Speaker 1: This is the Anxiety Bites podcast and I am your host,
Speaker 1: Jen Kirkman. Welcome to another episode of Anxiety Bites. I'm
Speaker 1: your host, Jen Kirkman. I'm so excited about our guest today,
Speaker 1: Dr Nina Vawson. She is so brilliant and so enthusiastic
Speaker 1: and so kind and it was just wonderful talking to her.
Speaker 1: And she addresses things that we haven't really talked about
Speaker 1: on the podcast before, which is what does the future
Speaker 1: brain for treatment of anxiety and other mental health issues?
Speaker 1: Where where are we falling short and and where are
Speaker 1: the spaces that need to be filled? And what I
Speaker 1: love about my conversation with Dr Boston is there are
Speaker 1: so many solutions that she gives and the science to
Speaker 1: back it up. And y'all are going to get something
Speaker 1: for free. So don't you fast forward this little intro.
Speaker 1: I'm gonna give it to you right now and we'll
Speaker 1: get into you'll hear in the episode more about what
Speaker 1: it is that Dr Vosson works on. But she is
Speaker 1: the chief medical officer of a company called Real And again,
Speaker 1: you're about to get something free, so keep listening. It's
Speaker 1: a mental health care company that's building a new therapy model.
Speaker 1: Through a monthly membership, Real provides care to members that
Speaker 1: they're able to access anonymously on their own terms, at
Speaker 1: a price that is more affordable than other therapeutic approaches.
Speaker 1: Through modernized therapist designed programs, they're improving the quality of
Speaker 1: mental health care and making it accessible to more people,
Speaker 1: especially the nearly of people that are left out of
Speaker 1: the current traditional one to one therapy systems. So right
Speaker 1: now there is a code you will get a free
Speaker 1: month of membership on a monthly membership offering valid through
Speaker 1: May thirty one. Okay, so you've got a month. The
Speaker 1: steps to redeem it are go to join dash real
Speaker 1: dot com. Select Join Now at the top, select the
Speaker 1: monthly option, and proceed to their member info at the paywall,
Speaker 1: where it asks you to input your credit card. There
Speaker 1: will be a selection for a coupon code promo and
Speaker 1: you will enter anxiety bites. Click and complete, and now
Speaker 1: you have one month of a free monthly membership to
Speaker 1: Reel and you can download the app to continue member
Speaker 1: on boarding and ultimately picking a pathway to get started.
Speaker 1: And so you may ask, well, what is this real?
Speaker 1: What are you talking about? You'll see when you go
Speaker 1: to the website. But basically what Dr Vasson does she
Speaker 1: leads something at Stanford University called brain Storm and it's
Speaker 1: a lab. So the Stanford Lab for Mental Health Innovation
Speaker 1: otherwise known as Brainstorm, focuses on trying to solve the
Speaker 1: mental health crisis through entrepreneurship. Right, So basically, there's a
Speaker 1: really depressing statistic that over the course of a lifetime,
Speaker 1: fifty of Americans will have a diagnosable mental health disorder. However,
Speaker 1: if we optimized all the therapists in the United States,
Speaker 1: we'd only have enough therapists to treat seven percent of
Speaker 1: the American population. Again, despite the fact that of Americans
Speaker 1: will have a diagnosable mental health disorder. So sometimes people
Speaker 1: need solutions. And what Nina's student, one of her students
Speaker 1: from her Brainstorm lab did was that that that's what
Speaker 1: they do with the the Stanford Brainstorm Lab is they
Speaker 1: come up with ways that young people can become entrepreneurs
Speaker 1: in ways that help people with mental health. So one
Speaker 1: of her or students is now the CEO and founder
Speaker 1: of Real which is one solution to mental health. And
Speaker 1: what Dr Voston works on with a lot of online
Speaker 1: companies like Pinterest, or TikTok is something known as micro therapeutics,
Speaker 1: which is a tool kit of exercises that are based
Speaker 1: in cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment
Speaker 1: therapy translated into two or three minute things that you
Speaker 1: can do online for free and actually feel better in
Speaker 1: just a few minutes. It's it's a compassionate experience. That
Speaker 1: is the opposite of when you log onto a website
Speaker 1: and something pops up and tries to sell you something,
Speaker 1: or you see a negative comment. It's literally the opposite.
Speaker 1: It's it's information that kind of just comes to you
Speaker 1: and it gives you things you can do right in
Speaker 1: that moment. Because, as I learned from Dr Boston, the
Speaker 1: average person who suddenly feels a symptom of anxiety or
Speaker 1: any kind of mental health issue, it takes up for
Speaker 1: some eleven years before they decide to set foot into
Speaker 1: a therapist office. So imagine, you know, and that was
Speaker 1: my story as well as Dr boston stories. It took
Speaker 1: almost a decade to go get help. And so imagine
Speaker 1: if in that time, uh that you know, imagine if
Speaker 1: in those ten years you have little tools along the
Speaker 1: way to help you in the moment with your symptoms.
Speaker 1: It would certainly alleviate all of the things we do
Speaker 1: that are you know, not great choices to alleviate our anxiety,
Speaker 1: right over, eating drugs, alcohol, maybe even just you know,
Speaker 1: taking our anger out on other people, sleeping all day whatever.
Speaker 1: It is just maladaptive behaviors that you know, we do
Speaker 1: because we're self soothing, we're self medicating. We don't know
Speaker 1: how to fix this, and you know, imagine doing things
Speaker 1: that help here and there on the way to your
Speaker 1: journey to finally walk in the door of a therapist office.
Speaker 1: And so I just found this conversation today so fascinating.
Speaker 1: I learned so much that although it seems like everybody
Speaker 1: is having mental health issues and it seems overwhelming, how
Speaker 1: are we going to get everyone this help? It is possible.
Speaker 1: And I love the idea that people are going to
Speaker 1: college and learning about ways to become an entrepreneur, not
Speaker 1: so they can sell us more lotions and and leggings,
Speaker 1: but so that they can find a way that that
Speaker 1: mental health solutions can be integrated into our you know,
Speaker 1: we're already online life. So again I hope you will
Speaker 1: sign up for the free offer for a month of
Speaker 1: real and again all of that will be in the
Speaker 1: show notes, so you can just click there and get
Speaker 1: on it. So again, today I talked to Dr Boston
Speaker 1: about the fact that she is someone that had anxiety
Speaker 1: and still has anxiety and depression as she still is this,
Speaker 1: you know, brilliant doctor. It happens to the best of us.
Speaker 1: And we talked a little bit about, you know, our
Speaker 1: COVID habits and what she's doing to make changes. She
Speaker 1: explains the biopsycho social model that is how we diagnose
Speaker 1: and treat anxiety, and she just has a lot of
Speaker 1: great facts about what actually helps alleviate our anxiety. And
Speaker 1: again there's no magic pill, and you're going to hear
Speaker 1: a lot of the same things that you've heard in
Speaker 1: other episodes about mindfulness and sleep and exercises because that
Speaker 1: stuff works. But what I love the Dr of Boston
Speaker 1: does she will actually write things like that on a
Speaker 1: prescription ban. Anyway, let me just let me just start
Speaker 1: the episode. You don't need to hear me describe what
Speaker 1: we talked about. Let's just go there now. Well, let
Speaker 1: me let me of course brief you on again who
Speaker 1: I'm chatting with. Dr Nina Vasston is the chief medical
Speaker 1: officer of Real, a mental health care company building a
Speaker 1: new therapy model. Outside of her work at Real, she
Speaker 1: is a psychiatrist and professor at Stanford, where she is
Speaker 1: the founder and executive director of Brainstorm, the Stanford Lab
Speaker 1: for Mental Health Innovation. She has served as a healthcare
Speaker 1: advisor to the United Nations, the World Health Organization, and
Speaker 1: the Obama and Biden presidential campaigns. Dr Vasson earned an
Speaker 1: a b in Government from Harvard College, graduating as one
Speaker 1: of Glamor magazine's top ten college women, m D from
Speaker 1: Harvard Medical School, NBA from Stanford Graduate School of Business,
Speaker 1: and completed psychiatry residency at the Stanford School of Medicine,
Speaker 1: where she was Chief Resident. Oh my god, Uh, I mean,
Speaker 1: I think she's pretty qualified to tell us what to do. Me.
Speaker 1: On the other hand, I got a Bachelor of Arts
Speaker 1: in modern dance. So so don't take don't take my
Speaker 1: word on anything. Just just let's just listen to Dr Boston. Okay,
Speaker 1: Dr Vosson, thank you for doing the show. And you know,
Speaker 1: everyone just heard in the intro your credentials and how
Speaker 1: um acclaimed and brilliant you are. But you're still a
Speaker 1: human and I would love to hear your experience with
Speaker 1: anxiety past and present. You know, how did it manifest
Speaker 1: in your life, how did you cope? What what does
Speaker 1: it look like on the day to day Now, First
Speaker 1: of all, thank you Jeds so much for having me
Speaker 1: and and let me take a step back, thank you
Speaker 1: for having this podcast. Thank you for talking about mental
Speaker 1: help with so many people. It's incredibly you know, important,
Speaker 1: and I just really appreciate the platform that that you
Speaker 1: created here. Oh thanks, It is the joy of my life.
Speaker 1: I could do this all day. So it's really easy
Speaker 1: to do because I love it. I love that. I
Speaker 1: absolutely love that. And to answer your question, so actually
Speaker 1: on my LinkedIn, the very first thing that I share
Speaker 1: before any credential, before any title, is UM, that is
Speaker 1: my now twenty plus history with both anxiety and depression,
Speaker 1: and going back, I think starting in as a teenage Jeer,
Speaker 1: I had pretty bad social anxiety as well as general anxiety,
Speaker 1: both kind of emotional and physical manifestations of that. And
Speaker 1: just to give you some examples, UM, I was a
Speaker 1: math nerd in your growing up and one of the
Speaker 1: things I remember is before any math competition, I would
Speaker 1: get like nausea, upset stomach, have to go to the
Speaker 1: bathroom multiple times in the morning. We we go to
Speaker 1: like other other schools and like I go to their
Speaker 1: their bathrooms like for like twenty minutes before the competitions
Speaker 1: would start. Had no idea what that meant. Oh, it
Speaker 1: took like ten years to finally figure out we know
Speaker 1: why that was always happening and that this was a pattern.
Speaker 1: And you know, sweaty palms, those were sort of the
Speaker 1: physical manifestations I would get pretty regularly before before things
Speaker 1: like that have stake sorts of things in particular. And
Speaker 1: then in terms of social anxiety, you know, getting really
Speaker 1: really nervous before but before kind of any type of
Speaker 1: social event. But moreover, you know, worrying that people were
Speaker 1: judging me and um anything that I would say, uh,
Speaker 1: be thinking so much about how are people going to
Speaker 1: you know, perceive what what that is that I'm saying.
Speaker 1: And uh so that that was one of the second thing.
Speaker 1: And I think, you know, as a teenager, of both
Speaker 1: were the things that definitely manifested. As time has gone on. Um, luckily,
Speaker 1: I think that both of those have certainly gotten better. However,
Speaker 1: I do still struggle with anxiety today, um, you know,
Speaker 1: twenty years later, and I think different manifestations of it. Um.
Speaker 1: It shows up in certainly in various forms. And one
Speaker 1: of the these I think is really important to understand
Speaker 1: about anxiety is that one is on a spectrum, you know,
Speaker 1: from zero to a hundred, if you will, and throughout
Speaker 1: our lifetimes that that will change. And even in what
Speaker 1: I'm standing, like, the flavor of anxiety can change for
Speaker 1: someone and as different you know, life stressors come and go, Um,
Speaker 1: things get better and worse and so um. You know.
Speaker 1: For me, I think that I've been in treatment now
Speaker 1: for I guess probably about ten years, um, meaning both
Speaker 1: both medications and various forms of therapy, as well as
Speaker 1: some of the things I hope we talked up today,
Speaker 1: um you know, doing things like um, gratitude, mindfulness, journaling, exercise,
Speaker 1: so many, so many of the kind of things that
Speaker 1: we talked about now is lifestyle and wellness and well being,
Speaker 1: and um, they've all you know, I would say that
Speaker 1: every kind of every type of treatment out there has
Speaker 1: definitely helped me a little in different ways. Um. And
Speaker 1: but but nothing also has been like a quick fix
Speaker 1: or a cure. Uh. Yeah, that one one more thing
Speaker 1: I'll share about that is that UM, I think most recently,
Speaker 1: certainly I I didn't even, I think, appreciate the extent
Speaker 1: of my anxiety until COVID started. And I think a
Speaker 1: lot of people have had similar experiences where maybe their
Speaker 1: anxiety was kind of under the radar, and then with
Speaker 1: COVID they like you know, became an overwhelming thing or
Speaker 1: have been something that they dealt with for a long time,
Speaker 1: it reached absolute new heights where for some people that
Speaker 1: was crippling. They's hard to have panic attacks. UM. For me,
Speaker 1: I think what I realized was one, uh, really a
Speaker 1: lack of self care. This is very very common that doctors,
Speaker 1: while we tell our patients to do all these things
Speaker 1: for them so for them, we do not do it ourselves.
Speaker 1: And that was something that was really big for me.
Speaker 1: But in the in the context of that, UM, really
Speaker 1: I think having when I was anxious, UM, for me,
Speaker 1: what that meant was often turning to food UM and
Speaker 1: and at times also also like having a couple of
Speaker 1: extra glasses of wine, you know. And I think that
Speaker 1: both of those kind of overeating over drinking are things
Speaker 1: that are you know, very very common sort of self
Speaker 1: you know self medicating if you will, for anxiety and
Speaker 1: and so those are things I actually stopped drinking UM
Speaker 1: and I'm now I'm actually right now learning how to
Speaker 1: deal with my anxiety and triggers. I said, I'm not
Speaker 1: having that extra cookie or you know, calling pizza delivery
Speaker 1: at ten pm. UM. But it's something I've stopping with
Speaker 1: real for a long time. And I think now what
Speaker 1: I realize is it's tart. I'm trying to accept it,
Speaker 1: realize I will struggle with it and that's okay, And
Speaker 1: let me get the right tools so that I can,
Speaker 1: um make things a little bit better on a daily basis.
Speaker 1: And just relating to that really quick, just so people
Speaker 1: can hear how anxiety is so sneaky. Um. I've had
Speaker 1: generalized anxiety order panic disorder undiagnosed since I was probably eight,
Speaker 1: diagnosed at age forty seven now, and it moves around,
Speaker 1: it changes. I feel like some things are completely mastered.
Speaker 1: And so what was interesting is because I had such
Speaker 1: a good handle on anxious feelings, panic attack symptoms and
Speaker 1: even rumination, I didn't suffer that in the pandemic. However,
Speaker 1: I did start. Oh, I'll just have a couple of
Speaker 1: drinks every night. Oh, I'll just order food at ten
Speaker 1: at night when I should just go to bed. But
Speaker 1: I wasn't feeling anything I could identify. I didn't feel nerves,
Speaker 1: I didn't feel the onset of panic. I didn't even
Speaker 1: feel sadness. I felt nothing. And now I know that
Speaker 1: all those coping mechanisms were anxiety. And what it doesn't
Speaker 1: actually frighten me. I'm just being verbose. But what is
Speaker 1: interesting to note is that unlike all beings IDEA had
Speaker 1: in my life, and I thought I was handling the
Speaker 1: pandemic so well because I wasn't panicking, is oh, I
Speaker 1: didn't even know how to identify it. It was so
Speaker 1: it didn't have any symptoms. Honestly, I just had the
Speaker 1: the the bad solutions, you know. And I think that's
Speaker 1: a little frightening. I guess it is frightening. It is.
Speaker 1: You're absolutely right. It is frightening because especially when we're
Speaker 1: aware of certain things, and we can tell our emotions
Speaker 1: have changed, you know, and we know what to look
Speaker 1: for when that goes away, and there's nothing that you
Speaker 1: can sense is very frightening. And in this case, I
Speaker 1: think what you saw was a change in your behavior
Speaker 1: but it was difficult to associate that behavior with anxiety
Speaker 1: because those same triggers that you had before weren't coming up, right. Um,
Speaker 1: And so I think that exactly what you dealt with,
Speaker 1: Jen is what I mean meant, like, you know, millions
Speaker 1: of people in our country and and certainly around the
Speaker 1: world experienced over the last few years with you know,
Speaker 1: and we saw that we saw like you know, weight
Speaker 1: gain increased, the amount of substances that people have been
Speaker 1: consuming has increased. And so these are very very common
Speaker 1: and the easiest accessible things that we know. That kind
Speaker 1: of sued us, right and so, um incredibly incredibly common.
Speaker 1: And I think that um, as we move forward, the
Speaker 1: more we can become aware of what are these things
Speaker 1: that we do and how do we cope? Um, that
Speaker 1: that will that benefit all of us because exactly like
Speaker 1: you said, it's like, oh, I didn't realize that's what
Speaker 1: it was. This question just came to me. It maybe
Speaker 1: less of a question than a comment. It's so hard
Speaker 1: because being a teenager, our hormones are going crazy, We're
Speaker 1: experiencing so many things for the first time. We don't
Speaker 1: have any life experience to draw, and of course we're
Speaker 1: going to have anxiety, So it's really hard to tell
Speaker 1: what's situational, you know what I'm a teenager and what's Oh,
Speaker 1: I might have an anxiety disorder and this will probably
Speaker 1: continue into my twenties and thirties. Do you think it's
Speaker 1: more of the way like sort of what the teen
Speaker 1: mager does to cope is what causes it to become
Speaker 1: an anxiety disorder or not? One. I think that's a
Speaker 1: great it's a great question one because it's like, how
Speaker 1: do we know for ourselves what's normal and what's not?
Speaker 1: And you know, I speak around around the country to
Speaker 1: big groups of people, especially now a lot of employers,
Speaker 1: will you know, we'll talk to large companies everything, And actually,
Speaker 1: one of the most common questions I get, jen is
Speaker 1: is kind of I think one of the things you're
Speaker 1: referred to is how do I know if this is
Speaker 1: normal or something that's actually a disorder? Wherein any to
Speaker 1: seek help? And so I think, even as a teenager,
Speaker 1: one big important way to distinguish that is how much
Speaker 1: does it affect in your life? In the sense that
Speaker 1: if we think about anxiety, is it you know, I
Speaker 1: get a little nervous before the s A T S
Speaker 1: or but you know, Oh there's a cute guy, and
Speaker 1: my palms get sweaty, you know, as he's trying to
Speaker 1: talk to me. That's what happens to me. But but um,
Speaker 1: you know, I think thinking about that versus I'm so
Speaker 1: anxious that I'm only sleeping three hours at night or
Speaker 1: you know, I I my grades dropped. You know, I
Speaker 1: used to be as straight a student and now I'm
Speaker 1: getting sees because I can't focus right, that type of
Speaker 1: a change where you're not taking care of yourself, like
Speaker 1: the goals you have in life for yourself, for sports,
Speaker 1: for relationships, for school, like those are all changing. That's
Speaker 1: I think the best way to see are you able
Speaker 1: to cope and live the life you want to or
Speaker 1: is this issue getting in the way. Um. So that's
Speaker 1: the first part of that. The second part what I'm
Speaker 1: hearing you is saying is like, how do we know what?
Speaker 1: You know? Why really is anxiety? Why does anxiety occur?
Speaker 1: And what are the things that happen in childhood that
Speaker 1: can lead to it being a bigger issue as an
Speaker 1: adult versus not? And what that I think it's ays
Speaker 1: to is the biopsychosocial model of e mentally list in
Speaker 1: particular of anxiety. UM, I'll pause, There is that something
Speaker 1: we should talk about? Yeah, biopsychosocial on my list. Well,
Speaker 1: let's go there now, and then I want to get
Speaker 1: into your um, you know, your academic laboratory and you're
Speaker 1: you know, concept of technology and entrepreneurship. But but let's
Speaker 1: get into biopsychosocial. So that's a new thing I'm hearing,
Speaker 1: and I know the concept is not new, But UM,
Speaker 1: I've heard you saying a lot in my research, and
Speaker 1: I would love for you to explain what do you
Speaker 1: mean when you say that? And how does that? How
Speaker 1: does how does that help you help people? Absolutely, So
Speaker 1: when we say biopsychosocial, what that refers to is the
Speaker 1: way that we think about why any mental health condition,
Speaker 1: whether that's anxiety, depression, trauma, obsessive compulsive disorder, why it occurs,
Speaker 1: why it manifest in the first place, as well as
Speaker 1: then actually it gives us a framework for how to
Speaker 1: then treat deep these conditions. So let me explain what
Speaker 1: that means. So when we say biopsychosocial, what that means
Speaker 1: is that the reason anxiety occurs is actually this combination
Speaker 1: of biological, psychological, and social factors. Biologically, that means like
Speaker 1: things like our genetics, right, like if mom or dad
Speaker 1: was anxious, there's a much higher likelihood that you're going
Speaker 1: to be anxious because this stuff gets passed on in
Speaker 1: the d n A. From the psychological perspective, that means
Speaker 1: how do you talk to yourself and cope with stressors
Speaker 1: and um that you know what, what's what's your dialogue
Speaker 1: with yourself? That's the kind of psychological what's your resilience
Speaker 1: like a component? I think the social component is actually
Speaker 1: one of the most fascinating. And when we say social,
Speaker 1: that's a mix of I would say two big things.
Speaker 1: One is historical, meaning what was your childhood like? You know,
Speaker 1: if we think about, for example, now all the kids
Speaker 1: who grew up throughout COVID, this will be a part
Speaker 1: of their life for you know, for their entire life,
Speaker 1: and how will that manifest as you know, as things continue?
Speaker 1: And so did you grow up in a household that
Speaker 1: was very supportive, encouraging, did you grow up, you know,
Speaker 1: in the midst of war, or have immense trauma where
Speaker 1: you bullied as a child. All those very much significantly
Speaker 1: lead to what anxiety can look like, not only as
Speaker 1: a child but also as an adult. And then secondly
Speaker 1: we have environment. And so I think the biggest way
Speaker 1: to think about the environment just let's think about the
Speaker 1: last two years and how everyone's life has changed, and
Speaker 1: where the environment that we're living in because of all
Speaker 1: these literally like you know, changes to what our home
Speaker 1: looks like, what work looks like, what our relationships look like,
Speaker 1: all of that, uh increases what you know, in this case,
Speaker 1: it increases anxiety. Um And so all of those together
Speaker 1: actually help us conceptualize why anxiety occurs. Now, what last
Speaker 1: thing will add about that, I think that's really important
Speaker 1: and makes is also what I think in a lot
Speaker 1: of ways, what makes mental health fascinating and frustrating, maybe
Speaker 1: compared to some other areas of medicine, is that in
Speaker 1: other areas of medicine, we have a blood test or
Speaker 1: you know, you can get an X ray or m
Speaker 1: r I and you can really see exactly what they are,
Speaker 1: or like you have the number telling you what level
Speaker 1: things are in terms of figuring out the severity of disease.
Speaker 1: The issue with mental health is that, um, one, you know,
Speaker 1: we don't have that, but moreover, we don't really know
Speaker 1: right now, how like what percentage of my anxiety versus
Speaker 1: your anxiety is biological versus psychological versus social. We can
Speaker 1: get a full history and kind of make some guesses like, oh,
Speaker 1: you know, my mom also has anxiety, so that certainly
Speaker 1: means it's probably and my brother has anxieties. There's probably
Speaker 1: a family component. How big is that, We're not quite sure.
Speaker 1: Hopefully in the future will start to have more information
Speaker 1: to get this, but right now we don't. UM. So
Speaker 1: I think really what we should take from this is recognizing,
Speaker 1: you know, it's not the kind of old school ways
Speaker 1: that people thought about why someone has mental illness. Nothing
Speaker 1: that was your fault. It's nothing that like quote someone did. Um.
Speaker 1: It is a very real biological part. But and and
Speaker 1: also medical station car environment. My listeners have part of
Speaker 1: me say this a million times. But the first time
Speaker 1: I went to get medication for depression was you know,
Speaker 1: early twenties. I don't believe I suffered from depression too
Speaker 1: much anymore, but the doctor, you know, was very kind
Speaker 1: and normalized it in fifteen minutes just by looking at me.
Speaker 1: Explained that I had a chemical imbalance. And I was
Speaker 1: so confused because I literally thought I was going to
Speaker 1: get a blood test or have electrodes put in my head,
Speaker 1: and I just didn't understand, Like, how can you say
Speaker 1: chemical but you didn't do anything, you know, And so
Speaker 1: I'm learning now that that's kind of like, uh, it's
Speaker 1: not a myth per se, because I know that chemicals
Speaker 1: are involved, but it would you say that it was
Speaker 1: just sort of like they named it badly. I think, yes,
Speaker 1: it's that bad marketing is what I would say that
Speaker 1: that and what that is is so you know, at
Speaker 1: the biological level, what we know is that, for example,
Speaker 1: with anxiety and depression, the level of the neurotransmitters things
Speaker 1: like sarah tonin dopamine uh nor an efferent the levels
Speaker 1: that we have in our brain are different. And so
Speaker 1: you and I who have anxiety, who who you know
Speaker 1: have also done with depression, we have different levels compared
Speaker 1: to someone who doesn't. And moreover, the medications for example
Speaker 1: ssr I selective serotonin re uptake inhibitors, medications like UM,
Speaker 1: sertraline of lu ox of tine, pro pro prosagne, medications
Speaker 1: like that UM. What they do is they block the
Speaker 1: debt the breakdown of the serotonin, so that leads to
Speaker 1: an increase of serotonin in our brain. Um, and that's
Speaker 1: what's trying to do because maybe you and I either
Speaker 1: make less or we break it down quicker. And so
Speaker 1: the point of the medication is to increase the amount
Speaker 1: of that in our body. So technically, yes, at that
Speaker 1: level there is a quote chemical imbalance, but I completely agree,
Speaker 1: like it's not the right way to talk about it
Speaker 1: or think about it, and um, there there's a much
Speaker 1: more kind of maybe eloquent or or kind and really
Speaker 1: educational way to explain that so people don't feel like
Speaker 1: I have wrong chemicals in my body or grain. You know.
Speaker 1: I had a psychiatrist used to say, we're gonna have
Speaker 1: to play scientists, and I found out for me, I
Speaker 1: do better with the UM drugs that are less the
Speaker 1: serotonin reuptake inhibitors, but better with the dopamine increasing you know,
Speaker 1: UM SMRI s. I think they're called right, Yeah, that's
Speaker 1: that's exactly right. And I yeah, and and um, I
Speaker 1: think that that's that's also something that I think can
Speaker 1: be frustrating. And I say that it's because I think
Speaker 1: that one something that's been important to me is actually
Speaker 1: trying to educate folks so much about these medications, and
Speaker 1: you know, one thing that happens is for a lot
Speaker 1: of people, the first medication might not be the right medication,
Speaker 1: and it is a little bit of trial and error.
Speaker 1: And I can imagine going to a doctorate and being like,
Speaker 1: we're going to experiment what but but the reality is
Speaker 1: that you know that not only actually is the case
Speaker 1: for psychiatric medications, for a lot of other medications. It
Speaker 1: is the same thing. We are not sure I like
Speaker 1: allergy medication, which allergy medication is going to work really
Speaker 1: well for you. We're not exactly sure from the get go.
Speaker 1: But that's why oftentimes we have to try a few
Speaker 1: and it is important to you know, work with your
Speaker 1: doctor to to see what's working, what's not working when
Speaker 1: other side effects so bad that they outweigh the positive effects.
Speaker 1: And one thing that's really hard about these medications is
Speaker 1: that you feel the negative side effects before you feel
Speaker 1: the positive um and that makes it really frustrating at times.
Speaker 1: But it is really important to give it a try
Speaker 1: because you know, I certainly seem both for myself as
Speaker 1: a patient as well as for you know, hundreds of
Speaker 1: of my own patients, how medication can just give people's
Speaker 1: lives back to them. We'll be right back. So the
Speaker 1: biopsychosocial Am I wrong in saying that? It sounds like
Speaker 1: the social aspect is sort of a newer discovery, or
Speaker 1: maybe not a newer discovery, but a newer has more gravitas,
Speaker 1: like people are taking it more seriously. I think that's
Speaker 1: absolutely right. People are now taking it more seriously and
Speaker 1: recognizing just how much and how complex it is. For example,
Speaker 1: only now I think we're recognizing how like early childhood
Speaker 1: traumas or as I said, you know, things like bullying
Speaker 1: can make a tremendous impact later on down the line
Speaker 1: in ways that we really didn't appreciate before. And so one,
Speaker 1: there's a lot of research now being done on you know,
Speaker 1: things from the past that help us see how it
Speaker 1: links to things in our present um as well as
Speaker 1: then recognizing that, you know, as I said, it's it's relationships,
Speaker 1: it's what work looks like, it's what family life looks like,
Speaker 1: it's in all these sorts of aspects of environment. So
Speaker 1: that that's definitely that's definitely becoming the bigger thing. But
Speaker 1: I what I actually think is really exciting about that
Speaker 1: is that it gives us so many more opportunities for
Speaker 1: intervention and rather for treatment. So you know, it's not
Speaker 1: just the when we think about biopsychosocial you know, as
Speaker 1: I said, it's not just why disease occurs, but it's
Speaker 1: how then we can treat. So what means is that,
Speaker 1: you know, we can treat with medication biologically, we can
Speaker 1: treat with therapy psychologically. But then when it comes to
Speaker 1: environment there's so many different types of treatments that help
Speaker 1: from the environmental perspective, everything from working on your relationships
Speaker 1: with your parents or with your spouse, exercise, mindfulness, meditation, journaling,
Speaker 1: gratitude like so the dozens and dozens of things. And
Speaker 1: I find that really exciting, and I hope I find
Speaker 1: that that gives hope to people that it isn't just
Speaker 1: a pills help. But it isn't just a pill that's
Speaker 1: the only answer. There are many many others that help
Speaker 1: improve anxiety and moreover, can build up a lifetime of
Speaker 1: resilience for you. Absolutely well, that brings me to your work.
Speaker 1: So you have an academic laboratory called Brainstorm, and on
Speaker 1: the website it says transforming mental health through technology and entrepreneurship,
Speaker 1: which then leads us to another project that you're involved
Speaker 1: with called Real which I've mentioned in the interest. So
Speaker 1: I don't I don't know. I I'm just so fascinated
Speaker 1: by that. I was like, I've never had anybody I've
Speaker 1: never liked to like, you're the only person doing this.
Speaker 1: It's so exciting. How did you come up with mental
Speaker 1: health and entrepreneurship like hand in hand. Yeah. Absolutely, I
Speaker 1: it's been such a such a passion really almost in
Speaker 1: the past decade or so, and I would absolutely like
Speaker 1: to to share that. And let me start with you know,
Speaker 1: in mental health and in psychiatry, one of the things
Speaker 1: that we talk about, it's sort of big, like a
Speaker 1: catchphrase for for the field for for years and years
Speaker 1: and years, is meet people where they are. And you know,
Speaker 1: it's something that we say figuratively around you know, whether
Speaker 1: you were just getting diagnosed or you're not sure if
Speaker 1: you want to take medication. You know, the way that
Speaker 1: you need to talk to people is seeing where they
Speaker 1: are right now and and really approaching discussions that way. Now,
Speaker 1: if we think about that from the figurative perspective, that's
Speaker 1: what that means. If we think about from the very list,
Speaker 1: So what just to take a step back as I
Speaker 1: think about how solve mental health is a problem, right,
Speaker 1: how to make things better? Two billion people around the world,
Speaker 1: first of all, have a diagnosable brain or behavioral health disorder.
Speaker 1: And I seem diagnosable with with that inflection, because what
Speaker 1: that means is that you know, you meet X number
Speaker 1: of criteria for depressional for anxiety. But what that also
Speaker 1: means is that let's say you're four out of eight
Speaker 1: you meet what if you meet three out of eight? Okay,
Speaker 1: you might not be diagnosable, but you're still really anxious, right,
Speaker 1: and you would still absolutely benefit from treatment, and you're
Speaker 1: still really struggling because that so. So I said that
Speaker 1: because you know, I think when we talk about statistics,
Speaker 1: the official diagnosa is important, but it's also just important
Speaker 1: to think about life, right and like the whole spectrum.
Speaker 1: Um So, so when you have a problem that big
Speaker 1: where it's billions of people around the world, um And
Speaker 1: I think the other thing, you know, you mentioned your
Speaker 1: mom and sister having anxiety. When anyone has anxiety, it's
Speaker 1: not just the person myself who struggles, is their loved
Speaker 1: one as well, right, like, and so it's really really
Speaker 1: something that goes much broader. So when you have a
Speaker 1: problem of that um magnitude and also urgency, especially in
Speaker 1: the US now you know, drug overdoses are the number
Speaker 1: one leading cause of death for the last few years
Speaker 1: for Americans ages eighteen to point five, right, Like, it
Speaker 1: is killing our generation of people. Um that is both
Speaker 1: prices and you know, and magnitude. So what are we
Speaker 1: gonna do about it? Right? And and that's to go
Speaker 1: back ten years. I was when I was you know,
Speaker 1: in in medical school and just getting into psychiatry. Um.
Speaker 1: That that's kind of what I was thinking about. And
Speaker 1: at that time it was the first time, you know,
Speaker 1: as as physicians, we treat one person at a time
Speaker 1: every you know, ten minutes, fifteen minutes, one hour. That's
Speaker 1: that's kind of what the traditional medical model looks like.
Speaker 1: My own background had really been actually in the nonprofit sector.
Speaker 1: I did a lot of work with the American Cancer
Speaker 1: Society as a child, and when as a teenager, I
Speaker 1: launched a network for a team volunteers for American to Society.
Speaker 1: And it's always been really interested in communities and the
Speaker 1: much bigger picture scale, like things like how is policy
Speaker 1: impact millions of the people at a time, What are
Speaker 1: these things that we can do to reach like entire populations.
Speaker 1: And so you know, in medicine, the idea of this
Speaker 1: kind of one by one when you think that, Okay,
Speaker 1: in a week, how many people can I touch? Forty
Speaker 1: hundred UM certainly like critically important and the foundation of
Speaker 1: our current medical system. And and you know, my father's
Speaker 1: a on collegist who does that. I have so much
Speaker 1: deep respect and admiration for that. And yet at the
Speaker 1: same time, for myself, as someone who was kind of
Speaker 1: always interested in that bigger picture UM sort of thing, Uh,
Speaker 1: became really fascinated because and just to go back in
Speaker 1: medical school, that's the first time that people started to
Speaker 1: think about how they use technology UM from the consumer side,
Speaker 1: like things that could help if you had diabetes or
Speaker 1: high blood pressure, things like that. So it's it's been
Speaker 1: out there for other diseases, had been very slow to
Speaker 1: get to mental health. So that makes sense. So that
Speaker 1: idea of UM, let's train a bunch of entrepreneurial types
Speaker 1: to handle these diseases. Right without even realizing it, I
Speaker 1: can see that it's been out there. It's out there,
Speaker 1: and it's mental health. Yeah, it sounds so new to me. Yeah, right,
Speaker 1: you know, but I think you're right, and it's the
Speaker 1: idea is, how do we think about all these new
Speaker 1: ways to address mental health not just seem like see
Speaker 1: a therapist and I'll throw out one statistic. What we
Speaker 1: know is that, you know, most people want to think
Speaker 1: about mental health, they think about therapy. If we optimize
Speaker 1: all therapists in the country to treat Americans, we would
Speaker 1: only have enough therapists to treat seven percent of the population.
Speaker 1: Oh my god, seven percent. Now the problem there is
Speaker 1: that over the course of a lifetime, fifty percent of
Speaker 1: Americans will have a diagnosed while mental health disorder. So yeah, clear, clear,
Speaker 1: you know, imbalanced there. And so we absolutely you know,
Speaker 1: one on one care, traditional medicine, clinical work, com medicine important.
Speaker 1: We will never be able to solve the problem unless
Speaker 1: we think about other ways that we can reach people.
Speaker 1: And that is where technology comes in. So I'm set
Speaker 1: at the beginning to meet people where they are. And
Speaker 1: to me, what was really fascinating is recognizing, Okay, like
Speaker 1: if you think from a literal perspective, where are people
Speaker 1: And back in the day, that meant like community medicine.
Speaker 1: People who would go in bans to you know, two
Speaker 1: different communities and work with the home of population or
Speaker 1: go go out there to folks and reach them in
Speaker 1: you know, in their homes or even the doctor with
Speaker 1: the you know, whould knock on doors and and and
Speaker 1: see boats. Today where are people? They're all online and
Speaker 1: we all spend you know, like the number of hours
Speaker 1: especially like teenagers and kids and young adults that online
Speaker 1: is really really big. And so given that we are
Speaker 1: like kind of living our lives online and it's this
Speaker 1: whole new world that we're living in, if we can
Speaker 1: address mental health online both thinking about it's this whole
Speaker 1: new community that we're living in, how do we keep
Speaker 1: people safe and make it uh environment that's mental health
Speaker 1: friendly as well as think about the online worlds as
Speaker 1: ways to deliver and provide mental health you know, therapeutic
Speaker 1: services education that that is a tremendous opportunity to reach
Speaker 1: people in ways that you know, is low cost, scales
Speaker 1: can be you know, and and just gets to you.
Speaker 1: And in particular because of stigma, it's so hard to
Speaker 1: go out and be proactive and even figure out that
Speaker 1: I have something I need to go to find a
Speaker 1: doctor or get this information. If we can get this
Speaker 1: to people as they're already on Pinterest or TikTok or Instagram.
Speaker 1: That allows us to really have a tremendous way of
Speaker 1: reaching people. And so that that's actually exactly what we
Speaker 1: do at Stanford Brainstorm. The biggest part of it is
Speaker 1: we work with companies like Pinterest and TikTok. I'll also
Speaker 1: work with organizations like but to Pop, Shu Core Foundation,
Speaker 1: with Kevin Love Foundation, groups like that that are really
Speaker 1: trying to think about how do we leverage technology to
Speaker 1: reach populations and also through platforms like like these online platforms.
Speaker 1: So to take it back, let's say, Um, you know
Speaker 1: you're talking with someone at Pinterest, what exactly would you
Speaker 1: be asking of them? Is that the right way to
Speaker 1: put it, that is perfect questions. So if we go
Speaker 1: back about three years we were speaking with pinterests and
Speaker 1: what Pinterest realized as they were looking at what people
Speaker 1: were looking for when they came to Pinterest. Most people
Speaker 1: come for things like wedding planning or interior design or
Speaker 1: searching for recipes. It turned out that the fourth most
Speaker 1: common category of search terms was actually related to mental health.
Speaker 1: That was really really surprising because it's not a place
Speaker 1: that you kind of just think, oh, and let me
Speaker 1: go sort of for mental health information there, right, And
Speaker 1: they really realized, yeah, and they really realized, like what
Speaker 1: can we do about it? Like how can we change
Speaker 1: the whole experience people have so that it feels safe
Speaker 1: and warm and welcoming to talk about mental health online?
Speaker 1: But moreover that you get tools and resources, you know,
Speaker 1: and now we're talking about so much like fake news
Speaker 1: and misinformation, how do we actually help people get top
Speaker 1: quality information that we know comes from doctors and is
Speaker 1: evidence based, like you know, not like really the best
Speaker 1: types of treatments. And that that's actually how the whole
Speaker 1: thing began. And so they're kind of four categories of
Speaker 1: things that we worked with them with. The first thing
Speaker 1: that we did was what we created what we call
Speaker 1: microwth therapeutics, And so basically, what now if you go
Speaker 1: to Pinterest and you type in I'm stressed or what
Speaker 1: do I do for depression? And these were some of
Speaker 1: the types of search terms that people were looking for
Speaker 1: before I'm going to do it while I'm talking to you. Yeah, yeah, yeah,
Speaker 1: So go go to pints and type in depression for example,
Speaker 1: or stress or anxiety. Now what happens is you get
Speaker 1: a whole pop up and it's a separate pop up
Speaker 1: and importantly it does not link to your home feed,
Speaker 1: meaning we're not tracking your UM search or anything. You know,
Speaker 1: it's it's it's all private information. So it's very applical
Speaker 1: in that way. YU and you get you get to
Speaker 1: pop up basically that saides you know, it looks like
Speaker 1: you're you're maybe struggling with something. How can we help you?
Speaker 1: I just got it. Yeah, So so it shows me.
Speaker 1: You know, people have their little memes and they're cute
Speaker 1: little UM charts. But then there's a little thing in
Speaker 1: blue that says, if you're feeling sadder stressed, here are
Speaker 1: some resources, and then you can click take a look,
Speaker 1: and it takes you to a separate thing UM suicide
Speaker 1: Prevention Lifeline. But then these little things too minute things
Speaker 1: you can listen to refocus your attention except your emotions.
Speaker 1: This is fantastic, that's exactly so those two many things.
Speaker 1: So it's basically all we called the micro therapeutics, and
Speaker 1: it's a whole like toolkit of exercises based in common
Speaker 1: behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy. These
Speaker 1: are the same therapies that we would use with patients
Speaker 1: one on one and right and you know over the
Speaker 1: course of weeks or months that we would do with patients.
Speaker 1: At of what we did was we translated it into
Speaker 1: a two minute, three minute thing exercise that you can
Speaker 1: do on pinterest thinking about what is the best scientific
Speaker 1: evidence tell us that you can uh how to think
Speaker 1: the best of these different things, and what can you
Speaker 1: actually do online without a doctor in the convenience of
Speaker 1: your home, such that the minute you type in stress
Speaker 1: or depression you can get something and actually feel a
Speaker 1: little bit better ingesting units. I love this, Yeah, I
Speaker 1: love this because you know, if someone is typing in
Speaker 1: stress depression and they might see a quote or I mean,
Speaker 1: which is great, but you so rarely online see something
Speaker 1: pop up and interrupt you that wants to help you
Speaker 1: rather than sell you something or you know, no, you're
Speaker 1: absolutely right, and that's act to something that's really important.
Speaker 1: And I'm so like appreciative, Like the CEO of Ben
Speaker 1: silvermanut Pinterest like has the best values. When we were
Speaker 1: working with him, he said, adamantly, you know this is
Speaker 1: not something I want to have ads. This is not
Speaker 1: at all something that I want to like, you know,
Speaker 1: be related to bringing in more money. This is completely
Speaker 1: just something I want to help people. So they're no
Speaker 1: ads with this or anything. And it's complete, it's free, right,
Speaker 1: So like think about you know the cost of mental
Speaker 1: health care so so difficult. It's this is a horde
Speaker 1: percent free. You go type you get these resources, you
Speaker 1: can access it at any time. Um. And I think
Speaker 1: what's really important here is, you know what the problem
Speaker 1: with mental health. You know, the average amount of time
Speaker 1: from first having a symptom of mental illness to seeking
Speaker 1: medical attention in the US is eleven years. Yeah, seven years,
Speaker 1: seven years. But my mind to mind too, imagine lighting
Speaker 1: out eleven years with you know, I think I am
Speaker 1: having a heart attack, you know, exactly exactly. And so
Speaker 1: having resources like this that are so easy to access
Speaker 1: and free means, you know, even if you have a
Speaker 1: little inkling I might be depressed or anxious, if you
Speaker 1: can go and actually get some sort of help, um,
Speaker 1: that that's really important to get started. And moreover, you know,
Speaker 1: the way all these diseases progress is in those early stages.
Speaker 1: They're they're small. You have mild disease early on, and
Speaker 1: it gets worse as things go along, and so things
Speaker 1: like this, especially if you reach people early, can make
Speaker 1: a tremendous difference actually, and I think that's really, really,
Speaker 1: really valuable. So so that was one big set is
Speaker 1: just how do we get more of these things online?
Speaker 1: And that's actually what I hope all other platforms start
Speaker 1: doing as well, so you know, you're you, you're able
Speaker 1: to get this sort of information. UM. The second big
Speaker 1: thing though, is uh, the actually term for this whole
Speaker 1: thing that we created on pinters is called compassionate search.
Speaker 1: And the idea is how do we actually change the
Speaker 1: user experience for when you're online so that instead of
Speaker 1: feeling like something that into your point is like toxic
Speaker 1: or you know, like the Facebook UM whistleblower who you
Speaker 1: know talked about eating disorders and how the more time
Speaker 1: people spend online, especially kids, we see that rates of
Speaker 1: self harm, suicidal ideation increase, body body eating disorder, eating
Speaker 1: disorders and body image issues get worse. How do we
Speaker 1: actually create a compassionate experience And so in addition to
Speaker 1: providing these resources, UM, the other thing we did is
Speaker 1: actually change things about the user experience. So one example
Speaker 1: is UM with autofill like when you you know you're type,
Speaker 1: you're searching for something, if it's something that's dangerous, like
Speaker 1: related to self harm, it actually won't auto fill in
Speaker 1: the way that you're searching for like you know, for me,
Speaker 1: like a navy re velvet couch, it might all right film,
Speaker 1: but in this case it won't. And moreover, it won't
Speaker 1: push things to you like you know, if you start
Speaker 1: to type something then in your inbox you might start
Speaker 1: to get a lot of other Navy blue couches. Nothing
Speaker 1: that like that would hume if it's something that we
Speaker 1: think is concerning. The third thing we did was actually
Speaker 1: work with the engineers to change the algorithms um and
Speaker 1: so what they were able to do there is actually
Speaker 1: by educating them and explaining what is harmful content, the
Speaker 1: context of harmful content for who is it harmful, we're
Speaker 1: actually able to decrease the amount of self harm content
Speaker 1: by a eight percent in about six months. Wow. And
Speaker 1: kanyex is so important too, because like a kind of
Speaker 1: side example is if you report someone on Twitter that's
Speaker 1: harassing you, unless they say these five words, it's not harassment.
Speaker 1: So it's it sounds so exciting that you're there is
Speaker 1: an ability to apply context too social media. You're absolutely right,
Speaker 1: and it's also very cultural to write, you know, like
Speaker 1: the work we did. We it was in English and
Speaker 1: eventually spread to I think so hard spread to nine
Speaker 1: other countries. But you can think that something that's bullying
Speaker 1: or harassment or or harmful in the US compared to
Speaker 1: in another country. They're tremendous issues there. Based on your age,
Speaker 1: based on your you know, your background, based on your gender,
Speaker 1: all of those context is really important. We'll continue the
Speaker 1: interview on the flip side of a quick message from
Speaker 1: our sponsors. You were telling me about a student of
Speaker 1: yours that started a company that you're very much an
Speaker 1: involved with real and I would love to hear more
Speaker 1: about them. Absolutely So I have to say a lot
Speaker 1: of my favorite students my part times million, so Arie
Speaker 1: Eli Sefira. So with my lab. In addition to you know,
Speaker 1: working with companies, I teach courses on how to start
Speaker 1: a company and mental health UM and at students for
Speaker 1: teaching these courses. And the very first time I taught
Speaker 1: this course was I guess around five or six years
Speaker 1: ago there was a rock Star UM it's actually graduate
Speaker 1: student course that taught at the d School and we
Speaker 1: have a lot of business school students and engineering school
Speaker 1: students and law school students. There was this rock star
Speaker 1: senior undergrad who was studying computer science and math whose
Speaker 1: name was Arielli Sepia and Um, and she came to
Speaker 1: the class really impressive background. She had been interested in
Speaker 1: mental health after one of her close friends had attempted
Speaker 1: suicide and it just really, you know, tremendously moved her
Speaker 1: and she was just really thinking not only how did
Speaker 1: this happen, but what can be done about it? And
Speaker 1: looked was really just this incredible student and someone who
Speaker 1: wanted to have taken all sorts of information and learn
Speaker 1: as much about mental health as she could. So she
Speaker 1: went all across the world. Actually she went to the
Speaker 1: UK and Um studied at the what's called the one
Speaker 1: of the most innovative in patient facilities around mental health.
Speaker 1: She worked with IDEO trying to understand how do we
Speaker 1: redesign mental health facilities and think about what the patient
Speaker 1: care experience looks like. UM, and it's so much stuff
Speaker 1: to try to understand more about mental health. And that's
Speaker 1: actually what we did in the classes really help people
Speaker 1: understand the nuances of mental health. You know, a lot
Speaker 1: of companies out there as well as folks who are
Speaker 1: doing anything to try to now make an impact in
Speaker 1: mental health usually have personal experience, their own experience or
Speaker 1: the experience of a friend. And what is really important,
Speaker 1: especially on my perspective this clinician, is understanding like the
Speaker 1: breath of experiences, because if you're going to create something,
Speaker 1: you really need to understand what is it like for
Speaker 1: entire populations and what are these things that come up
Speaker 1: so that when you're building, you can you know, we
Speaker 1: talked about like putting the user first, not like thinking
Speaker 1: what's right for the hospital or the clinician, but how
Speaker 1: do we actually start with the patient and what the
Speaker 1: patient needs and create a solution from their perspective? And
Speaker 1: that was that was really critical to you know, what
Speaker 1: we teach them, of course, and and what exactly I think,
Speaker 1: what what Ariela has done? Um and uh And so
Speaker 1: we met in the course and she graduated and uh,
Speaker 1: what went on to City Block Health, which is a
Speaker 1: company based out of New York that works with the
Speaker 1: Medicaid population. Uh And and you know tried multiple things.
Speaker 1: You actually thought about becoming a therapist um and then
Speaker 1: realized that she didn't want to come a therapy. She
Speaker 1: really wanted to change the system and that's what led
Speaker 1: to her starting REEL And that's where she started with
Speaker 1: with how do we actually start con scratched, Like what
Speaker 1: does what does system redesign look like? And what do
Speaker 1: we need to offer people to a really impact mental
Speaker 1: health in that way? And so you know, we we
Speaker 1: would we kind of continue this mentor vntie relationship. We
Speaker 1: would talk, you know, talk on the phone and stuff.
Speaker 1: And basically over the last three years. I started off
Speaker 1: the first time she she quit her job to try
Speaker 1: to start this company. She called me get said, I
Speaker 1: think I'm gonna do this. I was like, yes, you know,
Speaker 1: like a gun gun post work you all the way
Speaker 1: um and and little by little, you know, start off
Speaker 1: as an advisor and I guess within a year, the
Speaker 1: you know, was was thrilled to join her as the
Speaker 1: chief medical officer of real UM. And that's what we're doing,
Speaker 1: is we're now we're working together as for former professor's student.
Speaker 1: Now that you know she she is my CEO and
Speaker 1: my boss now and that's which is I love it
Speaker 1: and and that's what we're doing. We're trying, we're trying
Speaker 1: to build a new therapy model. And it's been I
Speaker 1: have to say, it's been really tremendous seeing UM for
Speaker 1: grow and how the whole company has grown. We're now
Speaker 1: over the UM you know, fifty employees, you know, the
Speaker 1: thousands and thousands of members and what to me has
Speaker 1: been really impressive. Actually, I'll say one more thing about
Speaker 1: Ariella is as we think about mental health, it's not
Speaker 1: just how do we change this system? I've actually gone
Speaker 1: a step further. It's how do we, you know, change
Speaker 1: the way that mental health looks, you know, across really
Speaker 1: like even more broadly than that, to thinking about like
Speaker 1: what does it look for employee? Like what does it
Speaker 1: look like for employees? And I think that actually, especially
Speaker 1: now as we think about COVID, the number of employers
Speaker 1: I've spoken with were realizing my employees are really really suffering.
Speaker 1: What do I do about it? That is one of
Speaker 1: the biggest opportunity points that we have to make change
Speaker 1: in mental health as adults. The majority of our time
Speaker 1: we actually spend in the workplace, and that's actually something
Speaker 1: that we've done. It real is you know, in addition
Speaker 1: to creating this product that we get out there to
Speaker 1: our members, UM we've actually looked to see how do
Speaker 1: we change the workplace and make it more mental health friendly.
Speaker 1: That starts with things like we have one our breaks
Speaker 1: throughout the week of just let's take a pause. We
Speaker 1: actually have what we call mental health break where one
Speaker 1: week every quarter, the whole company get off. And this
Speaker 1: is different from our PTO of time off. Literally the
Speaker 1: entire gets off. And it's whatever I tell people that
Speaker 1: they're like, you know, I start doing your company yesterday.
Speaker 1: But the thing is, like, what we know from COVID
Speaker 1: is that people didn't take vacation. And what we also
Speaker 1: know is that just like when we sleep, the importance
Speaker 1: of why sleep is so important to every human being,
Speaker 1: it's important to take time off of work because it
Speaker 1: allows us to spend time with family, to rejuvenate, to
Speaker 1: master other hobbies, and you know, spend time in nature
Speaker 1: and all these things that are so tremendously important for
Speaker 1: well being. Um, what we're actually trialing now, just as
Speaker 1: it literally started two weeks ago, is we're testing out
Speaker 1: the four day work week. This entire quarter, our whole
Speaker 1: company is trying the four day work week, and we're
Speaker 1: gonna we did the data. We we took surveys before,
Speaker 1: and we're gonna take surveys after and try to really
Speaker 1: just study to see how that has it made a difference,
Speaker 1: How has it made a difference, to to understand what
Speaker 1: are other things that we can do because the end
Speaker 1: of the day, at one of the things that's most
Speaker 1: fascinating to me about mental health is there is no
Speaker 1: one solution, right. It's not just one medication, it's not
Speaker 1: just one type of therapy. It's policy, it's economics. It's
Speaker 1: changing the workplace, it's delivering treatments like real it's changing
Speaker 1: the way that we talk to each other. It's having
Speaker 1: a podcast called Anxiety by that changes the way that
Speaker 1: our society talks about and thinks about and gets to
Speaker 1: laugh about mental health. All of those that's what needs
Speaker 1: to change if you think about it. I mean, I
Speaker 1: know not every school system works this way, but you know,
Speaker 1: growing up, you have the summers off and you reinvent yourself, right,
Speaker 1: and you come back a whole new person. And you know,
Speaker 1: I think we can do that. You wanted to reinvent
Speaker 1: ourselves quite as much as we did when we're still
Speaker 1: developing kids and teenagers. But I'm just I just mean,
Speaker 1: like you get a week off, you get such perspective, right,
Speaker 1: you just feel like yourself again. And I love this
Speaker 1: as opposed to the old school. Um, we're gonna take
Speaker 1: a week and we're gonna go on a group trip
Speaker 1: and team build and you know, climb trees. It's like,
Speaker 1: I don't want to spend it with people from like
Speaker 1: team building, and I think that essent should be as
Speaker 1: because honestly, if you take care of the individual, you'll
Speaker 1: probably have an easier time relating with others at work
Speaker 1: and working well with others. Like it sounds like that
Speaker 1: your student who's now your boss is um is solving,
Speaker 1: is one person solving the problem or you know, helping
Speaker 1: to solve the problem of only seven percent of the
Speaker 1: world would be able to see a therapist. So now
Speaker 1: like you're saying, they can get smaller doses of help,
Speaker 1: and it's not online therapy, it's it's all kinds of things.
Speaker 1: It's almost you know, it's like you and I were
Speaker 1: talking about we waited, you know, a decade to go
Speaker 1: get help. It's not even that like, oh, if only
Speaker 1: we've gotten help sooner, but if only we've had little
Speaker 1: things along the way to learn to cope, maybe we
Speaker 1: wouldn't have gotten into some bad habits you know that
Speaker 1: made our anxiety worse or whatnot. So I this is
Speaker 1: what I love about it. That is so beautiful. I
Speaker 1: will record that and share that with so many people.
Speaker 1: You are absolutely right. And also on is that this
Speaker 1: happening pretty sententistic. Is actually for the US, it's much
Speaker 1: worse when we pay worldwide and even like for I
Speaker 1: was like, it's worse. Uh, it's why it's worse In
Speaker 1: one one example in Ethiopia, literally the ratio of psychiatrists
Speaker 1: to people is one in a million, God right, So
Speaker 1: so worldwide, you know, much of much much worse. Um.
Speaker 1: So you know when we when we need to do more.
Speaker 1: At the same time, I think that what you said is, um,
Speaker 1: you know, you absolutely nailed it. And what we're doing
Speaker 1: it real is thinking about, you know, when what can
Speaker 1: we offer people? Because you're You're right, it's not when
Speaker 1: we think about behavior change. Behavior change is tremendously difficult.
Speaker 1: At the same time, it is all these little things,
Speaker 1: right like when we think about what we need to
Speaker 1: do to help with anxiety. The biggest things I'll tell
Speaker 1: you when I tell people I write prescriptions off and
Speaker 1: actually not just for medication. Oh yes, I'm wanted to
Speaker 1: ask you about this and so excited. Yes, yes, I'll
Speaker 1: tell you what I've prescriptions for. I write prescriptions for.
Speaker 1: And these are the things actually that have the most
Speaker 1: scientific evidence for making an impact and xiety across the board,
Speaker 1: whether you're severe or mild, or have just a little
Speaker 1: bit or and no matter who you are, it's things
Speaker 1: like mindfulness meditation. I'll actually give you, I'll give you,
Speaker 1: I'll give you ten my top ten ten list. That's
Speaker 1: right here we go, mindful mindfulness meditation with deep breathing, sleep, gratitude, nutrition,
Speaker 1: substances meaning like alcohol, drugs, the Meryl CBT products, things
Speaker 1: like that, exercise. Wait, I'll decrease the substances. Substance, that's
Speaker 1: a weird doctor wy decreasing, decreasing substances, decreasing to tobacco use,
Speaker 1: decreasing alcohol use as as much as possible or or
Speaker 1: none zero to none or or non done too little
Speaker 1: um uh. Nature, community and connection, giving an altruism um
Speaker 1: sexual pleasure actual are actually our chief therapy for for
Speaker 1: real Rachel Hoffman has for PhD and sex therapy, which
Speaker 1: one makes our company like the most live company to
Speaker 1: work at work at and is great, you know, water
Speaker 1: pooler conversation is fantastic. Um, But we to also know that,
Speaker 1: you know, sexual pleasure doesn't meense things for making anxiety better.
Speaker 1: So those are my top ten um and tave the
Speaker 1: best for last. But all of those, right, all of
Speaker 1: the nothing is new, right, none of those you're like, oh,
Speaker 1: I've never heard of that before, right, Like, but they're
Speaker 1: hard and the simplest things are offered to do. And
Speaker 1: that's actually also why I write a prescription, because what
Speaker 1: I've seen is that there's something about you know, the
Speaker 1: patient doctor relationship for a lot of people is very sacred.
Speaker 1: And while we know, you know, we all know, I
Speaker 1: know I probably shouldn't be eating nutella out of a jar,
Speaker 1: but I do that at times. Is it the best
Speaker 1: thing for me? It feels like it is. It probably isn't,
Speaker 1: I get that, right. But but at the end of
Speaker 1: the day, you know, whether it's around you know, health
Speaker 1: and exercise and nutrition or gratitude, mindfulness, taking out time
Speaker 1: and nature, um, all of these things we know it
Speaker 1: to be true, but it's still really hard to make
Speaker 1: these little changes. And at the end of the day, it. Actually,
Speaker 1: it's not like doing these big grand gestures that makes
Speaker 1: the biggest difference. It's doing small little things for example,
Speaker 1: like you know, actually have to tell you something. Um.
Speaker 1: I even for myself when I go to the gym,
Speaker 1: just in the last two weeks, I've been telling myself, hey,
Speaker 1: even if you don't have an hour, try to get
Speaker 1: on the elliptical or try to run even for twenty
Speaker 1: or thirty minutes. Yeah, I'm not doing the best workout ever.
Speaker 1: But but what I've really but you know, the consistency
Speaker 1: and having getting there every day. Consistency is what leads
Speaker 1: to you know, what your life looks like. All those
Speaker 1: little behaviors make a big difference. And then the prescriptions. Actually,
Speaker 1: there are two things that I've noticed make a big difference.
Speaker 1: One is, as I said, just it's almost like when
Speaker 1: you get it, you take it so much more seriously
Speaker 1: when it's coming as a prescription. The other things I've
Speaker 1: noticed I've noticed this actually specifically for women, is that
Speaker 1: I think it's almost like it gives you permission to
Speaker 1: take care of yourself. And so for so many women,
Speaker 1: you know, there's the sense that we take care of
Speaker 1: everyone else, but not ourselves, and I actually remember and
Speaker 1: that self care can sounds so indulgent, like we're not saying, like,
Speaker 1: go to a spa every day. We're just saying, you know,
Speaker 1: drink some water, that you're exactly right, you're exactly right.
Speaker 1: And I think that the prescription gives them that permission
Speaker 1: for self care. I remember having a patient who felt
Speaker 1: so guilty about taking time out, even like a few
Speaker 1: minutes to go for a walk. And I literally wrote
Speaker 1: this prescription thirty minutes in nature, um, you know, three
Speaker 1: times a week, and I gave it to her and
Speaker 1: she said that she came back the next week and
Speaker 1: started crying and saying that she showed it to her
Speaker 1: husband and that having that prescription it felt like that
Speaker 1: pass that I can go do this for myself. And
Speaker 1: how she noted her anxiety got so much better by
Speaker 1: being able to be out in nature and walk her
Speaker 1: dog and everything, and so little things like that I
Speaker 1: just think make a really big difference. And it's important
Speaker 1: for all of us to think about what are these
Speaker 1: little things, um it might seem with all these things
Speaker 1: out there, and let me just maybe say say kind
Speaker 1: of one one final way way to think about it. Yeah,
Speaker 1: I know a lot of people, even you know some
Speaker 1: of my best friends in medicine, they're like, does mindfulness
Speaker 1: really make a difference? You know? And then the reality
Speaker 1: is is, like you know, every day they're great scientific
Speaker 1: studies that come out and and tell us it does.
Speaker 1: I think at the at the end of the day,
Speaker 1: not everything will work for everyone, but most of these
Speaker 1: things actually will work for most of us, and so
Speaker 1: it's really important to find what works for you. You know,
Speaker 1: even when we say mindfulness and deep breathing, there are
Speaker 1: like fifty forms of mindfulness and deep breathing. It can
Speaker 1: be diaphragmatic breathing, it can be prayer, it can be
Speaker 1: you know, just doing like guided meditation, and those are
Speaker 1: quite different. Just like for exercise, if you're ombi eliptical
Speaker 1: or growing across fit or or playing soccer, those are
Speaker 1: all very different, right, So finding what works for you,
Speaker 1: UM that that that's really important and giving herself that commission.
Speaker 1: Have you heard this expression? My friend is in a
Speaker 1: a and she told me this, and I love it.
Speaker 1: It's um none are too dumb for recovery, but some
Speaker 1: are too smart. Yes, I have heard that. I absolutely
Speaker 1: love that. Yes I do gratitude list every day, and
Speaker 1: I was telling someone about it and they're like, but
Speaker 1: I don't feel grateful. I go, I don't feel anything
Speaker 1: when I make the list. I just write a list
Speaker 1: of things I'm mentally aware that I am glad I
Speaker 1: have in my life. And then now I have a notebook.
Speaker 1: So whenever I'm telling myself lies, which is how my
Speaker 1: anxiety starts, I get to look through my gratitude journal
Speaker 1: and be like, oh, wow, like I had a friend
Speaker 1: this day that said this to me, and this day
Speaker 1: I felt good about my body or whatever. I get
Speaker 1: to see proof that I actually don't believe the things
Speaker 1: I'm thinking. That's all I do it for. I think
Speaker 1: you're you're absolutely right and yeah and actually sure. One
Speaker 1: of the things that's most fascinating to me is I
Speaker 1: I do love the science behind it. Mindfulness, meditation, that
Speaker 1: the deep breathing. What we actually know now because people
Speaker 1: have done the science and you know, they actually can
Speaker 1: tell when we look at the basic cellular level. What
Speaker 1: we see is that when people do mindfulness and deep breathing,
Speaker 1: there literally are chemical changes at the cellular level that
Speaker 1: lead to the cell living longer. Basically, it leads to
Speaker 1: a decrease in the enzyme that breaks down the DNA
Speaker 1: of cells, and as a result of that, the cell
Speaker 1: lives longer. And as a result of that, that's why
Speaker 1: we know there's a link between doing mindfulness, meditation, and
Speaker 1: deep breathing and longevity and length of life. So like
Speaker 1: literally taking a few deep breaths today leads to you
Speaker 1: living longer. Like that is mind blowing to me, because,
Speaker 1: like you said, like sometimes I feel something, sometimes I don't,
Speaker 1: but like the actually it does cause like those chemical changes.
Speaker 1: But the thing is, we don't feel chemical changes in
Speaker 1: our selves right right. Well, it's yeah, it's not having
Speaker 1: a glass of wine where you're like, oh I feel
Speaker 1: that right away, you know, it's it's it's just experiential.
Speaker 1: It's over time. You look back and go, oh, I
Speaker 1: didn't make a total mess in my life this last
Speaker 1: year because I wasn't stuffing my feelings down or you
Speaker 1: know whatever. Then that's the other thing I was going
Speaker 1: to say at the beginning is it must be so
Speaker 1: hard to diagnose people because and it totally you know,
Speaker 1: people come in and they're like, okay, so I have
Speaker 1: the worst anxiety ever, and there's no test for it,
Speaker 1: and it's like, I know, you think that's the symptom.
Speaker 1: Is like you think, you know, you can't jump into
Speaker 1: someone else's body and feel what their anxiety feels like.
Speaker 1: But I know we all think ours is the worst.
Speaker 1: You know. Yep, you're absolutely right. You're absolutely right, and ultimately,
Speaker 1: you know, all these changes that we're trying to make,
Speaker 1: Like you were staying with the Gratitude Journal, you might
Speaker 1: not feel it in the moment, but like when you
Speaker 1: take a medication, you don't necessarily feel that like the
Speaker 1: minute you take it, right, some of these things it will.
Speaker 1: You might not notice it in the moment, but then
Speaker 1: you might reflect back in like a month and say, actually,
Speaker 1: you know, maybe I do it a little bit better,
Speaker 1: or it is that combination of seeing like a month's
Speaker 1: worth of gratitude that makes me feel differently. And at
Speaker 1: the end of the day, I know, as someone who
Speaker 1: just always starts with the science for me, you know,
Speaker 1: all those ten things I mentioned, those are all, as
Speaker 1: I said, again, the most scientifically back things that we had.
Speaker 1: When we know that all these studies show that like, oh,
Speaker 1: we've done it on thousands of people and we literally
Speaker 1: see that it absolutely makes a significant difference. That's something
Speaker 1: for me gives me a little or little a lot
Speaker 1: of confidence that even if I don't feel it at
Speaker 1: the end of the day, like I know that it's
Speaker 1: doing something good and that that helpful lot too. It's like,
Speaker 1: maybe that's the faith in science component. Well, it's true,
Speaker 1: and you're always framing those things is like not science
Speaker 1: because they're not pills or um, you know, cognitive behavioral therapy.
Speaker 1: But right, they're based in science, Like the success of
Speaker 1: them is based in scientific studies or else, you know,
Speaker 1: why would you recommend them? Um? So it's so true.
Speaker 1: It's framing it for the perfectionist or the type of like, no,
Speaker 1: this is as science c as CBT, and I love
Speaker 1: looking at it that way. Anxiety Bites will be right
Speaker 1: back after a quick little message from one of our sponsors. Okay,
Speaker 1: so this was something I've heard you say that you
Speaker 1: know when this goes back to what we were talking
Speaker 1: about earlier with this this chemical amalanced notion that the
Speaker 1: discovery that serotonin levels are connected to gut health. Now,
Speaker 1: how new is this discovery and what does that mean exactly?
Speaker 1: What should we do with this knowledge? Us? Everyday people
Speaker 1: absolutely great great question. So what we know about serotonin
Speaker 1: is it helps modulate your mood. And we were talking
Speaker 1: earlier about s s r I serotonin such and serotonin
Speaker 1: reuptake inhibitors, one of the most common or the most
Speaker 1: common psychiatric medication. That's what they target. Um. What's really
Speaker 1: interesting about this is there is actually more serotonin in
Speaker 1: your gut then there is in your brain. And so
Speaker 1: just to take a step back, so if we think
Speaker 1: about serotonin, basically there's serotonin in both places. It's the
Speaker 1: same molecule, but it's made from different cells. So in
Speaker 1: the brain it's made from these neuronal cells that are
Speaker 1: called the raphite neuron, versus in your gut it's made
Speaker 1: by endocrine immune and gut neuron cells. But they both
Speaker 1: produce saratonin. However, they function differently in each location based
Speaker 1: on what the brain needs and what the gut needs.
Speaker 1: But at the end of the day, what's important to
Speaker 1: realize here is that what it means is that there
Speaker 1: is this connection between the brain and the gut. And
Speaker 1: people are talking about that like mind body or gut
Speaker 1: brain connections acts, these things like that, And just to
Speaker 1: give an example, like how to think about what is
Speaker 1: this connection. How does this show up? I'll give you
Speaker 1: two examples. One is that when people start taking these
Speaker 1: medications this SSR eyes, one of the first side effects
Speaker 1: they will have is actually having some nausea or gas
Speaker 1: or intestinal upset. And you know you mentioned earlier about
Speaker 1: how uh you know the side effects maybe their differ
Speaker 1: for a short amount of time, but don't last forever.
Speaker 1: This is actually one of the most common things because
Speaker 1: usually for a lot of people, not everyone, for a
Speaker 1: lot of people, they'll have like three or four days
Speaker 1: of this nausea, upset stomach, but then it completely goes away.
Speaker 1: And the reason we think why that happens is because
Speaker 1: as the medication, basically, what the medication trying to do
Speaker 1: is increase the amount of serotonin. What it's not able
Speaker 1: to do is just increase the serotonin in your brain.
Speaker 1: Because the medication you swallow it, and it works throughout
Speaker 1: your entire body. It's not sophisticated enough to just target
Speaker 1: the serotonin in your brain, got it. But and so
Speaker 1: as a result, it also increases the serotonin in your gut.
Speaker 1: And because there's more serotonin in your gut than in
Speaker 1: your brain, you end up having these in you know,
Speaker 1: changes in the serotonin levels in your gut, and so
Speaker 1: your guts like, hey, what's going on. Something is different,
Speaker 1: and so that's why you actually feel noxious. That's amazing.
Speaker 1: So it's it's really doing its job. It's not some
Speaker 1: signed fact because it's some imperfect medication. It's actually doing
Speaker 1: its job. And it just doesn't mean to do it
Speaker 1: as much in your stomach, but your stomach will get
Speaker 1: used to it. Is that basically what happens. I think
Speaker 1: that that's it's a good way to think about it.
Speaker 1: That like the stomach. You know, the change is making
Speaker 1: of the stomach. It's not for what we know now,
Speaker 1: it's not hurting or helping necessarily anything related to the
Speaker 1: gut function. What it's really we're trying to get it
Speaker 1: to do is help those levels in the brain. Um.
Speaker 1: But that's like what that relationship is. And and to
Speaker 1: go a step further, the other thing is we know
Speaker 1: that there's a huge link between gut issues diseases. Even
Speaker 1: like irritable bowel syndrome, for example, is more common among
Speaker 1: people who have anxiety and depression, Meaning issues and diseases
Speaker 1: that come up in the gut. There's a higher correlation
Speaker 1: when folks have you know, biological issues with with their
Speaker 1: their braining is and anxiety depression. So you know, I
Speaker 1: muself talked about how I would get these you know,
Speaker 1: I would have nausea and stuff before these these math
Speaker 1: topic titians. That's actually kind of what we like that
Speaker 1: that was it's like, UM that you know, having physically
Speaker 1: having anxiety but also having you know, kind of other
Speaker 1: symptoms as well. And that because we know that there's
Speaker 1: this gut brain access and so UM studies have shown
Speaker 1: that there are certain types of gut bacteria that are
Speaker 1: associated with diseases like anxiety and depression, as well as
Speaker 1: diseases like autism and schizophrenia. And there's a lot of
Speaker 1: emerging research now that's trying to figure out exactly what
Speaker 1: this means. It's it is early, it's early research, UM,
Speaker 1: and what's really important is what we're trying to figure out.
Speaker 1: We know that these can there are these connections. What
Speaker 1: we're then trying to figure out is okay, based on that,
Speaker 1: how do we use that information to figure out how
Speaker 1: we can prevent disease, how we can treat disease better.
Speaker 1: It's a very exciting area and I think you know
Speaker 1: there's more more to come. Certainly it's interest an area
Speaker 1: follow um. But that's why even you like a lot
Speaker 1: of people talk about probiotics and why probiotics and the
Speaker 1: gut microbio can help with your anxiety. That that's why
Speaker 1: things like that are really interesting. So if someone has ABS,
Speaker 1: does it mean that their stomach doesn't have enough serotonin
Speaker 1: just in a very basic way that that Yeah, that
Speaker 1: that's actually different. It's more that ib S is a
Speaker 1: separate condition that is related when so their likelihood if
Speaker 1: someone has anxiety, there's higher correlation of having yes and anxiety. Um,
Speaker 1: So that the different different councules, but they kind of
Speaker 1: often go hand in hand. So if someone is not
Speaker 1: on any kind of S s R I and they
Speaker 1: don't take medication, but they have anxiety, just one of
Speaker 1: the things in their tool kit could be taking a
Speaker 1: probiotic just to have their gut health be O you know, optimize.
Speaker 1: That's exactly right, And I think it just as you said,
Speaker 1: you know, I think more and more. It's a fascinating
Speaker 1: area of research, and every every six months, I'm sure
Speaker 1: there will be something that comes out where we learn
Speaker 1: more about what we can do with our gut that
Speaker 1: will help our anxiety more and more. I even loved
Speaker 1: we know now that like there's certain foods that can
Speaker 1: increase and decrease anxiety and dean um like you know
Speaker 1: that salmon is good and nuts are good, and decreasing
Speaker 1: processed foods and sugar like you know. All we were
Speaker 1: seeing so many relationships between what we ingest and our
Speaker 1: mood and anxiety, and similarly we're learning more about our
Speaker 1: gut and the same. Lastly, I will ask you and
Speaker 1: I've had very different opinions on this podcast, are we,
Speaker 1: as everyone keeps saying, in a mental health crisis in
Speaker 1: this country. I have heard everything from no, it's always
Speaker 1: been there, but we just see it because of social media. Um, yes,
Speaker 1: everybody has some undiagnosed anxiety disorder. Um that just got
Speaker 1: worse with the pandemic. And then I've heard, no, it's
Speaker 1: not a mental health that year not everyone has a
Speaker 1: diagnosable anxiety disorder, but it's chronic stress and we're not
Speaker 1: meant for that. We're meant for acute stress. So what's
Speaker 1: your take on what's going on currently? I mean, what
Speaker 1: is your opinion? Is this a mental health crisis we're
Speaker 1: in or is it is it more nuanced? Yeah, I
Speaker 1: usally we absolutely are and I certainly I think it
Speaker 1: depends how how do you define crisis or when we
Speaker 1: say that is that everyone is certain populations. But here's
Speaker 1: why I think absolutely it is not. And here's why. First,
Speaker 1: you know, I would say that both are true. You
Speaker 1: know both we are in a crisis and we have
Speaker 1: a chronic stress issue. Or maybe it's like all of
Speaker 1: the above, right, like you know, it's answer E on
Speaker 1: the on the standardizing on the standardsize dies exam. Um,
Speaker 1: here's here's the issue. So even before COVID, we were
Speaker 1: in a crisis. And just to give you some of
Speaker 1: the statistics, on example, substance use sort of drug overdoses
Speaker 1: were the leading cause of death for Americans eighteen to
Speaker 1: forty five. That has only gotten worse. Despite the fact
Speaker 1: that you know, both the Trump administration and the Binding
Speaker 1: administration have put millions and millions of dollars, if not
Speaker 1: even billions of dollars into tackling the opioid epidemic. From
Speaker 1: all sorts of perspectives, those numbers only got worse. Okay,
Speaker 1: And so again it was a problem before the pandemic
Speaker 1: made it worse, but it was still a problem, right,
Speaker 1: and the problem loneliness. We were in the midst of
Speaker 1: the loneliness epidemic where everyone from elderly folks who like
Speaker 1: some who never see anyone for weeks at a time,
Speaker 1: all the way through, you know, all of the two
Speaker 1: teenagers who we are seeing changes in the UH in
Speaker 1: when teenagers hit certain social milestones and their growth and
Speaker 1: development because of all the kind of they spend online,
Speaker 1: that their ability to make relationships and form relationships in
Speaker 1: the way that you and I did growing up because
Speaker 1: we did not have our devices with us, you know,
Speaker 1: seven that we were able to do. This current generation
Speaker 1: is not able to do in the same way. And
Speaker 1: we're seeing seeing very real changes in the way that
Speaker 1: they form relationships and and in their own you know,
Speaker 1: kind of growth, growth and development. Just just two examples
Speaker 1: their loneliness and and substantius the suicide rates have increase
Speaker 1: in suicide rates were increasing in teenagers even before the pandemic.
Speaker 1: Since the pandemic has gotten worse. Was even more interesting
Speaker 1: and and concerning is how these rates have gotten worse
Speaker 1: for those who are already most marginalized. Sorry about that,
Speaker 1: All good, All good, I'm just getting an alert, I
Speaker 1: wanted alert. I'm in Brooklyn. I'm getting a wanted alert
Speaker 1: for the guy that did the subway shooting. UM a daylight.
Speaker 1: I think this alert is coming in. But okay, sorry,
Speaker 1: but that well, there you go. There's a real life
Speaker 1: I'm gonna keep that in the podcast. Is a real
Speaker 1: life My phone just stared at me that there's a
Speaker 1: shooter on the loose. I mean, you know, adding to
Speaker 1: our mental health crisis? Is this kind of stress? You're
Speaker 1: absolutely right, Yeah, I'm sorry, no, but no, but not
Speaker 1: is the example, right? But because actually know that was
Speaker 1: a perfect example, because to get at the point that
Speaker 1: there are all these other things going on and then
Speaker 1: something that that happens, right, and so even if you're
Speaker 1: able to get by, then you reached the threshold and
Speaker 1: you're at another level. And I think that you know,
Speaker 1: so when I was I was talking right before the
Speaker 1: before the alert um and how you know and how
Speaker 1: and how tragic um, But that you know before the
Speaker 1: alert um that what's really concerning, even most concerning is
Speaker 1: as for example, when since the pandemic started, the levels
Speaker 1: of depression, anxiety, substance use, trauma have in some case
Speaker 1: some cases doubled in certain populations even like quadrupled. And
Speaker 1: what specifically we see is that those who were already
Speaker 1: most marginalized, both because of their ability to get resources
Speaker 1: the way that they engage with the healthcare system, those
Speaker 1: are the populations for whom the rates have increased them most,
Speaker 1: so specifically in women in the black and Latin X populations,
Speaker 1: in UML, the LGBTQ populations, right and so for one,
Speaker 1: just example, were for kids were teenagers were saying that
Speaker 1: suicide rates for girls increased by about fifty percent over
Speaker 1: the first of pandemic for boys for for four percent,
Speaker 1: four versus fifty percent. So that what that gets that
Speaker 1: is what that's what what what do we do about it? Right? Like?
Speaker 1: And I think that's what we always need to be
Speaker 1: thinking about, is there are so many things that need
Speaker 1: to get done and so so on one, you know,
Speaker 1: I think all of those statistics show that, you know,
Speaker 1: when it comes to mental health, there are spectrum of issues,
Speaker 1: right There is anxiety, there's depression, there's trauma, there's self harm,
Speaker 1: there's there's a substance use, like all of these things
Speaker 1: and all and there's all these numbers are getting worse,
Speaker 1: and they're getting worse for the people who are already
Speaker 1: the most disadvantaged. That makes sense. That makes sense, right,
Speaker 1: because it's like, already things are hard and then it's
Speaker 1: hard to get help. And I think what all that
Speaker 1: leads to is number one, UM, I want to actually
Speaker 1: sort of end on on a hopeful note, is that
Speaker 1: Number one. I think what I'd like to actually shape
Speaker 1: the conversation around is treatment. And and let me go
Speaker 1: back one step to say that throughout the pandemic, what
Speaker 1: myself and I think all colleagues in the field have
Speaker 1: felt like is the silver lining from the mental health
Speaker 1: perspective has been the tremendous increase in people talking about
Speaker 1: mental health. The absolutely like the improvement in stigma and
Speaker 1: the way that mental health has changed, um in terms
Speaker 1: of who's talking about how they're talking about it has
Speaker 1: increased so much. It's where I thought it would be
Speaker 1: like five or ten years from now. And it's everything
Speaker 1: from the news media and the number of articles and
Speaker 1: stories out there about mental health. There literally now every
Speaker 1: day there's like a front page story or a big
Speaker 1: story on something like to mental health. It's it's it's
Speaker 1: in your world, right The entertainment world. Um, one of
Speaker 1: my best friends is an emergency room position, like brilliant,
Speaker 1: trained at Harvard at Stanford, and she actually works with
Speaker 1: her name is Jennifer, and she has this company called
Speaker 1: med Consults for Page, Stage, and Screen, and she works
Speaker 1: with writers who are working on scripts and how to
Speaker 1: make them more medically accurate. And there's the emergency room position. Yeah,
Speaker 1: it's it's really it's really really cool. Actually she's an
Speaker 1: emergency room position and so a lot of her work,
Speaker 1: you know, in the past, had been how do we,
Speaker 1: you know, get get this word right, or when someone
Speaker 1: is having a surgery or an accent, how do we
Speaker 1: make sure it shows up correctly. What you told me
Speaker 1: is like over the last couple of years, the number
Speaker 1: of scripts that get to her around mental health where
Speaker 1: people want to have mental health storylines, has like gone
Speaker 1: up tremendously, UM. And I think that's amazing because the
Speaker 1: more that the media is talking about this and really
Speaker 1: presenting these issues with much more like more reality based. Um.
Speaker 1: It really that that's what leads to all this culture
Speaker 1: change and gets people getting to the doctor earlier than
Speaker 1: eleven years. And you know, like that that all of
Speaker 1: that is so important. So that's this little religning, is
Speaker 1: that stigma's gotten better. We're talking about it so much better.
Speaker 1: I think the next big step is it needs to
Speaker 1: be around treatment. It's not just that we're talking about
Speaker 1: it and saying, hey, I had this too, but that
Speaker 1: all of that needs to lead to everyone seeking how
Speaker 1: do I get better as early as possible, and that
Speaker 1: we're making it safe and supportive, that parents and children,
Speaker 1: that school, that employers are creating time for people to
Speaker 1: take a month off or to you know, get proactive help,
Speaker 1: that that that that they're able to you know, to
Speaker 1: get and not interfere with Where all of these are
Speaker 1: really really important. Um And I think that what's amazing
Speaker 1: is that no matter who you are who's listening to
Speaker 1: this podcast, there is actually probably some way, based on
Speaker 1: what you're doing, that you can make an impact in this.
Speaker 1: You know, if if you're again, I'll just go back,
Speaker 1: like Jen, the fact that you've created this podcast, What
Speaker 1: that does, How that changes the dialogue, How that changes
Speaker 1: who even recognizes this is an issue, and that whether
Speaker 1: it means they themselves recognized earlier now that they have
Speaker 1: something and they can get help tremendously important. Whether they realize, oh,
Speaker 1: they actually work in a field that they can maybe
Speaker 1: make some change, Like they work in HR and they
Speaker 1: can change the benefits that the that their company gives people.
Speaker 1: That is huge. That is huge. Maybe they're a teacher
Speaker 1: and they want to change the way that they talked
Speaker 1: about invited their kids. That would be life changing for
Speaker 1: an entire generation, you know. So there's so many things
Speaker 1: that can be done. And um and I think that
Speaker 1: I like end on that level of hope it real
Speaker 1: We say celebrate therapy. We want to celebrate the experience
Speaker 1: and champion and make you proud of the fact that
Speaker 1: you got help and that you're getting help. You just
Speaker 1: gotta be super pumped up. I hope you're feeling as
Speaker 1: pumped up as I am about the future. And I'm
Speaker 1: going to get into our takeaways today. There's so many.
Speaker 1: I love it. I love it when a guest just
Speaker 1: downloads information into my brain and don't forget. If you
Speaker 1: go to join dash reel dot com j O I
Speaker 1: N dash r e a l dot com, select to
Speaker 1: join now at the top. Once you get to the paywall,
Speaker 1: you are going to select the coupon code and the
Speaker 1: promo and enter anxiety Bites all caps, all one word,
Speaker 1: and Anxiety Bites again. You can just go to the
Speaker 1: show notes, follow along and get your free month. And
Speaker 1: here are the takeaways from this episode. Now, don't forget.
Speaker 1: Please send me an email Anxiety Bites Weekly at gmail
Speaker 1: dot com. Let me know what you've learned from listening
Speaker 1: to the show. If you have any hot tips of
Speaker 1: your own that you have come up with that help
Speaker 1: your anxiety, please share it with me. I'll share it
Speaker 1: with our listeners and if you have any questions, it
Speaker 1: could be answered on an upcoming listener email episode. So
Speaker 1: please do that again. Anxiety Bites Weekly at gmail dot
Speaker 1: com would love that. All right, let's get into the
Speaker 1: takeaways from this episode. The first thing that Dr Vaston
Speaker 1: has on her LinkedIn bio before any credential, is her
Speaker 1: twenty year history with anxiety and depression due to COVID,
Speaker 1: many people whose anxiety was under the radar, they came
Speaker 1: overwhelming or reached new heights. Many people turned to overeating
Speaker 1: and alcohol in order to self medicate. So this sounds
Speaker 1: like you. It's normal. Even Dr Vasson herself did this.
Speaker 1: Dr Vasson has accepted that she may struggle daily with anxiety,
Speaker 1: and that's okay. She's got the right tools and is
Speaker 1: making things a little bit better for herself on a
Speaker 1: daily basis. Sometimes we can have a change in our
Speaker 1: behavior due to our anxiety, even though we didn't feel
Speaker 1: any of our usual anxiety triggers that led to the
Speaker 1: change in behavior. If you're a teenager, how do you
Speaker 1: know if you're super intense feelings your anxiety is something
Speaker 1: normal because you know you're a teenager and you've got
Speaker 1: all those hormones, or if this is going to be
Speaker 1: a disorder. The first thing you need to do is
Speaker 1: distinguish how much are these feelings and sensations affecting your life?
Speaker 1: Is your sleep disturbed, have your grades dropped? Are you
Speaker 1: having trouble focusing? Or are you able to cope and
Speaker 1: live the life you want? Or is the anxiety getting
Speaker 1: in the way? Why does anxiety even occur in some
Speaker 1: people in the first place. What's known as the biopsychosocial
Speaker 1: model in anxiety is a threefold explanation that helps to
Speaker 1: understand why it manifests in the first place and gives
Speaker 1: a framework for how to treat mental health conditions. So
Speaker 1: biosocho biosoco biopsychosocial, all one word means that the reason
Speaker 1: for anxiety is a combination of biological, psychological, and social factors.
Speaker 1: The biological is our genetics, like did family members have anxiety?
Speaker 1: It's passed down in our d n A. The psychological
Speaker 1: means how do you talk to yourself? How do you
Speaker 1: cope with stressors? The social component is a mix of
Speaker 1: historical what was your childhood like, was your household growing
Speaker 1: up supportive? Where you bullied? And the second component to
Speaker 1: social is our environment what's going on currently in our
Speaker 1: home life, our work life, or our relationships. The issue
Speaker 1: with mental health right now is that we don't have
Speaker 1: a way to measure, you know, say, like the way
Speaker 1: you could measure other diseases using a blood test. There's
Speaker 1: no way to measure what percentage of our anxiety is
Speaker 1: biological versus psychological versus social. We can get a full
Speaker 1: history verbally from a patient and from there make some
Speaker 1: educated guesses. But with this biopsychosocial model, the old way
Speaker 1: of thinking about mental illness is over. Nothing is your
Speaker 1: fault and it's nothing someone did. Anxiety has a very
Speaker 1: real biological part, and it's also a manifestation of our
Speaker 1: current environment. In regards to taking medication for anxiety, it
Speaker 1: does take a bit of trial and error. For example,
Speaker 1: even with allergy medication, doctors aren't sure from the get
Speaker 1: go what will work for patients. There is serotonin in
Speaker 1: our brain and in our gut, and a lot of
Speaker 1: antidepressant hills are what's known as ss R eyes, and
Speaker 1: one of the side effects of these antidepressants can be
Speaker 1: stomach upset for the first week or two because it's
Speaker 1: affecting the serotonin level in your gut, but it should
Speaker 1: eventually subside again. Trial and error with any kind of medication.
Speaker 1: With any mental health medication, you will feel the negative
Speaker 1: side effects before you feel the positive ones. But if
Speaker 1: you stick with it, medication can absolutely give people back
Speaker 1: their lives who need it. The social aspect of the
Speaker 1: biopsychosocial model is being taken more seriously these days, as
Speaker 1: people recognize whoops, why is my phone ringing that this
Speaker 1: whole thing is complex. We can appreciate now how early
Speaker 1: childhood traumas or things like bullying can make a big
Speaker 1: impact later on down the line, and this gives therapists
Speaker 1: and doctors more opportunities for treatment There are so many
Speaker 1: different types of anxiety treatments that help from an environmental perspective,
Speaker 1: from working on relationships with people, exercising, mindfulness, meditation, journaling, gratitude,
Speaker 1: and so much more. Two billion people around the world
Speaker 1: have a diagnosable mental, brain or behavioral health disorder. But
Speaker 1: even people who don't meet all of the criteria for
Speaker 1: a mental health diagnosis may still struggle with anxiety and
Speaker 1: could absolutely benefit from some kind of treatment. If we
Speaker 1: optimized all of the therapists in the United States, we
Speaker 1: would only have enough therapists to treat seven percent of
Speaker 1: the American population, despite the fact that over the course
Speaker 1: of a lifetime, fifty percent of Americans will have a
Speaker 1: diagnosable mental health disorder. The average amount of time from
Speaker 1: someone first having a symptom of mental illness to seeking
Speaker 1: medical attention in the United States is eleven years. Dr
Speaker 1: Vauson's lab at Stanford Brainstorm, the Stanford Lab for Mental
Speaker 1: Health Innovation, focuses on trying to solve the mental health
Speaker 1: crisis through entrepreneurship. We won't be able to solve the
Speaker 1: problem of getting people mental health care unless we think
Speaker 1: about other ways to reach people, which is where technology
Speaker 1: comes in. Dr Vowson's goal is to help foster entrepreneurs
Speaker 1: who find ways to address mental health online, as well
Speaker 1: as think about online worlds as ways to deliver and
Speaker 1: provide mental health therapeutic services and education to reach people
Speaker 1: in ways that is low cost and just gets right
Speaker 1: to you. One example of how Brainstorm has changed things
Speaker 1: online has been working with a company like Pinterest to
Speaker 1: get their users tools and resources that comes from doctors
Speaker 1: and is evidence space treatment from mental health known as
Speaker 1: micro therapeutics. Micro Therapeutics is a whole tool kit of
Speaker 1: exercises based in cognitive behavioral therapy, dialectical behavioral therapy, acceptance
Speaker 1: and commitment therapy translated into two or three minute things
Speaker 1: that you can do online and actually feel a little
Speaker 1: bit better in just a few minutes. It's a compassionate experience.
Speaker 1: Dr Vosson's former student, Ariella Sophia, is now the founder
Speaker 1: and CEO of Real and Real is a website and
Speaker 1: community that is a team of innovators, clinicians, and technologists
Speaker 1: on a mission to not just normalize mental health care,
Speaker 1: but celebrate it. They integrate empathy, creativity, and design to
Speaker 1: build a progressive mental health care experience while also improving
Speaker 1: the quality of care itself. Dr Vawson is the chief
Speaker 1: medical Officer. There is no one solution to mental health.
Speaker 1: It's not just one medication or one type of therapy.
Speaker 1: It's also policy and economics, and it's also about changing
Speaker 1: the workplace, and it's about changing the way we talk
Speaker 1: to each other. Dr Vauson's top ten prescriptions that she
Speaker 1: actually will write on a prescription pad for patients for
Speaker 1: treating anxiety. Mindfulness, meditation with deep breathing, sleep, gratitude, nutrition,
Speaker 1: reducing substance use like alcohol, drugs, tobacco, to use as
Speaker 1: little as possible, zero to none or none to little, exercise, nature,
Speaker 1: community and connecting, giving and altruism and sexual pleasure. It's
Speaker 1: not about big, grand gestures that help alleviate anxiety. It's
Speaker 1: doing small things and doing them regularly. And there is
Speaker 1: scientific evidence that things like journaling and getting outside actually
Speaker 1: help our brain. Studies have shown that mindfulness and deep
Speaker 1: breathing bring about chemical changes at the cellular level that
Speaker 1: lead to a cell living longer, which means that there's
Speaker 1: a link between mindfulness, meditation, and deep breathing and longevity.
Speaker 1: The length of your life all right, and if you
Speaker 1: want to read these takeaways, you can always go to
Speaker 1: my website, Jen Kirkman dot com and then click anxiety
Speaker 1: Bites again. That link will also be in the show notes.
Speaker 1: Thank you so much for listening and remember anxiety Bites,
Speaker 1: but You're in control. For more podcasts from My heart Radio,
Speaker 1: visit the I heart Radio app, Apple podcast, or wherever
Speaker 1: you listen to your favorite shows.