1 00:00:00,440 --> 00:00:03,960 Welcome to Sheeper Assisted. 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. Sheeper Assisted 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 --> 00:00:19,440 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 00:00:29,320 --> 00:00:32,439 She Persisted offers you a safe space to feel validated and 11 00:00:32,439 --> 00:00:35,120 understood in your struggle while encouraging you to take 12 00:00:35,120 --> 00:00:37,400 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 00:00:42,320 --> 00:00:45,600 The therapist and the patient are working together, moving in 15 00:00:45,600 --> 00:00:49,960 the same speed, same direction. Like 2 trains leaving a station 16 00:00:49,960 --> 00:00:52,520 on two separate tracks. Are we going the same speed in 17 00:00:52,520 --> 00:00:56,080 the same direction to the same next train station? 18 00:00:56,160 --> 00:00:58,680 That's therapeutic alliance. It's that real shared 19 00:00:58,680 --> 00:01:01,000 collaborative. We're doing this together to 20 00:01:01,000 --> 00:01:04,319 humans, to flawed humans, therapist included, right? 21 00:01:04,319 --> 00:01:06,280 We're going to help you figure out how do we get there 22 00:01:06,280 --> 00:01:09,520 together. Hello, hello, and welcome back 23 00:01:09,520 --> 00:01:11,920 to another episode of She Persisted. 24 00:01:12,320 --> 00:01:15,040 I'm really excited for you guys to listen to this one. 25 00:01:15,040 --> 00:01:18,680 I went in person to interview Doctor Rosenthal and Grace at 26 00:01:18,680 --> 00:01:21,760 the Duke Center for Misophonia and Emotion Regulation, and we 27 00:01:21,760 --> 00:01:24,480 talked about everything you could want to know both with 28 00:01:24,480 --> 00:01:26,760 emotion regulation and misophonia. 29 00:01:27,200 --> 00:01:31,840 Dr. Zachary Rosenthal is an expert in DBT and misophonia 30 00:01:31,840 --> 00:01:34,320 research. He is a clinical psychologist at 31 00:01:34,320 --> 00:01:39,120 Duke University and Grace Hepps is the outreach and education at 32 00:01:39,120 --> 00:01:41,280 their lab. And so we talk a lot about her 33 00:01:41,280 --> 00:01:44,160 lived experience, how you can support someone struggling with 34 00:01:44,160 --> 00:01:47,400 misophonia and how the treatment and research landscape has 35 00:01:47,400 --> 00:01:49,720 changed. We start by talking with Doctor 36 00:01:49,720 --> 00:01:52,400 Rosenthal about emotion regulation, emotion 37 00:01:52,400 --> 00:01:57,080 dysregulation, how this shows up in DBT, what the cycle of 38 00:01:57,080 --> 00:02:00,080 emotion looks like because it shows up in a lot of different 39 00:02:00,080 --> 00:02:03,760 ways, especially misophonia and people that find DBT to be 40 00:02:03,760 --> 00:02:06,000 effective. So if you were interested in 41 00:02:06,000 --> 00:02:09,400 learning more about emotion reactivity, regulation, 42 00:02:09,400 --> 00:02:13,840 recovery, DBT, misophonia, all the things, this is an episode 43 00:02:13,840 --> 00:02:17,480 you will absolutely enjoy. And if you guys haven't heard of 44 00:02:17,480 --> 00:02:19,720 misophonia, I'll give you a quick little definition that we 45 00:02:19,720 --> 00:02:22,800 do touch on it in this episode. It's a chronic condition that 46 00:02:22,800 --> 00:02:25,800 causes people to have extreme emotional reactions to specific 47 00:02:25,800 --> 00:02:27,800 sounds. So we talked about why we have 48 00:02:27,800 --> 00:02:30,440 different emotional reactions to things, how we can cope with 49 00:02:30,440 --> 00:02:33,680 them, and then also specifically with misophonia, which is a new 50 00:02:33,680 --> 00:02:37,160 area of research and is a really interesting way to apply a lot 51 00:02:37,160 --> 00:02:40,800 of this knowledge, knowledge about emotion regulation and the 52 00:02:40,800 --> 00:02:43,200 emotion cycle itself. So I really hope you guys enjoy 53 00:02:43,200 --> 00:02:45,320 this conversation with Doctor Rosenthal and Grace. 54 00:02:45,640 --> 00:02:47,400 I had an incredible time recording it. 55 00:02:47,440 --> 00:02:51,040 And so with that, let's dive in. Well, thank you guys so much for 56 00:02:51,040 --> 00:02:52,440 joining me today. And she persisted. 57 00:02:52,440 --> 00:02:56,240 I'm so incredibly excited to have you on the podcast and to 58 00:02:56,240 --> 00:02:59,680 talk about DBT and emotion regulation and misophonia, 59 00:03:00,120 --> 00:03:03,040 Really important conversation that we were talking off air 60 00:03:03,040 --> 00:03:06,040 that not a lot of people are having, but I think a lot of 61 00:03:06,040 --> 00:03:08,720 people could benefit from. So I'm really excited to have 62 00:03:08,720 --> 00:03:11,240 you both here today. It is wonderful to be here with 63 00:03:11,240 --> 00:03:13,960 you, and what a pleasure to be in person. 64 00:03:14,080 --> 00:03:15,800 Yeah. At Duke, Yes. 65 00:03:15,800 --> 00:03:17,760 Thank you for coming here. We're coming to you guys from 66 00:03:17,760 --> 00:03:19,840 North Carolina, which is different from my normal 67 00:03:19,840 --> 00:03:21,680 podcasting setup in Philadelphia. 68 00:03:21,680 --> 00:03:24,560 So exciting, and I'm just so glad to do this. 69 00:03:24,800 --> 00:03:28,640 So to get things started, I wanted to start with kind of 70 00:03:28,640 --> 00:03:31,600 laying a bit of a framework for this episode, which is that 71 00:03:31,600 --> 00:03:33,840 we're really talking about emotion regulation. 72 00:03:33,840 --> 00:03:37,520 And with that comes reactivity and recovery, which is a very 73 00:03:37,520 --> 00:03:40,760 complex topic and it's something that we all navigate and go 74 00:03:40,760 --> 00:03:43,280 through, but we probably don't have the vocabulary or 75 00:03:43,280 --> 00:03:46,240 understanding to be like, here are the phases that I'm going 76 00:03:46,240 --> 00:03:48,680 through when I experience an emotion or I'm in a stressful 77 00:03:48,680 --> 00:03:51,280 environment. And so I was wondering if we 78 00:03:51,280 --> 00:03:54,720 could give that insight and definition to listeners about 79 00:03:54,720 --> 00:03:58,120 what that cycle and process looks like when we experience 80 00:03:58,120 --> 00:04:02,160 emotions, why we experience them differently, how we regulate 81 00:04:02,160 --> 00:04:05,240 them and then what that looks like after the fact that like 82 00:04:05,280 --> 00:04:07,280 recovery cycle. Yeah, absolutely. 83 00:04:07,280 --> 00:04:10,360 And I'll do my best to not sound like a really boring professor 84 00:04:10,520 --> 00:04:12,520 doing this, I promise. And I may fail. 85 00:04:12,720 --> 00:04:14,640 Apologies in advance if I do. But here's the thing. 86 00:04:15,000 --> 00:04:19,959 All responses we have in the world always start with sensory 87 00:04:19,959 --> 00:04:21,200 input. We always do. 88 00:04:21,200 --> 00:04:24,400 Everything we experience starts with what we see or we smell or 89 00:04:24,400 --> 00:04:26,680 we taste or touch or what we hear. 90 00:04:27,160 --> 00:04:31,240 And what happens is that our brain super complicated organ, 91 00:04:32,160 --> 00:04:35,480 probably roughly around a 3 LB organ and its basic function, 92 00:04:35,960 --> 00:04:40,920 boil it all down, is survival. So what our brain is doing and 93 00:04:40,920 --> 00:04:44,200 taking in sensory information is it's trying to make sense of it 94 00:04:44,400 --> 00:04:49,360 in a way that gives it gives us an idea about how to respond, to 95 00:04:49,360 --> 00:04:52,320 stay away from danger, to stay away from threat, to kind of 96 00:04:52,320 --> 00:04:54,880 move through the world in a way that feels safe to us. 97 00:04:55,120 --> 00:04:56,760 So this is the first thing to understand. 98 00:04:56,760 --> 00:05:00,480 It's like there's a lot coming at us every single day, all 99 00:05:00,480 --> 00:05:03,440 sorts of sensory input. And that's the trigger, if you 100 00:05:03,440 --> 00:05:07,440 will, we're in how we make sense of the sensory input, which we 101 00:05:07,440 --> 00:05:11,920 could think of as our thinking. So that sensory input plus the 102 00:05:11,920 --> 00:05:15,840 way we make sense of it together is going to impact our biology, 103 00:05:15,840 --> 00:05:18,320 our body, and I mean throughout our whole body. 104 00:05:18,440 --> 00:05:20,640 Our nervous system is way complicated. 105 00:05:20,640 --> 00:05:24,240 There's lots of moving parts and what happens is the sensation, 106 00:05:24,240 --> 00:05:26,760 the cognition, all this stuff comes together and poof, 107 00:05:26,760 --> 00:05:30,200 instantly, like milliseconds, instantly we react. 108 00:05:30,640 --> 00:05:34,520 And what we call that reaction, we call it an emotion, right? 109 00:05:34,520 --> 00:05:36,640 We say, oh, I'm having this emotion. 110 00:05:36,920 --> 00:05:40,720 The emotion itself is a word, and it's a word we learn. 111 00:05:40,960 --> 00:05:43,040 It's a word we learn from the way we grow up. 112 00:05:43,400 --> 00:05:45,720 So people from different parts of the world have some different 113 00:05:46,000 --> 00:05:48,320 emotions that they might experience in similar 114 00:05:48,320 --> 00:05:50,080 situations. So it's actually really, really 115 00:05:50,080 --> 00:05:52,200 complicated. But what happens at the end of 116 00:05:52,200 --> 00:05:55,320 the day is we get emotions throughout the day, every day. 117 00:05:55,320 --> 00:05:58,440 We react, we have them, we experience them. 118 00:05:58,880 --> 00:06:02,240 Now we may not be aware, we may not put good words to them, but 119 00:06:02,240 --> 00:06:04,440 we have them. Sometimes they're small, 120 00:06:04,440 --> 00:06:08,360 sometimes they're big, and they last just a few seconds. 121 00:06:08,360 --> 00:06:13,640 This is a wild thing. Emotions last seconds and then 122 00:06:14,200 --> 00:06:15,520 they sometimes get triggered again. 123 00:06:16,000 --> 00:06:18,040 Now they last more than a few seconds. 124 00:06:18,240 --> 00:06:20,640 And now you start stringing them together with more and more and 125 00:06:20,640 --> 00:06:24,040 more firing of emotions. And now we start having minutes 126 00:06:24,400 --> 00:06:26,880 of emotional experiences or hours even. 127 00:06:27,240 --> 00:06:29,640 Some people might report days of experiencing this. 128 00:06:29,640 --> 00:06:33,320 And now this is where we really start to see struggle and 129 00:06:33,320 --> 00:06:35,760 distress and so on. Whether we're talking about 130 00:06:35,760 --> 00:06:41,640 shame, fear, anxiety, disgust, sadness, etcetera, etcetera. 131 00:06:41,920 --> 00:06:43,480 Now the emotions there, it's intense. 132 00:06:43,480 --> 00:06:46,520 How do we cope with it, right? This is the real key in 133 00:06:46,520 --> 00:06:50,640 understanding once the emotion is triggered and we react, how 134 00:06:50,640 --> 00:06:55,240 long it takes to come back down to where we started is mostly 135 00:06:55,240 --> 00:06:59,800 going to be due to how we regulate how we regulate and 136 00:06:59,800 --> 00:07:04,840 that is a complicated next stop. Yeah, I think there's this 137 00:07:04,880 --> 00:07:07,160 misconception, especially when you're struggling with your 138 00:07:07,160 --> 00:07:10,560 mental health, that the way you quote, UN quote should be 139 00:07:10,760 --> 00:07:14,080 experiencing life is like no emotion or very little emotion 140 00:07:14,080 --> 00:07:17,640 or maybe just positive emotions. That idea that if you were 141 00:07:18,160 --> 00:07:20,440 regulating your emotions properly or you could better 142 00:07:20,440 --> 00:07:23,520 tolerate your distress, that you wouldn't be having those initial 143 00:07:23,520 --> 00:07:25,800 experiences. And I think that's not 144 00:07:25,800 --> 00:07:28,400 necessarily the case. It's absolutely wrong. 145 00:07:28,400 --> 00:07:30,800 It's completely wrong. Emotions are there for reasons. 146 00:07:30,800 --> 00:07:33,400 Evolutionarily speaking, they make sense. 147 00:07:33,680 --> 00:07:36,480 They make total sense. Again, our brains and our 148 00:07:36,480 --> 00:07:39,280 bodies, they're they're engineered really, really well 149 00:07:39,280 --> 00:07:42,400 to help keep us going, keep us alive, keep us moving, keep us 150 00:07:42,440 --> 00:07:45,880 out of harm's way. And so when we feel an emotion, 151 00:07:46,240 --> 00:07:50,720 it's a signal means something and we need to kind of recognize 152 00:07:50,720 --> 00:07:54,040 what that is in the moment, try to make sense of it, which is 153 00:07:54,040 --> 00:07:56,840 hard, hard to do. That's a big part of emotion 154 00:07:56,840 --> 00:07:59,080 regulation. Try to make sense of what does 155 00:07:59,080 --> 00:08:01,400 that mean about what I'm experiencing. 156 00:08:01,960 --> 00:08:04,400 And it's a kind of self validation. 157 00:08:04,680 --> 00:08:08,160 You think about it, it's like it's the emotion itself is a 158 00:08:08,160 --> 00:08:13,440 communication to you about what's going on with you in that 159 00:08:13,440 --> 00:08:15,360 moment. So we got to listen to it. 160 00:08:15,800 --> 00:08:19,440 The other thing that emotions do that's really important, whether 161 00:08:19,440 --> 00:08:23,200 we're talking pleasant or unpleasant or whatever, not only 162 00:08:23,200 --> 00:08:26,280 do they tell us something, but we use the emotions to tell 163 00:08:26,280 --> 00:08:28,800 other people things. So emotions function as 164 00:08:28,800 --> 00:08:33,600 communication to others. Faces communicate our fists, our 165 00:08:33,600 --> 00:08:38,000 shoulders, our hands, the way we hold our bodies, our words, all 166 00:08:38,080 --> 00:08:41,520 of it communicates to others. And we need that to be able to 167 00:08:41,520 --> 00:08:44,760 function, right, to be able to have the type of relationships 168 00:08:44,760 --> 00:08:48,840 and day-to-day functioning that they all are striving to have. 169 00:08:49,440 --> 00:08:52,120 So then the third piece that emotions do is they motivate, 170 00:08:52,160 --> 00:08:53,680 right? They motivate actions. 171 00:08:53,720 --> 00:08:55,920 They motivate. If we listen to our emotions, 172 00:08:56,160 --> 00:08:58,320 they motivate us to do something. 173 00:08:58,480 --> 00:09:01,720 Now, is that something skillful and effective or is that 174 00:09:01,720 --> 00:09:03,120 something that might get us into trouble? 175 00:09:03,200 --> 00:09:06,800 That's a whole other distinction to make, but they motivate us. 176 00:09:07,480 --> 00:09:11,600 I think it's a lot of people, when we think about emotions, 177 00:09:12,000 --> 00:09:14,720 our mind immediately goes to ways when they're being 178 00:09:14,720 --> 00:09:16,360 ineffective. Like when we think about 179 00:09:16,600 --> 00:09:18,840 struggles with emotion regulation or emotion 180 00:09:18,840 --> 00:09:21,440 dysregulation, we think about these really extreme examples 181 00:09:21,440 --> 00:09:23,360 where maybe that's not going how it should be. 182 00:09:23,360 --> 00:09:26,440 And maybe that's populations that DBT is really effective 183 00:09:26,440 --> 00:09:28,840 for, whether it's borderline crystality disorder or 184 00:09:28,840 --> 00:09:32,080 depression, anxiety. In some cases, it's not so much 185 00:09:32,080 --> 00:09:34,680 that day-to-day cycle that you talked about, which is that our 186 00:09:34,680 --> 00:09:37,000 emotions come up, they're telling us something. 187 00:09:37,000 --> 00:09:39,600 We probably respond to that single signal hopefully 188 00:09:39,600 --> 00:09:43,720 effectively and then we regulate the emotion and it's kind of 189 00:09:43,720 --> 00:09:45,440 just passes without second thought. 190 00:09:45,640 --> 00:09:49,640 But we do have these individuals and populations where that 191 00:09:49,640 --> 00:09:52,080 doesn't happen effectively. And like you were saying, maybe 192 00:09:52,080 --> 00:09:55,440 the emotional signal is lasting for hours or days where it's 193 00:09:55,560 --> 00:09:57,760 more consistent. I don't want to say something's 194 00:09:57,760 --> 00:10:00,680 going like quote UN quote wrong in that situation, but it's not 195 00:10:00,680 --> 00:10:04,640 that typical cycle that maybe most of us experience when we're 196 00:10:04,640 --> 00:10:07,560 just navigating our day-to-day lives with these smaller 197 00:10:07,560 --> 00:10:10,280 stressors. So when we think about that 198 00:10:10,280 --> 00:10:16,160 reaction regulating recovery, at what point is that cycle not 199 00:10:16,160 --> 00:10:19,040 being as effective as it could be when we see this extreme 200 00:10:19,040 --> 00:10:21,600 emotion dysregulation? Yeah, that's a really good 201 00:10:21,600 --> 00:10:22,920 question. And probably different for 202 00:10:22,920 --> 00:10:25,280 different people, right? And different settings for the 203 00:10:25,280 --> 00:10:28,320 same person. What, what's complicated about 204 00:10:28,320 --> 00:10:31,680 emotion and emotion regulation is that there's a whole bunch of 205 00:10:31,680 --> 00:10:36,440 other intersecting processes that come together to give us 206 00:10:36,480 --> 00:10:38,800 what we call emotion or emotion regulation. 207 00:10:39,200 --> 00:10:42,640 And so someone might be really distressed and, and having a 208 00:10:42,640 --> 00:10:45,320 really, really hard time functionally. 209 00:10:45,520 --> 00:10:47,960 Maybe they're like not hanging with their friends or they're 210 00:10:48,400 --> 00:10:51,720 not able to go to school or, or do well in school, or maybe 211 00:10:51,720 --> 00:10:54,640 they're having a hard time with their family and, or work, 212 00:10:54,680 --> 00:10:56,760 whatever. So there's there's this kind of 213 00:10:57,280 --> 00:10:59,840 impairment is kind of like jargon we would use. 214 00:10:59,840 --> 00:11:02,680 And in my world we'd say there's impairment with day-to-day 215 00:11:02,680 --> 00:11:06,520 functioning that's consistent and it's related to this really 216 00:11:06,520 --> 00:11:09,360 intense big overwhelm set of emotions. 217 00:11:09,640 --> 00:11:11,880 But here's the thing, inside of those emotions, there's a whole 218 00:11:11,880 --> 00:11:15,520 bunch of other stuff that we can help people try to unpack and 219 00:11:15,520 --> 00:11:17,240 understand to change all of that. 220 00:11:17,920 --> 00:11:20,360 So whether it's what they're attending to with their 221 00:11:20,360 --> 00:11:24,280 attention or whether it's what they're automatically doing with 222 00:11:24,280 --> 00:11:29,000 their actions before they get triggered, anticipating they're 223 00:11:29,000 --> 00:11:32,400 going to be triggered, or whether it's when they do 224 00:11:32,400 --> 00:11:35,840 respond to some sort of really kind of intense emotional type 225 00:11:35,840 --> 00:11:38,840 of situation, what are they doing with their actions, right? 226 00:11:38,840 --> 00:11:40,960 Are they approaching? Are they avoiding? 227 00:11:41,160 --> 00:11:43,320 Are they escaping? Are they confronting? 228 00:11:43,600 --> 00:11:45,080 Are they right? There's all these sort of 229 00:11:45,080 --> 00:11:47,080 behavioral things that we can help people with. 230 00:11:47,160 --> 00:11:52,080 What are they thinking before, during, and after the emotional 231 00:11:52,080 --> 00:11:54,640 stimulus, if you will, before the thing triggers them? 232 00:11:55,400 --> 00:11:57,520 What are different types of thought processes? 233 00:11:57,920 --> 00:11:59,760 Because we can help people change those. 234 00:11:59,880 --> 00:12:03,320 There's really good evidence based ways, as you know, to 235 00:12:03,320 --> 00:12:06,800 change patterns of thinking and that can be before somebody's 236 00:12:06,800 --> 00:12:10,440 triggered, while they're in that intense distress, or after. 237 00:12:10,920 --> 00:12:14,560 We also can help people with how they communicate again, before, 238 00:12:15,240 --> 00:12:19,360 during and after. And those communication patterns 239 00:12:19,640 --> 00:12:24,120 also, if they change, can change how people think or what they do 240 00:12:24,120 --> 00:12:25,960 or how they feel. And then lastly, we have what's 241 00:12:25,960 --> 00:12:27,400 going on in people's bodies, right? 242 00:12:27,400 --> 00:12:30,880 So that of course, also can be something we can target changing 243 00:12:30,880 --> 00:12:34,120 before, during, or after a trigger. 244 00:12:34,520 --> 00:12:36,600 So I think it's really interesting because all these 245 00:12:36,600 --> 00:12:40,160 things come together kind of like in a network, kind of like 246 00:12:40,160 --> 00:12:43,960 holistically, right? Like what you feel, what you 247 00:12:43,960 --> 00:12:47,080 think, what you do, what's going on in your body, how you 248 00:12:47,080 --> 00:12:49,640 communicate. Those things are not separate 249 00:12:49,640 --> 00:12:52,000 from each other. They're all interrelated. 250 00:12:52,000 --> 00:12:55,280 And so if you change one, you can actually change some of the 251 00:12:55,280 --> 00:12:58,120 others, all in an effort to regulate. 252 00:12:58,960 --> 00:13:02,000 You mentioned different interventions that we can do to 253 00:13:02,000 --> 00:13:03,880 be more effective or target these things. 254 00:13:03,880 --> 00:13:07,600 DBT or dialectical behavioral therapy is a big one for emotion 255 00:13:07,600 --> 00:13:09,760 dysregulation and distress tolerance. 256 00:13:10,280 --> 00:13:14,160 I would love to talk to you a bit about training process for 257 00:13:14,160 --> 00:13:17,400 that because what makes DBT really unique is that if you're 258 00:13:17,400 --> 00:13:21,440 doing like DBT adherent treatment and you're working 259 00:13:21,440 --> 00:13:23,760 with someone who's gone through the training process and they 260 00:13:23,760 --> 00:13:25,600 have their board of clinicians that they're working with, 261 00:13:25,600 --> 00:13:27,800 you're going to group, you're going through the different 262 00:13:28,000 --> 00:13:31,320 phases of treatment. Your outcomes are pretty 263 00:13:31,320 --> 00:13:34,240 consistent statistically versus when you go to a normal 264 00:13:34,400 --> 00:13:37,040 psychotherapy appointment. The number one determinant is 265 00:13:37,240 --> 00:13:39,520 your relationship with that therapist, which is really 266 00:13:39,520 --> 00:13:42,680 interesting because DBT does lean so much on that skills 267 00:13:42,680 --> 00:13:45,640 group part of things and these things that are really set in 268 00:13:45,640 --> 00:13:48,320 stone, whether it's phone coaching or we start with phase 269 00:13:48,320 --> 00:13:50,560 one, like there would be interfering behaviors or life 270 00:13:50,560 --> 00:13:52,840 interfering behaviors, and work through this hierarchy. 271 00:13:53,080 --> 00:13:57,760 What is it about the training process and what are you guys 272 00:13:57,760 --> 00:14:02,280 doing to lead to those outcomes that are so consistent and 273 00:14:02,480 --> 00:14:04,200 adhering to this original protocol? 274 00:14:04,680 --> 00:14:08,240 Well, the number one thing in my opinion with training someone in 275 00:14:08,240 --> 00:14:13,080 DBT is, and I've been training people for decades. 276 00:14:13,080 --> 00:14:17,800 I train people around the world, in China and in the US a lot in 277 00:14:17,800 --> 00:14:20,760 North Carolina and here at Duke. I've done this for a long time 278 00:14:20,760 --> 00:14:22,800 and trained a lot of people. And I think the number one 279 00:14:22,800 --> 00:14:26,120 thing, if I take a step back with this question, it's really 280 00:14:26,120 --> 00:14:31,720 about helping people have and express compassion from the 281 00:14:31,720 --> 00:14:36,840 heart for the person in front of, but to do that in a way that 282 00:14:36,840 --> 00:14:41,640 is aligned with principles of behavior change, including 283 00:14:41,640 --> 00:14:45,000 acceptance based and change based strategies for change. 284 00:14:45,440 --> 00:14:49,200 So I think it's actually a false distinction to say that there's 285 00:14:49,200 --> 00:14:52,840 either, you know, kind of the relationship that accounts for 286 00:14:52,840 --> 00:14:57,000 outcomes in psychotherapy or there are things like skills or, 287 00:14:57,080 --> 00:15:00,480 or in DBT or other treatments. I actually think it's it's both. 288 00:15:00,680 --> 00:15:03,960 It's definitely and go figure, I'm dialectical here. 289 00:15:03,960 --> 00:15:06,120 So on the one hand, there's this, on the other hand, there's 290 00:15:06,120 --> 00:15:07,640 that. The way I tend to think of 291 00:15:07,640 --> 00:15:11,080 things is how do we integrate and synthesize so we get a both 292 00:15:11,080 --> 00:15:13,400 and here instead of an either or. 293 00:15:13,960 --> 00:15:15,680 And the both end is that that's what we're trying to train 294 00:15:15,680 --> 00:15:19,880 people to do, right? It's to really have strong 295 00:15:19,880 --> 00:15:24,720 therapeutic relationship in a DBT context, strong therapeutic 296 00:15:24,720 --> 00:15:27,880 alliance. And then the third piece is 297 00:15:27,920 --> 00:15:31,160 strong ability to do these really specific kind of DBT 298 00:15:31,160 --> 00:15:35,120 principles and skills and so on. That's like a three tier layer 299 00:15:35,120 --> 00:15:36,880 cake or a three layers to a cake. 300 00:15:37,560 --> 00:15:40,080 The relationship is not the same thing as alliance. 301 00:15:40,560 --> 00:15:44,320 Alliance is the degree to which 2 people, the therapist and the 302 00:15:44,320 --> 00:15:49,480 patient, are working together, moving in the same speed, same 303 00:15:49,480 --> 00:15:52,160 direction. Like 2 trains leaving a station 304 00:15:52,160 --> 00:15:55,320 on two separate tracks, right? Are we going the same speed, in 305 00:15:55,320 --> 00:15:58,920 the same direction, to the same next train station? 306 00:15:59,840 --> 00:16:02,480 That's therapeutic alliance. It's that real, shared, 307 00:16:02,480 --> 00:16:04,800 collaborative. We're doing this together to 308 00:16:04,800 --> 00:16:09,040 humans to flawed humans, therapist included, right. 309 00:16:09,080 --> 00:16:11,600 We're real people, but we we're going to help you figure out how 310 00:16:11,600 --> 00:16:14,840 do we get there together. And that's on top of this 311 00:16:14,840 --> 00:16:18,520 really, really strong, compassion driven, humane, 312 00:16:18,840 --> 00:16:22,520 deeply humane relationship that's expressive training 313 00:16:22,520 --> 00:16:25,360 people on how to do that and honestly how to get out of their 314 00:16:25,360 --> 00:16:29,560 own way to do that really well. That leads to therapeutic 315 00:16:29,560 --> 00:16:31,600 alliance. And then our third kind of the 316 00:16:31,800 --> 00:16:34,600 covering of the cake, if you will, what you see, the icing 317 00:16:34,600 --> 00:16:37,680 that the flowers, the happy birthday letters, right? 318 00:16:37,680 --> 00:16:40,680 What you see on top of the cake, that's the skills, right? 319 00:16:40,680 --> 00:16:44,520 That's the like, let's do a chain analysis and let's do, 320 00:16:44,520 --> 00:16:47,280 dear man, and let's do the stop and the tip skill. 321 00:16:47,560 --> 00:16:49,800 But that stuff's necessary too. But your question is about 322 00:16:49,800 --> 00:16:53,880 training. I want to train people who want 323 00:16:54,280 --> 00:16:58,480 and really deeply care about others they want, they want to 324 00:16:58,480 --> 00:17:02,240 learn how to how to channel that in a compassionate way that also 325 00:17:02,240 --> 00:17:05,480 includes using these evidence based strategies. 326 00:17:05,560 --> 00:17:09,240 It's not either or, it's both. Can we talk about some of those 327 00:17:09,240 --> 00:17:11,480 principles? Because I think people that have 328 00:17:11,480 --> 00:17:13,599 been in traditional psychotherapy versus when you 329 00:17:13,599 --> 00:17:16,280 enter DBT therapy, it's like a very stark difference. 330 00:17:16,599 --> 00:17:19,920 And I think that idea of teamwork is very clear. 331 00:17:19,920 --> 00:17:22,119 Your first session you're like, wow, we're all in this team 332 00:17:22,119 --> 00:17:24,440 together. They're in my corner, which for 333 00:17:24,440 --> 00:17:26,880 a lot of patients, you're like, I've never felt this way before. 334 00:17:26,880 --> 00:17:28,840 You get to the session and they're like, OK, we got to 335 00:17:28,840 --> 00:17:30,920 change this behavior and DBT, it's like, what do you want to 336 00:17:30,920 --> 00:17:32,200 work on? What are we focusing on? 337 00:17:32,200 --> 00:17:35,400 And obviously there's some like better kind of work on this so 338 00:17:35,400 --> 00:17:37,680 we can get to that later thing that you want to do. 339 00:17:37,960 --> 00:17:41,800 But there really is that idea of collaboration and I think the 340 00:17:41,800 --> 00:17:45,000 compassion piece as well, which also can sometimes feel really 341 00:17:45,000 --> 00:17:47,960 foreign, especially when your behaviors aren't making sense to 342 00:17:47,960 --> 00:17:50,200 those around you. And I liked what you said about 343 00:17:50,200 --> 00:17:53,080 getting out of your own way to be able to support someone 344 00:17:53,080 --> 00:17:55,480 that's in a position that they're struggling. 345 00:17:55,480 --> 00:17:58,480 I think that's relevant to parents, it's relevant to peers, 346 00:17:58,480 --> 00:18:00,440 especially when you want to support a friend. 347 00:18:00,640 --> 00:18:03,320 And there's these really specific philosophies that DBT 348 00:18:03,320 --> 00:18:05,960 has, like the patient is doing their best, but they can also do 349 00:18:05,960 --> 00:18:07,440 better. And you mentioned therapists and 350 00:18:07,440 --> 00:18:08,880 people too, not? But. 351 00:18:09,400 --> 00:18:11,720 Did I say butt? Oh, no hands. 352 00:18:11,880 --> 00:18:15,600 That's the number one DBT thing, not butt the dialectic. 353 00:18:15,880 --> 00:18:19,560 And so I'm wondering, are there any of those philosophies are 354 00:18:19,560 --> 00:18:22,480 ways that people can be more compassionate and understanding 355 00:18:22,480 --> 00:18:26,320 and open to get out of their own ways and support people that are 356 00:18:26,360 --> 00:18:28,440 are struggling in a way that they don't necessarily 357 00:18:28,440 --> 00:18:31,960 understand or it seems really out of left field or foreign? 358 00:18:32,000 --> 00:18:33,560 Yeah, Yeah, that's a really good question. 359 00:18:33,720 --> 00:18:35,160 There's a couple of things that come to my mind. 360 00:18:35,320 --> 00:18:37,880 I love the question. I'll answer it this way first. 361 00:18:38,320 --> 00:18:43,520 So the beating heart of DBT as a clinician, the beating heart 362 00:18:43,520 --> 00:18:47,840 that I experience week to week is my team of therapists that 363 00:18:47,840 --> 00:18:51,840 are the community of therapists working with me and I'm with 364 00:18:51,840 --> 00:18:54,800 them and we're all working together in a way to try to 365 00:18:54,800 --> 00:18:57,960 serve all of our our patients and clients, right? 366 00:18:58,240 --> 00:19:01,920 So that beating heart of there's a community of people helping to 367 00:19:01,920 --> 00:19:05,480 support each other. And when the way we do that is 368 00:19:05,480 --> 00:19:08,280 we essentially do therapy for the therapist, that's what we 369 00:19:08,280 --> 00:19:10,880 call it. So on our treatment teams, we 370 00:19:10,880 --> 00:19:13,920 are doing mindfulness practice every week. 371 00:19:14,640 --> 00:19:20,160 We are paying attention to how fatigued we are, how difficult 372 00:19:20,360 --> 00:19:22,120 things are in our personal lives. 373 00:19:22,400 --> 00:19:25,520 We are supporting each other. We're helping each other get out 374 00:19:25,520 --> 00:19:29,240 of our own way of our own tendencies to do this or that, 375 00:19:29,240 --> 00:19:31,920 right. So we have this group of 376 00:19:31,920 --> 00:19:34,680 therapists that are really providing a type of love and 377 00:19:34,680 --> 00:19:38,000 care for each other, and they're doing that in a way to help 378 00:19:38,360 --> 00:19:42,280 support doing DBT by the book. The patient is not lost in this. 379 00:19:42,280 --> 00:19:43,880 The patient is at the core of this. 380 00:19:44,160 --> 00:19:47,080 But to help the patient, what we recognize is we've got to make 381 00:19:47,080 --> 00:19:49,240 sure we are full, we are nurtured. 382 00:19:49,280 --> 00:19:52,720 That's not a thing you see in other treatment approaches. 383 00:19:53,320 --> 00:19:56,120 The reason we do that is because these are hard people to work 384 00:19:56,120 --> 00:19:59,280 with and this is a hard treatment to do. 385 00:19:59,480 --> 00:20:03,200 So we have to create structures around us to take care of us so 386 00:20:03,200 --> 00:20:06,640 we can take the best care of the treatment and most importantly 387 00:20:07,000 --> 00:20:10,160 patient. I think that's really important 388 00:20:10,160 --> 00:20:14,960 and very applicable to parents and just the everyday 389 00:20:14,960 --> 00:20:18,000 individual, that you can't help others until you can help 390 00:20:18,000 --> 00:20:20,120 yourself. And you're going to be able to 391 00:20:20,120 --> 00:20:24,320 support them more effectively if you done everything possible to 392 00:20:24,320 --> 00:20:27,320 be able to get your needs met. And that you're not pouring from 393 00:20:27,320 --> 00:20:29,160 an empty cup, which is common. That's right. 394 00:20:29,160 --> 00:20:31,800 We have to be aware because we're flawed humans. 395 00:20:31,800 --> 00:20:33,520 We're just clinicians, right? We're just people. 396 00:20:33,520 --> 00:20:36,440 We're, and this is a DBT way to think and talk about this, 397 00:20:36,440 --> 00:20:38,840 right, that we are people with some expertise. 398 00:20:39,000 --> 00:20:41,280 That's true. But we also are we're, we're 399 00:20:41,280 --> 00:20:43,760 real people. We have our own lives and our 400 00:20:43,760 --> 00:20:45,400 own stuff. And we want to make sure that we 401 00:20:45,400 --> 00:20:50,080 don't let that get in the way. So when, when hard things happen 402 00:20:50,080 --> 00:20:54,000 in our lives, we talk about it. I recently lost my mother not 403 00:20:54,000 --> 00:20:56,360 too long ago and that's been really, really hard. 404 00:20:56,640 --> 00:20:58,760 I was really, really hard losing my my mother. 405 00:20:58,960 --> 00:21:03,160 I talk about that with my team because I don't want that next 406 00:21:03,160 --> 00:21:06,400 patient who has anything that reminds me of my mother. 407 00:21:06,400 --> 00:21:08,560 I don't want any of that to interfere with care for that 408 00:21:08,560 --> 00:21:11,520 patient. And it might still anyway, but I 409 00:21:11,520 --> 00:21:14,080 want to try to make it be as kind of above board and, and 410 00:21:14,080 --> 00:21:16,200 help me be as aware as possible about that. 411 00:21:16,600 --> 00:21:17,840 So again, we're paying attention. 412 00:21:17,840 --> 00:21:21,360 We're looking out for each other and parents listening, you know 413 00:21:21,360 --> 00:21:24,600 the one I'm about to say is true because you've struggled with 414 00:21:24,600 --> 00:21:29,200 this when you are trying to find care for your teenage kids or 415 00:21:29,200 --> 00:21:32,200 your grown kids or even your late childhood kids. 416 00:21:32,200 --> 00:21:37,800 If you're trying to find care that is DBTDBT based, you know 417 00:21:37,800 --> 00:21:42,960 how difficult it is to know the quality of the clinician by 418 00:21:42,960 --> 00:21:46,200 looking at a website, you know this, you know, this is really, 419 00:21:46,200 --> 00:21:48,120 really hard. So here's a hack. 420 00:21:48,360 --> 00:21:53,240 A trick is you can ask them if they're part of a DBT therapist 421 00:21:53,240 --> 00:21:56,240 consultation team. You can find that out. 422 00:21:56,520 --> 00:21:59,760 And the answer is not going to be maybe it's going to be yes or 423 00:21:59,760 --> 00:22:03,280 no, right? And those that are, are likely 424 00:22:03,400 --> 00:22:07,160 going to have the type of support around them that is DBT 425 00:22:07,720 --> 00:22:11,160 and is part of really truly doing an adherent full model DBT 426 00:22:11,160 --> 00:22:13,200 program. The vast majority of those 427 00:22:13,200 --> 00:22:16,840 people in America and I would say probably everywhere who say 428 00:22:16,840 --> 00:22:21,920 they're doing DBT are probably just doing DBT group DBT skills 429 00:22:21,920 --> 00:22:26,120 training, which quite frankly is the least DBT thing about DBT. 430 00:22:27,320 --> 00:22:30,280 Just the skills. Literally Marsha, when she made 431 00:22:30,280 --> 00:22:33,160 the skills she collected, like it's like she took a basket and 432 00:22:33,160 --> 00:22:35,160 walked around the world and picked up skill after. 433 00:22:35,360 --> 00:22:38,440 Yeah, attachment theory. Does anybody think that Marcia 434 00:22:38,440 --> 00:22:41,080 invented mindfulness? I mean, this is, this is like 435 00:22:41,080 --> 00:22:44,000 really, truly like a, we could say what we want about it, but 436 00:22:44,000 --> 00:22:45,960 it's like it's a 3000 year old practice. 437 00:22:45,960 --> 00:22:48,800 She didn't make it up. She's taken it and she's made it 438 00:22:48,800 --> 00:22:52,040 secular to some extent, still Zen Buddhist to some extent, but 439 00:22:52,040 --> 00:22:57,040 she's really secularized it, modernized it, put it into a an 440 00:22:57,040 --> 00:23:00,280 evidence based psychological treatment. 441 00:23:00,280 --> 00:23:02,640 She didn't make it up. She didn't make up chain 442 00:23:02,640 --> 00:23:04,800 analysis. This is behavioral analysis. 443 00:23:04,800 --> 00:23:08,120 This is stuff from the 1960s. Police skills are not new police 444 00:23:08,120 --> 00:23:09,000 skills. We have health. 445 00:23:09,280 --> 00:23:12,520 Yeah, like, so you got to kind of like, think about the skills 446 00:23:12,520 --> 00:23:14,960 themselves are fabulous. They're skills for probably 447 00:23:14,960 --> 00:23:16,760 everybody. Yeah, I use the skills 448 00:23:16,760 --> 00:23:19,280 regularly. But skills alone are not a way 449 00:23:19,280 --> 00:23:22,480 to live every day. It's certainly not well, maybe 450 00:23:22,480 --> 00:23:25,960 more specifically distress tolerance skills alone are not a 451 00:23:25,960 --> 00:23:28,440 way to live every day. These some skills like the 452 00:23:28,440 --> 00:23:31,240 distress tolerance skills, these are good in certain moments, but 453 00:23:31,240 --> 00:23:34,640 we wouldn't like every day want to live just doing stop skill 454 00:23:34,640 --> 00:23:36,400 and you know, tip skill all day long. 455 00:23:37,080 --> 00:23:41,880 Not such a rewarding life. So take away here is that the 456 00:23:41,880 --> 00:23:44,840 skills themselves are probably what you're most likely to find 457 00:23:44,880 --> 00:23:48,000 parents listening and patients listening. 458 00:23:48,440 --> 00:23:50,080 And they might be really, really helpful. 459 00:23:50,240 --> 00:23:53,000 They can be helpful for anybody. But if what you're looking for 460 00:23:53,000 --> 00:23:57,040 is sort of full model DBT, ask if the therapist is on it. 461 00:23:57,040 --> 00:24:00,800 Therapist consultation team. We touched on this a little bit, 462 00:24:00,800 --> 00:24:04,960 but I want to circle back, which is that a lot of these ideas 463 00:24:04,960 --> 00:24:08,480 aren't new, like having a lot of compassion for the patient and 464 00:24:08,480 --> 00:24:11,720 working together as a team, and these skills that come from a 465 00:24:11,720 --> 00:24:13,480 lot of different psychological theories. 466 00:24:13,480 --> 00:24:17,800 These aren't brand new ideas and yet it was kind of revolutionary 467 00:24:17,800 --> 00:24:20,960 to see these kinds of outcomes in this demographic. 468 00:24:20,960 --> 00:24:23,840 And you've done some work on this, but there's this mechanism 469 00:24:23,840 --> 00:24:25,480 of change that's taking place here. 470 00:24:25,480 --> 00:24:28,600 And so I'm curious, obviously it's going to be a dialectic and 471 00:24:28,600 --> 00:24:31,360 a number of things, but do you feel strongly that it's like 472 00:24:31,360 --> 00:24:33,120 that therapist patient relationship? 473 00:24:33,120 --> 00:24:36,400 It's these basic beliefs and principles we talked about, like 474 00:24:36,400 --> 00:24:38,280 these dialectics that are at the core. 475 00:24:38,600 --> 00:24:41,120 What you kind of see is that mechanism for change that makes 476 00:24:41,120 --> 00:24:44,880 DBT so different for so many patients compared to trying the 477 00:24:44,880 --> 00:24:47,640 skills by themselves at home or just working with an individual 478 00:24:47,640 --> 00:24:50,040 therapist. I think it I'm going to answer 479 00:24:50,040 --> 00:24:52,160 this two ways. The first is simpler, which is 480 00:24:52,160 --> 00:24:56,200 that it's the ability to live your life with more intention, 481 00:24:56,600 --> 00:25:00,000 more purpose, more awareness, and more flexibility, which 482 00:25:00,000 --> 00:25:02,200 means lots and lots of things. But that's the short answer, 483 00:25:02,200 --> 00:25:03,640 right? It's that ability to do all of 484 00:25:03,640 --> 00:25:05,560 those things. A longer way to answer your 485 00:25:05,560 --> 00:25:07,680 question is that I think it's the wrong question. 486 00:25:08,520 --> 00:25:10,720 And what I mean by that is that I don't think there is a 487 00:25:10,800 --> 00:25:14,200 mechanism across all people. I think that that's actually not 488 00:25:14,200 --> 00:25:16,360 the way to think, the way to think about it. 489 00:25:16,360 --> 00:25:19,720 And the question to ask is for which people are which 490 00:25:19,720 --> 00:25:23,920 mechanisms of which treatment most likely to be helpful and 491 00:25:23,920 --> 00:25:26,680 why, right. So if you, if you approach it 492 00:25:26,680 --> 00:25:30,480 from that framework allows you to look at each person a little 493 00:25:30,480 --> 00:25:34,320 bit more flexibly, a little bit more like really truly treating 494 00:25:34,320 --> 00:25:38,800 each person differently and understanding how people really 495 00:25:38,800 --> 00:25:41,600 are different and their patterns are different, their backgrounds 496 00:25:41,600 --> 00:25:44,400 are different, their traumas are different, their family 497 00:25:44,400 --> 00:25:47,000 histories are different, their brains are different, and so on 498 00:25:47,000 --> 00:25:48,920 and so on and so on. So much is different. 499 00:25:49,360 --> 00:25:51,640 So much is so different about each person. 500 00:25:52,080 --> 00:25:56,920 So what may help one person really change in DBT may not 501 00:25:56,920 --> 00:26:00,560 actually be the same mechanism, singular speaking as the next 502 00:26:00,560 --> 00:26:01,560 person. And that's OK. 503 00:26:01,960 --> 00:26:04,480 I think we can look at mechanisms at different levels. 504 00:26:04,640 --> 00:26:08,800 So there might be interpersonal mechanisms, there might be more 505 00:26:08,800 --> 00:26:13,440 physiological mechanisms, there might be more behavioral, there 506 00:26:13,440 --> 00:26:15,360 might be more attentional mechanisms. 507 00:26:15,360 --> 00:26:18,720 All of these things, if we boil them down to 1, I think come 508 00:26:18,720 --> 00:26:23,280 back to like being more flexible, more skillful if you 509 00:26:23,280 --> 00:26:26,800 will, to use DVT language would be more flexible from a place of 510 00:26:26,800 --> 00:26:30,480 intention and awareness. We talked about trying to be 511 00:26:30,480 --> 00:26:34,200 compassionate with behaviors or feelings that we maybe can't 512 00:26:34,200 --> 00:26:36,320 empathize with. We can sympathize and that I can 513 00:26:36,320 --> 00:26:38,480 see you're really struggling. I can see you're in a lot of 514 00:26:38,480 --> 00:26:41,160 pain, but I don't understand it. And then it's challenging to 515 00:26:41,160 --> 00:26:46,240 take that compassionate lens and as a peer or parent or a 516 00:26:46,240 --> 00:26:50,920 therapist, be a team member and help someone work towards this 517 00:26:50,920 --> 00:26:53,640 goal or working towards maybe like phase two or phase three or 518 00:26:53,640 --> 00:26:55,520 whatever it is. And I think an example of that 519 00:26:55,520 --> 00:26:58,440 is suicidal ideation. A lot of people don't understand 520 00:26:59,040 --> 00:27:02,000 why people are having those thoughts or what would cause 521 00:27:02,000 --> 00:27:05,280 them to think that way or why that's the response to their 522 00:27:05,520 --> 00:27:07,960 environment, that they're maybe living in the same environment 523 00:27:07,960 --> 00:27:09,840 as someone else. And so I'm curious if you can 524 00:27:09,880 --> 00:27:13,320 unpack that a little bit and explain, especially from the 525 00:27:13,320 --> 00:27:15,800 emotion regulation piece, why there is that strong 526 00:27:15,800 --> 00:27:19,080 relationship between struggling to regulate emotions and then 527 00:27:19,120 --> 00:27:21,960 suicidal ideation, which a lot of people don't experience in 528 00:27:21,960 --> 00:27:23,840 their lifetimes. There's a lot of confusion and 529 00:27:23,840 --> 00:27:27,280 misunderstanding. Yeah, when somebody has 530 00:27:27,480 --> 00:27:31,360 extraordinary suffering, they imagine doing anything they 531 00:27:31,360 --> 00:27:35,440 possibly can to stop it because it's so extraordinary. 532 00:27:36,040 --> 00:27:40,280 I mean, the experience of being deeply in what feels like hell, 533 00:27:40,280 --> 00:27:45,960 like really, truly feels unbearable, leads one to imagine 534 00:27:45,960 --> 00:27:50,920 what they can do to stop it. And when each successive attempt 535 00:27:50,920 --> 00:27:55,560 to try to stop it, solution after solution does not seem to 536 00:27:55,560 --> 00:27:59,720 stop the pain, ultimately the person starts to think about 537 00:27:59,760 --> 00:28:02,880 ending their life as a type of way to end. 538 00:28:03,040 --> 00:28:05,960 And it so becomes this imagined solution. 539 00:28:05,960 --> 00:28:10,280 And what can happen for some people is that even thinking 540 00:28:10,280 --> 00:28:13,520 about this solution, even thinking about harming 541 00:28:13,520 --> 00:28:17,120 themselves, thinking about killing themselves in the moment 542 00:28:17,120 --> 00:28:21,640 they do, that can take the edge off of the emotion they're 543 00:28:21,640 --> 00:28:25,280 feeling in that moment. And that's relief in that 544 00:28:25,280 --> 00:28:28,280 moment. And that means in a more sort of 545 00:28:28,280 --> 00:28:30,840 jargony way, it's negative reinforcement. 546 00:28:30,840 --> 00:28:34,120 It's the reduction of something unpleasant. 547 00:28:34,120 --> 00:28:38,880 And anything that reduces something unpleasant for us is 548 00:28:38,880 --> 00:28:42,000 likely to be reinforced, meaning it's likely to happen again and 549 00:28:42,000 --> 00:28:44,840 again. It's the reason why when we shut 550 00:28:44,840 --> 00:28:48,200 our doors to our cars and the annoying Ding Ding Ding Ding 551 00:28:48,200 --> 00:28:50,560 Ding happens with our seatbelts, what do we do? 552 00:28:50,960 --> 00:28:52,760 Put on our seatbelts. We put on our seatbelts. 553 00:28:52,760 --> 00:28:53,720 Yeah. Why? 554 00:28:54,120 --> 00:28:55,120 In that moment? Why? 555 00:28:55,200 --> 00:28:58,520 We stop the annoying, distressing stimuli. 556 00:28:58,560 --> 00:29:00,600 It's just that, yeah, it's exactly that. 557 00:29:00,600 --> 00:29:05,840 So you can think of suicidal ideation or suicidal behavior as 558 00:29:05,840 --> 00:29:09,240 a behavior, even thinking you can think of it as a type of 559 00:29:09,240 --> 00:29:13,800 behavior that has a function that actually works in the 560 00:29:13,800 --> 00:29:15,640 moment that actually really does work. 561 00:29:15,640 --> 00:29:18,160 And therapists that seek to understand that and lean into 562 00:29:18,160 --> 00:29:20,920 that with compassion or they might be good DBT therapists 563 00:29:21,360 --> 00:29:23,400 because that's really dialectically how we might think 564 00:29:23,400 --> 00:29:24,800 about it. It doesn't mean we're going to 565 00:29:24,800 --> 00:29:27,800 support it or want it or, but it's about it understanding and 566 00:29:27,800 --> 00:29:31,240 acknowledging the function. The reason why this is happening 567 00:29:32,120 --> 00:29:37,040 is it has some effect that works, so it's going to then 568 00:29:37,040 --> 00:29:41,120 happen. Shifting gears a little bit into 569 00:29:41,120 --> 00:29:46,360 misophonia and people listening to the podcast who are 570 00:29:46,560 --> 00:29:50,400 interested in mental health and engaged in some way online 571 00:29:50,440 --> 00:29:52,120 probably heard of misophonia before. 572 00:29:52,120 --> 00:29:55,480 It's becoming more popular and more mainstream for people to 573 00:29:55,480 --> 00:29:57,440 talk about. We hear these conversations 574 00:29:57,440 --> 00:29:59,040 online. This is where people are getting 575 00:29:59,040 --> 00:30:01,920 their information, and we sometimes have misinformation 576 00:30:02,080 --> 00:30:05,960 because we're not coming at it from a research lens. 577 00:30:05,960 --> 00:30:09,600 We're not coming at it from really trying to understand what 578 00:30:09,600 --> 00:30:14,360 we objectively know about the lived experience and also how we 579 00:30:14,360 --> 00:30:17,120 can break it down and understand it in more of a research 580 00:30:17,120 --> 00:30:19,520 context. So I'd love to understand what 581 00:30:19,520 --> 00:30:24,040 the current definition of misophonia is and also how that 582 00:30:24,040 --> 00:30:26,440 shows up in the day today so we can shift. 583 00:30:26,440 --> 00:30:30,520 Sure, sure. So misophonia is a recently 584 00:30:30,520 --> 00:30:34,720 defined disorder of decrease sound tolerance, but it's really 585 00:30:34,760 --> 00:30:37,240 more complicated than that. You can think of it as an 586 00:30:37,240 --> 00:30:40,720 unusually strong reaction, unpleasant reaction to really 587 00:30:40,720 --> 00:30:45,560 particular sounds and other cues or stimuli that are related to 588 00:30:45,560 --> 00:30:48,880 those sounds. So the word translates literally 589 00:30:48,880 --> 00:30:52,360 into dislike of sounds. And that's kind of what it is. 590 00:30:52,360 --> 00:30:55,080 It's this strong reaction to particular sounds. 591 00:30:55,080 --> 00:30:58,040 Now the the sounds, we often call them triggers, even though 592 00:30:58,040 --> 00:31:00,160 I don't love that word. That's just the word that's 593 00:31:00,160 --> 00:31:03,680 used. And typical triggers are mouth 594 00:31:03,840 --> 00:31:06,320 or nose or face kinds of triggers. 595 00:31:06,320 --> 00:31:11,840 So sneezing, snorting, chewing, crunching, lip smacking, eating, 596 00:31:11,840 --> 00:31:15,520 swallowing, slurping, sniffing, throat clearing. 597 00:31:16,200 --> 00:31:19,280 Apologies to anybody out there that's getting a reaction even 598 00:31:19,280 --> 00:31:20,480 to those words. I know. 599 00:31:20,800 --> 00:31:21,920 It's like there's a lot of them, a lot of. 600 00:31:22,120 --> 00:31:25,520 Them it's odd they tend to break down into no to to noises that 601 00:31:25,520 --> 00:31:30,240 people make repetitively in their nose or their mouth or 602 00:31:30,240 --> 00:31:32,320 their throat. And there are other, there are 603 00:31:32,320 --> 00:31:36,160 other trigger sounds that are common that are not nose or or 604 00:31:36,160 --> 00:31:41,080 mouth or throat, pants, clicking keyboards, typing, environmental 605 00:31:41,080 --> 00:31:43,840 noises that are repetitive. But in the research studies of 606 00:31:43,840 --> 00:31:47,800 people with misophonia, most of the people report having among 607 00:31:47,800 --> 00:31:51,360 their primary triggers eating sounds, chewing sounds and or 608 00:31:51,360 --> 00:31:53,240 any of those nasal or, or throats. 609 00:31:53,640 --> 00:31:55,800 Yeah. And the reactions, these sounds 610 00:31:55,800 --> 00:31:58,120 vary quite a bit. But the way you can think about 611 00:31:58,120 --> 00:32:00,400 it is that this is not being bothered by sounds. 612 00:32:00,400 --> 00:32:03,520 This is an extreme reaction. Think of it this way. 613 00:32:03,680 --> 00:32:06,240 It's kind of like, you know, if you're listening right now and 614 00:32:06,240 --> 00:32:07,600 you're kind of tuning me out. Here's the thing. 615 00:32:07,600 --> 00:32:10,360 Think about this, you feel anxiety sometimes. 616 00:32:10,640 --> 00:32:13,800 Most everybody does. If you never feel anxiety, 617 00:32:13,800 --> 00:32:15,800 there's maybe maybe something else we should talk about, 618 00:32:17,240 --> 00:32:19,160 right? But everybody, everybody feels 619 00:32:19,160 --> 00:32:21,000 anxious from time to time. And that's probably good. 620 00:32:21,000 --> 00:32:23,640 But not everybody has an anxiety disorder, right? 621 00:32:23,880 --> 00:32:26,760 We can do the same thing if we want with depression. 622 00:32:26,760 --> 00:32:30,320 We can say most everybody could say they've felt sad before. 623 00:32:30,440 --> 00:32:32,760 That doesn't mean you have major depression, right? 624 00:32:32,760 --> 00:32:35,720 Some people think about things a lot, they might obsess, but that 625 00:32:35,720 --> 00:32:37,720 doesn't mean they have OCD, right? 626 00:32:37,720 --> 00:32:40,760 So misophonia, think of it as sort of like that. 627 00:32:40,880 --> 00:32:44,200 It's the extreme end of sound sensitivity, where the 628 00:32:44,200 --> 00:32:49,120 sensitivity leads to really strong and very distressing and 629 00:32:49,120 --> 00:32:53,400 very, very impairing reactions. The reactions are anger, 630 00:32:53,400 --> 00:32:58,480 irritation, disgust, anxiety, really a wide array of different 631 00:32:58,480 --> 00:33:01,440 negative emotions. The emotions are hard to 632 00:33:01,440 --> 00:33:03,960 regulate because they're unwanted, they're automatic, 633 00:33:03,960 --> 00:33:06,400 they're intense, they're disabling in the moment. 634 00:33:06,520 --> 00:33:08,680 The student can't focus in class. 635 00:33:09,480 --> 00:33:11,800 The students not being manipulative, they can't 636 00:33:11,840 --> 00:33:14,200 actually focus. And there's research studies 637 00:33:14,200 --> 00:33:17,000 that have looked at this, that in the brains of people with 638 00:33:17,000 --> 00:33:20,200 misophonia, when they're triggered, they lose the ability 639 00:33:20,200 --> 00:33:24,200 to learn, to pay attention, to remember, to do the kinds of 640 00:33:24,200 --> 00:33:26,960 things we want people to do when they're in classrooms. 641 00:33:27,640 --> 00:33:31,320 So these triggers come, they elicit these really big 642 00:33:31,320 --> 00:33:34,280 reactions and responses in the brain, in the brain and 643 00:33:34,280 --> 00:33:37,520 throughout the nervous system. And that can then lead to 644 00:33:37,520 --> 00:33:41,880 behavioral reactions, often needing to leave the room to 645 00:33:41,880 --> 00:33:45,280 escape, to avoid or to confront somebody or to seek out that 646 00:33:45,280 --> 00:33:47,520 sound source and try to understand it. 647 00:33:48,000 --> 00:33:49,880 If you're still not clear what I'm talking about, these are the 648 00:33:49,880 --> 00:33:53,120 people who look at you sideways on the airplane or the bus. 649 00:33:53,200 --> 00:33:55,880 They look at you sideways. When you open up that bag of 650 00:33:55,880 --> 00:33:58,280 potato chips and you start crinkling that bag and you pull 651 00:33:58,280 --> 00:34:00,960 up that potato chip and you put it in your mouth and you make 652 00:34:00,960 --> 00:34:03,120 that crunching noise. These are the folks that might 653 00:34:03,120 --> 00:34:07,080 look over at you and there's daggers coming out of their eyes 654 00:34:07,080 --> 00:34:09,199 because they're really intensely triggered. 655 00:34:09,280 --> 00:34:13,840 I mean, this is not a dislike. This is really really unbearable 656 00:34:13,960 --> 00:34:17,920 nervous system reaction that is automatic and really really 657 00:34:17,920 --> 00:34:20,639 distressing. I would love to hear a little 658 00:34:20,639 --> 00:34:22,800 bit about the lived experience of that. 659 00:34:22,800 --> 00:34:26,520 We have an objective definition of how that can show up, but I 660 00:34:26,600 --> 00:34:29,800 imagine one of the biggest areas would also be interpersonal 661 00:34:29,800 --> 00:34:32,480 relationships because a lot of those triggers are outside of 662 00:34:32,480 --> 00:34:37,280 your control and you have to employ some relationship skills 663 00:34:37,360 --> 00:34:40,760 to be able to alleviate the distress or get out of that 664 00:34:40,760 --> 00:34:42,320 situation. I'm sure there's a lot of 665 00:34:42,320 --> 00:34:46,480 setting intentional boundaries, but how does that show up in 666 00:34:46,560 --> 00:34:49,320 your day today? With regard to gauging in 667 00:34:49,320 --> 00:34:52,600 relationships, things like class, like you guys mentioned, 668 00:34:52,600 --> 00:34:55,280 is a really big factor. You can imagine things like 669 00:34:55,280 --> 00:34:57,160 eating out or going out with friends. 670 00:34:57,400 --> 00:34:58,720 Can you speak to that a little bit? 671 00:34:59,280 --> 00:35:01,200 Yes. So I've been reflecting on this 672 00:35:01,200 --> 00:35:04,480 a lot in the past week because we got the chance to go to the 673 00:35:04,480 --> 00:35:06,720 Misophonia Research Fund meeting last week. 674 00:35:06,960 --> 00:35:10,320 And it was funny for it to hear you say that. 675 00:35:10,320 --> 00:35:13,560 Like if you're online and you've probably heard of this thing 676 00:35:13,760 --> 00:35:16,040 that was. I never thought I'd hear that 677 00:35:16,040 --> 00:35:18,200 sentence in my life. Maybe I'm too deep on TikTok. 678 00:35:19,080 --> 00:35:22,200 But, but I think that it the awareness is increasing so 679 00:35:22,200 --> 00:35:25,440 rapidly like I so I'm I turned 23 today. 680 00:35:25,440 --> 00:35:27,560 Another reason why I'm reflecting a lot is because I 681 00:35:27,560 --> 00:35:31,280 started at 13 is when I started to experience symptoms of 682 00:35:31,280 --> 00:35:34,800 misophonia. So it's been 10 years now and 683 00:35:35,280 --> 00:35:38,080 back then that wasn't in our vocabulary. 684 00:35:38,600 --> 00:35:42,080 And eventually my mom, my older sister found that word out. 685 00:35:42,200 --> 00:35:45,040 And when you look it up, everything is negative. 686 00:35:45,080 --> 00:35:49,440 It's parents blogging about how their child is suffering so much 687 00:35:49,440 --> 00:35:53,640 and they can't do anything. So I actually refused to look up 688 00:35:53,640 --> 00:35:57,240 the word for years because there was nothing positive. 689 00:35:57,240 --> 00:36:01,920 It was you're getting no help. And I can't believe how fast 690 00:36:01,920 --> 00:36:06,240 that is changing right now. And when we went last week, 691 00:36:06,840 --> 00:36:10,680 there were 21 studies being presented, ongoing studies. 692 00:36:10,680 --> 00:36:16,320 And I, I cried several times during the meeting because I 693 00:36:16,320 --> 00:36:19,320 couldn't believe that there was so much work being done. 694 00:36:19,320 --> 00:36:22,880 And all around the world, too, there are people from Poland 695 00:36:22,920 --> 00:36:26,320 there being studies being done with people in South Korea. 696 00:36:26,320 --> 00:36:29,760 It, it was just, I couldn't believe it, something that I 697 00:36:29,760 --> 00:36:34,480 didn't think I would see and not within 10 years at least. 698 00:36:34,680 --> 00:36:39,920 And I just can't believe that hearing you say like, you've 699 00:36:39,920 --> 00:36:42,640 probably heard of this. Yeah, it really does blow my 700 00:36:42,640 --> 00:36:45,480 mind. And I'm so grateful that people 701 00:36:45,480 --> 00:36:48,800 are finally learning what it is. And I get I don't have TikTok 702 00:36:48,800 --> 00:36:51,800 but my friends send me the links to them all the time and people 703 00:36:51,800 --> 00:36:54,680 whenever someone just miss a phone yet my phone blows up 704 00:36:54,760 --> 00:36:57,720 because everyone I know sends me that TikTok. 705 00:36:57,720 --> 00:37:01,000 And it really does warm my heart that people are finally finding 706 00:37:01,000 --> 00:37:04,520 out and I've talking about relationships. 707 00:37:05,040 --> 00:37:07,320 Something I've been thinking about a lot recently is the 708 00:37:07,320 --> 00:37:08,960 relationship I had with my parents. 709 00:37:08,960 --> 00:37:13,120 And we spent years going to different doctors. 710 00:37:13,120 --> 00:37:15,920 I grew up in New York. We would drive in Jersey and 711 00:37:15,920 --> 00:37:19,120 different parts of the state just to find someone who could 712 00:37:19,120 --> 00:37:21,840 help me. And it was a nightmare. 713 00:37:21,960 --> 00:37:25,320 I would go to these doctors and they would be asking what 714 00:37:25,320 --> 00:37:29,440 misophonia was and I would just immediately break down the spot. 715 00:37:29,440 --> 00:37:32,960 And I would get upset with my parents because I feel like I 716 00:37:32,960 --> 00:37:35,520 need to put the blame on someone and I would be upset. 717 00:37:35,520 --> 00:37:37,200 Why are you bringing me to these people? 718 00:37:37,200 --> 00:37:38,880 And they don't even know what this is. 719 00:37:38,880 --> 00:37:43,080 And I have to, I'm, I'm a child and I have to explain this to 720 00:37:43,080 --> 00:37:44,680 them and I'm asking them for help. 721 00:37:45,200 --> 00:37:47,280 And why are you bringing me to these people? 722 00:37:47,280 --> 00:37:52,000 And looking back on it now, like I have so much empathy for what 723 00:37:52,000 --> 00:37:54,680 my parents went through during that time of they just wanted to 724 00:37:54,680 --> 00:37:57,000 help me. And I was so frustrated. 725 00:37:57,000 --> 00:37:59,320 They were too. But there was nothing there. 726 00:37:59,840 --> 00:38:04,440 There was no one saying we can help or if they were, there was 727 00:38:04,440 --> 00:38:08,480 no evidence behind it. And I really feel for my mom and 728 00:38:08,480 --> 00:38:12,840 dad looking back now and it's hard to see it in that moment 729 00:38:12,920 --> 00:38:14,840 when you are dealing with so much. 730 00:38:14,840 --> 00:38:18,840 And I was so overstimulated all the time of trying to. 731 00:38:18,840 --> 00:38:20,760 I couldn't even. I wore headphones all the time 732 00:38:20,760 --> 00:38:24,280 in my own home because my walls were thin. 733 00:38:24,280 --> 00:38:27,720 I shared a room with my sister until I was like 15 and I felt 734 00:38:28,280 --> 00:38:31,440 like there was no escape and that definitely affected my 735 00:38:31,440 --> 00:38:33,920 relationship with my parents because they're also my biggest 736 00:38:33,920 --> 00:38:35,960 triggers. I can't even hear my dad 737 00:38:35,960 --> 00:38:37,520 breathe. It's really hard to be in the 738 00:38:37,520 --> 00:38:40,120 same room as my parents unfortunately if there's not 739 00:38:40,120 --> 00:38:45,440 some sort of background noise. And I love them so dearly and 740 00:38:45,440 --> 00:38:49,200 they've done nothing wrong, but I can't stand in the same room 741 00:38:49,200 --> 00:38:52,560 as them sometimes and going out to eat. 742 00:38:52,840 --> 00:38:56,200 Growing up, I just felt like this annoying teenager because I 743 00:38:56,200 --> 00:38:58,840 would have my headphones in and I'd be like in the corner of the 744 00:38:58,840 --> 00:39:02,080 booth not looking at anyone. The waitress would come up and I 745 00:39:02,080 --> 00:39:03,720 would like not even see them come up. 746 00:39:03,720 --> 00:39:06,160 And I'd be like, they're probably think that I'm just 747 00:39:06,160 --> 00:39:11,080 this annoying, bratty teenager listening to her music and is 748 00:39:11,200 --> 00:39:14,160 having these hormonal changes. Is it being dramatic? 749 00:39:14,760 --> 00:39:16,200 I'm the youngest of four as well. 750 00:39:16,200 --> 00:39:18,680 So that was also something I heard a lot was get over it. 751 00:39:18,800 --> 00:39:21,400 Like, what are you doing? When I would get upset at dinner 752 00:39:21,400 --> 00:39:27,240 and one time my oldest sister said to me she was she's like 8 753 00:39:27,240 --> 00:39:29,560 years older than me. So she was away at college for a 754 00:39:29,560 --> 00:39:33,720 lot of this time, a lot of when the onset happened and didn't 755 00:39:33,720 --> 00:39:37,280 really see my day-to-day difficulties as my other 756 00:39:37,280 --> 00:39:39,840 siblings did. And she came home for a break 757 00:39:39,840 --> 00:39:42,560 once and said you haven't gotten over this yet. 758 00:39:43,000 --> 00:39:45,920 Even my other sister was like oh she shouldn't have said that. 759 00:39:47,160 --> 00:39:50,920 So that even just getting that understanding within my own 760 00:39:50,920 --> 00:39:54,720 household took a long time, let alone outside of it. 761 00:39:54,720 --> 00:39:58,360 I was so afraid to tell anyone outside of my house. 762 00:39:58,840 --> 00:40:02,400 The first time I told my friends I was at a sleepover with two of 763 00:40:02,400 --> 00:40:06,640 them and they were eating pretzels and I just broke down. 764 00:40:06,640 --> 00:40:10,880 I hadn't told anyone about it and they immediately were like 765 00:40:10,880 --> 00:40:12,960 what is wrong? And it took me a while to even 766 00:40:12,960 --> 00:40:17,000 get the words out and. They were so supportive and made 767 00:40:17,000 --> 00:40:19,720 sure that they didn't do those things around me and that that 768 00:40:19,720 --> 00:40:21,840 allowed me that experience because I was so afraid people 769 00:40:21,840 --> 00:40:25,240 wouldn't believe me because there's there was nothing on it 770 00:40:25,240 --> 00:40:30,080 and no one knew what this was. And it was just, it was 771 00:40:30,080 --> 00:40:33,640 embarrassing and I felt guilty for telling people to stop 772 00:40:33,720 --> 00:40:36,000 eating. So it's just something that 773 00:40:36,000 --> 00:40:39,120 everyone has to do. And that's also something that I 774 00:40:39,120 --> 00:40:41,520 would hear in my house too. And like, the very beginning 775 00:40:41,520 --> 00:40:44,960 was, well, I have to eat. And my dad said that to me 776 00:40:44,960 --> 00:40:50,160 actually last year and that it brought me back. 777 00:40:50,600 --> 00:40:55,000 Like it's how devastating that time period was for me, really 778 00:40:55,000 --> 00:40:57,720 came back to me in that moment. I'm like, I got this like rush 779 00:40:57,720 --> 00:41:01,560 of just, Oh my God, of me being kind of grateful that I don't 780 00:41:01,560 --> 00:41:03,080 experience that day-to-day anymore. 781 00:41:03,080 --> 00:41:06,640 But also like it is so frustrating to hear things like 782 00:41:06,640 --> 00:41:10,040 that. And someone asked me last night 783 00:41:10,040 --> 00:41:12,840 actually, well, what's the difference between just being 784 00:41:12,840 --> 00:41:16,040 annoying and I was in a social setting. 785 00:41:16,040 --> 00:41:18,720 And I feel like I've been because I work here now, I'm in 786 00:41:18,720 --> 00:41:21,680 the setting where people are understanding me and I don't 787 00:41:21,680 --> 00:41:23,480 have to explain myself to people. 788 00:41:23,880 --> 00:41:27,800 And I just kind of shut down because I felt like my 13 year 789 00:41:27,800 --> 00:41:30,960 old self again of not being able to explain things and feeling 790 00:41:30,960 --> 00:41:32,400 like no one's going to believe me. 791 00:41:32,720 --> 00:41:35,840 And I'm just so grateful that the research is happening and 792 00:41:35,840 --> 00:41:38,000 that people are hearing this word now. 793 00:41:38,000 --> 00:41:41,720 And sometimes when I ask people if they've heard of it, some 794 00:41:41,720 --> 00:41:44,160 people are saying yes now and they never did. 795 00:41:44,640 --> 00:41:47,120 They never did. I always had to explain. 796 00:41:47,440 --> 00:41:49,600 Or at least they're like, oh, it's something with sounds 797 00:41:49,600 --> 00:41:51,160 right. And then I'm able to build off 798 00:41:51,160 --> 00:41:53,840 of that. But it's really, really hard 799 00:41:54,040 --> 00:41:57,480 day-to-day and having to decide what social events I'm going to 800 00:41:57,480 --> 00:41:59,000 go to or how I'm going to handle them. 801 00:41:59,960 --> 00:42:04,080 And even going to a meeting yesterday here, knowing that it 802 00:42:04,080 --> 00:42:06,960 was going to be during lunch and having to decide whether I was 803 00:42:06,960 --> 00:42:08,920 going to risk going down there. And I did. 804 00:42:08,920 --> 00:42:13,120 And it was hard, but I knew that I had the option of walking out 805 00:42:13,120 --> 00:42:15,360 if I need to because I'm an understanding environment. 806 00:42:16,200 --> 00:42:18,360 But in other situations, it's not like that, where you feel 807 00:42:18,360 --> 00:42:22,400 like you have to explain yourself and just feel like no 808 00:42:22,400 --> 00:42:23,880 one's going to believe you. Yeah. 809 00:42:24,080 --> 00:42:29,000 When I was in high school, there was a class that I was in and 810 00:42:29,080 --> 00:42:31,480 one of my classmates was given permission to eat their lunch. 811 00:42:32,160 --> 00:42:36,160 And I told my teacher like I need to leave because I had a 812 00:42:36,240 --> 00:42:39,600 five O 4 plan to be able to leave if I needed to. 813 00:42:39,920 --> 00:42:42,600 And he looked to me in the eye and said, do you actually have 814 00:42:42,600 --> 00:42:44,000 to? It's like whoa. 815 00:42:44,960 --> 00:42:48,560 Allowed to ask. Yeah, that was that was wild. 816 00:42:48,600 --> 00:42:52,720 And I went home very upset and my mom sent this like 6 817 00:42:52,720 --> 00:42:58,280 paragraph e-mail to all my teachers and she said if one of 818 00:42:58,280 --> 00:43:01,160 the kids in your class had a peanut allergy, you would not 819 00:43:01,160 --> 00:43:04,080 let someone eat peanuts. I'm not going to go into 820 00:43:04,080 --> 00:43:08,720 anaphylactic shock, obviously, but I am suffering when I hear 821 00:43:08,720 --> 00:43:11,160 those sounds. I can't, it's debilitating. 822 00:43:11,280 --> 00:43:13,520 I can't pay attention. What's the point of me sitting 823 00:43:13,520 --> 00:43:16,720 there? And it's so harmful. 824 00:43:16,720 --> 00:43:21,760 And I remember when my memories actually of the onset are very 825 00:43:21,760 --> 00:43:25,760 foggy because it was such a dark time for me and very confusing. 826 00:43:26,200 --> 00:43:29,320 And I just remember sitting at the dinner table bawling my eyes 827 00:43:29,320 --> 00:43:33,120 out, just not understanding why I felt so tortured just by 828 00:43:33,120 --> 00:43:38,320 hearing my family And just this feeling inside my chest of like 829 00:43:39,120 --> 00:43:42,280 I am in so much danger right now when I'm actually not. 830 00:43:42,640 --> 00:43:51,720 And that it's, I just had the need to leave and I, I just, 831 00:43:51,800 --> 00:43:56,320 yeah, it's, it's so hard to explain in the feeling in words, 832 00:43:56,640 --> 00:44:00,600 but that I think danger is, is probably one of the best. 833 00:44:01,080 --> 00:44:05,160 I, I once had a patient tell me that it's like having a grizzly 834 00:44:05,160 --> 00:44:09,920 bear suddenly out of nowhere, unpredictably sitting next to 835 00:44:09,920 --> 00:44:12,440 you. And in terms of how your body 836 00:44:12,440 --> 00:44:18,160 feels, it's that really intense sudden surge of threat is 837 00:44:18,160 --> 00:44:20,680 present threat. There's something and that's 838 00:44:20,680 --> 00:44:25,080 what's happening biologically in the brain is the sound pathways 839 00:44:25,080 --> 00:44:29,200 seem to be intersecting with the emotion pathways and eliciting 840 00:44:29,200 --> 00:44:31,520 this really automatic overwhelming. 841 00:44:31,840 --> 00:44:35,200 There's danger, there's threat, and then the threat reactions 842 00:44:35,200 --> 00:44:37,200 behaviorally and cognitively follow. 843 00:44:37,360 --> 00:44:41,480 Yeah, yeah. You mentioned headphones, 844 00:44:41,480 --> 00:44:43,560 background noise. There were some things that were 845 00:44:43,560 --> 00:44:46,800 incredibly invalidating as responses. 846 00:44:47,240 --> 00:44:51,240 But you said more recently it's been different in a positive 847 00:44:51,240 --> 00:44:54,200 way. What has been helpful as far as 848 00:44:54,640 --> 00:44:58,520 boundaries being set, skills being used, even just having a 849 00:44:58,520 --> 00:45:01,440 more nuanced understanding of the experience itself? 850 00:45:01,440 --> 00:45:04,680 I imagine it's really helpful. What has been helpful in your 851 00:45:04,680 --> 00:45:08,120 journey? I think the the validation of 852 00:45:08,120 --> 00:45:11,080 even just being in the meeting last week of seeing so many 853 00:45:11,080 --> 00:45:13,920 people working on it and that there are people putting in this 854 00:45:13,920 --> 00:45:17,520 effort to help us because I think all of us felt so alone 855 00:45:17,520 --> 00:45:22,880 for so long. And I think having those papers 856 00:45:22,880 --> 00:45:26,200 being published and all these things and moving towards a 857 00:45:26,200 --> 00:45:29,240 place where we can better understand it, I think does make 858 00:45:29,240 --> 00:45:32,400 me feel better. And I think I also have 859 00:45:32,400 --> 00:45:34,440 different expectations of people too. 860 00:45:34,440 --> 00:45:39,040 And that applies to my triggers. And I think that's might be part 861 00:45:39,040 --> 00:45:41,680 of why people get more triggered by their family as they expect 862 00:45:41,680 --> 00:45:45,000 them to understand and. I also have no boundaries 863 00:45:45,000 --> 00:45:47,680 though, siblings especially. It's like you don't expect a 864 00:45:47,680 --> 00:45:51,000 decorum at the table. There's like you're not using 865 00:45:51,000 --> 00:45:53,480 manners, so it's so much worse. Right. 866 00:45:53,720 --> 00:45:58,200 No, you're right. So it is, it's that. 867 00:45:58,200 --> 00:46:02,920 And I, I, I don't really know because I did go, I've gone to 868 00:46:02,920 --> 00:46:07,960 therapy, but I don't really know if we use and like it wasn't 869 00:46:07,960 --> 00:46:10,160 DBT. I don't know what I didn't find 870 00:46:10,160 --> 00:46:12,440 it helpful in the beginning, but it was helpful to talk to 871 00:46:12,440 --> 00:46:16,200 someone. And I think just over time, 872 00:46:16,200 --> 00:46:20,880 learning to regulate my emotions as I grew up as well and being a 873 00:46:20,880 --> 00:46:23,640 different environment and more understanding environments as 874 00:46:23,640 --> 00:46:25,160 well. Like at work, I don't have to 875 00:46:25,160 --> 00:46:28,160 worry at all because we're working with Miss phony people 876 00:46:28,160 --> 00:46:31,000 understand. And at home, it's much better 877 00:46:31,000 --> 00:46:34,120 now that if I need to step out, people aren't yelling at me or 878 00:46:34,120 --> 00:46:36,880 judging me and aren't upset by it. 879 00:46:37,240 --> 00:46:41,280 So I think it's it's still very difficult with strangers. 880 00:46:41,640 --> 00:46:45,040 They trigger me less, but I still have that feeling of 881 00:46:45,040 --> 00:46:48,160 embarrassed guilt. Yeah, Yeah. 882 00:46:48,520 --> 00:46:51,680 I think DBT especially comes from this lens of like, you 883 00:46:52,080 --> 00:46:54,520 always have the choice. And I think you have a more 884 00:46:54,520 --> 00:46:58,320 nuanced understanding of that as you get older, where, yes, 885 00:46:58,320 --> 00:47:01,280 there's things we have to do and we have to go through and be in 886 00:47:01,280 --> 00:47:03,360 certain environments. But you do have a lot of 887 00:47:03,360 --> 00:47:06,240 autonomy and choice over who you surround yourself with and the 888 00:47:06,240 --> 00:47:09,000 boundaries you set and who you're choosing to put in your 889 00:47:09,000 --> 00:47:11,360 circle to support you. And whether that's in high 890 00:47:11,360 --> 00:47:14,480 school or college, you just have a lot more choice there than I 891 00:47:14,480 --> 00:47:16,840 think we initially think. Especially because as we're 892 00:47:16,840 --> 00:47:19,280 younger, so many of those relationships are defined for us 893 00:47:19,280 --> 00:47:22,120 and parents and siblings and family, friends and classroom 894 00:47:22,120 --> 00:47:24,360 you're in. But you really do have a lot of 895 00:47:24,360 --> 00:47:28,360 autonomy to build that community to set you up for success. 896 00:47:29,120 --> 00:47:32,640 And I think that that's also the difference is I'm so much more 897 00:47:32,640 --> 00:47:34,680 in control of my own life right now. 898 00:47:35,000 --> 00:47:38,640 I don't live in the same home as my my family members now. 899 00:47:38,640 --> 00:47:42,120 And college, like you said, you can choose your friends. 900 00:47:42,560 --> 00:47:45,320 High school you're like. Told where to go. 901 00:47:45,640 --> 00:47:48,560 You're told where to go. You have this set schedule every 902 00:47:48,560 --> 00:47:50,920 single day and you have to ask go to the bathroom. 903 00:47:50,920 --> 00:47:55,040 Like there's these set rules that you have to follow and 904 00:47:55,040 --> 00:47:57,080 you've been following them for 13 years. 905 00:47:57,360 --> 00:48:01,640 So it's it's much more structured and you have no 906 00:48:01,640 --> 00:48:04,680 control over it. So that's also a really hard 907 00:48:04,680 --> 00:48:07,640 part of being a teenager is feeling like you have less 908 00:48:07,640 --> 00:48:11,840 control over things. But I hope that there will be 909 00:48:11,840 --> 00:48:15,440 more education and people will be able to allow teenagers to 910 00:48:15,440 --> 00:48:18,040 have more control over, especially with mental health 911 00:48:18,040 --> 00:48:21,480 and misophonia, and accommodating them and making 912 00:48:21,480 --> 00:48:23,520 their own decisions that would help them. 913 00:48:24,120 --> 00:48:26,840 Absolutely. So two thoughts on this part of 914 00:48:26,840 --> 00:48:31,480 the dialogue. 1 is that as people age, they tend to be able 915 00:48:31,480 --> 00:48:34,120 to, generally speaking, kind of get a little bit better at 916 00:48:34,120 --> 00:48:36,720 regulating emotions. It's really, really hard to do 917 00:48:36,720 --> 00:48:40,000 that when you're a teenager. It's hardest probably in general 918 00:48:40,000 --> 00:48:42,440 to do that when you're younger and you learn, you learn in lots 919 00:48:42,440 --> 00:48:46,480 of ways and, and, and life hopefully allows you privileges 920 00:48:46,480 --> 00:48:49,800 to help you be able to learn more easily how to be in control 921 00:48:49,800 --> 00:48:52,480 of what you feel and who you're around and the environment and 922 00:48:52,480 --> 00:48:54,280 so on. So all of that and, and 923 00:48:54,280 --> 00:48:57,240 therapies you might do or whatever, you might do all sorts 924 00:48:57,240 --> 00:49:00,520 of things to develop really good coping strategies to, to deal 925 00:49:00,520 --> 00:49:02,840 with, with hard stuff. So that's generally true for 926 00:49:02,840 --> 00:49:06,640 everyone. I think this question about 927 00:49:06,640 --> 00:49:11,040 teens and misophonia and the environments, I really think 928 00:49:11,040 --> 00:49:14,760 about this dialectically and maybe that's because I'm a DBT 929 00:49:15,040 --> 00:49:17,240 person. I don't know, maybe probably 930 00:49:17,320 --> 00:49:19,280 that's probably why I think about it this way. 931 00:49:19,280 --> 00:49:25,720 I think that on the one hand, we probably do need to provide more 932 00:49:25,720 --> 00:49:31,080 support, more structural support in school systems and in 933 00:49:31,080 --> 00:49:33,160 environments. I mean, probably we need to 934 00:49:33,160 --> 00:49:37,440 think about noise and noise generally for all people as an 935 00:49:37,440 --> 00:49:40,640 irritant and as something that is a stressor. 936 00:49:41,040 --> 00:49:43,760 And this is scientifically shown and lots of studies here in the 937 00:49:43,760 --> 00:49:46,080 world that just noise, lots and lots of noise is kind of like 938 00:49:46,360 --> 00:49:46,920 not great. Why? 939 00:49:47,080 --> 00:49:49,640 Do we take tests and quiet because people need to focus? 940 00:49:49,640 --> 00:49:52,320 Right, exactly. So I think on the one hand, 941 00:49:52,800 --> 00:49:56,600 systems, whether there's school or whether it's work or whether 942 00:49:56,600 --> 00:50:00,440 it's wherever, systems do need to accommodate better around 943 00:50:00,880 --> 00:50:03,600 noise and around noise sensitivity for everyone, 944 00:50:03,720 --> 00:50:07,200 especially for people on the tail end of this distribution 945 00:50:07,200 --> 00:50:10,720 who have misophonia or other sound intolerance disorders. 946 00:50:11,000 --> 00:50:12,400 So I think that's true. They do need to. 947 00:50:12,400 --> 00:50:16,600 However, I think on the other hand, the person themself also 948 00:50:16,920 --> 00:50:20,240 needs to accommodate the environment that they're in. 949 00:50:20,640 --> 00:50:22,960 There's a little bit of a dialectical here is that we 950 00:50:22,960 --> 00:50:25,920 can't expect the world to completely accommodate all 951 00:50:25,920 --> 00:50:28,000 people with misophonia. That's just not realistic. 952 00:50:28,440 --> 00:50:31,680 It's not, it's not realistic for anybody with any condition to be 953 00:50:31,680 --> 00:50:34,480 accommodated by all people everywhere, all the time, right? 954 00:50:34,480 --> 00:50:37,920 That's just not real. But we can strive in that 955 00:50:37,920 --> 00:50:41,400 direction as long as we're balanced by and what can that 956 00:50:41,400 --> 00:50:44,280 person do that's reasonable, that's feasible, that's 957 00:50:44,280 --> 00:50:49,000 skillful, that's effective for them given their culture, given 958 00:50:49,000 --> 00:50:51,280 their identities, given their context, right? 959 00:50:51,280 --> 00:50:54,080 Given who they are, what can they do, right? 960 00:50:54,080 --> 00:50:55,960 And I think that's, that's really hard. 961 00:50:55,960 --> 00:50:57,920 That's a hard thing. And this is something that 962 00:50:57,920 --> 00:51:00,640 therapists can help people sort through. 963 00:51:00,760 --> 00:51:03,760 Therapists can help be reasonable and flexible. 964 00:51:04,040 --> 00:51:07,080 And therapists can also support people with misophonia by 965 00:51:07,200 --> 00:51:10,520 helping to write letters of support for them to, for, for 966 00:51:10,520 --> 00:51:13,120 requests at school and accommodations and such. 967 00:51:13,640 --> 00:51:16,880 So finding that balance and finding that that blend I think 968 00:51:16,880 --> 00:51:18,760 is really an important way to to look at this. 969 00:51:18,840 --> 00:51:21,000 Yeah. And you mentioned lame and shame 970 00:51:21,000 --> 00:51:23,760 as being like those really strong initial emotions. 971 00:51:24,240 --> 00:51:28,440 I think there's so much benefit and talking through those really 972 00:51:28,440 --> 00:51:30,720 intense emotions, especially when they've been building up 973 00:51:30,720 --> 00:51:32,920 for years. And therapy can be a helpful 974 00:51:32,920 --> 00:51:35,400 setting for that because you don't move through those 975 00:51:35,400 --> 00:51:38,080 overnight. And once you're back in those 976 00:51:38,080 --> 00:51:41,080 dynamics or relationships, it can continue to arise. 977 00:51:41,080 --> 00:51:43,920 And so even getting to that point of like, I want to 978 00:51:44,040 --> 00:51:47,080 implement skills or I want to accommodate the environment 979 00:51:47,240 --> 00:51:50,560 while also requesting that the environment accommodates me. 980 00:51:50,720 --> 00:51:54,400 Having someone to support you through that process to even get 981 00:51:54,400 --> 00:51:57,200 in that headspace is really important too and doesn't happen 982 00:51:57,200 --> 00:51:59,720 overnight and takes a lot of work for sure. 983 00:52:00,360 --> 00:52:03,440 You guys are putting out a lot of information and media and you 984 00:52:03,440 --> 00:52:05,760 guys mentioned there's a lot of research still coming out, so if 985 00:52:05,760 --> 00:52:09,240 people want to follow along with that or keep up with you guys 986 00:52:09,480 --> 00:52:11,080 and your lab, where can they do that? 987 00:52:11,600 --> 00:52:16,240 Our website www.misophonia.duke.edu and our 988 00:52:16,240 --> 00:52:18,120 Instagram Duke Center for Misophonia. 989 00:52:18,600 --> 00:52:20,400 Amazing. I'll put that in the show notes 990 00:52:20,400 --> 00:52:22,520 and thank you guys so much for coming on the show.