1 00:00:00,500 --> 00:00:04,100 Welcome to she persisted I'm your host Sadie Saxton a 19 year 2 00:00:04,100 --> 00:00:07,000 old from the Bay Area studying psychology at the University of 3 00:00:07,000 --> 00:00:10,300 Pennsylvania. She persisted is the Teen Mental 4 00:00:10,300 --> 00:00:13,800 Health podcast made for teenagers by a team in each 5 00:00:13,800 --> 00:00:15,300 episode. I'll bring you authentic 6 00:00:15,300 --> 00:00:18,500 accessible and relatable conversations about every aspect 7 00:00:18,500 --> 00:00:21,500 of mental Wellness. You can expect evidence-based, 8 00:00:21,500 --> 00:00:25,200 Tina, proof resources, coping skills, including lots of DBT, 9 00:00:25,500 --> 00:00:28,200 insights and education. In each piece of content, you 10 00:00:28,200 --> 00:00:31,600 consume, she persisted Offers you a safe space to feel 11 00:00:31,600 --> 00:00:33,700 validated and understood in your struggle. 12 00:00:33,900 --> 00:00:36,300 While encouraging you to take ownership of your journey and 13 00:00:36,300 --> 00:00:38,800 build your life worth living. So let's Dive In. 14 00:00:41,100 --> 00:00:42,600 Hello, hello, and welcome back to. 15 00:00:42,600 --> 00:00:44,800 She persisted. I'm so excited to hear today. 16 00:00:44,800 --> 00:00:47,400 This is one of my favorite episodes that I've recorded in a 17 00:00:47,400 --> 00:00:50,500 really long time. It is with one of my professors 18 00:00:50,500 --> 00:00:53,600 from Pain professor, ruscio. She taught my abnormal 19 00:00:53,600 --> 00:00:57,300 psychology class, and she is a practicing clinician. 20 00:00:57,300 --> 00:01:00,500 She works with adults, and she just brought so much interesting 21 00:01:00,500 --> 00:01:04,200 insight to the conversation, about mental illness and mental 22 00:01:04,200 --> 00:01:05,900 health. That I learned so much during 23 00:01:05,900 --> 00:01:08,700 this semester course, that you've probably heard bits and 24 00:01:08,700 --> 00:01:11,000 pieces of in the podcast, if you've been listening It 25 00:01:11,000 --> 00:01:13,600 consistently. But this episode is a really 26 00:01:13,600 --> 00:01:16,900 powerful conversation. About depression, about anxiety. 27 00:01:16,900 --> 00:01:19,300 We talked about the importance of skills education. 28 00:01:19,600 --> 00:01:22,000 We talk about sub clinical depression. 29 00:01:22,000 --> 00:01:24,600 We talked about stress, we talked about common cognitive 30 00:01:24,600 --> 00:01:28,400 experiences, and depression, we talked about comorbidity and so. 31 00:01:28,400 --> 00:01:31,500 So so many things that I think most people aren't aware of when 32 00:01:31,500 --> 00:01:33,200 it comes to depression and anxiety. 33 00:01:33,700 --> 00:01:38,000 But really are very helpful to know if you are struggling or if 34 00:01:38,000 --> 00:01:39,600 you know someone that is struggling. 35 00:01:39,600 --> 00:01:42,700 So I'm so glad that Professor ruscio joined me for this 36 00:01:42,700 --> 00:01:46,100 conversation and I hope you enjoy it as much as I did. 37 00:01:46,300 --> 00:01:48,300 Her links will be in the show notes today. 38 00:01:48,300 --> 00:01:51,400 If you want to learn more about her research, but yeah, I'm so 39 00:01:51,400 --> 00:01:55,500 excited to bring you into the classroom with me and learn more 40 00:01:55,500 --> 00:01:57,900 about mental health and specifically, depression and 41 00:01:57,900 --> 00:02:00,300 anxiety. So with that, let's dive in. 42 00:02:00,500 --> 00:02:02,200 Thank you so much for joining me today on. 43 00:02:02,200 --> 00:02:05,000 She persisted, I'm so so excited to have you on the show. 44 00:02:05,100 --> 00:02:08,000 It's such a pleasure to be here with you, of course. 45 00:02:08,000 --> 00:02:09,900 So I'm really excited for this conversation. 46 00:02:09,900 --> 00:02:12,300 We're going to kind of go A little bit all over but we're 47 00:02:12,300 --> 00:02:16,800 centering a lot on anxiety and depression and what lays the 48 00:02:16,800 --> 00:02:20,200 foundation for mental illness and really just kind of diving 49 00:02:20,200 --> 00:02:24,000 into those, not risk factors per se but talking about what 50 00:02:24,000 --> 00:02:27,600 happens in childhood with teens can do to reduce risks and then 51 00:02:27,600 --> 00:02:30,900 talking about how similar some of these different distress 52 00:02:30,900 --> 00:02:34,500 disorders can be. So to start I'd love to talk 53 00:02:34,500 --> 00:02:38,500 about why adolescent is such a critical period for depression. 54 00:02:38,500 --> 00:02:40,600 It's something that most people are somewhat. 55 00:02:40,600 --> 00:02:45,400 Oh, Aware of that things, develop before 1824, but there's 56 00:02:45,400 --> 00:02:48,100 not a ton of understanding as to why that is. 57 00:02:48,100 --> 00:02:50,700 So I would love to get your perspective there. 58 00:02:51,100 --> 00:02:54,600 Oh yeah, such a good question and it's a question that mental 59 00:02:54,600 --> 00:02:57,200 health professionals have been pondering for a long time. 60 00:02:57,300 --> 00:02:59,400 So, you know, we for a long time. 61 00:02:59,500 --> 00:03:02,600 People thought that depression really didn't start until 62 00:03:02,600 --> 00:03:07,000 adulthood, and it's really been the last few decades that 63 00:03:07,100 --> 00:03:10,300 increasingly psychologists psychiatrists have realized 64 00:03:10,300 --> 00:03:12,300 that. Fact, depression, often begin 65 00:03:12,300 --> 00:03:15,000 sooner than that. We know that there is a really, 66 00:03:15,000 --> 00:03:19,000 really large increase in the rate of depression that happens 67 00:03:19,000 --> 00:03:22,800 during adolescence. So prior to about age, 12 or 13, 68 00:03:22,800 --> 00:03:25,000 there are kids who get depressed, but they're 69 00:03:25,000 --> 00:03:29,100 relatively few, and most of those cases, don't persist into 70 00:03:29,100 --> 00:03:32,700 adolescence and adulthood, but starting at around age, 12 to 13 71 00:03:32,700 --> 00:03:35,100 is just a dramatic rise in the rate of depression. 72 00:03:35,400 --> 00:03:39,000 So you see an increase of about three percent of kids or so 73 00:03:39,300 --> 00:03:42,300 might become depressed at some point but then the rates go up 74 00:03:42,300 --> 00:03:47,600 to about 17 percent by age 18, which is much more similar to 75 00:03:47,600 --> 00:03:52,500 the rates that we see in adults. So why that is is really 76 00:03:52,500 --> 00:03:54,200 important and interesting question. 77 00:03:54,300 --> 00:03:55,800 We don't have a great understanding. 78 00:03:55,800 --> 00:04:00,200 If there are sort of some indicators from research studies 79 00:04:00,800 --> 00:04:03,500 as to what might be going on in the Adolescent period, that 80 00:04:03,500 --> 00:04:05,200 could be contributing to the increase. 81 00:04:05,800 --> 00:04:09,100 There is some thinking that this could be connected in part to 82 00:04:09,100 --> 00:04:12,000 biological factors. Particularly those that are 83 00:04:12,000 --> 00:04:15,800 linked to puberty. And it does seem for example, 84 00:04:15,800 --> 00:04:19,399 that kids who experienced onset of puberty earlier, are 85 00:04:19,399 --> 00:04:23,000 increased risk for depression, particularly girls, so there may 86 00:04:23,000 --> 00:04:25,600 be something going on almost certainly something going on 87 00:04:25,600 --> 00:04:28,400 related to hormones. In addition, there it appears 88 00:04:28,400 --> 00:04:31,500 that there are increasing levels of stress, particularly 89 00:04:31,500 --> 00:04:34,400 uncontrollable stressors that occur in adolescence compared to 90 00:04:34,400 --> 00:04:37,000 Childhood. And in particular, interpersonal 91 00:04:37,000 --> 00:04:40,000 stressors, especially for girls. So I don't know if we'll get 92 00:04:40,000 --> 00:04:42,700 into this more Later. But there's a very long 93 00:04:42,700 --> 00:04:45,000 literature indicating that there is a sex difference in 94 00:04:45,000 --> 00:04:47,400 depression. Girls are about twice as likely 95 00:04:47,400 --> 00:04:51,500 as boys to develop depression some point in their lives and 96 00:04:51,500 --> 00:04:54,200 that sex difference in merges in adolescence. 97 00:04:54,500 --> 00:04:57,700 So, something about stress, especially interpersonal, stress 98 00:04:58,000 --> 00:05:01,400 may be important in helping understand why it is that 99 00:05:01,400 --> 00:05:04,800 adolescents, much more so than younger kids become depressed. 100 00:05:05,400 --> 00:05:08,000 Yeah, it's also interesting because, I think a lot of the 101 00:05:08,008 --> 00:05:11,500 times when adults experienced periods of stress, It's just a 102 00:05:11,500 --> 00:05:14,300 period, they've navigated that before they know they can get 103 00:05:14,300 --> 00:05:16,500 through it. Whereas in adolescence when you 104 00:05:16,500 --> 00:05:19,300 experience academic stress or relationship stress or 105 00:05:19,300 --> 00:05:22,100 interpersonal stress, it's really for the first time so you 106 00:05:22,108 --> 00:05:24,400 don't have that experience to be like, okay I've coped through 107 00:05:24,400 --> 00:05:27,700 this before it's going to be okay I know how to navigate this 108 00:05:27,700 --> 00:05:30,500 this won't last forever. It's like the first time you're 109 00:05:30,500 --> 00:05:33,800 navigating it there's not a lot of guidance there and so it 110 00:05:33,800 --> 00:05:37,000 feels subjectively like that much overwhelming more 111 00:05:37,000 --> 00:05:38,900 overwhelming. Yeah I think that's a really 112 00:05:38,900 --> 00:05:40,600 important point when we've gone through. 113 00:05:40,800 --> 00:05:43,400 Something many times before we know we can weather that we have 114 00:05:43,400 --> 00:05:45,800 coping strategies that have worked for us before. 115 00:05:45,900 --> 00:05:48,100 We have kind of the bigger perspective to put this 116 00:05:48,100 --> 00:05:52,000 particular situation into we know we can lean on our supports 117 00:05:52,100 --> 00:05:55,000 to get through it, but it's harder when you're experiencing 118 00:05:55,000 --> 00:05:57,500 these things for the first time especially when you're an 119 00:05:57,500 --> 00:05:59,800 adolescent and you're still trying to figure out who am I, 120 00:05:59,800 --> 00:06:03,400 how do I navigate the world, who are the people in my world who I 121 00:06:03,400 --> 00:06:06,800 have trusting relationships with so that definitely makes it more 122 00:06:06,800 --> 00:06:08,400 challenging. Yeah. 123 00:06:08,400 --> 00:06:10,700 Are there other factors that add to that gender? 124 00:06:10,800 --> 00:06:13,700 Gap. In addition to girls having an 125 00:06:13,700 --> 00:06:17,200 onset of puberty more earlier on there is kind of more social 126 00:06:17,200 --> 00:06:20,200 tension than there is with boys. That is there anything else that 127 00:06:20,200 --> 00:06:22,400 adds to that risk? For sure. 128 00:06:22,400 --> 00:06:25,200 There are some of the factors that have been most studied our 129 00:06:25,200 --> 00:06:28,400 cognitive or Sinking related processes. 130 00:06:28,400 --> 00:06:31,100 So, girls are much more likely than boys to ruminate. 131 00:06:31,100 --> 00:06:35,400 This is sort of a style of coping with stress, where girls 132 00:06:35,400 --> 00:06:39,300 are more likely to sort of sit and dwell on all the bad things 133 00:06:39,300 --> 00:06:41,500 that have happened. How how, how is it? 134 00:06:41,500 --> 00:06:44,000 Why do I feel this way? Why do I always get into these 135 00:06:44,000 --> 00:06:46,700 patterns? Why did that go wrong and the 136 00:06:46,700 --> 00:06:49,000 more that people sort of sit and stew? 137 00:06:49,000 --> 00:06:52,700 And that sort of negative past, Focus thinking about things that 138 00:06:52,700 --> 00:06:56,000 are abstract things, I can't do anything about any more, the 139 00:06:56,000 --> 00:06:59,700 less productive that can be. So generally speaking girls are 140 00:06:59,700 --> 00:07:02,400 more likely to ruminate boys are more likely to engage in more 141 00:07:02,400 --> 00:07:04,600 active problem-solving types of coping. 142 00:07:05,000 --> 00:07:08,200 And it turns out that all of us when we ruminate feel worse and 143 00:07:08,200 --> 00:07:12,600 all of us, when we engage in more active, Focus coping tend 144 00:07:12,600 --> 00:07:16,100 to be sort of more successful. So, you know, I think it's 145 00:07:16,100 --> 00:07:18,800 important to recognize that these are thoughts down that can 146 00:07:18,800 --> 00:07:22,100 be changed an interesting, sort of related line of research is 147 00:07:22,100 --> 00:07:24,700 that girls are more likely to KO ruminate meaning there are more 148 00:07:24,700 --> 00:07:27,300 likely to get together with friends and dwell together on 149 00:07:27,300 --> 00:07:30,100 that things that have happened. And that's also a pattern that's 150 00:07:30,100 --> 00:07:32,800 associated with sort of maintaining negative emotions 151 00:07:32,800 --> 00:07:35,800 over time. So, you know, one of the things 152 00:07:35,800 --> 00:07:38,200 that your listeners might think about is, if they find 153 00:07:38,200 --> 00:07:41,300 themselves or sitting and stewing about Out, bad things 154 00:07:41,300 --> 00:07:44,200 that have happened, they really can't do anything about anymore. 155 00:07:44,200 --> 00:07:45,700 Thinking about, okay, what can I do? 156 00:07:45,700 --> 00:07:49,000 That is constructive right now. Something active, something that 157 00:07:49,000 --> 00:07:52,100 will get me moving instead of sitting here and dwelling on bad 158 00:07:52,100 --> 00:07:54,000 things. And also, if they find 159 00:07:54,000 --> 00:07:56,500 themselves getting into conversations with friends, 160 00:07:56,500 --> 00:08:00,200 where they're kind of feeling stuck there, they're helping 161 00:08:00,200 --> 00:08:03,800 each other in a way, stay stuck by going over and over bad 162 00:08:03,800 --> 00:08:05,800 things again. And again, thinking about how 163 00:08:05,800 --> 00:08:08,900 can we change this conversation to be more constructive, more 164 00:08:08,900 --> 00:08:12,300 future focused more. Tom, what can we do in this 165 00:08:12,300 --> 00:08:14,700 situation or even like? Let's stop talking about this 166 00:08:14,700 --> 00:08:17,600 for now and go and do something active and fun as a way of 167 00:08:17,608 --> 00:08:19,300 breaking that negative thought cycle. 168 00:08:19,500 --> 00:08:22,700 I love that and it's definitely helpful because you can hold 169 00:08:22,700 --> 00:08:25,300 each other accountable. So it's not just you that's like 170 00:08:25,300 --> 00:08:28,100 okay I gotta stop ruminating but together you can back. 171 00:08:28,100 --> 00:08:30,300 Okay, what can we do? We're getting into this pattern 172 00:08:30,300 --> 00:08:33,000 again. Are there other best practices 173 00:08:33,000 --> 00:08:35,200 that people can Implement to counteract? 174 00:08:35,200 --> 00:08:38,600 These risk factors that are so common in teenagers adolescents. 175 00:08:38,600 --> 00:08:42,200 I'm sure there's basic things like getting outside more being 176 00:08:42,200 --> 00:08:45,100 engaged in relationships, but are there other recommendations 177 00:08:45,100 --> 00:08:49,200 that you like to give for sure? So I should say it's important 178 00:08:49,200 --> 00:08:51,800 to qualify this by saying that I work clinically with adults, not 179 00:08:51,800 --> 00:08:54,300 without a lessons. But a lot of the same strategies 180 00:08:54,300 --> 00:08:56,800 I think are helpful for adolescents, as are helpful for 181 00:08:56,800 --> 00:09:00,100 young adults, or older adults. So generally speaking doing 182 00:09:00,100 --> 00:09:03,100 activities that are active or good. 183 00:09:03,100 --> 00:09:06,500 So, exercise is always recommended as a way of 184 00:09:06,500 --> 00:09:09,300 improving mood, as well as keeping you sort of healthy and 185 00:09:09,300 --> 00:09:12,600 fit doing. He's that give you a sense of 186 00:09:12,600 --> 00:09:15,500 Mastery and accomplishment are good, so these can be 187 00:09:15,500 --> 00:09:18,400 pleasurable activities. They can also be things that 188 00:09:18,400 --> 00:09:20,400 aren't about pleasurable. That gives you a feeling of 189 00:09:20,400 --> 00:09:22,600 accomplishment. Like okay, did the laundry 190 00:09:22,600 --> 00:09:23,500 check? Right? 191 00:09:23,600 --> 00:09:26,200 You know, I ran this Aaron that had to be done check where you 192 00:09:26,200 --> 00:09:27,900 feel like, okay I'm accomplishing things. 193 00:09:27,900 --> 00:09:31,800 So those are good too but especially good are activities. 194 00:09:31,800 --> 00:09:34,000 That give you a sense of pleasure things that you really 195 00:09:34,000 --> 00:09:36,300 enjoy. That can be by yourself or with 196 00:09:36,300 --> 00:09:37,600 other. People doesn't have to be a 197 00:09:37,600 --> 00:09:39,700 great. Big thing could be as simple as 198 00:09:39,700 --> 00:09:40,600 okay. I'm going. 199 00:09:40,700 --> 00:09:44,800 To go for a walk with a friend. I'm going to spend some fun time 200 00:09:44,800 --> 00:09:47,900 with a sibling. I really enjoy, you know, 201 00:09:47,900 --> 00:09:50,400 reading this particular author. I'm going to go and to the 202 00:09:50,400 --> 00:09:53,300 library and get a book. I really enjoy reading your, all 203 00:09:53,300 --> 00:09:55,900 of those are good things. It definitely makes me think of 204 00:09:55,900 --> 00:09:59,000 why a lot of teenagers experience like a shift in 205 00:09:59,000 --> 00:10:01,800 mental health, when they go to college because all of these 206 00:10:01,800 --> 00:10:05,000 things whether it's building Mastery or doing activities, you 207 00:10:05,000 --> 00:10:08,900 enjoy being active on a team are really built into your schedule 208 00:10:08,900 --> 00:10:10,500 in high school and then in college. 209 00:10:10,700 --> 00:10:13,100 Up to you to maintain those. So if you don't build those into 210 00:10:13,100 --> 00:10:16,300 your schedule if you don't prioritize those, it makes 211 00:10:16,300 --> 00:10:17,700 sense. Why your mental health would 212 00:10:17,700 --> 00:10:20,700 struggle as a result? I think that's absolutely right. 213 00:10:20,800 --> 00:10:23,500 All of us, experience a change in routine when we go to 214 00:10:23,500 --> 00:10:24,700 college, right? Yeah. 215 00:10:24,700 --> 00:10:27,000 Your routine is completely completely unattended. 216 00:10:27,000 --> 00:10:29,800 And in addition your, you're making your way with new 217 00:10:29,800 --> 00:10:32,700 relationships, your this structure that's built into your 218 00:10:32,700 --> 00:10:35,500 life in terms of when you eat and when you sleep. 219 00:10:35,500 --> 00:10:40,500 And so on is changed and a lot more is put on the student too. 220 00:10:40,700 --> 00:10:43,700 To place those structures in place, right for them. 221 00:10:43,900 --> 00:10:46,300 They're our parents, they're saying, okay, time to go to bed, 222 00:10:46,300 --> 00:10:47,700 right? Or what did you eat for 223 00:10:47,700 --> 00:10:49,500 breakfast? You serve have to do those 224 00:10:49,500 --> 00:10:52,800 things for yourself. And so it requires establishing 225 00:10:52,800 --> 00:10:55,500 new routines and routines that are healthy and productive for 226 00:10:55,500 --> 00:10:56,600 you. Yeah. 227 00:10:57,000 --> 00:10:59,600 One of the questions that I've gotten most frequently recently 228 00:10:59,600 --> 00:11:03,500 which I hadn't had a lot of questions about before was like 229 00:11:03,500 --> 00:11:07,300 high functioning or sub syndrome will depression that isn't 230 00:11:07,300 --> 00:11:11,300 necessarily completely derail any activities or EPS but it's 231 00:11:11,300 --> 00:11:13,900 definitely there. I would love to hear kind of 232 00:11:13,900 --> 00:11:17,300 what that clinical definition is and then why it's still 233 00:11:17,300 --> 00:11:22,300 important to try and either get help utilize resources or at 234 00:11:22,300 --> 00:11:25,700 least attempt to problem. Solve shift, your behaviors and 235 00:11:25,700 --> 00:11:28,900 routines even if it's not at the point where it's like, this is 236 00:11:28,900 --> 00:11:31,600 completely interfering with my quality of life. 237 00:11:31,800 --> 00:11:34,000 Yeah, that's such an important question. 238 00:11:34,000 --> 00:11:37,700 So we know that many many more individuals experience 239 00:11:37,700 --> 00:11:40,800 subclinical levels of depression and then those who, It's 240 00:11:40,800 --> 00:11:44,500 clinical levels of depression. For some of those individuals, 241 00:11:44,500 --> 00:11:48,200 those symptoms escalated over time and can turn into a major 242 00:11:48,200 --> 00:11:52,300 depressive episode that might need clinical attention, you 243 00:11:52,300 --> 00:11:54,300 know, all of us experience ups and downs. 244 00:11:54,300 --> 00:11:57,100 So, it's important to recognize that having a few bad days. 245 00:11:57,100 --> 00:11:59,900 Doesn't necessarily mean you have a disorder or that, this is 246 00:11:59,900 --> 00:12:04,300 something even Ducks concerning, but it's good to be attuned to 247 00:12:04,300 --> 00:12:07,100 how your mood is, and how your behavior is, and if you're 248 00:12:07,100 --> 00:12:10,500 finding that your day after day, you're feeling very low. 249 00:12:10,900 --> 00:12:13,800 Motivation to do things that are important or things that you 250 00:12:13,800 --> 00:12:17,700 usually enjoy or your mood is really low consistently. 251 00:12:17,700 --> 00:12:21,600 Then it's a really good idea to do something to attend to that. 252 00:12:21,900 --> 00:12:23,800 There are lots of things that can be done. 253 00:12:24,500 --> 00:12:27,700 One of the things that can be done, it's to seek help from a 254 00:12:27,700 --> 00:12:30,000 treatment professional either, Psychotherapy. 255 00:12:30,000 --> 00:12:33,300 Or if you feel it's necessary in your provider recommends, it 256 00:12:33,300 --> 00:12:37,100 some kind of medication, and it's also possible to do other 257 00:12:37,100 --> 00:12:40,500 things that are less intensive. But that will be helpful. 258 00:12:40,600 --> 00:12:44,100 All to your mood, some of those things can be as simple as some 259 00:12:44,100 --> 00:12:46,700 of the activities we talked about, but it also, there are 260 00:12:46,700 --> 00:12:50,300 self-help books, there are at based or internet based 261 00:12:50,300 --> 00:12:53,800 interventions that are less intensive than doing what's a 262 00:12:53,800 --> 00:12:57,100 individual psychotherapy but that can be quite helpful. 263 00:12:57,600 --> 00:13:00,500 So looking into those resources, can be good and of course, 264 00:13:00,500 --> 00:13:03,600 talking with friends and family who can be helpful to you as 265 00:13:03,600 --> 00:13:06,100 well. I also loved reminding listeners 266 00:13:06,100 --> 00:13:09,100 that the skills that are working for people that are like 267 00:13:09,100 --> 00:13:11,300 severely severely. Best. 268 00:13:11,300 --> 00:13:13,900 If those are working to lift that level of depression, 269 00:13:14,100 --> 00:13:17,000 there's a very high chance that those same skills are going to 270 00:13:17,000 --> 00:13:18,600 work if you're having an off day. 271 00:13:18,900 --> 00:13:21,700 So if there's one person that like physically cannot get out 272 00:13:21,700 --> 00:13:24,100 of bed and the skill that will work for them is doing the 273 00:13:24,100 --> 00:13:26,900 opposite of what they're feeling and lowering their physical 274 00:13:26,900 --> 00:13:29,700 physiological, emotional intensity. 275 00:13:29,700 --> 00:13:33,000 And asking for help and distracting from the emotion. 276 00:13:33,000 --> 00:13:36,200 Those same things will likely work if you're like, I just 277 00:13:36,200 --> 00:13:39,200 cannot get to school today. I'm feeling so overwhelmed and 278 00:13:39,200 --> 00:13:42,200 feeling unmotivated like those. Those skills transfer and you 279 00:13:42,208 --> 00:13:45,200 don't have to get to a certain level of distress to The Quay. 280 00:13:45,200 --> 00:13:47,500 Now we use the skills. Like if it's feeling 281 00:13:47,500 --> 00:13:50,500 uncomfortable, if it's bothering, you use the skills 282 00:13:50,500 --> 00:13:53,600 and it'll be easy to use them because the emotional intensity 283 00:13:53,600 --> 00:13:56,300 is lower than that. Like, life interfering 284 00:13:56,300 --> 00:13:58,600 life-altering, super bad depression. 285 00:13:58,600 --> 00:14:01,800 That some people experience. I agree completely say to you're 286 00:14:01,800 --> 00:14:04,800 absolutely right. Those skills are useful because 287 00:14:04,800 --> 00:14:07,100 they're like a good life skills, right? 288 00:14:07,200 --> 00:14:09,900 So I cannot avoid it, things that are making you 289 00:14:09,900 --> 00:14:13,600 uncomfortable Or you've nervous is always a good skill. 290 00:14:13,600 --> 00:14:16,500 Like staying, active is a good skill examining. 291 00:14:16,500 --> 00:14:19,100 Thoughts that are unproductive and substituting more 292 00:14:19,100 --> 00:14:20,000 constructive. Helpful. 293 00:14:20,000 --> 00:14:23,100 Thoughts, those are all great skills that can and should be 294 00:14:23,100 --> 00:14:26,800 used, even when you're let's say, more Motley distressed 295 00:14:27,000 --> 00:14:28,900 compared to being clinically depressed. 296 00:14:29,000 --> 00:14:31,400 I feel like that's one of the biggest ways that I've seen 297 00:14:31,400 --> 00:14:33,800 stigma show up. It's like that emotional 298 00:14:33,800 --> 00:14:36,600 thought, block where people are like, well, it's not that bad. 299 00:14:36,600 --> 00:14:39,000 We don't need those skills. That people would learn in 300 00:14:39,000 --> 00:14:42,400 therapy, and it's It's like, you're not even engaging in 301 00:14:42,400 --> 00:14:44,700 treatment, you're not even getting a diagnosis. 302 00:14:44,700 --> 00:14:48,300 Like it's not close to what you think of stigma preventing 303 00:14:48,300 --> 00:14:51,100 people from doing. And yet their stats still that 304 00:14:51,100 --> 00:14:54,500 emotional block of like, well other people have it worse or I 305 00:14:54,508 --> 00:14:57,600 don't need that help yet. And it's like well why not 306 00:14:57,600 --> 00:15:00,100 targeted early? So like you said it doesn't get 307 00:15:00,100 --> 00:15:03,100 worse over time and develop into severe. 308 00:15:03,100 --> 00:15:05,700 Major depression. You're absolutely right. 309 00:15:05,800 --> 00:15:09,100 And these are skills I use all the time and it's actually look 310 00:15:09,200 --> 00:15:11,600 one of the best things I think. About being trained in 311 00:15:11,600 --> 00:15:14,500 Psychology is if you learn these great skills that are helpful 312 00:15:14,500 --> 00:15:17,500 for everybody and I tell everyone I know about them 313 00:15:17,500 --> 00:15:19,000 including healthy people. Yes. 314 00:15:19,000 --> 00:15:22,800 So these are just they're just sort of good coping strategies 315 00:15:22,800 --> 00:15:26,300 that all of us can benefit from and you don't have to get to a 316 00:15:26,300 --> 00:15:28,400 certain level of severity to use them. 317 00:15:28,400 --> 00:15:31,100 And in fact, using those skills will help prevent you from 318 00:15:31,100 --> 00:15:34,400 getting to that point. Yeah, I remember being an 319 00:15:34,400 --> 00:15:38,100 intensive treatment and being surrounded 24/7 by people that 320 00:15:38,100 --> 00:15:41,300 were like highly trained in DBT and use Seeing it in every 321 00:15:41,300 --> 00:15:44,700 single aspect of their life. Both at home, and in practice, 322 00:15:44,700 --> 00:15:46,900 there is therapist they were the community. 323 00:15:46,900 --> 00:15:49,500 They weren't called Community residents but they were the like 324 00:15:49,500 --> 00:15:52,600 psychology students that were getting their hours in in 325 00:15:52,600 --> 00:15:54,900 practice and they would do daily activities with us. 326 00:15:55,100 --> 00:15:57,600 And then there was the Educators and then, of course, all the 327 00:15:58,000 --> 00:16:00,400 kids and teens themselves were using these skills. 328 00:16:00,700 --> 00:16:03,500 And I remember leaving being like, why is everyone being so 329 00:16:03,500 --> 00:16:06,100 ineffective? Like, where is the dear man? 330 00:16:06,100 --> 00:16:09,300 Where is the emotion regulation? Like guys, this could be so much 331 00:16:09,300 --> 00:16:13,000 easier and it was And just like regulating anxiety and 332 00:16:13,000 --> 00:16:15,200 depression. It was just basic functioning 333 00:16:15,200 --> 00:16:18,300 and asking for help when you need it and advocating for an 334 00:16:18,300 --> 00:16:20,500 objective. Like, these are all things that 335 00:16:20,500 --> 00:16:22,700 if you're functioning, well, you're probably already doing. 336 00:16:22,700 --> 00:16:25,800 And if you're not there skills to address it, that's exactly 337 00:16:25,800 --> 00:16:27,400 right. I think these are often skills 338 00:16:27,400 --> 00:16:31,100 that people who are doing really well, high functioning and 339 00:16:31,100 --> 00:16:33,600 achieving the important goals they've set for themselves. 340 00:16:33,700 --> 00:16:37,400 Those are skills that they're doing intuitively and you're 341 00:16:37,400 --> 00:16:40,300 absolutely right like interpersonal, Effectiveness. 342 00:16:40,300 --> 00:16:42,400 That's It's always something you want to do, right? 343 00:16:42,400 --> 00:16:44,800 Emotion regulation. That's always a good go. 344 00:16:44,800 --> 00:16:48,600 Like, use those skills. It's actually, it's a gift to 345 00:16:48,600 --> 00:16:52,800 have that knowledge and using it in a regular basis, can make you 346 00:16:53,000 --> 00:16:55,700 flourish. Even when you are sort of 347 00:16:55,700 --> 00:16:58,700 emotionally doing really well. It just strengthens everything. 348 00:16:59,000 --> 00:17:01,500 Yeah and then when you do have those low points which everyone 349 00:17:01,500 --> 00:17:04,300 dies, you know, the skills, you know, how to get them they 350 00:17:04,300 --> 00:17:07,599 worked before and that's one less block to getting out of 351 00:17:07,599 --> 00:17:11,500 that low point because you are skilled and Knowledgeable and 352 00:17:11,500 --> 00:17:13,800 how to navigate The Challenge. Exactly. 353 00:17:13,800 --> 00:17:15,900 And having practiced those skills again. 354 00:17:15,900 --> 00:17:18,500 And again means that when you most need them, they'll be there 355 00:17:18,500 --> 00:17:21,200 for you. I love that this week's episode 356 00:17:21,200 --> 00:17:23,099 is brought to you by teen counseling. 357 00:17:23,099 --> 00:17:26,300 If you've heard of better help teen counseling is their Branch 358 00:17:26,300 --> 00:17:28,800 specifically for teenagers. So it's an online Therapy 359 00:17:28,800 --> 00:17:31,800 Program with over 14,000 licensed therapist within their 360 00:17:31,800 --> 00:17:34,400 Network and they offered support on things like depression, 361 00:17:34,400 --> 00:17:37,700 anxiety, relationships, trauma, and so much more, and this 362 00:17:37,700 --> 00:17:40,400 episode professor ruscio. And I talked about how effective 363 00:17:40,500 --> 00:17:43,400 Treatment can be for both depression anxiety, and other 364 00:17:43,400 --> 00:17:47,400 mental health issues. And one proven way to depression 365 00:17:47,400 --> 00:17:50,300 and treat anxiety is therapy and Psychotherapy. 366 00:17:50,300 --> 00:17:52,900 And so, a great way to get access to therapy is teen 367 00:17:52,900 --> 00:17:55,300 counseling. What you do is you get a teen 368 00:17:55,300 --> 00:17:58,000 counseling.com says, she persisted and you fill out a 369 00:17:58,000 --> 00:17:59,900 survey about what you're hoping to work on. 370 00:17:59,900 --> 00:18:03,000 So maybe it is depression, maybe it's anxiety, maybe it's 371 00:18:03,000 --> 00:18:05,700 relationships, trauma, whatever it is, that were, you are hoping 372 00:18:05,700 --> 00:18:07,400 to work on. They match you with a therapist 373 00:18:07,400 --> 00:18:11,600 that fits your needs and fits that area of We'll see if you're 374 00:18:11,600 --> 00:18:14,200 under 18 you then put in a parent or Guardians email so 375 00:18:14,208 --> 00:18:17,300 they can provide consent to treatment and payment but not if 376 00:18:17,300 --> 00:18:19,500 your information that you just closed in the survey is shared 377 00:18:19,500 --> 00:18:21,200 with your parents, hip has enacted. 378 00:18:21,200 --> 00:18:24,200 So I tried it myself. All it says is Sadie or whatever 379 00:18:24,200 --> 00:18:25,600 your name is. Is hoping to work with a 380 00:18:25,600 --> 00:18:28,800 therapist from Teen counselor from Teen counseling, please 381 00:18:28,800 --> 00:18:32,500 click here to learn more and give consent, but teen, 382 00:18:32,500 --> 00:18:35,600 counseling is a great way to start therapy or meet with a new 383 00:18:35,600 --> 00:18:37,400 therapist. It's talk text video, 384 00:18:37,400 --> 00:18:41,200 counseling, all from your home and extremely Accessible. 385 00:18:41,200 --> 00:18:44,200 So if you would like to try out teen counseling, you can go to 386 00:18:44,200 --> 00:18:47,400 teen counseling.com. So she persisted again, that is 387 00:18:47,400 --> 00:18:50,300 teen counseling.com, she persisted. 388 00:18:50,400 --> 00:18:52,600 So another thing that I wanted to touch on related to 389 00:18:52,600 --> 00:18:55,400 depression, which I think is so interesting, which is again, not 390 00:18:55,400 --> 00:18:58,200 something that is, commonly known as the relationship 391 00:18:58,200 --> 00:19:01,200 between stress and depression. So kind of stress generation in 392 00:19:01,200 --> 00:19:03,700 the kindling hypothesis which if you don't know what those mean, 393 00:19:03,900 --> 00:19:05,300 we will explain. Don't worry. 394 00:19:05,300 --> 00:19:08,800 But I would love to kind of hear your perspective there because 395 00:19:08,800 --> 00:19:12,200 it's a really interesting. Love thought that isn't always 396 00:19:12,200 --> 00:19:15,200 something that comes to mind when people are struggling but 397 00:19:15,200 --> 00:19:18,100 it can be very helpful to be aware of if you are navigating 398 00:19:18,100 --> 00:19:20,200 depression. Yeah, absolutely. 399 00:19:20,200 --> 00:19:23,700 So the basic principle of stress generation was introduced by 400 00:19:23,700 --> 00:19:27,800 Connie Hammond, an a depression researcher and what you 401 00:19:27,800 --> 00:19:31,000 discovered in her research is that many individuals who are 402 00:19:31,000 --> 00:19:35,600 depressed seem to be engaging in behaviors that almost got in 403 00:19:35,600 --> 00:19:39,000 their own way that were making things more difficult for them. 404 00:19:39,100 --> 00:19:43,300 And so, these were Events that rather than sort of completely 405 00:19:43,300 --> 00:19:47,300 random acts like, you know, I got, let's say, you know, 406 00:19:47,300 --> 00:19:49,800 there's a hurricane, for example, you know, that's 407 00:19:49,800 --> 00:19:51,500 something that I have no control over. 408 00:19:51,500 --> 00:19:53,600 I did nothing for this hurricane to happen. 409 00:19:53,600 --> 00:19:55,900 I'm unfortunately, sort of stuck in the wrong place at the wrong 410 00:19:55,900 --> 00:19:59,700 time that would be a an independent stress. 411 00:19:59,700 --> 00:20:03,500 Some things independent from me. But I what you found was that 412 00:20:03,500 --> 00:20:05,300 many individuals depression were engaging. 413 00:20:05,300 --> 00:20:08,400 Also in what she called or experiencing what she called 414 00:20:08,400 --> 00:20:12,200 dependent stress so dependent. An example would be like 415 00:20:12,200 --> 00:20:15,200 frequent arguments with a boyfriend or girlfriend. 416 00:20:16,000 --> 00:20:18,900 This is something that I contribute to in somewhere 417 00:20:18,900 --> 00:20:21,800 potentially contribute to our might have a very quarrelsome 418 00:20:21,800 --> 00:20:25,900 boyfriend or girlfriend, but I also may be a person who is 419 00:20:26,000 --> 00:20:28,900 through repeatedly doing things, that's causing arguments to 420 00:20:28,900 --> 00:20:31,400 happen or contributing in some way to this dress. 421 00:20:32,100 --> 00:20:35,800 This has been a first at least. This was a controversial idea 422 00:20:35,800 --> 00:20:37,900 because we don't want to blame the victim. 423 00:20:37,900 --> 00:20:40,800 We don't want to say you like you know, people who Are 424 00:20:40,800 --> 00:20:43,700 depressed, are doing like bad things for themselves. 425 00:20:44,400 --> 00:20:46,900 And the other hand, I think it's really important to recognize 426 00:20:46,900 --> 00:20:50,300 when we are doing things that are making things harder for us 427 00:20:50,500 --> 00:20:53,600 so that we can take steps to try to improve the situation. 428 00:20:54,200 --> 00:20:57,800 And so, the basic idea behind stress generation is that to 429 00:20:57,800 --> 00:21:00,000 some extent. All of us contribute or can 430 00:21:00,000 --> 00:21:03,900 contribute to the stress we experience and the opposite side 431 00:21:03,900 --> 00:21:08,600 are flip side of that is that we all have the opportunity to 432 00:21:08,600 --> 00:21:11,100 reduce our stress levels by You can go hard. 433 00:21:11,100 --> 00:21:14,100 Look at what are we potentially doing that may be increasing 434 00:21:14,100 --> 00:21:17,300 stress for us. So I'll give you maybe a minor 435 00:21:17,300 --> 00:21:19,400 example. If I'm a person who's 436 00:21:19,400 --> 00:21:22,600 chronically late. I just like I can't get myself 437 00:21:22,600 --> 00:21:26,900 on schedule. Yeah, myself to write. 438 00:21:26,900 --> 00:21:30,500 So you know, if I'm a person who's always late, then I'm 439 00:21:30,500 --> 00:21:32,900 going to be generating some stress for myself, right? 440 00:21:32,900 --> 00:21:36,300 I'm going to, let's say, pay a bill late and as a result, I'm 441 00:21:36,300 --> 00:21:38,800 going to have a fine. And I'm going to have to pay our 442 00:21:39,000 --> 00:21:40,300 let's say I'm going to arrive late. 443 00:21:40,400 --> 00:21:42,400 To a meeting. And as a result, I'm going to be 444 00:21:42,408 --> 00:21:44,200 taken less seriously. By the people. 445 00:21:44,200 --> 00:21:45,200 I'm supposed to be meeting with her. 446 00:21:45,200 --> 00:21:46,800 I'll miss some important information. 447 00:21:46,800 --> 00:21:50,600 So maybe for students like maybe I because I'm over sleeping all 448 00:21:50,600 --> 00:21:53,400 the time I'm missing class or late for class and then I miss 449 00:21:53,400 --> 00:21:57,200 information, I need to know in order to do well in exams if I 450 00:21:57,200 --> 00:22:00,200 recognize that I am contributing to the stress that I'm 451 00:22:00,200 --> 00:22:02,700 experiencing by not managing my time. 452 00:22:02,700 --> 00:22:05,900 Well, then by improving my time management skills, I can 453 00:22:05,900 --> 00:22:09,300 actually reduce stress in my life, that's an on interpersonal 454 00:22:09,300 --> 00:22:12,800 example but One thing to note is that kind of Hammond observed 455 00:22:12,800 --> 00:22:15,500 that most of the dependence, Fasteners that she observed, 456 00:22:15,600 --> 00:22:18,800 especially in the women in her sample, were interpersonal in 457 00:22:18,800 --> 00:22:21,600 nature. So the women were engaging in 458 00:22:21,600 --> 00:22:25,400 behaviors that were increasing the likelihood of others in 459 00:22:25,400 --> 00:22:28,900 their life's or arguing with them leaving them. 460 00:22:29,100 --> 00:22:33,500 You know where relationships were more unstable or ending or 461 00:22:33,500 --> 00:22:37,500 just a more stressful more, you know in their lives. 462 00:22:37,800 --> 00:22:42,400 So thinking very hard about what are the Ways in which I may be 463 00:22:42,400 --> 00:22:44,600 contributing to difficult relationships. 464 00:22:44,900 --> 00:22:48,100 And, and, and that includes selecting people to have 465 00:22:48,100 --> 00:22:51,200 relationships with, who may not treat us the way we deserve to 466 00:22:51,208 --> 00:22:52,700 be treated. Yeah. 467 00:22:52,800 --> 00:22:55,000 Yeah. I think that's a huge thing 468 00:22:55,000 --> 00:22:58,100 that. I mean it's very very valid 469 00:22:58,100 --> 00:23:01,200 stress to experience. And with depression, a huge 470 00:23:01,200 --> 00:23:04,500 thing is having a support system and a group of people that can 471 00:23:04,500 --> 00:23:07,500 support you and if your support system is doing the opposite of 472 00:23:07,500 --> 00:23:10,300 that either like you and is she getting that or them? 473 00:23:10,600 --> 00:23:15,100 Initiating, those conflicts that can add to how difficult it is 474 00:23:15,100 --> 00:23:18,600 to come out of that depression. Ask for help, utilize resources, 475 00:23:19,000 --> 00:23:22,400 and all of those things. In addition to kind of creating 476 00:23:22,400 --> 00:23:24,000 stress in different relationships. 477 00:23:24,000 --> 00:23:26,900 There are some like, neurobiological emotional 478 00:23:26,900 --> 00:23:30,600 cognitive experiences that are pretty Universal in people that 479 00:23:30,600 --> 00:23:33,100 experience, depression. What are some of those that 480 00:23:33,100 --> 00:23:37,400 listeners can kind of listen for, and kind of observe that 481 00:23:37,400 --> 00:23:40,300 might be happening. I think it's a great way. 482 00:23:40,400 --> 00:23:43,000 It can to hear things that can be really validating, because 483 00:23:43,000 --> 00:23:47,100 depression can be so isolating. And yet, like you'll highlight 484 00:23:47,100 --> 00:23:49,900 in these Universal things, it can be very relatable, and 485 00:23:49,900 --> 00:23:52,900 again, Universal in the experience, even though it is so 486 00:23:52,900 --> 00:23:57,200 internal and feel so subjective. Yeah, great question. 487 00:23:57,200 --> 00:23:59,000 So I can highlight a few of them. 488 00:23:59,000 --> 00:24:02,300 So, what is kind of on a neurobiological level? 489 00:24:02,300 --> 00:24:05,400 What is has been seen? As often happening in 490 00:24:05,408 --> 00:24:08,000 depression? As individuals who have a 491 00:24:08,000 --> 00:24:11,400 heightened sensitivity to stress, And and heightened 492 00:24:11,400 --> 00:24:14,500 reactivity to stress. So, areas of the brain that are 493 00:24:14,500 --> 00:24:17,300 in the sort of the limbic part of the brain, particularly the 494 00:24:17,300 --> 00:24:20,900 olympique De le are sort of heightened an individual with 495 00:24:20,900 --> 00:24:23,600 depression. So, a tendency to experience 496 00:24:23,600 --> 00:24:26,200 negative emotion to react, very strongly distressed. 497 00:24:26,400 --> 00:24:29,600 And we see that prefrontal cortex areas of the brain that 498 00:24:29,600 --> 00:24:32,300 are involved in planning. And in self-control, 499 00:24:32,300 --> 00:24:35,800 self-regulation, are reduced activity in those areas are 500 00:24:35,800 --> 00:24:38,600 reduced and the routine. Those aren't even fully 501 00:24:38,600 --> 00:24:40,200 developed, so that's exactly right. 502 00:24:40,400 --> 00:24:43,000 Right more susceptible, that's exactly right. 503 00:24:43,000 --> 00:24:45,800 And in terms of the Cross talk between the limbic system and 504 00:24:45,800 --> 00:24:49,200 the prefrontal systems of the brain, they're sort of less 505 00:24:49,500 --> 00:24:53,700 tamping down of emotion by those frontal regions of the brain. 506 00:24:53,700 --> 00:24:57,800 And so people with depression, kind of a universal feature is 507 00:24:57,900 --> 00:24:59,700 the sort of heightened, sensitivity, and hind 508 00:24:59,700 --> 00:25:02,800 reactivity. When stressors occur, and all of 509 00:25:02,800 --> 00:25:07,700 us experienced an increase in distress and increase in sort of 510 00:25:07,708 --> 00:25:10,300 that cortisol response when we're stressed. 511 00:25:10,400 --> 00:25:13,400 That isn't normal. It's actually very adaptive. 512 00:25:13,400 --> 00:25:16,100 What seems to happen in depression is that people have 513 00:25:16,100 --> 00:25:19,400 trouble shutting that process off in a prompt way. 514 00:25:19,400 --> 00:25:23,300 So, you know, it's good that we react strongly want to stress or 515 00:25:23,300 --> 00:25:26,000 first occur so we can Marshal our resources and deal 516 00:25:26,000 --> 00:25:28,400 adaptively with that stressor. We don't want to ignore the 517 00:25:28,400 --> 00:25:30,100 stress, right? There's it's there for a reason 518 00:25:30,100 --> 00:25:33,500 to warn us that something's going on environment, we need to 519 00:25:33,500 --> 00:25:35,900 deal with. But then once the stressor has 520 00:25:35,900 --> 00:25:39,200 resolved, we need to be able to bring our bodies back down and 521 00:25:39,200 --> 00:25:42,700 back to a regular Our stable State and often individuals with 522 00:25:42,700 --> 00:25:46,400 depression have trouble coming back down in a timely way and 523 00:25:46,400 --> 00:25:49,300 they're sort of more sensitive and more sort of hyper aroused 524 00:25:49,300 --> 00:25:52,800 for for a period of time beyond what healthy individuals might 525 00:25:52,800 --> 00:25:55,000 experience. And maybe I'll talk about each 526 00:25:55,000 --> 00:25:56,900 of these Universal, and then we can talk about it. 527 00:25:57,100 --> 00:25:59,900 What could be done about it? So, cognitive, great. 528 00:25:59,900 --> 00:26:03,800 So cognitively, what we often see is people tending to respond 529 00:26:03,800 --> 00:26:08,800 in ways that heighten the stress, by doing things, like 530 00:26:08,800 --> 00:26:12,200 blaming the stress. On themselves and unstable 531 00:26:12,200 --> 00:26:16,600 things that can't be changed as opposed to looking for outside 532 00:26:16,600 --> 00:26:20,100 reasons why this dresser might have happened or recognizing the 533 00:26:20,100 --> 00:26:23,400 stressors come and go that they can be temporary rather than a 534 00:26:23,400 --> 00:26:27,400 stable feature of me. So, if I believe that when I 535 00:26:27,400 --> 00:26:30,100 encounter stressors, it's because something is inherently 536 00:26:30,100 --> 00:26:33,400 bad, about me, it's unavoidable and it's always going to be 537 00:26:33,400 --> 00:26:35,200 around. I'm going to be much more likely 538 00:26:35,200 --> 00:26:38,000 to stay depressed. And if I recognize that 539 00:26:38,000 --> 00:26:41,600 stressors also are, you know can be Things that are temporary 540 00:26:41,600 --> 00:26:45,000 that are outside of me and that can be controlled emotionally. 541 00:26:45,000 --> 00:26:49,300 We often see high levels of sadness and distress but also 542 00:26:49,300 --> 00:26:54,300 low levels of positive emotion. So what seems to happen is that 543 00:26:54,300 --> 00:26:58,000 people are feeling sore, very sad, very hopeless. 544 00:26:58,100 --> 00:27:01,700 But in addition, they can feel just a really difficult time. 545 00:27:01,700 --> 00:27:06,200 Feeling pleasure and enjoy and connection to other people that 546 00:27:06,200 --> 00:27:09,200 really contributes to the difficulties of this disorder 547 00:27:09,800 --> 00:27:13,900 and an Personally, oftentimes people withdraw from others, 548 00:27:14,000 --> 00:27:17,100 they isolate themselves rather than reaching out and connecting 549 00:27:17,100 --> 00:27:19,300 with other people. And that can make it very 550 00:27:19,300 --> 00:27:23,200 difficult for the depression to stop in part because when we're 551 00:27:23,200 --> 00:27:26,800 alone, were more likely to ruminate and we're less likely 552 00:27:26,800 --> 00:27:30,200 to talk to people who can help distract us from what's going 553 00:27:30,200 --> 00:27:32,700 on, can help give us A New Perspective that might be 554 00:27:32,700 --> 00:27:34,900 helpful and help us lift our mood. 555 00:27:35,600 --> 00:27:39,500 So all these universals I think in terms of thinking about how 556 00:27:39,500 --> 00:27:41,700 to address them M. An important. 557 00:27:41,700 --> 00:27:45,500 First step is to recognize that, you know, one stressors occur. 558 00:27:45,600 --> 00:27:49,600 All of us are going to react. What we have some control over 559 00:27:49,600 --> 00:27:54,500 is, how are we going to respond? And so, if we know that we're a 560 00:27:54,500 --> 00:27:57,700 person, who, when we experience a stress or tends to be, you 561 00:27:57,700 --> 00:28:00,000 know, could react really strongly, which is actually very 562 00:28:00,000 --> 00:28:01,400 common. Not just among people with 563 00:28:01,400 --> 00:28:04,800 depression and thinking about hey, what can I do now to deal 564 00:28:04,800 --> 00:28:09,100 productively with this. So talked earlier about active 565 00:28:09,200 --> 00:28:12,400 problem-solving types. Copying what I brought about the 566 00:28:12,400 --> 00:28:15,500 situation is sort of out of my control and it's like, I need to 567 00:28:15,500 --> 00:28:18,200 let go of that. And what part of this can I do 568 00:28:18,200 --> 00:28:21,200 something about? Let me actually make a plan for 569 00:28:21,200 --> 00:28:24,900 how we're going to address this taking, kind of concrete steps, 570 00:28:24,900 --> 00:28:27,900 and having a plan in place to address the things that can be 571 00:28:27,900 --> 00:28:30,800 addressed cognitively. Emotionally interpersonally, 572 00:28:31,100 --> 00:28:34,700 rather than kind of withdrawing and isolating myself and 573 00:28:34,700 --> 00:28:37,500 thinking about all the ways in which things are going wrong. 574 00:28:37,800 --> 00:28:41,000 Can I, can I instead approach? So instead of To avoid. 575 00:28:41,000 --> 00:28:44,900 I'm going to go approach, I'm going to reach out to people who 576 00:28:45,000 --> 00:28:48,400 I trust and who I love who I know will help me get through 577 00:28:48,400 --> 00:28:50,800 the situation. Give me something else to do, 578 00:28:50,800 --> 00:28:53,000 encourage me to try something different. 579 00:28:53,000 --> 00:28:57,200 Can I sir think about activities that I can engage in that are 580 00:28:57,200 --> 00:29:01,400 going to lift my positive emotion and will help me curtail 581 00:29:01,400 --> 00:29:03,500 that negative emotional experience. 582 00:29:04,200 --> 00:29:06,600 It's so interesting. I remember one of the biggest 583 00:29:06,600 --> 00:29:10,000 skills that I utilized initially and DBT was opposite action. 584 00:29:10,300 --> 00:29:13,000 It sounds so counterintuitive because it's like, you're going 585 00:29:13,000 --> 00:29:15,900 to do exactly the opposite of what your emotions are telling 586 00:29:15,900 --> 00:29:20,100 you to do and it's almost it is on Instinct that we listen to 587 00:29:20,100 --> 00:29:23,600 our emotions that we lean into those urges because they're 588 00:29:23,600 --> 00:29:26,100 there to Keep Us Alive. Its evolutionarily something 589 00:29:26,100 --> 00:29:30,100 that's very beneficial. And yet when you have struggled 590 00:29:30,100 --> 00:29:32,900 with depression for a while and that's kind of skewing these 591 00:29:32,900 --> 00:29:36,400 emotional cues and it's not serving you to listen to them. 592 00:29:36,400 --> 00:29:39,600 You have to reteach yourself to not, listen to them. 593 00:29:39,600 --> 00:29:41,900 And then at some point, What you kind of go back to listening to 594 00:29:41,900 --> 00:29:45,200 your emotional cues as they get more balanced, but it can be 595 00:29:45,200 --> 00:29:48,200 very counterintuitive, especially initially, that's 596 00:29:48,200 --> 00:29:50,900 exactly right. And I think, you know, it's very 597 00:29:50,900 --> 00:29:55,500 natural that we want to avoid situations that give us pain, 598 00:29:55,500 --> 00:29:57,400 emotional pain, or physical pain. 599 00:29:57,400 --> 00:29:59,700 It's, you're absolutely right. That, when you've been depressed 600 00:29:59,700 --> 00:30:03,600 for a long time, sometimes those emotions, don't serve us very 601 00:30:03,600 --> 00:30:05,700 well. And we tend to want to avoid 602 00:30:05,700 --> 00:30:08,500 everything including things that are potential sources of 603 00:30:09,200 --> 00:30:12,500 pleasure. And I meant for us and so doing 604 00:30:12,500 --> 00:30:15,700 the opposite sort of encourages us to approach, rather than 605 00:30:15,700 --> 00:30:17,800 avoid in ways that can be very helpful. 606 00:30:18,300 --> 00:30:21,000 Yeah, but you did touch on this little bit of avoidance as 607 00:30:21,000 --> 00:30:24,200 something that can show up a lot with anxiety with OCD. 608 00:30:24,200 --> 00:30:27,600 With other mental illnesses. There is a pretty high level of 609 00:30:27,600 --> 00:30:30,800 comorbidity of depression with other mental disorders. 610 00:30:30,800 --> 00:30:35,700 What are your thoughts there? Is it something that like the is 611 00:30:35,700 --> 00:30:38,400 it like depression is the first thing that causes these other 612 00:30:38,400 --> 00:30:43,500 things to pop up or Do these other stressors and overwhelming 613 00:30:43,500 --> 00:30:46,100 emotions and lead to this feeling of depression. 614 00:30:46,500 --> 00:30:49,100 I think it's probably both, you're absolutely right. 615 00:30:49,100 --> 00:30:52,600 That rates of comorbidity or co-occurrence of depression. 616 00:30:52,600 --> 00:30:57,100 With other mental disorders is very high in teens very often. 617 00:30:57,100 --> 00:31:01,600 The co-occurring conditions are other anxiety disorders they can 618 00:31:01,600 --> 00:31:04,400 be eating disorders substance use disorders. 619 00:31:04,900 --> 00:31:09,100 Sometimes depression is a response or reaction to having 620 00:31:09,100 --> 00:31:13,400 those other conditions. So for example, if I'm really 621 00:31:13,400 --> 00:31:17,000 anxious the depression May almost be like a demoralization 622 00:31:17,000 --> 00:31:20,700 reaction it. So I'm so tired of struggling. 623 00:31:20,700 --> 00:31:23,200 So much life is really really hard. 624 00:31:23,600 --> 00:31:25,900 Other times. Depression can actually 625 00:31:25,900 --> 00:31:27,700 contribute to these other disorders. 626 00:31:27,700 --> 00:31:31,000 So for example if I'm feeling really down and depressed, I 627 00:31:31,000 --> 00:31:34,900 might use substances to try to make me feel better and that can 628 00:31:34,900 --> 00:31:38,300 lead to a substance use problem and then very often, there's 629 00:31:38,300 --> 00:31:41,600 some third Factor that's Rebooting to both the depression 630 00:31:41,600 --> 00:31:44,800 and the other disorders. So if I have a lot of stress, 631 00:31:44,800 --> 00:31:47,900 for example, that might increase depression, as well as anxiety 632 00:31:47,900 --> 00:31:51,600 or substance use disorders. If I tend to engage in kind of 633 00:31:51,600 --> 00:31:55,200 problematic coping strategies that are causing problems for 634 00:31:55,200 --> 00:31:56,800 me. I may I may give rise to 635 00:31:56,800 --> 00:32:00,200 multiple disorders. Yeah, today's episode is brought 636 00:32:00,200 --> 00:32:02,700 to you by to Karis the car. 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So those are my two favorites. 658 00:32:53,900 --> 00:32:55,300 You should definitely check them out. 659 00:32:55,300 --> 00:32:57,900 The link will be in today's show notes and if you would like to 660 00:32:57,900 --> 00:33:01,000 get 20% off your first order you can use codex. 661 00:33:01,000 --> 00:33:05,200 Oh Sadie at checkout again. That is the Codex, Osa D, IE at 662 00:33:05,200 --> 00:33:07,600 checkout, for 20% off your first order. 663 00:33:07,800 --> 00:33:10,600 The last thing I want to touch on which I thought was So 664 00:33:10,600 --> 00:33:13,000 interesting, one of my favorite things we learned this semester 665 00:33:13,000 --> 00:33:16,400 was about the idea of distress disorders and how similar 666 00:33:16,700 --> 00:33:21,900 generalized, anxiety disorder and depression can be because if 667 00:33:21,900 --> 00:33:24,000 I were to think about it, going in blind at be like, well, 668 00:33:24,000 --> 00:33:26,800 they're completely opposite like one is completely dampening. 669 00:33:26,800 --> 00:33:29,700 Your emotional expression in your mood and the other one it's 670 00:33:29,700 --> 00:33:33,200 like heightened arousal and yeah, as you explained, they can 671 00:33:33,200 --> 00:33:36,300 be so similar. And it's almost like how you're 672 00:33:36,300 --> 00:33:39,200 interacting with your environment and causal factors 673 00:33:39,200 --> 00:33:41,200 that can kind of create. Create the difference of how 674 00:33:41,200 --> 00:33:42,600 you're presenting. So, I'd love to hear your 675 00:33:42,600 --> 00:33:46,000 thoughts there about the similarities and the differences 676 00:33:46,000 --> 00:33:48,500 of generalized, anxiety and depression. 677 00:33:49,000 --> 00:33:50,700 Yeah. So this is an area that I study 678 00:33:50,700 --> 00:33:53,900 and I find this so fascinating. So, one of the things we talked 679 00:33:53,900 --> 00:33:56,900 about in class is that actually the genetic research suggests 680 00:33:56,900 --> 00:34:00,100 that genetically generalized anxiety disorder and major 681 00:34:00,100 --> 00:34:02,000 depression are the same disorder. 682 00:34:02,800 --> 00:34:06,000 It's so interesting and we look at the clinical features of 683 00:34:06,000 --> 00:34:07,900 these disorders. They do have a lot of features 684 00:34:07,900 --> 00:34:11,400 in common, right. So both Writers, for example, 685 00:34:11,400 --> 00:34:15,000 have involved difficulties with sleep involve difficulties with 686 00:34:15,000 --> 00:34:17,100 concentration and decision-making, involve 687 00:34:17,100 --> 00:34:19,500 difficulties with mood, especially high levels of 688 00:34:19,500 --> 00:34:22,699 negative, mood negative emotion, but there are some important 689 00:34:22,699 --> 00:34:26,100 differences to in GA day. Of course, we see heightened 690 00:34:26,100 --> 00:34:30,500 levels of worry and anxiety and depression. 691 00:34:30,600 --> 00:34:33,600 These are not Central features although we know that depression 692 00:34:33,600 --> 00:34:36,199 is very heterogeneous and there are many divisions with 693 00:34:36,199 --> 00:34:39,100 depression who actually are quite anxious. 694 00:34:39,199 --> 00:34:43,000 And very Very, very restless have difficulty falling asleep 695 00:34:43,000 --> 00:34:45,800 and so on it has a very kind of anxious depressed mixed 696 00:34:45,800 --> 00:34:49,400 presentation, although worry has traditionally been thought of, 697 00:34:49,400 --> 00:34:52,100 as a feature of anxiety, not depression. 698 00:34:52,400 --> 00:34:56,900 We now know that rumination and depression and worry and gadd 699 00:34:56,900 --> 00:35:00,500 are close cousins. They're not the same exact thing 700 00:35:00,500 --> 00:35:05,000 but they are very, very similar both involve this process of 701 00:35:05,000 --> 00:35:09,400 thinking in an abstract, uncontrollable fashion about 702 00:35:09,400 --> 00:35:12,900 things that Bad about me. And that I for the most part 703 00:35:12,900 --> 00:35:17,200 cannot change. And worry is for future-focused 704 00:35:17,300 --> 00:35:20,500 elimination is or cast focused. But other than that, there's not 705 00:35:20,500 --> 00:35:23,000 too many things that distinguish worry from elimination. 706 00:35:23,400 --> 00:35:25,800 So one of the possibilities, my students and I have been 707 00:35:25,800 --> 00:35:30,300 actually studying is perhaps that tendency to get stuck and - 708 00:35:30,300 --> 00:35:33,900 repetitive patterns of thinking actually is a shared 709 00:35:33,900 --> 00:35:38,600 vulnerability factor for gadd and major depression and there 710 00:35:38,600 --> 00:35:42,500 are active Treatments for depression and anxiety. 711 00:35:43,500 --> 00:35:46,300 Have a lot of shared features, many of the same. 712 00:35:46,300 --> 00:35:50,200 Strategies are helpful in Psychotherapy, for JT and major 713 00:35:50,200 --> 00:35:52,100 depression. And many of the same 714 00:35:52,100 --> 00:35:55,100 pharmacological treatments are effective or GED and major 715 00:35:55,100 --> 00:35:57,600 depression. So they're definitely seem to be 716 00:35:57,600 --> 00:36:02,000 a lot of commonalities there for us to think about there are some 717 00:36:02,000 --> 00:36:05,900 differences between D and m d d. If they're hard to find anxiety 718 00:36:05,900 --> 00:36:10,000 disorders have been described in the literature as disorders. 719 00:36:10,200 --> 00:36:14,700 People are primarily concerned about threat, very sensitive to 720 00:36:14,700 --> 00:36:18,300 detecting potential threats in the environment. 721 00:36:18,400 --> 00:36:21,800 And I don't mean just threats like a spider, you know, a 722 00:36:21,800 --> 00:36:25,100 snake, those Arts of threats, but that's where I perceive. 723 00:36:25,100 --> 00:36:27,600 There's some potential for negative outcome. 724 00:36:27,600 --> 00:36:32,400 For me, in GA D, this tends to take the form of thinking about 725 00:36:32,400 --> 00:36:35,100 all the bad things that could happen to me in the future. 726 00:36:35,100 --> 00:36:37,600 And why I think I'm not going to be able to cope with those bad 727 00:36:37,600 --> 00:36:39,700 things, if they happen to me, right? 728 00:36:40,300 --> 00:36:43,300 And we'd have found some evidence that threat sensitivity 729 00:36:43,300 --> 00:36:47,900 is higher in GA D than in major depression, however, major 730 00:36:47,900 --> 00:36:51,200 depression tends to show higher threat, sensitivity than people 731 00:36:51,200 --> 00:36:53,400 who have no Psychopathology at all. 732 00:36:53,800 --> 00:36:57,000 So it might more of a matter of degree than really a complete 733 00:36:57,000 --> 00:36:58,300 difference. Exactly. 734 00:36:58,800 --> 00:37:02,300 And sort of conversely for major depression, we've been pursuing 735 00:37:02,300 --> 00:37:05,200 the possibility that in depression with distinguishes it 736 00:37:05,200 --> 00:37:08,600 from JD and from other anxiety disorders, is that low positive 737 00:37:08,600 --> 00:37:13,400 emotionality Difficulty finding pleasure and joy in life and 738 00:37:13,400 --> 00:37:16,300 enjoying rewarding experiences when they happen. 739 00:37:17,300 --> 00:37:21,000 And we have found some evidence that yes, reward sensitivity 740 00:37:21,000 --> 00:37:24,200 word responding is lower in depression than in gadd. 741 00:37:24,600 --> 00:37:27,200 But once again, people with deity show lower, reward 742 00:37:27,200 --> 00:37:29,400 responding than healthy individuals who have no 743 00:37:29,400 --> 00:37:34,000 Psychopathology. So again, a matter of degree, so 744 00:37:34,000 --> 00:37:37,000 interesting. And again, going in blind, you 745 00:37:37,000 --> 00:37:38,900 would not pick up on those things like. 746 00:37:38,900 --> 00:37:41,500 I think, the way that we're aware of them as a society, they 747 00:37:41,500 --> 00:37:44,400 seem so different. And yet, when you really do, 748 00:37:44,400 --> 00:37:47,100 look at the presentations and when you look at the the 749 00:37:47,100 --> 00:37:51,200 presentation in compared to a normal presenting person, 750 00:37:52,100 --> 00:37:55,200 they're very similar. And there's a lot of things that 751 00:37:55,200 --> 00:37:58,600 overlap and again, like even from the treatment perspective, 752 00:37:58,600 --> 00:38:01,400 things that are effective on both fronts, which is great if 753 00:38:01,400 --> 00:38:04,100 you are struggling with comorbid depression, Shouldn't and 754 00:38:04,100 --> 00:38:06,100 anxiety. I think, that's right. 755 00:38:06,100 --> 00:38:09,000 And what we know about generalized, anxiety, and major 756 00:38:09,000 --> 00:38:11,900 depression, is that they usually go together. 757 00:38:12,100 --> 00:38:14,600 It's very hard, especially in clinical settings. 758 00:38:14,600 --> 00:38:17,500 It's very hard to find people who have one and not the other. 759 00:38:17,500 --> 00:38:21,100 They often go together and individuals who have both 760 00:38:21,100 --> 00:38:24,200 generally have sort of the most emotional distress. 761 00:38:24,200 --> 00:38:29,700 The most reactive to stress and sometimes over time, their the 762 00:38:29,700 --> 00:38:32,100 individuals who are going to be sort of more have a more chronic 763 00:38:32,100 --> 00:38:34,500 course of illness. So those Are the individual we 764 00:38:34,500 --> 00:38:37,100 see, as where it's, especially important, that they seek help 765 00:38:37,100 --> 00:38:41,100 and learn and use the strategies regularly to manage their 766 00:38:41,100 --> 00:38:43,900 emotions and to cope successfully with stress. 767 00:38:44,100 --> 00:38:47,900 Yeah, if there is one piece of research or literature, or a 768 00:38:47,900 --> 00:38:51,000 statistic that you wish, the general population was more 769 00:38:51,000 --> 00:38:54,300 aware of relating to depression, anxiety, and mental health. 770 00:38:54,300 --> 00:38:59,100 What would it be? I know that's hard one. 771 00:38:59,100 --> 00:39:03,800 So I think that I don't know if this is a statistic for say, 772 00:39:03,800 --> 00:39:05,700 maybe I'll give you two things if it's okay. 773 00:39:05,800 --> 00:39:08,600 Yeah, so one thing that we talked about in class a semester 774 00:39:08,600 --> 00:39:11,500 and for me, is sort of the most blunt mind-blowing statistic 775 00:39:11,500 --> 00:39:15,900 about mental illness is a. Most of us will develop a mental 776 00:39:15,900 --> 00:39:18,100 disorder at some time in our lives. 777 00:39:18,500 --> 00:39:22,100 So general population, surveys in the US have shown that 778 00:39:22,100 --> 00:39:27,100 approximately half of the adult population, the us will have a 779 00:39:27,107 --> 00:39:28,900 mental disorder at some time in their life. 780 00:39:28,900 --> 00:39:32,600 That's probably an under estimate because that number it 781 00:39:32,600 --> 00:39:36,500 comes from studies of people who are living out in the community. 782 00:39:36,700 --> 00:39:40,800 And we know that people who are let's say in institutions for 783 00:39:40,800 --> 00:39:44,300 example in prisons or an inpatient hospitals or people 784 00:39:44,300 --> 00:39:47,900 who've died prematurely due to Suicide or accidents have an 785 00:39:47,900 --> 00:39:51,300 elevated rate of Psychopathology relative to others in the 786 00:39:51,300 --> 00:39:54,900 population and it's also the case that when we ask people, 787 00:39:54,900 --> 00:39:59,100 have you Your life experience, dot dot dot, sometimes people 788 00:39:59,100 --> 00:40:01,200 forget. And they are, they any proper 789 00:40:01,200 --> 00:40:04,500 stigma in our society, right? Under that, people would under 790 00:40:04,500 --> 00:40:06,700 report and that's the other thing that people may be 791 00:40:06,700 --> 00:40:09,400 reluctant to report. Especially since these surveys 792 00:40:09,400 --> 00:40:12,500 are usually done with lay interviewers, who are strangers. 793 00:40:12,500 --> 00:40:15,300 And these are sensitive things to talk about, especially with 794 00:40:15,300 --> 00:40:17,400 some stranger, who's come to your right? 795 00:40:17,900 --> 00:40:20,900 And so when people are followed forward, in time, we actually 796 00:40:20,900 --> 00:40:24,600 see rates as high as 70 or even 80 percent of people, will 797 00:40:24,600 --> 00:40:26,400 eventually develop A mental disorder. 798 00:40:27,000 --> 00:40:30,000 Now, that's really important and hopeful in a way because it 799 00:40:30,000 --> 00:40:34,400 tells us that it need not be stigmatized to have a mental 800 00:40:34,400 --> 00:40:36,900 disorder. In fact, the more rare and 801 00:40:36,900 --> 00:40:40,300 unusual situation is the person who reaches, you know, the age 802 00:40:40,300 --> 00:40:42,700 of 80 or 90 having never had a mental disorder. 803 00:40:42,700 --> 00:40:44,800 I think we have a lot to learn from those individuals. 804 00:40:44,800 --> 00:40:48,600 Like, are you okay? I know exactly how did you do 805 00:40:48,600 --> 00:40:57,500 that? That normalizes at some point in 806 00:40:57,500 --> 00:40:59,900 our lives, for going to go through rough patch. 807 00:40:59,900 --> 00:41:03,000 The might be really rough for some individuals, there will be 808 00:41:03,000 --> 00:41:05,100 recurrent problems or chronic problems. 809 00:41:05,100 --> 00:41:09,300 And for others, the problem will be resolved and not recur. 810 00:41:09,500 --> 00:41:12,400 So I think it's just important to recognize that mental illness 811 00:41:12,400 --> 00:41:15,900 is all around us and one form or another and that having 812 00:41:15,900 --> 00:41:18,600 experienced this, we're not alone, we're actually in the 813 00:41:18,600 --> 00:41:20,600 majority. So that's that's really 814 00:41:20,600 --> 00:41:22,900 important to note. And then I'll pair that with the 815 00:41:22,900 --> 00:41:25,300 second observation I want to share, which is that. 816 00:41:25,400 --> 00:41:28,700 Effective treatments exist. We have some really effective 817 00:41:28,700 --> 00:41:32,200 treatments out there and the real heartbreak for me, is that 818 00:41:32,200 --> 00:41:35,900 so many people who struggle and suffer don't know about these 819 00:41:35,900 --> 00:41:38,100 treatments or don't have access to be treatments. 820 00:41:38,500 --> 00:41:40,800 So I think if you're a person who is struggling with 821 00:41:40,800 --> 00:41:43,300 depression with anxiety because I know that's the focus of 822 00:41:43,300 --> 00:41:46,900 today's conversation, we have effective treatments, you know, 823 00:41:46,900 --> 00:41:50,600 it's so important to get help because those treatments can be 824 00:41:50,600 --> 00:41:55,000 extremely helpful and given that these are problems that can 825 00:41:55,000 --> 00:41:59,500 persist To become chronic or recurrent over time the earlier, 826 00:41:59,500 --> 00:42:02,900 you seek help the better because learning those skills will help 827 00:42:02,900 --> 00:42:04,900 you. Not only deal with the current 828 00:42:04,900 --> 00:42:08,200 episode of depression but prevent future episodes from 829 00:42:08,200 --> 00:42:10,300 happening in your life. I love that. 830 00:42:10,300 --> 00:42:13,300 I think that's the perfect note to end on and it's relevant to 831 00:42:13,300 --> 00:42:16,400 anyone and everyone whether you yourself have struggled in the 832 00:42:16,400 --> 00:42:19,100 past currently struggling, May struggle in the future are 833 00:42:19,100 --> 00:42:21,200 trying to support, someone who is struggling. 834 00:42:21,500 --> 00:42:23,600 It really. Is something that is universally 835 00:42:23,600 --> 00:42:27,600 important to know and be aware of Of and it just, it really 836 00:42:27,600 --> 00:42:30,300 just makes me wonder again how we have so much stigma. 837 00:42:30,300 --> 00:42:33,800 When again, the majority of us do struggle or will struggle at 838 00:42:33,800 --> 00:42:36,500 some point. Yeah, I think that so often we 839 00:42:36,500 --> 00:42:39,500 don't talk about these things because we feel like we're 840 00:42:39,500 --> 00:42:43,200 alone, we feel ashamed. And I think if we open up the 841 00:42:43,200 --> 00:42:46,400 dialogue and are open with one another about this, both 842 00:42:46,400 --> 00:42:48,900 discover that, in fact, many other people are dealing with 843 00:42:48,900 --> 00:42:51,300 very similar things. Yeah, yeah. 844 00:42:51,300 --> 00:42:53,300 Well, thank you so much for joining me today. 845 00:42:53,300 --> 00:42:55,300 I'm so glad we got to do this me. 846 00:42:55,400 --> 00:42:57,100 Me to thank you so much for inviting me. 847 00:42:57,100 --> 00:42:59,300 It's been such a pleasure Sadie, of course. 848 00:42:59,300 --> 00:43:01,900 Thank you so much for listening to this week's episode of she 849 00:43:01,900 --> 00:43:03,800 persisted. If you enjoyed make sure to 850 00:43:03,800 --> 00:43:05,300 share with a friend or family member. 851 00:43:05,300 --> 00:43:08,600 It really helps out the podcast and if you haven't already leave 852 00:43:08,600 --> 00:43:12,000 a review on Apple podcast or Spotify you can also make sure 853 00:43:12,000 --> 00:43:14,800 to follow along at at she persisted podcast on both 854 00:43:14,800 --> 00:43:17,500 Instagram and Tick-Tock and check out all the bonus 855 00:43:17,500 --> 00:43:20,500 resources content and information on my website. 856 00:43:20,500 --> 00:43:23,800 She persisted podcast.com, thanks for supporting, keep 857 00:43:23,800 --> 00:43:25,200 persisting and I'll see you next. 858 00:43:25,400 --> 00:43:25,800 Week.