend to believe that they can't do much to change that. 115 00:05:25,680 --> 00:05:29,240 And I got really interested as a clinical psychology graduate 116 00:05:29,240 --> 00:05:33,000 student that we talk about mental health and genetic and 117 00:05:33,000 --> 00:05:36,000 biological terms all the time. You know, we even say things 118 00:05:36,000 --> 00:05:38,440 like depressions due to a chemical imbalance. 119 00:05:38,920 --> 00:05:43,520 And so I got curious thinking, does that mean then that people 120 00:05:43,520 --> 00:05:45,960 think they can't change their depression if they think it's a 121 00:05:45,960 --> 00:05:47,960 chemical imbalance? And so that's what my research 122 00:05:47,960 --> 00:05:51,240 is essentially focused on is, is finding the right message for 123 00:05:51,240 --> 00:05:54,480 the right people who resonates with what and what implications 124 00:05:54,480 --> 00:05:57,080 those types of messages have. I think this is really 125 00:05:57,080 --> 00:06:00,600 interesting because when I heard about this, I almost thought it 126 00:06:00,600 --> 00:06:03,680 was counterintuitive because I think a lot of people, the 127 00:06:04,160 --> 00:06:06,680 biological side of things can be very validating. 128 00:06:06,680 --> 00:06:08,680 People hear that and they're like, it's not my fault. 129 00:06:08,680 --> 00:06:11,480 This is something that's happening and it's not a choice 130 00:06:11,480 --> 00:06:14,320 I've made or a way that I'm going about life. 131 00:06:14,320 --> 00:06:16,280 Like this is something that's out of my control. 132 00:06:16,280 --> 00:06:18,640 And that's almost a good thing. But I think what you're 133 00:06:18,640 --> 00:06:21,720 mentioning is so important, which is that if you're saying 134 00:06:21,720 --> 00:06:23,960 this is something that's happening to me and it's not 135 00:06:23,960 --> 00:06:28,160 something I've done to myself, then you were less motivated to 136 00:06:28,160 --> 00:06:31,680 make these changes to then improve your mental health and 137 00:06:32,120 --> 00:06:34,960 makeshifts that might be necessary to overcome different 138 00:06:34,960 --> 00:06:37,360 challenges or diagnosis or whatever it is. 139 00:06:38,160 --> 00:06:42,160 Can you explain to people who are not familiar from like a 140 00:06:42,160 --> 00:06:45,240 research perspective, this biological way that we talk 141 00:06:45,240 --> 00:06:47,000 about depression? I think most of us have heard 142 00:06:47,000 --> 00:06:50,320 about this at some point, but it's really far reaching. 143 00:06:50,320 --> 00:06:52,640 And I think most people aren't fully aware with like the 144 00:06:52,640 --> 00:06:56,400 language we use and how it comes up in things like therapy. 145 00:06:56,400 --> 00:06:58,680 And also, like you mentioned, what that means when people talk 146 00:06:58,680 --> 00:07:01,280 about getting better. Yeah, absolutely. 147 00:07:01,280 --> 00:07:04,560 So we've been thinking and talking about mental health and 148 00:07:04,560 --> 00:07:07,520 depression for a very long time. And if you look at the history 149 00:07:07,520 --> 00:07:10,960 of psychiatry and medicine, there's been kind of a pendulum 150 00:07:10,960 --> 00:07:13,280 in terms of thinking about it more biologically, thinking 151 00:07:13,280 --> 00:07:14,880 about things more psychologically. 152 00:07:15,720 --> 00:07:19,520 But in today's era, there's a lot of messages about mental 153 00:07:19,520 --> 00:07:21,360 health as being due to a chemical imbalance. 154 00:07:22,000 --> 00:07:24,960 This kind of thinking came out in the like, earliest forms in 155 00:07:24,960 --> 00:07:28,360 the 50s and 60s when the first medications came out that were 156 00:07:28,360 --> 00:07:31,520 prescribed for depression. And what they kind of put 157 00:07:31,520 --> 00:07:35,080 together is that we have medication that we know 158 00:07:35,080 --> 00:07:38,360 increases serotonin. We also know that that same 159 00:07:38,360 --> 00:07:40,920 medication decreases depression symptoms. 160 00:07:41,400 --> 00:07:44,840 So that must mean depression is caused by low serotonin. 161 00:07:45,040 --> 00:07:47,960 OK, that logic kind of makes sense intuitively, right? 162 00:07:47,960 --> 00:07:49,800 I mean, that kind of like the medication works to increase 163 00:07:49,800 --> 00:07:51,080 serotonin. It must work in the same 164 00:07:51,080 --> 00:07:54,200 mechanism. But that same logic would break 165 00:07:54,200 --> 00:07:58,120 down very quickly if I said Tylenol helps my headache. 166 00:07:58,560 --> 00:08:01,360 So my headache is caused by low Tylenol, right? 167 00:08:01,360 --> 00:08:04,040 No one would ever say that. And so that's kind of the 168 00:08:04,040 --> 00:08:06,000 origins of the chemical imbalance message. 169 00:08:06,000 --> 00:08:09,840 But we've also seen this in pharmaceutical advertisements. 170 00:08:10,160 --> 00:08:13,520 Media portrays depression as biochemical. 171 00:08:13,760 --> 00:08:16,400 Even researchers who study the biology of depression kind of 172 00:08:16,400 --> 00:08:18,640 espouse this view that depression is biological. 173 00:08:19,200 --> 00:08:22,840 And I just want to clarify for everyone, I'm not anti biology. 174 00:08:22,840 --> 00:08:25,440 There absolutely is biology and genetics involved with 175 00:08:25,440 --> 00:08:27,760 depression. But I'm more curious about how 176 00:08:28,040 --> 00:08:30,720 therapists and providers talk about depression. 177 00:08:30,720 --> 00:08:33,480 Is that the first thing we want to tell patients that this is a 178 00:08:33,559 --> 00:08:36,360 biological disease? And I'm curious about what are 179 00:08:36,360 --> 00:08:39,240 the psychological impacts of hearing that which I can talk 180 00:08:39,320 --> 00:08:40,520 about too. Yeah. 181 00:08:41,000 --> 00:08:44,280 I think another really interesting piece of this puzzle 182 00:08:44,280 --> 00:08:49,680 is over medication and how that has now become a key player in 183 00:08:49,680 --> 00:08:53,000 mental health and especially mental health of a generally 184 00:08:53,000 --> 00:08:56,840 younger generation. We know that with mild cases of 185 00:08:56,840 --> 00:09:01,240 depression, antidepressants are as effective as the placebo. 186 00:09:01,240 --> 00:09:04,840 And when you have more severe cases of depression, they can be 187 00:09:04,840 --> 00:09:08,000 really effective and a really necessary piece of the puzzle. 188 00:09:08,240 --> 00:09:11,120 And I imagine that in that physician having that belief 189 00:09:11,120 --> 00:09:14,520 that it's only biological would be a huge challenge to overcome 190 00:09:14,600 --> 00:09:18,160 within the treatment experience. But do you think that this 191 00:09:18,360 --> 00:09:21,720 belief and mindset that it's a chemical imbalance, that's the 192 00:09:21,720 --> 00:09:25,280 primary way that we conceptualize these diagnosis 193 00:09:25,280 --> 00:09:29,440 has contributed to that, that rise in prescriptions and kind 194 00:09:29,440 --> 00:09:32,960 of that being a more prominent tool in the tool kit that we're 195 00:09:33,000 --> 00:09:35,680 reaching for? Yeah, that's a great question. 196 00:09:35,680 --> 00:09:38,800 I think there's probably a lot of factors that have contributed 197 00:09:38,800 --> 00:09:41,640 to people taking meds more than seeking therapy. 198 00:09:42,000 --> 00:09:44,760 It's less time intensive for sure. 199 00:09:45,120 --> 00:09:48,000 I think insurance companies have also prioritized shorter 200 00:09:48,000 --> 00:09:52,400 treatments and cover medications more so than long term therapy. 201 00:09:52,680 --> 00:09:54,800 They're more willing to do that. So sometimes it comes down to 202 00:09:54,800 --> 00:09:58,520 practicalities like what's cheaper to get help faster? 203 00:09:58,920 --> 00:10:01,840 But certainly the chemical imbalance narrative has come up 204 00:10:01,840 --> 00:10:05,200 more with the introduction of antidepressant medications. 205 00:10:06,000 --> 00:10:07,680 I just want to circle back to something you said earlier, 206 00:10:07,680 --> 00:10:08,840 which I think is a really good point. 207 00:10:08,840 --> 00:10:12,560 And the chemical imbalance belief does reduce blame. 208 00:10:12,760 --> 00:10:15,360 And there's definitely some positives to that mindset. 209 00:10:15,480 --> 00:10:18,280 Like when we're depressed, we blame ourselves for everything, 210 00:10:18,320 --> 00:10:20,240 even being depressed in the 1st place. 211 00:10:20,320 --> 00:10:23,320 So if we can have a narrative that decreases that blame, I'm 212 00:10:23,320 --> 00:10:25,600 all for that. It also has a way of like, 213 00:10:25,600 --> 00:10:29,200 legitimizing suffering in a very powerful way for some folks, 214 00:10:29,200 --> 00:10:34,120 where it's like, if you can see or visualize my serotonin being 215 00:10:34,120 --> 00:10:38,200 low or my brain misfiring, it makes it more real, like a real 216 00:10:38,200 --> 00:10:41,800 thing that deserves treatment. And I'm all for beliefs that get 217 00:10:41,800 --> 00:10:44,240 you into treatment and start changing your life, making 218 00:10:44,280 --> 00:10:46,560 significant changes to overcome things like this. 219 00:10:47,320 --> 00:10:51,800 The downside of these beliefs, though, is that implicitly and 220 00:10:51,800 --> 00:10:55,320 intuitively, people feel a little less hope for making 221 00:10:55,320 --> 00:10:57,720 changes on their own when they think it's a chemical imbalance. 222 00:10:57,720 --> 00:11:01,360 Like I'm a therapist, so people might say, well, how are you 223 00:11:01,360 --> 00:11:03,600 going to change my serotonin just by talking with me, right? 224 00:11:05,160 --> 00:11:07,560 How are you going to change my brain, Right, right. 225 00:11:07,560 --> 00:11:09,560 But actually there's studies that say that talk therapy does 226 00:11:09,560 --> 00:11:11,160 change the brain, which is interesting too. 227 00:11:11,160 --> 00:11:14,040 So it's really complicated, but it's definitely pros and cons of 228 00:11:14,040 --> 00:11:18,600 these types of messages. Leaning into that clinical side 229 00:11:18,600 --> 00:11:22,640 of this process, you mentioned that there are real implications 230 00:11:22,720 --> 00:11:25,760 of the chemical imbalance theory and how that shows up when 231 00:11:25,760 --> 00:11:30,040 people do pursue treatment and look for support and even when 232 00:11:30,040 --> 00:11:33,680 they're in therapy at that point, how they see themselves, 233 00:11:33,680 --> 00:11:36,520 how they might see how effective therapy is. 234 00:11:36,520 --> 00:11:38,880 Can you speak a little bit to that and how the that theory 235 00:11:38,880 --> 00:11:41,920 doesn't even impact just our general conceptualization but 236 00:11:41,920 --> 00:11:44,240 also lived experience of people that are depressed? 237 00:11:44,640 --> 00:11:47,760 Yeah, yeah. So in our studies, we're finding 238 00:11:47,760 --> 00:11:50,720 that a couple things. One, people who've been in the 239 00:11:50,720 --> 00:11:53,920 system more like been hospitalized, have had 240 00:11:53,920 --> 00:11:57,600 medications or therapy or have a family member with depression or 241 00:11:57,600 --> 00:12:00,520 have been diagnosed themselves. Those folks believe in the 242 00:12:00,520 --> 00:12:03,400 chemical imbalance theory more, which is interesting. 243 00:12:03,400 --> 00:12:05,720 And I'm very curious. This research is just starting, 244 00:12:05,720 --> 00:12:07,600 but very curious where they're hearing these messages. 245 00:12:07,600 --> 00:12:10,120 Is it from providers? Is it from being in the doctor's 246 00:12:10,120 --> 00:12:11,640 office? Does it seem like some medical 247 00:12:11,640 --> 00:12:14,840 thing? So exposure matters to these 248 00:12:14,840 --> 00:12:17,200 beliefs. We're also finding that people 249 00:12:17,600 --> 00:12:20,400 who have strong chemical imbalance beliefs think that 250 00:12:20,400 --> 00:12:22,720 therapy is going to be less effective and medications might 251 00:12:22,720 --> 00:12:24,440 be more effective, but it's complicated. 252 00:12:24,440 --> 00:12:26,480 Some studies show that. Some other studies don't show 253 00:12:26,480 --> 00:12:28,000 that. I think there's mixed findings 254 00:12:28,000 --> 00:12:32,240 there, but just from my clinical experience, folks that really 255 00:12:32,240 --> 00:12:34,200 hang on to, I just got to change my brain. 256 00:12:34,200 --> 00:12:37,560 Camels, I just got to do this. It kind of becomes a roadblock 257 00:12:37,560 --> 00:12:40,440 sometimes in therapy where I'm trying to talk through problems 258 00:12:40,440 --> 00:12:44,080 and offer skills and it feels like if I can just get my brain 259 00:12:44,080 --> 00:12:46,560 chemistry right, then I could participate in this more. 260 00:12:46,880 --> 00:12:49,160 And I think sometimes that's true for folks, but other times 261 00:12:49,160 --> 00:12:53,760 I think it's it becomes like a fixation that there's got to be 262 00:12:53,760 --> 00:12:55,960 something in my brain that's off. 263 00:12:56,680 --> 00:13:00,280 And sometimes that can take away our sense of autonomy and 264 00:13:00,280 --> 00:13:02,920 agency. Like if it's my genes, it's my 265 00:13:02,920 --> 00:13:05,840 chemicals, I don't have any control over that stuff. 266 00:13:06,120 --> 00:13:08,080 Which then actually feeds into depression. 267 00:13:08,560 --> 00:13:10,680 Yeah. Do you think there's an element 268 00:13:10,680 --> 00:13:13,760 of cognitive dissonance here where people see how the way 269 00:13:13,760 --> 00:13:17,520 they feel and think and act has changed significantly because of 270 00:13:17,560 --> 00:13:22,080 depression, and they don't want to be like, this is now who I am 271 00:13:22,080 --> 00:13:24,640 and how I feel and how I think and how I'm interacting with 272 00:13:24,640 --> 00:13:26,720 people. And so being like this is a 273 00:13:26,720 --> 00:13:29,080 cognitive imbalance. This is something that's again 274 00:13:29,080 --> 00:13:32,040 happening to me and not something that I'm participating 275 00:13:32,040 --> 00:13:34,240 in is almost like a coping mechanism. 276 00:13:34,640 --> 00:13:39,440 Absolutely, Absolutely yes. We're actually just about to get 277 00:13:39,440 --> 00:13:42,760 a paper published on this very idea where we ask college 278 00:13:42,760 --> 00:13:46,000 students, do you sometimes think about a chemical balance to make 279 00:13:46,000 --> 00:13:48,480 yourself feel a little bit better when you're depressed? 280 00:13:48,480 --> 00:13:51,160 Do you, do you remind yourself that your depression is 281 00:13:51,160 --> 00:13:53,560 biological in order to blame yourself less? 282 00:13:53,960 --> 00:13:56,760 And there's a small minority of participants that really endorse 283 00:13:56,760 --> 00:13:58,600 that. They say, I do do that. 284 00:13:58,920 --> 00:14:02,160 So we almost think of this. It can be sometimes used as an 285 00:14:02,160 --> 00:14:05,960 emotion regulation strategy. And I think that gets tricky, 286 00:14:05,960 --> 00:14:07,680 right? Because it can get really 287 00:14:07,680 --> 00:14:10,640 overwhelming thinking about, OK, if my depression is really 288 00:14:10,640 --> 00:14:14,840 coming from my relationships that I'm in or my family or this 289 00:14:14,840 --> 00:14:16,960 job that I'm in. And I feel really stuck. 290 00:14:17,200 --> 00:14:21,680 That is terrifying. So something like maybe deep 291 00:14:21,680 --> 00:14:25,320 down intuitively, it's like if I view this as a serotonin 292 00:14:25,320 --> 00:14:27,360 deficiency or a chemical imbalance, it's a little easier 293 00:14:27,360 --> 00:14:30,760 to swallow than to than to start facing all the things that are 294 00:14:30,760 --> 00:14:33,240 going on that I do that I am involved with. 295 00:14:33,520 --> 00:14:36,400 Yeah, it's so interesting because when you logistically 296 00:14:36,400 --> 00:14:39,000 think through it, if you were like, OK, it's a serotonin 297 00:14:39,000 --> 00:14:41,600 imbalance, you're like, OK, maybe I can try medication, but 298 00:14:41,600 --> 00:14:43,640 I can't will this to make a difference. 299 00:14:43,640 --> 00:14:46,280 But if it's a job or a friendship or a family member, 300 00:14:46,640 --> 00:14:49,240 you would think, OK, maybe it would be easier to adjust that 301 00:14:49,240 --> 00:14:52,440 aspect in my life. And yet people do still, again, 302 00:14:52,440 --> 00:14:55,280 gravitate towards this chemical imbalance theory. 303 00:14:55,280 --> 00:14:57,840 And that seems to be more effective, like you were saying, 304 00:14:58,000 --> 00:15:02,760 in terms of emotion regulation rather than the agency aspect. 305 00:15:03,600 --> 00:15:06,360 Yeah, I think the trick is when it becomes like major depressive 306 00:15:06,360 --> 00:15:09,200 disorder and really bad depression, the things that we 307 00:15:09,200 --> 00:15:13,240 have to adjust are really big and really daunting, like 308 00:15:13,840 --> 00:15:18,480 intimate relationships that need some serious boundary work or 309 00:15:18,600 --> 00:15:21,720 leaving relationships. And that's scary for folks. 310 00:15:21,720 --> 00:15:24,720 Or you know, we see this a lot, the overlap between something 311 00:15:24,720 --> 00:15:26,600 like post traumatic stress and depression. 312 00:15:26,720 --> 00:15:29,560 When we experience trauma, that's the last thing we want to 313 00:15:29,560 --> 00:15:32,680 think about and revisit. And yet that's often one of the 314 00:15:33,160 --> 00:15:36,480 the main things for recovery is accepting it, acknowledging it, 315 00:15:36,480 --> 00:15:39,280 talking through the trauma and coming to a different 316 00:15:39,280 --> 00:15:42,200 understanding. And so I think about that as 317 00:15:42,520 --> 00:15:45,600 completely understandable apprehension to get into that 318 00:15:45,600 --> 00:15:49,720 stuff, which might make us go towards these other types of 319 00:15:49,720 --> 00:15:52,800 explanations that take us away from what's maybe really going 320 00:15:52,800 --> 00:15:55,440 on or contributing a lot to it. And this is, I just want to 321 00:15:55,440 --> 00:15:57,080 acknowledge this is all complicated because there is 322 00:15:57,080 --> 00:15:59,920 biology involved, right? And there's life things 323 00:15:59,920 --> 00:16:01,400 involved. We've known this for a very long 324 00:16:01,400 --> 00:16:02,080 time. It's not. 325 00:16:02,200 --> 00:16:04,640 It's not a simple thing. Yeah, yeah. 326 00:16:05,120 --> 00:16:06,440 OK. So now that we kind of 327 00:16:06,440 --> 00:16:09,400 understand what the experience of the individual is when 328 00:16:09,480 --> 00:16:12,520 they're hearing these messaging, kind of how they're relating to 329 00:16:12,520 --> 00:16:15,760 these beliefs and how that might affect how they're coping with 330 00:16:15,760 --> 00:16:18,280 things or thinking about them or seeking help. 331 00:16:19,120 --> 00:16:23,240 What is your best case scenario moving forward with how we talk 332 00:16:23,240 --> 00:16:25,760 about these things? Because we're definitely moving 333 00:16:25,880 --> 00:16:28,800 into a position where people are more generally aware of 334 00:16:28,800 --> 00:16:31,160 depression and they're more generally aware of mental health 335 00:16:31,160 --> 00:16:32,600 challenges. And that's amazing. 336 00:16:32,800 --> 00:16:36,040 But like you're saying, how we talk about these things also 337 00:16:36,240 --> 00:16:37,920 potentially might have consequences. 338 00:16:38,120 --> 00:16:41,320 So I guess from like a medical and public health perspective, 339 00:16:41,600 --> 00:16:44,160 what is your best case scenario with how we're having these 340 00:16:44,160 --> 00:16:46,640 conversation? Yeah, it's a great question, 341 00:16:46,640 --> 00:16:49,360 Sadie. So what I've been studying for 342 00:16:49,360 --> 00:16:52,600 the last seven years and experimenting with in the clinic 343 00:16:52,600 --> 00:16:55,840 is not talking about depression as a chemical imbalance right 344 00:16:55,840 --> 00:16:59,120 away, but instead talking about it as a signal that something in 345 00:16:59,120 --> 00:17:00,640 your life might need more attention. 346 00:17:01,040 --> 00:17:05,640 So I'm actually trying to kind of reframe this as maybe your 347 00:17:05,640 --> 00:17:08,480 body is telling you something is going on in your life that needs 348 00:17:08,480 --> 00:17:10,720 more attention. By the way, this is not new at 349 00:17:10,720 --> 00:17:11,880 all. People have been actually 350 00:17:11,880 --> 00:17:14,319 talking about depression in this way for a very long time, like 351 00:17:14,319 --> 00:17:16,400 hundreds of years. It's just that we're not aware 352 00:17:16,400 --> 00:17:20,200 of these types of messages. And so this comes really from 353 00:17:20,200 --> 00:17:23,720 interesting research by Aaliyah Crumb, who looks at stress and 354 00:17:23,720 --> 00:17:27,200 people's beliefs about stress. Is stress right before a test 355 00:17:27,200 --> 00:17:29,600 helpful or is it completely debilitating? 356 00:17:30,120 --> 00:17:32,840 And if people believe that stress is helpful, they actually 357 00:17:32,840 --> 00:17:34,480 do better on the standardized tests. 358 00:17:34,680 --> 00:17:38,080 They do better in challenging situations, even like Navy SEAL 359 00:17:38,080 --> 00:17:40,640 training. You do better in those really 360 00:17:40,640 --> 00:17:43,680 high stress environments if you think that stress is helpful. 361 00:17:44,080 --> 00:17:46,800 So I'm trying to apply that concept to the concept of 362 00:17:46,800 --> 00:17:48,800 depression. Is depression actually trying to 363 00:17:48,800 --> 00:17:51,880 tell you something? And I've been working with 364 00:17:51,880 --> 00:17:55,520 patients with depression in in Group settings basically saying 365 00:17:55,520 --> 00:17:57,760 this message. And it's been really interesting 366 00:17:57,760 --> 00:18:00,040 hearing their feedback. Some patients hate it. 367 00:18:00,040 --> 00:18:04,360 They'll they'll say, no, no, no, this is this is not a signal. 368 00:18:04,360 --> 00:18:06,520 I have a chemical balance, right? 369 00:18:06,520 --> 00:18:08,840 It's a chemical balance. And I'm like, hey, you know 370 00:18:08,840 --> 00:18:11,520 what, if you're in treatment and you're doing the things that you 371 00:18:11,520 --> 00:18:14,000 need to do and living a meaningful life, I've got no 372 00:18:14,000 --> 00:18:15,640 problem with that. I'm not going to argue with you 373 00:18:16,160 --> 00:18:18,560 other folks that will say, you know, I've been in treatment for 374 00:18:18,560 --> 00:18:21,560 like 30 years. Never heard the idea that 375 00:18:21,560 --> 00:18:22,800 depression could have a function. 376 00:18:22,840 --> 00:18:24,600 And for the first time, I'm having some hope. 377 00:18:24,880 --> 00:18:27,520 First time in a while, I've got some ideas about how to manage 378 00:18:27,520 --> 00:18:29,120 this thing. And that's the piece that I 379 00:18:29,120 --> 00:18:31,800 really want to, I really want to understand is, are there 380 00:18:31,800 --> 00:18:34,600 different ways of framing depression from the get go? 381 00:18:34,600 --> 00:18:37,120 When people first come into therapy or first come in to see 382 00:18:37,120 --> 00:18:39,760 their doctor? Can we get people curious about 383 00:18:39,760 --> 00:18:42,640 their lives to make some adjustments on their own before 384 00:18:42,640 --> 00:18:45,360 doing things like therapy and then maybe medications and then 385 00:18:45,360 --> 00:18:46,680 some other types of interventions? 386 00:18:47,120 --> 00:18:50,160 Yeah, I love that so much. I think it's so important. 387 00:18:50,160 --> 00:18:54,120 And I think that was one of the biggest elements of my own 388 00:18:54,120 --> 00:18:58,000 experience. I was like 1314, so I wasn't 389 00:18:58,000 --> 00:18:59,880 really leading into the chemical imbalance. 390 00:18:59,880 --> 00:19:02,240 I don't think I really knew what serotonin was at that point. 391 00:19:02,560 --> 00:19:05,240 But there was the validating aspect of like, this is 392 00:19:05,240 --> 00:19:08,000 something wrong to the point where I'm seeing a doctor and 393 00:19:08,000 --> 00:19:10,120 there is no interventions for this thing. 394 00:19:10,120 --> 00:19:12,040 Like there's a diagnosis, this happens. 395 00:19:12,040 --> 00:19:16,080 This isn't just me experiencing this thing and I'm the only one 396 00:19:16,080 --> 00:19:18,640 that's ever been in this position, but that was a very 397 00:19:18,640 --> 00:19:21,440 common narrative that I struggled with was that there 398 00:19:21,440 --> 00:19:23,160 wasn't a reason why I was depressed. 399 00:19:23,160 --> 00:19:25,280 There was no big loss. There was no big change in my 400 00:19:25,280 --> 00:19:27,560 life. There was nothing that shifted 401 00:19:27,560 --> 00:19:29,880 and then resulted in these experiences. 402 00:19:29,880 --> 00:19:33,240 And of course, hindsight's 2020, when you look at it as a signal, 403 00:19:33,240 --> 00:19:36,000 it was different belief systems. It was how I showed up in my 404 00:19:36,000 --> 00:19:39,080 relationships. It was not being vulnerable and 405 00:19:39,080 --> 00:19:41,960 so you're not able to feel seen, which is so important and how we 406 00:19:41,960 --> 00:19:45,520 function and not having that sense of community or whatever 407 00:19:45,520 --> 00:19:48,480 these different things that were at play that were showing up 408 00:19:48,480 --> 00:19:50,440 were. But I didn't hear that messaging 409 00:19:50,440 --> 00:19:54,720 early on that this is a signal. What is this potentially telling 410 00:19:54,720 --> 00:19:56,800 us about your life? And ended up kind of finding 411 00:19:56,800 --> 00:20:00,160 what those signals were through all the therapy and all the 412 00:20:00,160 --> 00:20:02,440 things. But I think that what you're 413 00:20:02,440 --> 00:20:06,080 saying is really very true is that it provides a lot of hope 414 00:20:06,080 --> 00:20:08,800 for people. When you say this is a signal, 415 00:20:08,800 --> 00:20:11,480 this is saying something isn't effective or going the way it 416 00:20:11,480 --> 00:20:14,240 should be, and this might be the reason why you're feeling this 417 00:20:14,240 --> 00:20:17,000 way because the worst is when it's like you're feeling this 418 00:20:17,000 --> 00:20:18,040 way. It's horrible. 419 00:20:18,040 --> 00:20:21,240 It's taking over your entire life and there's no reason. 420 00:20:21,280 --> 00:20:23,560 We don't really know how it's going to get better. 421 00:20:23,800 --> 00:20:26,480 And I think a lot of people struggle with that experience 422 00:20:26,480 --> 00:20:29,400 because it is very disorienting and very hopeless. 423 00:20:30,120 --> 00:20:33,200 Wow, I'm so glad that you've, it sounds like you've done a lot of 424 00:20:33,200 --> 00:20:36,320 work to uncover some of these signals along the way. 425 00:20:36,320 --> 00:20:41,200 And it is interesting, like the dysfunction disorder framing 426 00:20:41,280 --> 00:20:44,120 does get people into treatment, and that's helpful for a lot of 427 00:20:44,120 --> 00:20:45,840 folks. And so if it's like something's 428 00:20:45,840 --> 00:20:49,400 wrong, I got to go in and, you know, get this looked at. 429 00:20:49,920 --> 00:20:52,040 And yeah, I think it's really hard. 430 00:20:52,040 --> 00:20:54,040 It's not obvious. I tell folks it's not obvious 431 00:20:54,040 --> 00:20:56,320 what the signal is, and it's going to take some 432 00:20:56,320 --> 00:20:58,480 introspection. It's always easier to do with a 433 00:20:58,480 --> 00:21:00,960 therapist. None of this is easy, but it can 434 00:21:00,960 --> 00:21:04,240 be helpful to work with someone else and to dig a little bit to 435 00:21:04,440 --> 00:21:07,920 understand what's going on. I like to think about this as 436 00:21:07,920 --> 00:21:10,920 needs not being met. You know, there's universal 437 00:21:10,920 --> 00:21:12,680 needs that we need. We need to love. 438 00:21:12,680 --> 00:21:14,560 We need to be loved. We need to have a sense of 439 00:21:14,560 --> 00:21:16,240 respect. We need boundaries and we need 440 00:21:16,240 --> 00:21:18,320 space. We need meaning in our lives. 441 00:21:18,680 --> 00:21:22,200 And if something's gotten in the way of us being able to meet 442 00:21:22,200 --> 00:21:24,680 those needs, depression is going to come up and tell us about 443 00:21:24,680 --> 00:21:26,440 that. And it's going to try to tell us 444 00:21:26,440 --> 00:21:28,800 that at least It might not be so obvious what it's trying to tell 445 00:21:28,800 --> 00:21:29,840 us. But yeah. 446 00:21:30,000 --> 00:21:33,120 And I think your experience is so common, it takes a while to 447 00:21:33,120 --> 00:21:37,680 put the pieces together. And that's where like CBT or DBT 448 00:21:37,680 --> 00:21:40,160 can be really helpful to learn to manage uncomfortable emotions 449 00:21:40,160 --> 00:21:42,640 along the way while you're putting all the pieces together 450 00:21:42,640 --> 00:21:44,320 about what, where did this come from? 451 00:21:44,320 --> 00:21:46,760 What is this all about? And it's funny because that's 452 00:21:46,760 --> 00:21:49,480 always the most frequent question people ask, especially 453 00:21:49,480 --> 00:21:51,880 parents will be like, what happened in your childhood? 454 00:21:51,920 --> 00:21:55,480 What caused this? And I'm like, if I knew we like 455 00:21:56,120 --> 00:21:59,840 no one would be in therapy or need multiple providers or be in 456 00:21:59,840 --> 00:22:02,520 this lifelong journey. But I think what you're saying 457 00:22:02,520 --> 00:22:05,320 is so important, which is that we all have unmet needs in the 458 00:22:05,320 --> 00:22:09,000 degree to which they are unmet and how sensitive we are to 459 00:22:09,000 --> 00:22:12,000 those needs being unmet and how much people we fill those needs 460 00:22:12,000 --> 00:22:15,280 ourselves versus rely on others or our environment to kind of 461 00:22:15,280 --> 00:22:19,600 fill those gaps has a really big impact on our mental health and 462 00:22:19,840 --> 00:22:22,120 then how we are able to show up in these different commitments 463 00:22:22,120 --> 00:22:24,160 that we have. Yeah, that's, that's exactly 464 00:22:24,160 --> 00:22:25,280 right. I really like how you framed 465 00:22:25,280 --> 00:22:27,200 that. It's frustrating. 466 00:22:27,200 --> 00:22:28,600 Well, it's frustrating to multiple levels. 467 00:22:28,600 --> 00:22:31,280 It's frustrating to not know yourself what's going on. 468 00:22:31,280 --> 00:22:33,160 And then it's frustrating when people want to know, 469 00:22:33,160 --> 00:22:35,920 understandably, like what? What what happened to get you to 470 00:22:35,920 --> 00:22:38,200 this point. And yeah, I always joke with 471 00:22:38,200 --> 00:22:40,760 patients, like, if we knew and I wouldn't have a job, yeah. 472 00:22:41,000 --> 00:22:41,960 I wouldn't exist. Yeah. 473 00:22:42,680 --> 00:22:44,640 Yeah. So it's, it's complicated, which 474 00:22:44,640 --> 00:22:47,880 makes it, you know, hard. The best question is always what 475 00:22:47,880 --> 00:22:51,440 can I as a parent do to prevent any mental health problems? 476 00:22:51,720 --> 00:22:55,320 And I'm like, I could not tell you as a junior in college, I 477 00:22:55,320 --> 00:22:57,960 could not tell you. But maybe someday people will 478 00:22:57,960 --> 00:23:00,720 have that answer. Yeah, I think, I don't think 479 00:23:00,720 --> 00:23:03,840 it's possible. And part of the reframing with 480 00:23:03,840 --> 00:23:07,240 all of this is that it's not inherently bad to be depressed 481 00:23:07,240 --> 00:23:09,280 every once in a while. It's definitely not inherently 482 00:23:09,280 --> 00:23:13,560 bad to feel sad or really angry or really guilty. 483 00:23:13,880 --> 00:23:16,560 These are emotions that have evolved, that tell us things. 484 00:23:16,560 --> 00:23:19,360 They're signals that or telling us about our environment, 485 00:23:19,360 --> 00:23:21,400 telling us about our lives and what's important to us. 486 00:23:21,400 --> 00:23:24,480 If we didn't have those, life would be very boring. 487 00:23:24,480 --> 00:23:26,680 We probably wouldn't be around very much longer. 488 00:23:27,040 --> 00:23:30,320 Yeah. Before we dive into immediate 489 00:23:30,320 --> 00:23:34,120 interactions with friends and family members and even just 490 00:23:34,120 --> 00:23:37,320 conversations that we have about mental health and how we can 491 00:23:37,320 --> 00:23:41,040 best have those in a way that's productive and effective, I 492 00:23:41,040 --> 00:23:44,360 would love to get your thoughts on the DSM and the diagnostic 493 00:23:44,360 --> 00:23:46,960 model that we currently operate within. 494 00:23:46,960 --> 00:23:50,680 And I think what you're saying with thinking about depression 495 00:23:50,680 --> 00:23:53,760 as a signal and being really conscious of these unmet needs 496 00:23:54,000 --> 00:23:56,640 is really important. And it leans into this idea that 497 00:23:56,640 --> 00:23:58,960 like all mental health challenges kind of exist on a 498 00:23:58,960 --> 00:24:00,920 spectrum. And maybe if it's really low 499 00:24:00,920 --> 00:24:03,560 level depression and subclinical, there's still is so 500 00:24:03,560 --> 00:24:06,240 much benefit understanding, OK, like what needs aren't met? 501 00:24:06,240 --> 00:24:09,360 What signal am I being told? And the same can be true for 502 00:24:09,360 --> 00:24:11,720 people that are really severely depressed with recurrent 503 00:24:11,720 --> 00:24:13,840 episodes. But what do you think about the 504 00:24:13,840 --> 00:24:15,840 DSM and how we kind of categorize those things? 505 00:24:15,840 --> 00:24:18,760 Because this is another big barrier for people when they're 506 00:24:19,080 --> 00:24:22,480 maybe getting treatment or maybe considering asking for help is, 507 00:24:22,880 --> 00:24:25,800 well, it's not bad enough. I'm not on medication. 508 00:24:25,800 --> 00:24:28,920 Other people have it worse. It's another barrier that people 509 00:24:28,920 --> 00:24:32,080 are navigating. Yeah, it's a great question. 510 00:24:32,520 --> 00:24:35,000 So the history of the DSM is really interesting here. 511 00:24:35,320 --> 00:24:39,520 So the first two editions came out in the 1950s, and they had 512 00:24:39,520 --> 00:24:42,600 words like depressive reaction, anxious reaction. 513 00:24:42,600 --> 00:24:45,080 And the assumption was, yeah, people get depressed because 514 00:24:45,080 --> 00:24:46,360 something happened in their lives. 515 00:24:46,360 --> 00:24:49,440 And it was coming from a psychoanalytic perspective where 516 00:24:49,440 --> 00:24:51,680 we're not exactly sure. There might be some unconscious 517 00:24:51,680 --> 00:24:53,920 conflicts going on that might contribute to someone's 518 00:24:53,920 --> 00:24:56,560 depression, but it qualifies as a diagnosis. 519 00:24:56,560 --> 00:24:59,120 So we should get treatment. And in those days, of course, 520 00:24:59,120 --> 00:25:02,640 this was prior to certainly all of the major SSRI's that are out 521 00:25:02,640 --> 00:25:05,240 now that are effective for treating depression. 522 00:25:06,040 --> 00:25:09,240 DSM three came out in 1980 and got rid of all of that reaction 523 00:25:09,240 --> 00:25:11,960 language. So it would now became major 524 00:25:11,960 --> 00:25:14,960 depressive disorder. And there's no reaction to it. 525 00:25:14,960 --> 00:25:18,320 It's just its own thing. And that was really 526 00:25:18,320 --> 00:25:20,880 revolutionary in the field of psychiatry where from a 527 00:25:20,880 --> 00:25:24,360 diagnostic perspective, like a purely DSM perspective, we got 528 00:25:24,360 --> 00:25:27,520 less curious about what contributed to that and more 529 00:25:27,520 --> 00:25:30,760 just like, can you count the checklist to see like, do they 530 00:25:30,760 --> 00:25:33,680 add up to qualify as a, for a diagnosis? 531 00:25:33,800 --> 00:25:35,640 It's definitely an imperfect model. 532 00:25:36,080 --> 00:25:38,160 I have lots of problems with the DSM. 533 00:25:38,520 --> 00:25:41,720 I think there is a place for diagnosis and conceptualization 534 00:25:42,240 --> 00:25:44,800 only to get people into the most effective treatment. 535 00:25:45,400 --> 00:25:48,360 I was just having a conversation today with some psychiatry 536 00:25:48,360 --> 00:25:51,840 interns about this and we were talking about how diagnosis is 537 00:25:51,840 --> 00:25:55,960 really only useful for getting you into the best fit treatment, 538 00:25:56,520 --> 00:25:59,240 not for explaining your entire life. 539 00:25:59,880 --> 00:26:02,680 You know, we used to say like even the language was, oh, she's 540 00:26:02,680 --> 00:26:05,080 a depressive, right? We don't use that type of 541 00:26:05,080 --> 00:26:06,960 language anymore. You know, she might have some 542 00:26:06,960 --> 00:26:09,520 depression right now. She's experiencing a major 543 00:26:09,520 --> 00:26:12,440 depressive episode. It's person first language. 544 00:26:12,800 --> 00:26:16,720 I think we're shifting away from defining you as a person, as 545 00:26:16,720 --> 00:26:19,040 your disorder, and contextualizing. 546 00:26:19,040 --> 00:26:20,840 That is, this is one part of your life. 547 00:26:21,400 --> 00:26:23,440 Yeah, I think that's so interesting. 548 00:26:23,440 --> 00:26:26,480 And I, you spoke a little bit to this at ADAA, but I think this 549 00:26:26,480 --> 00:26:29,280 is another really interesting aspect of this whole puzzle, 550 00:26:29,280 --> 00:26:32,840 which is people really strongly identifying with these diagnosis 551 00:26:32,840 --> 00:26:35,800 and seeing them with the growth mindset research, seeing them as 552 00:26:35,800 --> 00:26:39,320 permanent and not something that can change or evolve. 553 00:26:39,320 --> 00:26:41,080 And being like, I am a depressive. 554 00:26:41,080 --> 00:26:44,000 I'm just depressed regardless of what happens around being rather 555 00:26:44,000 --> 00:26:48,680 than I am depressed currently. But like everything in life, 556 00:26:48,680 --> 00:26:52,160 these change in intensity and there's many things that I can 557 00:26:52,160 --> 00:26:56,920 do to adjust how I'm feeling. You obviously are working with 558 00:26:56,920 --> 00:26:59,040 patients. You have a lot more experience 559 00:26:59,040 --> 00:27:01,080 with what this looks like and how this shows up. 560 00:27:01,080 --> 00:27:04,680 But do you think this is also connected to how we're speaking 561 00:27:04,680 --> 00:27:07,120 to individuals about depression and anxiety? 562 00:27:07,640 --> 00:27:11,600 And that this kind of where there's that issue of people 563 00:27:11,680 --> 00:27:14,480 really identifying being like, I'm depressed and it's very 564 00:27:14,480 --> 00:27:17,480 validating for them to have those labels, but it almost 565 00:27:17,480 --> 00:27:20,080 becomes a negative with how much people hold on to them. 566 00:27:20,600 --> 00:27:23,080 Yeah, it's really interesting these days, especially with 567 00:27:23,080 --> 00:27:25,800 social media and short videos about how you know you have 568 00:27:25,800 --> 00:27:27,480 ADHD. Like, these are the top 10 569 00:27:27,480 --> 00:27:30,440 signs. And it's interesting because I 570 00:27:30,440 --> 00:27:34,040 feel that there's a natural pull for people to want to not feel 571 00:27:34,040 --> 00:27:36,000 alone. Someone else is experiencing 572 00:27:36,000 --> 00:27:36,680 this too. Wow. 573 00:27:36,680 --> 00:27:39,120 That is super validating in and of itself. 574 00:27:39,360 --> 00:27:41,240 I'm not alone in this experience. 575 00:27:41,600 --> 00:27:44,920 And we can take that too far and say, oh, this is my identity 576 00:27:44,920 --> 00:27:46,320 now. This is who I am. 577 00:27:46,800 --> 00:27:49,200 So we're seeing the entire world as I, this is just through my 578 00:27:49,200 --> 00:27:51,040 depression. I am depressed. 579 00:27:51,040 --> 00:27:53,560 I'm a depressive person. And this is how it's going to 580 00:27:53,560 --> 00:27:56,320 be. The depression experience in and 581 00:27:56,320 --> 00:27:59,880 of itself is, you know, by definition, it engenders a sense 582 00:27:59,880 --> 00:28:04,040 of hopelessness as a low energy, low motivation to address the 583 00:28:04,040 --> 00:28:05,400 things that you might need to address. 584 00:28:05,400 --> 00:28:09,280 So it becomes kind of this reinforcing cycle where I don't 585 00:28:09,280 --> 00:28:13,840 even know where to start and I'm too tired to do anything about 586 00:28:13,840 --> 00:28:15,560 it. So then depression lasts for a 587 00:28:15,560 --> 00:28:17,880 lot longer, and then we think this is just how it's going to 588 00:28:17,880 --> 00:28:20,600 be. So instead I would say, can we 589 00:28:20,600 --> 00:28:23,760 think about depression like emotions in a way? 590 00:28:23,920 --> 00:28:26,920 The first blush, let's say maybe this is telling me something. 591 00:28:26,920 --> 00:28:29,360 What is going on? Let's do an assessment about my 592 00:28:29,520 --> 00:28:31,360 values. Am I living according to my 593 00:28:31,360 --> 00:28:33,280 values? How are my relationships doing? 594 00:28:33,440 --> 00:28:36,480 Is there trauma or stressful life events that I haven't quite 595 00:28:36,880 --> 00:28:39,280 come to terms with yet? How is my diet? 596 00:28:39,520 --> 00:28:42,520 How is my sleep? How is my fitness or movement 597 00:28:42,800 --> 00:28:45,880 exercise going on right now with my work life balance? 598 00:28:46,240 --> 00:28:49,160 Doing an assessment around those things, taking some time, being 599 00:28:49,160 --> 00:28:51,840 curious, I think would be a helpful starting place. 600 00:28:52,000 --> 00:28:55,600 And I, I do think that's how we can talk about depression. 601 00:28:56,200 --> 00:29:00,800 Yeah, it's, it's so funny because I very vividly remember 602 00:29:00,880 --> 00:29:03,800 in outpatient it was like adolescent outpatients. 603 00:29:03,800 --> 00:29:07,440 You go after school, you do the activities, lots of snacks, 604 00:29:07,440 --> 00:29:09,960 incentivizing kids to be there when they don't want to be. 605 00:29:10,480 --> 00:29:12,960 And we would do occupational therapy, which of course with 606 00:29:12,960 --> 00:29:15,720 arts and crafts as therapy. And one of the things that we 607 00:29:15,720 --> 00:29:20,000 did was like drawing and collaging our identities and the 608 00:29:20,000 --> 00:29:22,240 new like share around the group. Here are the aspects of my 609 00:29:22,240 --> 00:29:27,040 identity and almost everyone had is like a very prominent and 610 00:29:27,040 --> 00:29:31,480 stagnant sense of self was I'm depressed, I'm anxious or fill 611 00:29:31,480 --> 00:29:33,000 in the blank with whatever disorder it was. 612 00:29:33,000 --> 00:29:35,600 They were like drawing these dark storm clouds or this 613 00:29:35,600 --> 00:29:38,240 representation that was so prominent in their life. 614 00:29:38,240 --> 00:29:42,440 And it obviously was a very relevant emotional experience 615 00:29:42,440 --> 00:29:45,360 was impacting them enough that they were seeking help multiple 616 00:29:45,360 --> 00:29:48,120 hours a day. But it really was synonymous 617 00:29:48,120 --> 00:29:50,400 with who they were as a person. They were depressed, they were 618 00:29:50,400 --> 00:29:52,000 anxious, they were whatever it was. 619 00:29:52,000 --> 00:29:54,880 And I still look back at that and I think that's one of the 620 00:29:54,880 --> 00:29:58,320 most challenging aspects of adolescent mental health, 621 00:29:58,320 --> 00:30:02,880 especially because as you seek support, which is so helpful to 622 00:30:02,880 --> 00:30:05,680 feel validated and I'm not alone and other people have been here 623 00:30:05,680 --> 00:30:07,560 too. You then end up in this echo 624 00:30:07,560 --> 00:30:10,440 chamber because unlike adults who are crazy with all the self 625 00:30:10,440 --> 00:30:13,160 help podcasts and there's a book on anything and you can tune 626 00:30:13,160 --> 00:30:16,000 into anyone talking about how to solve any problem in your life, 627 00:30:16,560 --> 00:30:18,000 adolescents aren't really doing that. 628 00:30:18,080 --> 00:30:20,560 And they definitely aren't talking about how they're 629 00:30:20,560 --> 00:30:23,400 maintaining their mental health or how they reduce their stress 630 00:30:23,400 --> 00:30:25,960 and how they live a happy and fulfilled life. 631 00:30:25,960 --> 00:30:27,680 It's not a conversation that happens. 632 00:30:28,240 --> 00:30:32,280 But the converse issue is that once you are depressed, you are 633 00:30:32,680 --> 00:30:35,400 in Group therapy. You're consistently interacting 634 00:30:35,400 --> 00:30:37,720 with individuals that are in the same position. 635 00:30:38,160 --> 00:30:41,920 And there's no one that's really saying to fellow teens, I've 636 00:30:41,920 --> 00:30:45,560 been here, I know what it's like and I have made the changes that 637 00:30:45,560 --> 00:30:47,720 I need to make and I'm no longer depressed. 638 00:30:48,160 --> 00:30:51,640 And so it's such a challenging experience to be in. 639 00:30:51,640 --> 00:30:54,760 And of course, there's so many clinicians and adults that say 640 00:30:55,680 --> 00:30:57,720 it will get better. Maybe anecdotally, I've 641 00:30:57,720 --> 00:30:59,080 struggled and things have shifted. 642 00:30:59,080 --> 00:31:01,960 I've seen other kids experience recovery. 643 00:31:01,960 --> 00:31:04,560 I promise this is possible. But it's so challenging to 644 00:31:04,560 --> 00:31:06,960 identify with that. And teens are already resistant 645 00:31:06,960 --> 00:31:09,040 enough, and they're like, I don't believe you. 646 00:31:09,200 --> 00:31:11,440 You're an adult. You have more autonomy, you have 647 00:31:11,440 --> 00:31:14,400 more agency. And so it's this really 648 00:31:14,400 --> 00:31:17,320 interesting aspect of identity because so much of our 649 00:31:17,320 --> 00:31:19,560 relationships are dependent on our identity. 650 00:31:19,560 --> 00:31:22,120 And I think we're a mental health perspective that becomes 651 00:31:22,120 --> 00:31:23,680 another piece of the puzzle as well. 652 00:31:23,680 --> 00:31:26,160 And we are identifying with those things so strongly. 653 00:31:26,680 --> 00:31:29,800 Yeah, you're making me think of a growth mindset researcher who 654 00:31:29,800 --> 00:31:33,120 worked with Carol Direct named David Yeager, who's in Texas, 655 00:31:33,440 --> 00:31:35,480 and he has interventions for adolescence. 656 00:31:35,480 --> 00:31:37,640 Viewing him, he just sent me his book. 657 00:31:38,080 --> 00:31:38,960 What? Yeah. 658 00:31:39,000 --> 00:31:41,320 Really reviewing him in August when his book comes. 659 00:31:41,320 --> 00:31:42,080 Out. No kidding. 660 00:31:42,080 --> 00:31:44,520 OK, so he'll tell you way more. I'm so excited. 661 00:31:44,720 --> 00:31:47,000 Yay. I'm like I know that name. 662 00:31:47,440 --> 00:31:48,520 That's amazing. Yeah. 663 00:31:48,840 --> 00:31:49,600 That's perfect. Yeah. 664 00:31:49,600 --> 00:31:51,320 So he'll be great. He'll tell you way more about 665 00:31:51,320 --> 00:31:53,320 this. But he has interventions where 666 00:31:53,520 --> 00:31:56,240 he'll have students who are depressed, high school students, 667 00:31:56,240 --> 00:32:00,680 and they'll read blurbs or narratives from other students 668 00:32:01,000 --> 00:32:03,080 and they'll say, like, hey, look, I was in your shoes last 669 00:32:03,080 --> 00:32:06,080 year and I'm way better now. I learned some skills. 670 00:32:06,080 --> 00:32:08,720 I did these things. And that that element of those 671 00:32:08,720 --> 00:32:10,760 interventions is so powerful to resonate with. 672 00:32:10,800 --> 00:32:12,400 Like this is someone who's just like me. 673 00:32:12,880 --> 00:32:16,000 And it's a sense of belongingness that increases. 674 00:32:16,040 --> 00:32:19,200 And, and having a sense of belongingness in and of itself 675 00:32:19,200 --> 00:32:21,440 is really helpful. Like that's built into our DNA. 676 00:32:22,080 --> 00:32:25,200 We need to feel like we're part of the group, and things like 677 00:32:25,200 --> 00:32:28,520 depression and anxiety and other mental health concerns can make 678 00:32:28,520 --> 00:32:32,120 us feel very outside of the group and ostracized and other. 679 00:32:32,800 --> 00:32:34,440 Yeah. So it's funny that you bring 680 00:32:34,440 --> 00:32:36,440 that up. It's it's a good idea. 681 00:32:37,160 --> 00:32:41,240 No, it's it's so challenging. And Penn has like a positive 682 00:32:41,240 --> 00:32:43,760 psychology spit on that. They have a resilience program 683 00:32:43,760 --> 00:32:47,040 and they did pilot testing with Penn freshman and they had them 684 00:32:47,040 --> 00:32:49,760 read blurbs like that where freshman year is really hard. 685 00:32:49,760 --> 00:32:51,360 You're not going to feel like you know your people. 686 00:32:51,360 --> 00:32:53,000 You're going to feel really overwhelmed. 687 00:32:53,000 --> 00:32:55,040 You're going to feel like you're doing everything wrong. 688 00:32:55,440 --> 00:32:58,920 And I was in the same position and I'm now graduating senior 689 00:32:58,920 --> 00:33:02,160 and I found my people and I have my purpose and it all gets 690 00:33:02,160 --> 00:33:03,920 better and you'll be able to handle the stress. 691 00:33:04,360 --> 00:33:06,960 And they followed them for for years and they looked at career 692 00:33:06,960 --> 00:33:09,840 outcomes and job satisfaction and relationships. 693 00:33:10,240 --> 00:33:13,880 And the impact that that really simple minute intervention had 694 00:33:13,920 --> 00:33:16,560 is wild. It had an extremely positive 695 00:33:16,560 --> 00:33:18,480 impact. And the way that we speak about 696 00:33:18,480 --> 00:33:21,440 these things is so important because it does have a really 697 00:33:21,440 --> 00:33:24,480 meaningful impact on not only how people feel, but also the 698 00:33:24,840 --> 00:33:28,240 action steps that they take to make changes in their life. 699 00:33:28,280 --> 00:33:31,040 And it's not health promoting behaviors, but it's like mental 700 00:33:31,040 --> 00:33:34,080 health promoting behaviors. No, I think it is health because 701 00:33:34,080 --> 00:33:35,600 I think that you're all the same thing. 702 00:33:35,600 --> 00:33:37,680 Health and mental health, really, really, it's part of the 703 00:33:37,680 --> 00:33:40,200 same thing. And I, you're making me think of 704 00:33:40,200 --> 00:33:44,120 the concept of vulnerability. Being vulnerable with each other 705 00:33:44,120 --> 00:33:46,640 actually makes connections stronger. 706 00:33:47,080 --> 00:33:50,400 And one phrase I learned at an OCD conference actually is when 707 00:33:50,400 --> 00:33:54,240 you're disclosing a diagnosis to somebody, the goal should be I'm 708 00:33:54,680 --> 00:33:58,200 trying to deepen and strengthen our relationship versus like 709 00:33:58,200 --> 00:34:01,760 sharing a shameful secret. And I really like that spin on 710 00:34:01,760 --> 00:34:03,280 it. Not to say that you're going on, 711 00:34:03,280 --> 00:34:06,160 I don't know if anybody uses Facebook anymore, but I'm old 712 00:34:07,000 --> 00:34:10,239 not to go on Facebook and say, hey everybody, I have MDD, but 713 00:34:10,239 --> 00:34:11,960 they're. Doing that on TikTok now for. 714 00:34:11,960 --> 00:34:14,560 People are doing, people are doing that. 715 00:34:14,880 --> 00:34:17,239 And it's funny, like, I work with college students and I'm, 716 00:34:17,239 --> 00:34:19,440 you know, quite a few years out of college now, but they're 717 00:34:19,440 --> 00:34:21,400 saying, oh, yeah, I talked about this with my therapist and I 718 00:34:21,400 --> 00:34:23,159 said, I just met you. I don't know. 719 00:34:23,239 --> 00:34:24,960 I'm surprised that you're telling me this. 720 00:34:24,960 --> 00:34:27,920 I would when I was in college, you would never talk about 721 00:34:27,920 --> 00:34:31,719 because it's so like shameful, don't don't see a therapist and 722 00:34:31,719 --> 00:34:33,199 don't certainly don't talk about it. 723 00:34:33,199 --> 00:34:35,159 I think there are some positive changes happening. 724 00:34:35,159 --> 00:34:38,400 People are opening up a bit more, but I think vulnerability 725 00:34:38,400 --> 00:34:41,280 is a piece here that makes us feel more connected, less alone. 726 00:34:41,719 --> 00:34:44,560 Yeah, no, it's so true. I was in multiple classes this 727 00:34:44,560 --> 00:34:45,960 semester and it's seminars to out. 728 00:34:45,960 --> 00:34:48,120 We're not quite at like raise your hand and lecture and say 729 00:34:48,120 --> 00:34:50,120 these kinds of things, but people be like, oh, I was 730 00:34:50,120 --> 00:34:52,159 talking to my therapist about this or I mentioned that we 731 00:34:52,159 --> 00:34:54,719 learned this thing in class and it's really cool how people see 732 00:34:54,719 --> 00:34:56,800 it very positively. And it's a really cool thing. 733 00:34:57,120 --> 00:34:59,040 I want to be in therapy. Like, how did you do that? 734 00:34:59,040 --> 00:35:01,520 Tell me what the steps are. And so it's, I think it's a good 735 00:35:01,520 --> 00:35:03,120 direction overall that we're moving in. 736 00:35:03,560 --> 00:35:06,280 Yeah, my pipe dream with all of this is that, well, I don't know 737 00:35:06,280 --> 00:35:08,400 if this has all ever happened because of insurance, but 738 00:35:08,720 --> 00:35:10,160 therapy should be like the dentist. 739 00:35:10,160 --> 00:35:12,960 You go every year to do a checkup and if you need more 740 00:35:12,960 --> 00:35:15,160 attention, you get a referral to a specialist. 741 00:35:15,160 --> 00:35:17,920 And everybody sees a mental health person every year. 742 00:35:18,080 --> 00:35:20,560 That would really put medical care and mental health care on 743 00:35:20,560 --> 00:35:23,920 the same page because it is hard to find a therapist and with 744 00:35:23,920 --> 00:35:27,280 therapy it's hard to find the right fit, which is of course 745 00:35:27,280 --> 00:35:28,880 the most important part. Yeah. 746 00:35:29,560 --> 00:35:32,840 Well, circling back to the way that we can speak about these 747 00:35:32,840 --> 00:35:36,480 things and how we can be most effective, I'm wondering if the 748 00:35:36,480 --> 00:35:40,520 conversations that we have with family members or friends or 749 00:35:40,520 --> 00:35:44,000 even peers or general acquaintances, how we can be 750 00:35:44,000 --> 00:35:46,040 most effective in those interactions. 751 00:35:46,040 --> 00:35:48,440 Because you mentioned that people that have a relative that 752 00:35:48,640 --> 00:35:51,960 has struggled with depression in the past, they tend to learn 753 00:35:51,960 --> 00:35:54,240 more towards the chemical imbalance theory. 754 00:35:54,880 --> 00:35:57,480 I'm wondering what you're like best practices, best case 755 00:35:57,480 --> 00:36:00,640 scenario is for having these conversations so we can validate 756 00:36:00,640 --> 00:36:02,760 and help people feel seen and like they have that sense of 757 00:36:02,760 --> 00:36:06,640 belonging, but also increase agency as much as possible. 758 00:36:07,000 --> 00:36:09,280 Yeah, it's a really good question and and I don't have a 759 00:36:09,280 --> 00:36:11,960 definitive answer yet. A couple thoughts though. 760 00:36:12,440 --> 00:36:16,920 One is it's interesting that with depression, it's tricky 761 00:36:16,920 --> 00:36:19,240 because sometimes depression might be telling us about the 762 00:36:19,240 --> 00:36:22,520 very relationships that you're talking about, that even within 763 00:36:22,520 --> 00:36:25,600 the family, there are things that are going on that I'm 764 00:36:25,680 --> 00:36:29,160 unable to meet my needs because of you, something is going on 765 00:36:29,560 --> 00:36:31,760 or, or you're not helping me meet my needs. 766 00:36:32,120 --> 00:36:34,600 And so family members might be a little resistant to the idea 767 00:36:34,600 --> 00:36:36,600 that this is a signal that might be telling something that 768 00:36:36,600 --> 00:36:38,680 they're contributing to your loved ones depression. 769 00:36:38,960 --> 00:36:41,440 So one thing I just learned about is this. 770 00:36:41,480 --> 00:36:45,880 It's very quick, easy to understand intervention, which 771 00:36:45,880 --> 00:36:48,480 is validate what you're going through. 772 00:36:48,960 --> 00:36:51,560 I think so many people with depression here invalidating 773 00:36:51,560 --> 00:36:56,560 statements like you just gotta take a walk outside or you just 774 00:36:56,560 --> 00:36:59,600 gotta get up and go to work or in one of my. 775 00:36:59,600 --> 00:37:01,880 Groups, I heard. Have you tried yoga? 776 00:37:02,120 --> 00:37:03,760 One of my groups this made me so mad. 777 00:37:03,760 --> 00:37:06,680 They said their dad said just have an ice cream cone. 778 00:37:08,200 --> 00:37:10,400 This is the basic thing. Sounds good. 779 00:37:10,480 --> 00:37:14,640 Would play Amazon Music orchestra volume Ted and he 780 00:37:14,640 --> 00:37:17,240 would be like surely this will get her to start her day and go 781 00:37:17,240 --> 00:37:19,680 to school. This is 100% work. 782 00:37:20,160 --> 00:37:21,840 Yeah, yeah. And it's tricky because of 783 00:37:21,840 --> 00:37:24,360 course our parents and family love us and they want, they're 784 00:37:24,360 --> 00:37:27,760 trying to be helpful, but it's kind of actually makes us feel 785 00:37:27,760 --> 00:37:31,720 less connected, more alone, less understood when we use the J 786 00:37:31,720 --> 00:37:33,480 word, just just do this, Just do that. 787 00:37:34,320 --> 00:37:37,480 So validating. Oh my gosh, I see you as really 788 00:37:37,480 --> 00:37:39,600 struggling right now. This sounds awful. 789 00:37:39,920 --> 00:37:43,160 Even something like that can go a long way to, to get that one 790 00:37:43,160 --> 00:37:46,440 connection going back. The other piece that I'm a 791 00:37:46,440 --> 00:37:48,840 really big fan of and I just learned about this actually on 792 00:37:48,840 --> 00:37:53,520 Monday is validating and then giving language that says 793 00:37:53,520 --> 00:37:55,840 something along the lines of, and I believe that you can get 794 00:37:55,840 --> 00:37:58,080 through this. So it's very growth mindset 795 00:37:58,080 --> 00:38:00,000 actually. I know that with effort you can 796 00:38:00,000 --> 00:38:03,000 get through this, that with support, I have no doubt that 797 00:38:03,000 --> 00:38:06,280 you can overcome whatever it is that you're going through and 798 00:38:06,280 --> 00:38:07,880 you need both. You need both. 799 00:38:07,880 --> 00:38:10,840 You can't just have the validation and you can't just 800 00:38:10,840 --> 00:38:14,000 have the you got this. You have to have the validation 801 00:38:14,000 --> 00:38:16,920 and kind of the messaging that says let's talk through this. 802 00:38:17,200 --> 00:38:20,040 I think the application makes a lot of sense with kids with 803 00:38:20,040 --> 00:38:23,080 anxiety and I just learned about this from a colleague on Monday. 804 00:38:23,080 --> 00:38:25,040 So. Getting exclusive. 805 00:38:25,280 --> 00:38:26,040 I love it. Yeah. 806 00:38:26,280 --> 00:38:28,560 Exactly. So it's, you know, let's say 807 00:38:28,560 --> 00:38:30,560 someone's afraid of thunderstorms or snakes or 808 00:38:30,560 --> 00:38:32,480 something, and you say, oh, my gosh, yeah. 809 00:38:32,520 --> 00:38:34,320 You look really scared. It sucks. 810 00:38:34,320 --> 00:38:38,240 It's really it's it's hard. It's scary to feel this much 811 00:38:38,240 --> 00:38:39,960 anxiety all at once about something. 812 00:38:40,400 --> 00:38:42,520 And you know what? I bet there's ways that we can 813 00:38:42,520 --> 00:38:44,680 work around this, that we can work through this so that you 814 00:38:44,680 --> 00:38:48,160 can learn to cope with that anxiety and maybe have a 815 00:38:48,160 --> 00:38:50,320 different relationship with snakes or thunderstorms and 816 00:38:50,640 --> 00:38:52,480 change that. So it's, it's a very growth 817 00:38:52,480 --> 00:38:55,800 mindset message. This can change, but also the 818 00:38:55,840 --> 00:38:58,560 emotional validation piece. I love it. 819 00:38:58,560 --> 00:39:03,320 And so DBT, which was what I found to be so helpful because 820 00:39:03,320 --> 00:39:05,880 those two pieces are absolutely essential. 821 00:39:05,880 --> 00:39:09,080 And when you just have one, people respond not very well. 822 00:39:09,080 --> 00:39:10,320 They're like, what are you saying? 823 00:39:10,320 --> 00:39:13,600 Like how dare you suggest that? And the idea that it's 824 00:39:13,600 --> 00:39:17,320 acceptance and change, you're doing your best and you can do 825 00:39:17,320 --> 00:39:18,880 better. You didn't create these 826 00:39:18,880 --> 00:39:20,840 problems, but you do have to solve them. 827 00:39:21,320 --> 00:39:23,880 You have that validation piece, which is so important. 828 00:39:23,880 --> 00:39:26,680 And for a lot of people who feel so misunderstood. 829 00:39:26,680 --> 00:39:29,720 And if they don't feel like that need is met, there's just so 830 00:39:29,720 --> 00:39:32,160 much resistance to doing anything to move forward. 831 00:39:32,640 --> 00:39:37,200 And so having that initial, like I see you, I get it, this is 832 00:39:37,360 --> 00:39:39,600 really challenging and you're trying your best. 833 00:39:39,680 --> 00:39:43,440 And I have so much faith that you can and will continue to 834 00:39:43,440 --> 00:39:47,160 overcome this. And I think that if we spoke to 835 00:39:47,160 --> 00:39:49,400 everyone that way, I think there would be a lot of positive 836 00:39:49,400 --> 00:39:51,360 changes that took place, but we're not quite there yet, 837 00:39:51,360 --> 00:39:55,040 unfortunately. We're not there yet, and I think 838 00:39:55,040 --> 00:39:56,680 there's lots of reasons why we're not there. 839 00:39:56,680 --> 00:39:59,120 And I think part of it is that we're uncomfortable when we see 840 00:39:59,120 --> 00:40:03,000 our loved ones suffering, right? And I understand it's way more 841 00:40:03,000 --> 00:40:06,320 now that I have a son. It is hard when he's crying his 842 00:40:06,320 --> 00:40:08,920 eyes out, like he's really just really upset. 843 00:40:08,920 --> 00:40:10,160 It sucks. It breaks my heart. 844 00:40:10,160 --> 00:40:14,920 I am also sad and anxious and I want to make it stop for both of 845 00:40:14,920 --> 00:40:16,960 us. There's a natural pull to like 846 00:40:16,960 --> 00:40:18,920 reduce the anxiety. Oh no, no, no, it's OK. 847 00:40:18,920 --> 00:40:20,440 It's OK. We're going to calm both 848 00:40:20,440 --> 00:40:24,120 ourselves down. But what we, I think most of us 849 00:40:24,120 --> 00:40:27,640 probably can benefit from his mindfulness, sitting with 850 00:40:27,640 --> 00:40:30,560 uncomfortable emotions. And I certainly can benefit from 851 00:40:30,560 --> 00:40:32,560 that. Just sitting with, yeah, I'm 852 00:40:32,560 --> 00:40:34,880 uncomfortable right now, but we can, we can get through this 853 00:40:34,880 --> 00:40:36,360 together. Emotions aren't something that 854 00:40:36,360 --> 00:40:39,040 we need to run away from it. Also, the last thing I'll just 855 00:40:39,040 --> 00:40:42,160 say is reminds me of this tip I learned in an internship, which 856 00:40:42,160 --> 00:40:46,160 is for every psychotherapy group we do, we want two things to 857 00:40:46,160 --> 00:40:47,560 come across to every participant. 858 00:40:48,080 --> 00:40:49,800 You're not alone and there's hope. 859 00:40:50,280 --> 00:40:51,600 I'm just putting that together now. 860 00:40:51,600 --> 00:40:54,120 That's message that we're talking about does that. 861 00:40:54,400 --> 00:40:55,560 You're not alone. I get it. 862 00:40:55,560 --> 00:40:57,280 And I think you can do this. There's hope. 863 00:40:57,880 --> 00:41:02,080 Yeah, it's, it's so important and it goes back to the unmet 864 00:41:02,080 --> 00:41:03,720 needs again. Like if you're seeing someone 865 00:41:03,720 --> 00:41:06,880 else in distress, your need is to try and fix that and problem 866 00:41:06,880 --> 00:41:08,600 solve. And that's the best thing you 867 00:41:08,600 --> 00:41:12,000 can offer is like, I can try and get rid of this pain for you. 868 00:41:12,520 --> 00:41:14,440 But then the person that's actually struggling, that 869 00:41:14,440 --> 00:41:17,480 biggest unmet need that they're navigating is not feeling seen 870 00:41:17,480 --> 00:41:19,400 or understood or feeling alone in that. 871 00:41:19,720 --> 00:41:23,200 And so it's balancing both of those things and being aware of 872 00:41:23,200 --> 00:41:24,920 what people's experience, like you said. 873 00:41:25,840 --> 00:41:26,720 Yeah, yeah. Amazing. 874 00:41:27,080 --> 00:41:30,120 Well, if people want to read your research, continue to 875 00:41:30,120 --> 00:41:32,080 follow along with all the amazing work you're doing. 876 00:41:32,080 --> 00:41:35,480 Where can they do that? Well, I have a Google Scholar 877 00:41:35,480 --> 00:41:37,760 page. I don't have a website. 878 00:41:38,680 --> 00:41:41,440 I can help people. My wife, my wife has told me for 879 00:41:41,440 --> 00:41:43,040 years that yeah, I have to have a website. 880 00:41:43,280 --> 00:41:44,720 I just. Didn't have my dad because my 881 00:41:44,720 --> 00:41:48,800 mom was like Jason need a website and he was like so 882 00:41:48,840 --> 00:41:53,840 unique can you help me? Yeah, but on Google Scholar. 883 00:41:53,840 --> 00:41:57,040 All my research papers are on there, and people feel free to 884 00:41:57,080 --> 00:41:59,400 e-mail me if I wanna talk more about this stuff. 885 00:41:59,960 --> 00:42:01,560 Amazing. Well, thank you so much. 886 00:42:01,560 --> 00:42:02,720 This was absolutely incredible.