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Speaker 1: What happens in the brain when we face adversity and

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Speaker 1: why do two people with the same hardship walk away

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Speaker 1: with such totally different outcomes. Is resilience something that you're

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Speaker 1: born with or is it something your brain can develop?

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Speaker 1: And if so, how, what does any of this have

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Speaker 1: to do with the diving bell and the butterfly, or

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Speaker 1: using magnetic fields to zap the brain or the less

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Speaker 1: famous partner to the brain's reward system, or.

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Speaker 2: What seemingly unrelated.

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Speaker 1: Disorders in psychiatry all have in common. Welcome to Inner

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Speaker 1: Cosmos with me David Eagleman. I'm a neuroscientist and an

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Speaker 1: author at Stanford, and in these episodes we sail deeply

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Speaker 1: into our three pound universe to understand why and how

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Speaker 1: our lives look the way they do. Today's episode is

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Speaker 1: about resilience. We all know someone who's been through hell

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Speaker 1: and somehow comes out standing. Maybe you know a person

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Speaker 1: undergoing chemotherapy who still manages to raise a family and

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Speaker 1: be a good parent, or a refugee who rebuilds their

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Speaker 1: life from nothing, or a friend who keeps going after

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Speaker 1: losing her job. There's something about resilience going on here

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Speaker 1: that's different from what a lot of other people would

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Speaker 1: do in the same situation.

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Speaker 2: We're thinking about.

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Speaker 1: This one a young man who gets an early onset

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Speaker 1: motor neuron disease and slowly ends up completely paralyzed in

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Speaker 1: a wheelchair and eventually loses his ability to speak, but

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Speaker 1: he keeps on plugging along and eventually ends up becoming

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Speaker 1: one of the premire mathematical physicists in the world. This

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Speaker 1: is the story of Stephen Hawking. How did he stay

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Speaker 1: so resilient in the face of a slowly creeping disease

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Speaker 1: that ate his body but didn't seem to slow him down?

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Speaker 2: That kind of drive, that kind of adaptation.

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Speaker 1: It raises the question what enables some people to keep

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Speaker 1: going when everything falls apart? What is human resilience made of?

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Speaker 1: In this episode, we're going to answer this question by

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Speaker 1: diving into the brain. And I'm going to do so

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Speaker 1: with my colleague and friend, Jonathan Downer, who's been on

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Speaker 1: Inner Cosmos before, and he's one of the most compassionate

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Speaker 1: and insightful thinkers that I know. He has an MD

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Speaker 1: and specializes in psychiatry, and he also has a PhD

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Speaker 1: in neuroscience, and he's become one of the world's experts

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Speaker 1: in transcranial magnetic stimulation, which is a technique that we'll

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Speaker 1: come back to in a minute now. Jonathan was on

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Speaker 1: Inner Cosmos about a year ago to talk about depression,

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Speaker 1: and that episode moved and inspired a huge number of people.

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Speaker 1: So I've wanted to sit down with Jonathan again to

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Speaker 1: zoom out the camera one notch to talk about an idea,

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Speaker 1: change and focus the idea that clinical depression is actually

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Speaker 1: one expression of a more fundamental issue, one that has

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Speaker 1: accidentally surfaced as neuroscientists around the globe have performed hundreds

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Speaker 1: and hundreds of individual studies and then looked at the

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Speaker 1: emerging shape that all of these studies were pointing to.

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Speaker 1: What we'll learn today is an issue that sets right

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Speaker 1: at the center of our lives. So let's dive in

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Speaker 1: with Jonathan Downer to understand it. So, Jonathan, we've all

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Speaker 1: known people who are in very terrible circumstances in life,

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Speaker 1: and yet they figure out a way to keep going.

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Speaker 1: So we might by this says resilience, So tell us

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Speaker 1: about resilience. Yeah, So it's a fascinating topic to get into.

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Speaker 3: I think a good example to start us off by

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Speaker 3: way of illustration. You and I in our textbook talked

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Speaker 3: about the case of Jean Boubie, who was the author

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Speaker 3: of The Diving Bell and the Butterfly. I really like

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Speaker 3: his examples. He had an absolutely horrific situation in which

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Speaker 3: this was a successful author and editor of the French

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Speaker 3: fashion magazine a magazine, and he unfortunately suffered a tiny

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Speaker 3: little stroke in his brain stem that left him with

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Speaker 3: this syndrome called locked in syndrome. And for those who

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Speaker 3: are hearing about that for the first time, it's a

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Speaker 3: horrible syndrome where the output passages from your the output

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Speaker 3: tracks from your brain down to the spinal cord, and

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Speaker 3: the muscles are just severed by the stroke. So you're

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Speaker 3: perfectly awake, you're perfectly conscious, you can feel sensations, but

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Speaker 3: you can't send any signals out to your body, and

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Speaker 3: there's no recovery. He was then bedridden and the only

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Speaker 3: part of his body he could move where he could blink,

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Speaker 3: and that was pretty much all he could do, and

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Speaker 3: with the assistance of some of the people who work

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Speaker 3: with him, he would use a blinking code to specify

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Speaker 3: letter by letter what he wanted to say.

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Speaker 1: Specifically, the assistant would read out the letters of the

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Speaker 1: alphabet in order of their frequency, and then when she

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Speaker 1: got to the right letter, he would blink his eye

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Speaker 1: and she would write down that letter and then start

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Speaker 1: the process over again.

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Speaker 3: Yeah, and so the fact that he was even able to, like,

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Speaker 3: I don't know what would happen to you or I

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Speaker 3: or most of the people I know if they were

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Speaker 3: in that situation.

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Speaker 2: Certainly.

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Speaker 3: I mean, imagine having an inch which you can't scratch

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Speaker 3: because you can't move, or a pain in your leg,

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Speaker 3: or a cramping your leg that you can't do anything

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Speaker 3: about for hours. It's very hard to maintain a positive

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Speaker 3: attitude in a situation like that. And yet he was

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Speaker 3: able to laboriously blink out an entire book describing his experience,

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Speaker 3: which the butterfly exactly. So, when I think about the

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Speaker 3: fact that, to me, the most remarkable part about this

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Speaker 3: is that is not the stroke or the fact that

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Speaker 3: there's an assistant with this amazing blinking code. To me,

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Speaker 3: the astonishing part is the fact that there's a there's

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Speaker 3: a resilient spirit in there that's capable of doing that,

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Speaker 3: that is laying there in this betting it somehow has

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Speaker 3: the patience and the resilience and the I guess the

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Speaker 3: inner fortitude to do something like that.

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Speaker 2: So what is that about?

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Speaker 3: So we I mean, there are a few different ways

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Speaker 3: of looking at resilience that's been studied to death, and

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Speaker 3: there are whole books that have been written on it.

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Speaker 3: You can talk about psychological sources of resilience. You can

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Speaker 3: talk about cultural practices and interventions and therapies that support it.

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Speaker 3: You can talk about you know, social practices that support it.

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Speaker 3: What I want to dive into a little bit is

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Speaker 3: the actual neural circuitry behind it. Because we are learning

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Speaker 3: a lot about what that neural circuitry is, and it

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Speaker 3: turns out that there are indeed specific brain circuits which

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Speaker 3: support our ability to be resilient. So, for example, a

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Speaker 3: person who suffers a terrible stroke, if these circuits are

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Speaker 3: preserved and the person can actually function a lot better

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Speaker 3: than you would expect given the circumstances they're in. And

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Speaker 3: then surprisingly, if those circuits are damaged in the stroke,

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Speaker 3: the person may have minimal physical limitations and yet is

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Speaker 3: not functioning at all. Is to sort of emotionally always

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Speaker 3: getting stuck on things, cognitively always getting stuck on things,

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Speaker 3: and just not able to get up and start moving.

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Speaker 3: So I think what would be interesting to get into

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Speaker 3: a little bit is the circuitry that we've been able

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Speaker 3: to delineate behind the general ability to be resilient to

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Speaker 3: life stresses and challenges and the general ability to function.

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Speaker 1: And just before we get into the details of the circuitry,

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Speaker 1: what is the variation in the circuitry across the population.

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Speaker 2: Yeah, so that's fascinating.

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Speaker 3: There's been a lot of studies done on that using

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Speaker 3: techniques using MRI scans. So, for example, you can have

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Speaker 3: a person going the scanner and you can actually map

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Speaker 3: the thickness of their gray matter across the hole using

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Speaker 3: a technique called boxel based morphometry. So they take all

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Speaker 3: the little voxels in the scan and they look at

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Speaker 3: how thick the grain matter is in different areas, and

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Speaker 3: they can compare people who have more resilience versus less resilience.

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Speaker 3: There was a famous study done, I guess about a

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Speaker 3: decade ago now where they did exactly the question we're

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Speaker 3: asking about. They took a whole bunch of people who

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Speaker 3: had suffered horrible adverse childhood experiences. There's actually a psychological

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Speaker 3: questionnaire called the adverse childhood experiences questionnaire. So all these people,

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Speaker 3: you know, had been through horrible traumatic experiences, and yet

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Speaker 3: a subset of them had never gone on to develop

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Speaker 3: post traumatic stress disorder or depression or any other sort

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Speaker 3: of classic you know, axis one mental disorder, and the

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Speaker 3: question was, what's going on with them? It turns out

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Speaker 3: that there were specific areas of the frontal lobes that

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Speaker 3: had thicker gray matter. In these areas we were pinpointing

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Speaker 3: specifically as an area we can get into called the

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Speaker 3: left or salalateral prefrontal cortex, but it's actually a network

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Speaker 3: of areas in the brain. Who seemed if you just had,

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Speaker 3: by luck of the draw, you happen to have more

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Speaker 3: gray matter in these areas, then you were more likely

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Speaker 3: to be resilient to even quite horrible adverse childhood experiences.

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Speaker 1: And is it luck of the draw a genetic issue

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Speaker 1: or is it environmental practices or social practices.

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Speaker 3: It's a really good point there are you know, the

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Speaker 3: literature around resilience suggests that there's a lot to this,

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Speaker 3: so you know, there is although there is some genetic

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Speaker 3: component to resilience that I think that is greatly overshadowed

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Speaker 3: by one's environment and one's psychology and one's upbringing and

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Speaker 3: the practices that one implements. Early adverse childhood experiences are

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Speaker 3: really bad for people's resilience, whereas growing up in a

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Speaker 3: supportive childhood environment and having social supports and sort of

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Speaker 3: a calm parenting environment and all the rest of it

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Speaker 3: can often provide a person with quite a lot of

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Speaker 3: resilience that they can tap into later on in life.

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Speaker 1: Yeah, although there are you know, like everything it's a

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Speaker 1: gene environment interaction. There are these studies done by Steven

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Speaker 1: Swami with monkeys where he is looking at these monkey

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Speaker 1: t and with half the adolescent monkeys he has them

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Speaker 1: with their mothers and the other half he has them

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Speaker 1: just with their peers. So they're raised with peers, and

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Speaker 1: just like in junior higher high school, monkey peers are

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Speaker 1: mean to one another. And so he looks at who

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Speaker 1: ends up doing well and who doesn't, and it turns

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Speaker 1: out it's not as obvious as you would think. It

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Speaker 1: turns out that there are genetic predispositions that cause some

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Speaker 1: of the monkeys in the bad group being raised with

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Speaker 1: their peers to still do fine and others not. So

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Speaker 1: there's definitely an interaction between how you're raised and what

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Speaker 1: you come to the table with genetically.

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Speaker 2: So let's jump.

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Speaker 1: Into what you see when you're looking at this in

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Speaker 1: the brain scanner. What are these prefrontal areas that you're

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Speaker 1: talking about. So I think that might be a good

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Speaker 1: place to start. So on the one hand, you know,

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Speaker 1: let's say we have this technique called box based morphometry

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Speaker 1: that's capable of pinpointing areas of gray matter they're thicker

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Speaker 1: versus thinner in certain groups of people. And let's say

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Speaker 1: we've used that to find people were unusually resilient to

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Speaker 1: developing access one disorders despite adverse childhood experiences. The flip

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Speaker 1: side of that would be looking at people who do

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Speaker 1: have access one disorders and saying okay. And this was

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Speaker 1: an enterprise that began, and I guess around twenty ten

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Speaker 1: or so on. They started being able to gather up

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Speaker 1: big data sets of lots of people who had succumbed

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Speaker 1: to depression or bipolar disorder OCT substance use anxiety disorders PTSD.

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Speaker 2: And this is what you mean by access one disorder,

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Speaker 2: So access one disorder exactly.

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Speaker 3: So the sort of the classic sort of psychiatric disorders

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Speaker 3: DSM one is the Diagnostic and Statistical Manual, and so

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Speaker 3: the access one of that is just one way of

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Speaker 3: describing formal clinical psychiatric disorders. So this was a team

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Speaker 3: led by a meet at Ken at Stanford University and

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Speaker 3: Madaline Goodkind was the first author, And in twenty fifteen

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Speaker 3: they gathered up over two hundred studies that had been done,

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Speaker 3: or close to two hundred studies that have been done

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Speaker 3: looking at the thickness of grain matter across all these

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Speaker 3: different disorders, and they asked a really interesting question, are

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Speaker 3: all the different disorders like OCD and PTSD are.

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Speaker 2: They completely different?

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Speaker 3: Do they all involve different brain circuits or is there

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Speaker 3: some common element like if you did a bend diagram

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Speaker 3: and overlaid them all. Is there some common element to

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Speaker 3: all the brain disorders that we have lumped into the

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Speaker 3: basket of psychiatric disorders as opposed to neurological disorders.

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Speaker 1: And so amazing by the way that we can do

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Speaker 1: this now because we have enough brain scans from enough

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Speaker 1: patients with different disorders that for the first time in

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Speaker 1: history we can ask that question.

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Speaker 2: It was fair. Yeah, absolutely, So what do they find fascinating?

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Speaker 3: So they turn out that yes, indeed, if you overlapped

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Speaker 3: all the maps of all these two hundred different studies

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Speaker 3: involving I think close to seven thousand patients versus healthy controls.

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Speaker 3: There were indeed some areas which were universally thinned out

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Speaker 3: across all these different disorders, and as you might expect,

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Speaker 3: they belong to the same network that this resilient network was,

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Speaker 3: except it was in the other direction. So people will

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Speaker 3: then use with quite thick gray matter in this network

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Speaker 3: of regions were resilient to disorder. And on the other hand,

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Speaker 3: if you looked at people who had these disorders PTSD

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Speaker 3: or anxiety, one common element they all had was that

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Speaker 3: this specific network of regions was a little bit thinner

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Speaker 3: in terms of the gray matter. There are a bunch

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Speaker 3: of different networks in the brain that perform various functions.

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Speaker 3: Some of them move your upper body or your lower body,

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Speaker 3: or do vision or hearing. This particular network having an

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Speaker 3: interesting name, it's called the salience network.

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Speaker 2: And so what was need about this popped out?

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Speaker 3: The common element across all these different disorders when people

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Speaker 3: lose their resilience is the salience network. And on the

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Speaker 3: other hand, if your salience network is intact, then you

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Speaker 3: tend to have this resilience.

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Speaker 1: So help us understand this a little bit more so,

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Speaker 1: if you have less resilience, how does that connect with

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Speaker 1: psychiatric disorders?

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Speaker 3: So that's really I think that's a really great question

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Speaker 3: and the right way of putting it. So the salience network,

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Speaker 3: it helps understand what the salience nets works function seems

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Speaker 3: to be. What was need about discovering that the salience

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Speaker 3: network was involved is that separately, people had been studying

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Speaker 3: the saliens network for fifteen years. I accidentally did my

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Speaker 3: PhD audit back in the late nineteen nineties before we really.

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Speaker 2: Knew what it was.

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Speaker 3: But its job seems to be a thing called cognitive control,

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Speaker 3: the ability to self regulate your thoughts and your behaviors

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Speaker 3: and your emotions. What's unique about it in terms of

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Speaker 3: the brain regions it involves is it has some brain

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Speaker 3: reasons that are part of the limbic system, the so

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Speaker 3: called emotional system the brain, but it also has some

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Speaker 3: areas that are part of the brain's kind of executive

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Speaker 3: function and cognitive system. So it's out of all the

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Speaker 3: various dozens of brain networks that are there, it uniquely

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Speaker 3: seems to break between the limbic system and the cognitive

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Speaker 3: system between sort of reason and emotion, and you will

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Speaker 3: see people activating it when they have to inhibit a

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Speaker 3: particular thought in order to do or a prepotent response.

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Speaker 3: So a classic example that would be the go No

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Speaker 3: Go task, which is a task where people have a

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Speaker 3: signal that tells inn apress button and then another signal

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Speaker 3: says no, wait, don't do that, and so you have

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Speaker 3: to inhibit that predisposition.

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Speaker 1: So for example, if if the banana comes on the screen,

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Speaker 1: I pound the button, and if the strawberry appears on

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Speaker 1: the screen, I have to not hit the button.

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Speaker 2: That's a great example, that'd be it.

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Speaker 3: Another example would be the classic stroop task, which in

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Speaker 3: the stroop task, this is a tricky one. If you

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Speaker 3: ever have to try it, you can They have them

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Speaker 3: online if you ever want to go and try them.

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Speaker 3: With the word blue will be written in red ink

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Speaker 3: or the word red will be written in green ink,

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Speaker 3: and you have to not say the word, which is

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Speaker 3: the thing you want to do, but you have to

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Speaker 3: actually push past that prepotent response and say the color

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Speaker 3: of the word, even though there's an interference effect there.

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Speaker 3: So the stroop task and all these things volitionally activates

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Speaker 3: your cognitive control capacity. It essentially allows you to stop

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Speaker 3: ruminating to or and to focus on what kind of

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Speaker 3: response you're going to make, so the salience network will

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Speaker 3: kick in. If a person, I'll give you an example,

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Speaker 3: if you, for example, got bored with what I was

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Speaker 3: saying right now in your mind started to wander till

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Speaker 3: yesterday or.

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Speaker 2: Tomorrow or why.

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Speaker 3: I usually say this lectures, and you know, it's a

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Speaker 3: room full of people, so you know, you could always

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Speaker 3: see the people like some people are paying attention to

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Speaker 3: It's totally natural. It's very hard to focus your attention

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Speaker 3: for a long time, so people start thinking about something

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Speaker 3: else and then maybe suddenly I say something interesting and

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Speaker 3: their attention comes back again. At that moment when you

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Speaker 3: stop mind wandering and you return to the present moment,

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Speaker 3: your salience networking is activating at that moment. For people

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Speaker 3: who have done mindfulness meditation, we've all experienced this.

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Speaker 2: You know, Okay, I'm going to be mindful.

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Speaker 3: I'm going to pay attention to my breathing, and then

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Speaker 3: after about you know, three seconds, your brain starts wandering

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Speaker 3: off to something you have to do later that day

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Speaker 3: or whatever. And then and you wander and wander and

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Speaker 3: then after about a minute you're like, oh, I actually,

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Speaker 3: I wasn't supposed to be doing that. I'm supposed to

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Speaker 3: be paying attention to my breath, and at that moment

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Speaker 3: of mindfulness you return. So at the moment of mindfulness

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Speaker 3: being again, your salience network comes on as you break

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Speaker 3: the train of thought. So we can imagine that as

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Speaker 3: we go through life, we're often not in the present moment.

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Speaker 3: We're ruminating about the past or the future or something else.

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Speaker 3: But the moment that we snap out of it and

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Speaker 3: return to the present moment the sailing this network seems

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Speaker 3: to activate every time that happens. So you can imagine

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Speaker 3: what would happen if the sailings network goes down. If

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Speaker 3: you lose that capacity to easily snap out of things,

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Speaker 3: then your ruminations will just keep going and keep going

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Speaker 3: and keep going. And the minute that you can't snap

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Speaker 3: out of things, all of a sudden, it's harder to function.

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Speaker 2: Right.

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Speaker 3: So, you know, all of us, if we're faced with

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Speaker 3: a stressful situation, let's say we start worrying about it

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Speaker 3: and thinking about something horrible that's happened, you know, if

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Speaker 3: we lost someone important to us. But as long as

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Speaker 3: we can snap out of that thought and return to

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Speaker 3: our task or our work or whatever doing. We don't

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Speaker 3: have an access one disorder. We have stress, we have distress,

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Speaker 3: but we don't have disorder. But the day you can't

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Speaker 3: snap out of it again is the day you flip

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Speaker 3: over into having a disorder.

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Speaker 1: So, with this understanding coming into focus, what kind of

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Speaker 1: therapeutic approaches are there?

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Speaker 2: Beautiful? So let's go to that.

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Speaker 3: So let me also tie that back to resilience, because

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Speaker 3: I'll say, resilience has a few different As we start

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Speaker 3: to tease apart this circuitry, we start to realize that

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Speaker 3: resilience has a few components to it. One of this

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Speaker 3: isn't the only circuit behind resilience, but one of the

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Speaker 3: circuits behind resilience is this salience network and its role

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Speaker 3: of cognitive control and the ability to snap out of

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Speaker 3: mind wandering and rumination. So that thing we call cognitive

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Speaker 3: control or cognitive flexibility is one of the ingredients of resilience,

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Speaker 3: and it is one that can be enhanced over time,

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Speaker 3: as you say, one of the classic ways to enhance it.

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Speaker 3: We know that, as I mentioned during Moments of Mindfulness,

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Speaker 3: that the salience networks engage. So people who wish to

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Speaker 3: enhance their resilience, mindfulness based stress reduction and mindfulness based

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Speaker 3: cognitive therapy are tried and true sentxuries old, I mean

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Speaker 3: thousands of years old methods that if you spend years

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Speaker 3: and years practicing, you can strengthen one your capacity to

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Speaker 3: be in the present moment or at least return to

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Speaker 3: the present moment when you need to, and to maintain

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Speaker 3: yourself there. When you're sitting there meditating for ten or

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Speaker 3: twenty minutes, every time you catch yourself and bring yourself back.

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Speaker 3: You can think about that as one rep. It's like

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Speaker 3: one sit up of this system. And so the idea

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Speaker 3: behind ten years of mindful at practices you're going to

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Speaker 3: do a whole lot of situps and at the end

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Speaker 3: that that system is going to be fairly strong.

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Speaker 1: So we have mindfulness meditation is one way to practice this.

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Speaker 1: How else are you thinking about this from the neurological point?

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Speaker 3: Yeah, I think that's great. So there are Yeah, So

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Speaker 3: that's exactly it. So that's one way of doing it.

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Speaker 3: When people go for there are. Evidence based psychotherapy is

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Speaker 3: like cognitive behavioral therapy, and that's a little bit different

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Speaker 3: from mind welellss. You're not merely returning to be present

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Speaker 3: with whatever feelings or thoughts are there. But the trick

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Speaker 3: is when you get into a difficult situation and your

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Speaker 3: emotional state goes out of control or your behavior goes

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Speaker 3: out of control. In cognitive behavioral therapy, we teach ourselves

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Speaker 3: to reframe situations or thoughts in a different way, so

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Speaker 3: we're actually exerting cognive control to look at the situation

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Speaker 3: a bit differently and figure out whether our emotions and

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Speaker 3: our thoughts are proportionate to the situation or disproportionate, and

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Speaker 3: then try and bring them back again. And that also

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Speaker 3: involves activatingly at these regions. So those are tried and

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Speaker 3: true methods that have been out there. I'm not aware

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Speaker 3: of any specific medication that in a targeted way boost

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Speaker 3: these things. So there are medications that help with the

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Speaker 3: access one disorders, but I'm not aware of a medication

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Speaker 3: that specifically does this one thing of enhancing one's cognitive control. Uh.

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Speaker 3: You know, stimulants for some people and things like ADHD

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Speaker 3: when they are is just a little underactive. There are

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Speaker 3: certain groups of people who find that they gain contentitive

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Speaker 3: control on you know, people with ADHD, for example, may

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Speaker 3: find that medications enhance their ability to exercise or exert

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Speaker 3: cognitive control.

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Speaker 1: One of your errors expertise is transcriminal magnetic stimulation, So

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Speaker 1: tell us about that.

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Speaker 2: That's exactly where I was going.

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Speaker 1: So first, for the benefit of the listenership, tell us

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Speaker 1: what TMS is, and then tell us how it applies here.

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Speaker 3: Perfect, Okay, So yes, So right now, we've got this

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Speaker 3: target circuit in the brain that we'd really love to

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Speaker 3: strengthen because if only we could strengthen it for people,

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Speaker 3: they would have more cognitive control, and they'd have more

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Speaker 3: resilience and so on. And medications don't do it for

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Speaker 3: most people, but and therapy takes a really long time,

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Speaker 3: and not everyone has the capacity to do it.

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Speaker 2: But if we could.

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Speaker 3: Somehow stimulate that area and turn it on over and

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Speaker 3: over again, like do the sit ups for people, then

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Speaker 3: you know, we could be able to strengthen it. And

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Speaker 3: the method that we're using successfully to do that right

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Speaker 3: now is called transcranial magnetic stimulation. TMS is the short form.

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Speaker 3: It's a method for stimulating the brain non invasively. So

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Speaker 3: in the old days, you want to stimulate the brain,

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Speaker 3: you have to do surgery, open up the skull and

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Speaker 3: implant use an electrode to stimulate the brain. Nowadays we

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Speaker 3: can do that non invasively using a device that stimulates

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Speaker 3: the brain through the skull using powerful focused magnetic field pulses.

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Speaker 3: So a little inductor paddles placed over the target region

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Speaker 3: of the brain and it'p little quick pulses. It's powerful

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Speaker 3: enough that if you apply the little pulses to the

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Speaker 3: area of your hand that moves your thumb, for example,

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Speaker 3: you'll actually see the person's thumb move. And I think

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Speaker 3: you and I have gone through that as a little demonstration,

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Speaker 3: and it was discovered back in the nineteen ninety is

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Speaker 3: that if you do this not once or twice, but

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Speaker 3: if you do this hundreds of times, you can strengthen

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Speaker 3: the circuits that you're stimulating via the mechanisms of neuroplasticity,

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Speaker 3: which of course you've discussed elsewhere at length. The neurons

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Speaker 3: that you fire together will gradually wire together. So when

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Speaker 3: you deliver tms to any area of the brain, not

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Speaker 3: only do you activate that area, but the other areas

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Speaker 3: it's connected to will also light up, and they all

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Speaker 3: fire together, and they all wire together. So you can

440
00:22:40,560 --> 00:22:42,440
Speaker 3: sort of do hundreds of sit ups for a person

441
00:22:42,480 --> 00:22:46,640
Speaker 3: in about three minutes of TMS using these sequences of pulses.

442
00:22:46,840 --> 00:22:50,400
Speaker 3: It's been known for a long time dorsal that TMS

443
00:22:50,440 --> 00:22:53,000
Speaker 3: two regions like the dorsalateral proof on cortex and so on.

444
00:22:54,040 --> 00:22:56,720
Speaker 3: Back in nineteen ninety five, it was first demonstrated that

445
00:22:56,760 --> 00:22:59,000
Speaker 3: this can be useful in treating depression, and then it

446
00:22:59,040 --> 00:23:00,840
Speaker 3: turned out to be useful in treating other things like

447
00:23:00,880 --> 00:23:03,680
Speaker 3: anxiety and other targets turned out to be useful in

448
00:23:03,720 --> 00:23:08,760
Speaker 3: OCD and PTSD and binge eating disorder and bolivia orvosa

449
00:23:08,800 --> 00:23:12,120
Speaker 3: and lots of other conditions. Interestingly, when we look back

450
00:23:12,200 --> 00:23:14,479
Speaker 3: at what areas we'd been stimulating back in the nineties

451
00:23:14,480 --> 00:23:16,000
Speaker 3: and later on, it turned out that a lot of

452
00:23:16,000 --> 00:23:19,480
Speaker 3: the areas we were activating with TMS corresponded very nicely

453
00:23:19,560 --> 00:23:22,879
Speaker 3: to this network, this alience network, which had been active

454
00:23:22,920 --> 00:23:26,200
Speaker 3: across many different disorders. For those of us in the field,

455
00:23:26,200 --> 00:23:28,560
Speaker 3: that solved the mystery where we come in and say, look,

456
00:23:28,680 --> 00:23:30,200
Speaker 3: I thought we were just trying to treat the page.

457
00:23:30,200 --> 00:23:32,600
Speaker 3: And when I opened my TMS clinic in twenty ten,

458
00:23:32,600 --> 00:23:34,479
Speaker 3: we kept seeing this. We'd have a person who came

459
00:23:34,480 --> 00:23:36,399
Speaker 3: from the eating disorders clinic. Oh, well, but you know

460
00:23:36,440 --> 00:23:38,119
Speaker 3: you're depressed, so let's see if we can help you.

461
00:23:38,160 --> 00:23:40,440
Speaker 3: So we treat the depression and they come back in

462
00:23:40,480 --> 00:23:42,359
Speaker 3: and they say, well, Doc, you didn't tell me my

463
00:23:42,440 --> 00:23:45,080
Speaker 3: Bolivia was going to go away. And they said, wow,

464
00:23:45,119 --> 00:23:47,880
Speaker 3: that's interesting. How do you think about that? And then

465
00:23:48,240 --> 00:23:50,520
Speaker 3: you'd have a person who came in for depression, but

466
00:23:50,560 --> 00:23:52,840
Speaker 3: their bigger picture they were a veteran with PTSD and

467
00:23:52,840 --> 00:23:55,400
Speaker 3: they come and say, you know, I'm not having flashbacks anymore.

468
00:23:55,640 --> 00:23:58,920
Speaker 3: I can walk into Walmart now without having panic attacks,

469
00:23:58,960 --> 00:24:02,680
Speaker 3: Like my anxiety is way down. You'd have other people

470
00:24:02,720 --> 00:24:05,159
Speaker 3: who'd walk in and say, you know, I took a

471
00:24:06,080 --> 00:24:08,760
Speaker 3: mindfulness course once and I just couldn't do it, but

472
00:24:08,840 --> 00:24:11,480
Speaker 3: I noticed after the TMS, now I can do mindfulness,

473
00:24:12,560 --> 00:24:14,359
Speaker 3: or say I took a therapy course once and I

474
00:24:14,400 --> 00:24:16,120
Speaker 3: tried to learn how to do CBT and I tried

475
00:24:16,119 --> 00:24:18,560
Speaker 3: the techniques and you know, I really I tried for

476
00:24:18,560 --> 00:24:20,719
Speaker 3: two years. I was like teaching it to my roommate

477
00:24:20,760 --> 00:24:22,440
Speaker 3: and she could do it, but I couldn't do it.

478
00:24:22,640 --> 00:24:24,480
Speaker 3: But now after the TMS, I can do it now,

479
00:24:24,560 --> 00:24:27,719
Speaker 3: like it actually works now. So there's a synergy between

480
00:24:27,760 --> 00:24:30,000
Speaker 3: these areas of brain and our ability to stimulate them

481
00:24:30,040 --> 00:24:32,800
Speaker 3: with TMS. And what we've noticed as we stimulate these

482
00:24:32,840 --> 00:24:35,320
Speaker 3: areas is is it turned out to be very hard

483
00:24:35,359 --> 00:24:38,440
Speaker 3: to just treat the person's depression or just treat their PTSD.

484
00:24:38,600 --> 00:24:41,080
Speaker 2: If it kicked in and worked, a lot of things

485
00:24:41,160 --> 00:24:41,640
Speaker 2: got better.

486
00:24:42,240 --> 00:24:44,800
Speaker 3: And it was really fascinating what they would come in

487
00:24:44,880 --> 00:24:47,000
Speaker 3: and you would ask them, Okay, well, okay, I see

488
00:24:47,000 --> 00:24:49,399
Speaker 3: the numbers on your scale are down, but just tell me,

489
00:24:49,440 --> 00:24:51,560
Speaker 3: in your own words, what's different now, And they say,

490
00:24:51,600 --> 00:24:52,440
Speaker 3: you know, it's really weird.

491
00:24:53,240 --> 00:24:53,439
Speaker 2: You know.

492
00:24:53,600 --> 00:24:57,760
Speaker 3: Traditionally, I'm constantly ruminating about my body image all day,

493
00:24:57,960 --> 00:25:00,280
Speaker 3: Like I can't stop thinking about my weight, I can't

494
00:25:00,280 --> 00:25:02,199
Speaker 3: think about the way I look. And then I noticed that,

495
00:25:03,000 --> 00:25:05,760
Speaker 3: you know, I had a and then someone said, someone

496
00:25:05,800 --> 00:25:08,560
Speaker 3: made a comment, my aunt made a comment about my appearance.

497
00:25:08,600 --> 00:25:11,280
Speaker 3: And normally that would have ruined my entire day, and

498
00:25:11,320 --> 00:25:13,080
Speaker 3: I would have been still ruminating about it when I

499
00:25:13,119 --> 00:25:16,120
Speaker 3: went to bed, and it was really weird. I noticed

500
00:25:16,240 --> 00:25:18,560
Speaker 3: an hour later that I just wasn't thinking about it.

501
00:25:18,760 --> 00:25:20,280
Speaker 3: I was kind of over it. I was thinking about

502
00:25:20,320 --> 00:25:22,680
Speaker 3: other things again. And so these are the kind of

503
00:25:22,680 --> 00:25:25,719
Speaker 3: things people would keep on talking about that some challenge

504
00:25:25,760 --> 00:25:28,479
Speaker 3: would come along and what they were used to over

505
00:25:29,040 --> 00:25:30,200
Speaker 3: years of having the disorders.

506
00:25:30,200 --> 00:25:32,280
Speaker 2: Not a challenger come along. Okay, that's my week gone.

507
00:25:32,359 --> 00:25:35,080
Speaker 3: I'm going to be stuck ruminating about this for the

508
00:25:35,119 --> 00:25:35,680
Speaker 3: rest of the week.

509
00:25:35,800 --> 00:25:36,919
Speaker 2: I won't be able to do anything.

510
00:25:37,400 --> 00:25:39,640
Speaker 3: And what they kept noticing was saying, yeah, I get upset,

511
00:25:39,800 --> 00:25:43,560
Speaker 3: and then twenty minutes later, I'm over it. And I said, well,

512
00:25:43,680 --> 00:25:45,480
Speaker 3: is that a weird experience? You feel like you're being

513
00:25:45,520 --> 00:25:47,439
Speaker 3: emotionally numbed or emotionally blunted.

514
00:25:47,520 --> 00:25:47,680
Speaker 2: No.

515
00:25:47,680 --> 00:25:49,520
Speaker 3: No, I still have my emotions, but I can get

516
00:25:49,520 --> 00:25:52,600
Speaker 3: over things now and I don't overreact as much as

517
00:25:52,600 --> 00:25:54,719
Speaker 3: I used to. My reaction is like sort of, you know,

518
00:25:55,000 --> 00:25:58,280
Speaker 3: more proportionate. And I find I can and say, what's

519
00:25:58,320 --> 00:26:01,840
Speaker 3: the experience like? And they use words like willpower and control?

520
00:26:02,280 --> 00:26:04,520
Speaker 3: They say, I feel more like I'm in control again.

521
00:26:04,640 --> 00:26:06,960
Speaker 3: I feel like I have that willpower thing that everyone's

522
00:26:06,960 --> 00:26:09,800
Speaker 3: been telling me. I need more of that. Their subjective

523
00:26:09,840 --> 00:26:12,919
Speaker 3: experience of having this network strengthen is an experience of

524
00:26:13,000 --> 00:26:15,080
Speaker 3: greater willpower, greater control.

525
00:26:17,200 --> 00:26:20,200
Speaker 1: And so does it matter which part of the network

526
00:26:20,320 --> 00:26:23,720
Speaker 1: was stimulated or were these many different studies stimulating various

527
00:26:23,760 --> 00:26:26,280
Speaker 1: different parts, but it all happened to be of this network.

528
00:26:26,400 --> 00:26:28,320
Speaker 3: Well, so it's been a long time piecing that together

529
00:26:28,320 --> 00:26:31,960
Speaker 3: because in the TMS literature, different people targeted. Some people

530
00:26:32,000 --> 00:26:34,160
Speaker 3: will do the left hemispheres, someone do the right hemisphere,

531
00:26:34,240 --> 00:26:37,400
Speaker 3: someone go in the middle between between the two hemispheres,

532
00:26:37,400 --> 00:26:39,399
Speaker 3: and so on. And now that we've got enough of

533
00:26:39,440 --> 00:26:41,240
Speaker 3: these studies and we put them together, it looks like

534
00:26:41,280 --> 00:26:43,800
Speaker 3: you kind of get fairly similar results no matter which

535
00:26:43,880 --> 00:26:45,919
Speaker 3: as long as it's one of the members of this

536
00:26:46,080 --> 00:26:49,479
Speaker 3: network of regions, all the other networks are lighting up

537
00:26:49,920 --> 00:26:51,920
Speaker 3: as well, And so it seems to have a similar

538
00:26:51,960 --> 00:26:55,119
Speaker 3: effect when we scan people while we do TMS. You

539
00:26:55,200 --> 00:26:58,320
Speaker 3: see that when you're stimulating one area, all the other

540
00:26:58,359 --> 00:26:59,800
Speaker 3: areas and its network will light up.

541
00:27:00,720 --> 00:27:04,240
Speaker 2: And how effective is this approach?

542
00:27:04,400 --> 00:27:07,560
Speaker 1: Is it ninety percent of patients get better in some

543
00:27:07,640 --> 00:27:08,639
Speaker 1: way as it ten percent?

544
00:27:08,920 --> 00:27:12,520
Speaker 3: So that's been that remembering the TMS is a technology.

545
00:27:12,600 --> 00:27:14,960
Speaker 3: So if you asked me the question in nineteen ninety five,

546
00:27:14,960 --> 00:27:17,120
Speaker 3: it would be asking a little bit like how far

547
00:27:17,160 --> 00:27:19,760
Speaker 3: can your electric car drive in nineteen ninety five versus

548
00:27:19,760 --> 00:27:22,119
Speaker 3: how far can your electric car drive in twenty twenty five.

549
00:27:22,080 --> 00:27:23,640
Speaker 2: There's the good. Dow says, there's progress.

550
00:27:24,800 --> 00:27:28,159
Speaker 3: The early TMS studies were only getting about ten or

551
00:27:28,160 --> 00:27:31,040
Speaker 3: fifteen percent of people their emission, but they were also

552
00:27:31,080 --> 00:27:33,560
Speaker 3: only doing about ten or fifteen sessions of treatment. And

553
00:27:33,600 --> 00:27:36,040
Speaker 3: then later studies did about thirty sessions of treatment and

554
00:27:36,080 --> 00:27:38,160
Speaker 3: got about thirty percent of people better. And then later

555
00:27:38,200 --> 00:27:40,560
Speaker 3: studies did about fifty sessions of treatment and sometimes you

556
00:27:40,560 --> 00:27:43,920
Speaker 3: get fifty percent of people better. And then other studies

557
00:27:43,960 --> 00:27:47,159
Speaker 3: were using MRI guidance to kind of fine tune the

558
00:27:47,200 --> 00:27:50,040
Speaker 3: location of the stimulation, and it turns out some people,

559
00:27:50,280 --> 00:27:52,360
Speaker 3: it turns out there because of their anatomy, you need

560
00:27:52,359 --> 00:27:55,320
Speaker 3: to have map their anatomy a little more closely to

561
00:27:55,320 --> 00:27:58,720
Speaker 3: get the coil over the right spot. But the biggest breakthrough,

562
00:27:58,760 --> 00:28:00,240
Speaker 3: I think in the last two or three years is

563
00:28:00,320 --> 00:28:06,240
Speaker 3: noticing that TMS require, as we mentioned, it requires the

564
00:28:06,240 --> 00:28:11,320
Speaker 3: brain to have neuroplasticity. Right. There are implantable brain stimulators

565
00:28:11,320 --> 00:28:13,479
Speaker 3: that people use for Parkinson's and depression and so on,

566
00:28:13,520 --> 00:28:15,440
Speaker 3: and then a surgeon will implant them like a little

567
00:28:15,440 --> 00:28:17,760
Speaker 3: pacemaker in the target circuit and then you walk around

568
00:28:17,760 --> 00:28:20,679
Speaker 3: with it all day long. TMS isn't like that you

569
00:28:20,720 --> 00:28:22,520
Speaker 3: sit in the chair, you get a session a treatment

570
00:28:22,560 --> 00:28:24,639
Speaker 3: for three minutes, and after a bunch of sessions you

571
00:28:24,720 --> 00:28:27,480
Speaker 3: then it has to keep lasting for weeks or months,

572
00:28:27,760 --> 00:28:31,200
Speaker 3: even after you've gotten the treatment done. So the only

573
00:28:31,240 --> 00:28:34,520
Speaker 3: way that that works is if you have neuroplasticity, and

574
00:28:34,560 --> 00:28:36,480
Speaker 3: some people just don't have very much. We don't know why,

575
00:28:36,520 --> 00:28:38,520
Speaker 3: but there's a lot of variation. So when we treat

576
00:28:38,520 --> 00:28:40,640
Speaker 3: a bunch of people with depression, about twenty percent of

577
00:28:40,640 --> 00:28:43,800
Speaker 3: people show really strong and really rapid response, and then

578
00:28:43,840 --> 00:28:46,000
Speaker 3: about ten percent of people show nothing at all, and

579
00:28:46,040 --> 00:28:47,800
Speaker 3: everyone else is somewhere in the middle.

580
00:28:48,200 --> 00:28:49,640
Speaker 2: It's almost like you're bailing.

581
00:28:49,360 --> 00:28:51,040
Speaker 3: A bit of a leaky boat, so you're kind of

582
00:28:51,240 --> 00:28:53,240
Speaker 3: bailing it out, but they're getting worse, and then they

583
00:28:53,280 --> 00:28:55,440
Speaker 3: tend to keep coming back. These are the ones who

584
00:28:55,480 --> 00:28:57,840
Speaker 3: seem to need more plasticity. And one of the ways

585
00:28:57,920 --> 00:29:00,000
Speaker 3: that has just come out in the last two orths

586
00:29:00,240 --> 00:29:03,080
Speaker 3: years to make TMS a lot better is it turns

587
00:29:03,080 --> 00:29:05,880
Speaker 3: out that there are some simple, off the shelf old

588
00:29:05,920 --> 00:29:09,720
Speaker 3: medications that enhance the brain's plasticity, and if you take

589
00:29:09,760 --> 00:29:12,160
Speaker 3: those medications a little like an hour or so before

590
00:29:12,200 --> 00:29:14,720
Speaker 3: you get your TMS sessions, it works a lot better,

591
00:29:14,880 --> 00:29:16,440
Speaker 3: and it lasts a lot longer.

592
00:29:17,160 --> 00:29:19,280
Speaker 1: Give us a sense of what some of these meds are,

593
00:29:19,400 --> 00:29:21,240
Speaker 1: just in case the name strikes that any was familiar.

594
00:29:21,400 --> 00:29:22,800
Speaker 2: Happy to do it, so there is.

595
00:29:23,200 --> 00:29:26,600
Speaker 3: So my colleague Alex McGear at the University of Calgary

596
00:29:26,640 --> 00:29:28,920
Speaker 3: back in twenty twenty two publish a paper in Gemo

597
00:29:28,920 --> 00:29:32,720
Speaker 3: Psychiatry using an old it's actually an old anti tuberculosis

598
00:29:32,800 --> 00:29:37,400
Speaker 3: medication called de cyclosarine. Decyclo Sarine works on the brain's

599
00:29:37,400 --> 00:29:39,760
Speaker 3: glutamate system. If we want to get really nerdy, it

600
00:29:39,880 --> 00:29:43,400
Speaker 3: acts on the NMDA receptor. The NMDA receptor is the

601
00:29:43,440 --> 00:29:46,200
Speaker 3: receptor that detects whether two neurons are being fired at

602
00:29:46,200 --> 00:29:49,080
Speaker 3: the same time and then responds to that by strengthening

603
00:29:49,080 --> 00:29:51,800
Speaker 3: the connection between them. So you need your NMDA receptors

604
00:29:51,800 --> 00:29:54,080
Speaker 3: to do that whole plasticity thing where the neurons that

605
00:29:54,120 --> 00:29:57,240
Speaker 3: fire together wire together. So what happens if you add

606
00:29:57,280 --> 00:29:59,960
Speaker 3: a medication that tickles the NMDA receptor and kind of

607
00:30:00,160 --> 00:30:02,520
Speaker 3: helps it stay open a little bit longer and then

608
00:30:02,600 --> 00:30:05,200
Speaker 3: do the tms. Decycoserian has been around since the fifties

609
00:30:05,240 --> 00:30:08,000
Speaker 3: and psychiatrists have been using it and medical researchers have

610
00:30:08,040 --> 00:30:10,160
Speaker 3: been using it not for tuberculosis, but to try and

611
00:30:10,320 --> 00:30:13,560
Speaker 3: enhance plasticity while they give therapy and give other kinds

612
00:30:13,560 --> 00:30:18,120
Speaker 3: of treatments exposure therapy and phobias and OCD and so on,

613
00:30:18,520 --> 00:30:22,040
Speaker 3: And I think one of my colleagues described the results

614
00:30:22,040 --> 00:30:25,080
Speaker 3: as myth after many many years, the result was sort

615
00:30:25,080 --> 00:30:27,880
Speaker 3: of some But interestingly, it might just be that those

616
00:30:27,960 --> 00:30:30,600
Speaker 3: kind of therapies don't provide the direct kind of potent

617
00:30:30,720 --> 00:30:33,920
Speaker 3: immediate stimulation of the neural connections the way that TMS does.

618
00:30:33,960 --> 00:30:37,280
Speaker 3: Because the first time this was tried for TMS, the

619
00:30:37,320 --> 00:30:41,680
Speaker 3: effect was not small. It doubled the remission rate, and

620
00:30:41,680 --> 00:30:44,040
Speaker 3: that was just giving it for the first ten out

621
00:30:44,040 --> 00:30:46,920
Speaker 3: of twenty sessions of TMS. You know, instead of the

622
00:30:46,960 --> 00:30:49,840
Speaker 3: twenty percent remission rate you might expect with twenty sessions,

623
00:30:49,840 --> 00:30:53,040
Speaker 3: it went up to forty percent. And then actually just

624
00:30:53,120 --> 00:30:55,560
Speaker 3: two months ago Alex mcgerr's team went back and they

625
00:30:55,720 --> 00:30:58,880
Speaker 3: tried it again for all twenty sessions and the remission

626
00:30:58,960 --> 00:31:03,960
Speaker 3: rate went from twenty percent to seventy percent, eighty five

627
00:31:03,960 --> 00:31:06,360
Speaker 3: percent of people showing at least. So it turns out

628
00:31:06,360 --> 00:31:09,200
Speaker 3: there are a lot of people who just need more

629
00:31:09,240 --> 00:31:11,680
Speaker 3: plasticity to do well on TMS, and TMS actually can

630
00:31:11,760 --> 00:31:14,920
Speaker 3: be extremely powerful if you just enhance the plasticity first.

631
00:31:15,280 --> 00:31:18,120
Speaker 3: So that was and then of course this is just

632
00:31:18,160 --> 00:31:21,000
Speaker 3: about depression. So he also went to a different brain

633
00:31:21,040 --> 00:31:24,520
Speaker 3: area that was involved in OCD. Because there is a

634
00:31:24,520 --> 00:31:28,360
Speaker 3: TMS protocol for OCD, OCD is a tough nut to

635
00:31:28,400 --> 00:31:32,880
Speaker 3: crack among TMS researchers. We think of it obsessed with

636
00:31:32,920 --> 00:31:35,280
Speaker 3: compulsive disorders reckoned to be one of the toughest things,

637
00:31:35,760 --> 00:31:40,000
Speaker 3: just for when they do clinical studies on OCD, they

638
00:31:40,000 --> 00:31:43,239
Speaker 3: will often declare thirty five percent improvement in symptoms as

639
00:31:43,640 --> 00:31:46,680
Speaker 3: a strong response, and they if you like, we don't

640
00:31:46,720 --> 00:31:48,600
Speaker 3: expect to cure you of your OCD. If we can

641
00:31:48,640 --> 00:31:50,480
Speaker 3: even get your thirty five percent better, we'll call that

642
00:31:50,520 --> 00:31:54,760
Speaker 3: a win. That's often how structure studies are done. Alex

643
00:31:54,880 --> 00:31:57,600
Speaker 3: mcgear's team when they did this in OCD, they found

644
00:31:57,600 --> 00:32:01,560
Speaker 3: that twenty sessions. Uh, there's a school or there's a

645
00:32:01,560 --> 00:32:04,200
Speaker 3: scale from zero to forty called the Yale Brown Obsessive

646
00:32:04,240 --> 00:32:07,200
Speaker 3: Compulsive Score. It's the standard clinical scale you used to

647
00:32:07,240 --> 00:32:11,360
Speaker 3: measure how bad somebody's OCD is. And you know you'll

648
00:32:11,360 --> 00:32:13,240
Speaker 3: have a person who might have a score of twenty

649
00:32:13,280 --> 00:32:15,480
Speaker 3: six which would be severe, or thirty which would be

650
00:32:15,600 --> 00:32:20,800
Speaker 3: very severe, and twenty sessions of TMS would reduce their

651
00:32:20,840 --> 00:32:24,520
Speaker 3: score by about two or three points, but with decyclicerine

652
00:32:24,640 --> 00:32:27,479
Speaker 3: it was closer to ten points of reduction in twenty sessions.

653
00:32:27,600 --> 00:32:29,640
Speaker 2: Great, so it's a big difference.

654
00:32:29,720 --> 00:32:31,760
Speaker 3: And you know, the question is, well, okay, TMS is

655
00:32:31,800 --> 00:32:34,000
Speaker 3: used for lots of other things, like TMS is being

656
00:32:34,040 --> 00:32:36,480
Speaker 3: used for other brain circuits and Parkinson's and Alzheimer's, so

657
00:32:36,880 --> 00:32:39,320
Speaker 3: could this be used to treat lots of things. There's

658
00:32:39,360 --> 00:32:43,360
Speaker 3: a second wave of enhancing plasticity, which is dopamine. So

659
00:32:43,520 --> 00:32:45,240
Speaker 3: dopamine has a lot of roles in the brain, but

660
00:32:45,280 --> 00:32:48,360
Speaker 3: it does look like TMS relies upon dopamine for at

661
00:32:48,400 --> 00:32:51,600
Speaker 3: least some of the plasticity. And there have been studies

662
00:32:51,640 --> 00:32:54,280
Speaker 3: done in both in laboratory and in the real world

663
00:32:54,640 --> 00:32:57,520
Speaker 3: in which if you give people medications that boost their

664
00:32:57,560 --> 00:33:01,040
Speaker 3: dopamine levels, like el dopa for example, Parkinson's drug that

665
00:33:01,360 --> 00:33:03,800
Speaker 3: adds dopamine to the brain, and then you do the

666
00:33:03,840 --> 00:33:07,400
Speaker 3: TMS the excited where ATMs protocols get stronger, the effect

667
00:33:07,400 --> 00:33:09,880
Speaker 3: of the TMS gets stronger, so you're boosting plasticity.

668
00:33:10,040 --> 00:33:10,560
Speaker 2: So it looks like.

669
00:33:10,560 --> 00:33:13,440
Speaker 3: There's at least two or three different receptor and neurotransmitter

670
00:33:13,480 --> 00:33:14,040
Speaker 3: systems that.

671
00:33:14,000 --> 00:33:16,280
Speaker 2: Can be used to do this. How about a seedyl colin.

672
00:33:16,720 --> 00:33:17,680
Speaker 2: That's an interesting one.

673
00:33:17,760 --> 00:33:20,760
Speaker 3: So that hasn't been try yet, but you know there

674
00:33:20,840 --> 00:33:24,200
Speaker 3: are easily four or five or six different methods for

675
00:33:24,280 --> 00:33:26,480
Speaker 3: doing this. I don't know if you've had Lee Williams

676
00:33:26,560 --> 00:33:28,520
Speaker 3: come in and talks of Lee Williams here at Stanford

677
00:33:28,560 --> 00:33:33,239
Speaker 3: has been looking at it at guanphisine, not necessarily on

678
00:33:33,240 --> 00:33:35,200
Speaker 3: a cell colin, but looking at guanfessine to see what

679
00:33:35,400 --> 00:33:41,680
Speaker 3: that's a third neurotransmitter system involving neuropinephrin, and has been

680
00:33:41,720 --> 00:33:45,160
Speaker 3: showing that people with problem there are specific people with

681
00:33:45,240 --> 00:33:49,640
Speaker 3: depression who stand out for having particularly prominent difficulties with

682
00:33:49,720 --> 00:33:53,960
Speaker 3: cognitive control. And here's a medication called guafisene that isn't

683
00:33:53,960 --> 00:33:57,600
Speaker 3: normally used as an antidepressant, but in these patients, they

684
00:33:57,680 --> 00:33:59,680
Speaker 3: who happen to have what they call the cognitive control

685
00:33:59,760 --> 00:34:04,000
Speaker 3: that fense. This medication does work as an antidepressant for

686
00:34:04,000 --> 00:34:07,840
Speaker 3: these folks, probably by enhancing their cognitive control so they

687
00:34:07,840 --> 00:34:09,600
Speaker 3: don't get stuck in rumination all the time.

688
00:34:09,920 --> 00:34:12,800
Speaker 1: Right, Yeah, you know, this is such an exciting moment

689
00:34:12,800 --> 00:34:17,040
Speaker 1: in time. We're in neuroscience where everybody has been doing

690
00:34:17,120 --> 00:34:21,560
Speaker 1: these studies and we well know that to get a

691
00:34:21,640 --> 00:34:24,719
Speaker 1: patient and do a study and so on a ton

692
00:34:24,760 --> 00:34:27,960
Speaker 1: of work to do one patient, two patients, and suddenly

693
00:34:27,960 --> 00:34:31,080
Speaker 1: we can do these meta analyzes and put together the

694
00:34:31,120 --> 00:34:35,080
Speaker 1: big picture and start seeing the jigsaw puzzle more broadly.

695
00:34:35,200 --> 00:34:38,680
Speaker 1: So what our next steps. We're almost halfway through twenty

696
00:34:38,680 --> 00:34:40,160
Speaker 1: twenty five. Now where is this all going?

697
00:34:40,200 --> 00:34:43,920
Speaker 3: Absolutely so, first of all, one of the there are

698
00:34:43,960 --> 00:34:46,960
Speaker 3: two directions that the field is going in right now.

699
00:34:47,040 --> 00:34:49,400
Speaker 3: One of them, which I think is a broader trend

700
00:34:49,440 --> 00:34:52,480
Speaker 3: in psychiatry in general, is the field of personalized medicine.

701
00:34:52,520 --> 00:34:54,360
Speaker 3: So let's look at your symptoms and let's see if

702
00:34:54,400 --> 00:34:57,879
Speaker 3: we can achieve a higher chance of success by looking

703
00:34:57,960 --> 00:35:01,000
Speaker 3: at your specific symptoms and personalizing maybe the frequency of

704
00:35:01,000 --> 00:35:03,000
Speaker 3: treatment or the type of medication we use, or the

705
00:35:03,040 --> 00:35:06,479
Speaker 3: location of the coil based on your specific parameters. Which

706
00:35:06,520 --> 00:35:08,600
Speaker 3: is great if it works, but the downside of courses,

707
00:35:08,640 --> 00:35:10,520
Speaker 3: it also has a lot more complexity. So you know,

708
00:35:10,600 --> 00:35:13,080
Speaker 3: psychiatric treatments are already costly and hard to get, and

709
00:35:13,120 --> 00:35:15,080
Speaker 3: so this makes them more costly and more hard to

710
00:35:15,120 --> 00:35:18,279
Speaker 3: get the other potential approach that we could try not

711
00:35:18,320 --> 00:35:19,640
Speaker 3: to say that then there's certainly going to be a

712
00:35:19,719 --> 00:35:22,160
Speaker 3: role for that. Personalized medicine is certainly looking very exciting.

713
00:35:22,560 --> 00:35:25,799
Speaker 3: But there are some things there's a different approach where

714
00:35:25,840 --> 00:35:27,960
Speaker 3: we try not to personalize and when we simply try

715
00:35:27,960 --> 00:35:29,880
Speaker 3: to come up with the sort of greatest good for

716
00:35:29,920 --> 00:35:32,400
Speaker 3: the greatest number approach. And so I want to unpack

717
00:35:32,440 --> 00:35:36,160
Speaker 3: that a little bits to point at the idea that

718
00:35:36,200 --> 00:35:38,239
Speaker 3: there might be some brain story. I mentioned earlier, there

719
00:35:38,280 --> 00:35:41,040
Speaker 3: are some brain circuits that are universally involved across a

720
00:35:41,120 --> 00:35:44,160
Speaker 3: variety of different disorders. And so one of the questions

721
00:35:44,160 --> 00:35:45,920
Speaker 3: I asked one of my colleagues at Harvard who have

722
00:35:45,960 --> 00:35:48,399
Speaker 3: been doing one of these brain mapping type studies and seeing,

723
00:35:48,440 --> 00:35:51,320
Speaker 3: instead of mapping the circuits that are associated with depression

724
00:35:51,640 --> 00:35:55,600
Speaker 3: or PTSD or addictions or whatever, we notice that some

725
00:35:55,640 --> 00:35:58,760
Speaker 3: people just have resilience, so they actually function much better

726
00:35:58,800 --> 00:36:01,560
Speaker 3: than expected. For those of us whore working clinics and

727
00:36:01,560 --> 00:36:03,320
Speaker 3: see thousands of patients, you'll see these people who have

728
00:36:03,440 --> 00:36:06,600
Speaker 3: like terrible depression and yet somehow like they're still functioning

729
00:36:06,640 --> 00:36:09,440
Speaker 3: really well. Or people who have terrible Parkinsons and can

730
00:36:09,440 --> 00:36:12,560
Speaker 3: barely move, and somehow they're still kind of functioning or

731
00:36:12,600 --> 00:36:14,359
Speaker 3: you know, have had a stroke that's crippling to them,

732
00:36:14,360 --> 00:36:17,359
Speaker 3: and as we mentioned earlier, somehow still functioning and then

733
00:36:17,600 --> 00:36:20,719
Speaker 3: functioning mentally and in the activities of daily life, like yes,

734
00:36:20,760 --> 00:36:24,239
Speaker 3: they're super you know, there's somehow still. I actually saw

735
00:36:24,280 --> 00:36:27,600
Speaker 3: a gentleman, what was it, I don't know whose name.

736
00:36:27,600 --> 00:36:29,799
Speaker 3: We were having brunction pol Walta just up the road

737
00:36:30,680 --> 00:36:33,279
Speaker 3: and there was a little man, it looked in his

738
00:36:33,360 --> 00:36:36,040
Speaker 3: nineties in a wheelchair by himself, and he was out

739
00:36:36,040 --> 00:36:38,160
Speaker 3: for a while. He was using one leg and his

740
00:36:38,200 --> 00:36:40,880
Speaker 3: heel to drag his wheelchair along one foot at a time,

741
00:36:41,200 --> 00:36:42,920
Speaker 3: and he smiled and waved to us, and he kind

742
00:36:42,920 --> 00:36:45,719
Speaker 3: of crept along sidewalk for his morning stroll. And he

743
00:36:45,920 --> 00:36:48,040
Speaker 3: was and I don't know who got him into the

744
00:36:48,120 --> 00:36:49,759
Speaker 3: chair or how he's getting along, but there he was,

745
00:36:49,760 --> 00:36:52,000
Speaker 3: just using one foot to drag himself around the block

746
00:36:52,040 --> 00:36:54,320
Speaker 3: for a little morning scroll. And so we can evaluate

747
00:36:54,360 --> 00:36:57,440
Speaker 3: how severe your symptoms are, but we can independently evaluate

748
00:36:57,520 --> 00:37:00,560
Speaker 3: how well you're functioning in daily life. So that gentlemen

749
00:37:00,600 --> 00:37:02,200
Speaker 3: I mentioned would be an example of someone who if

750
00:37:02,239 --> 00:37:04,520
Speaker 3: you measured their physical symptoms, they would be totally crippled.

751
00:37:04,520 --> 00:37:06,120
Speaker 2: But if you actually they're still.

752
00:37:06,120 --> 00:37:08,640
Speaker 3: Getting up every morning and walking around and having breakfast

753
00:37:08,640 --> 00:37:10,919
Speaker 3: and doing all their stuff, So on that level, they're

754
00:37:10,920 --> 00:37:13,400
Speaker 3: better than expected. So the question becomes, let's run an

755
00:37:13,320 --> 00:37:16,360
Speaker 3: analysis of strokes or lesions or other things and figure

756
00:37:16,360 --> 00:37:19,600
Speaker 3: out are there areas that correlate with your better than

757
00:37:19,760 --> 00:37:22,640
Speaker 3: expected or worse than expected number if we think of that,

758
00:37:22,719 --> 00:37:25,360
Speaker 3: But and they do, they pop out and one of

759
00:37:25,400 --> 00:37:27,000
Speaker 3: the two There are two circuits that popped out of

760
00:37:27,000 --> 00:37:30,799
Speaker 3: that analysis, which was led by Beatrice Milano and with

761
00:37:30,840 --> 00:37:33,200
Speaker 3: my colleague Shan Sidiki and his group over at Harvard.

762
00:37:33,440 --> 00:37:35,200
Speaker 3: They went through a whole bunch of stroke patients and

763
00:37:35,239 --> 00:37:39,680
Speaker 3: they looked at their ability to function in general. And

764
00:37:39,719 --> 00:37:43,120
Speaker 3: the circuits that popped out. Number one involved this one

765
00:37:43,120 --> 00:37:45,840
Speaker 3: of these salients network circuits that I talked about. But

766
00:37:45,880 --> 00:37:48,560
Speaker 3: there was a second circuit that was down just above

767
00:37:48,560 --> 00:37:50,719
Speaker 3: the eye in another circuit we haven't gotten to yet,

768
00:37:50,719 --> 00:37:54,640
Speaker 3: called the orbit of frontal cortex, and it was also involved,

769
00:37:54,640 --> 00:37:56,920
Speaker 3: but in the opposite polarity. In other words, it was

770
00:37:56,920 --> 00:37:59,120
Speaker 3: actually good to have lesions in this area. And if

771
00:37:59,120 --> 00:38:01,080
Speaker 3: this area was preserved you were more likely to be

772
00:38:01,120 --> 00:38:03,880
Speaker 3: functionally impaired. How do we understand that? So that's an

773
00:38:03,880 --> 00:38:07,280
Speaker 3: interesting one because this circuit is also pretty well studied

774
00:38:08,120 --> 00:38:11,080
Speaker 3: and it is the counterpart to the brain's so called

775
00:38:11,120 --> 00:38:13,640
Speaker 3: reward circuit. So the brain most of us know, has

776
00:38:13,640 --> 00:38:15,359
Speaker 3: this sort of a reward circuit whose job it is

777
00:38:15,400 --> 00:38:19,200
Speaker 3: to identify goals that are worth pursuing and to motivate

778
00:38:19,280 --> 00:38:21,840
Speaker 3: us to go and pursue those goals. The problem is

779
00:38:21,840 --> 00:38:24,160
Speaker 3: that that would only allow us to pursue positive goals.

780
00:38:24,200 --> 00:38:28,320
Speaker 3: We also need a partner circuit to identify potential pitfalls

781
00:38:28,360 --> 00:38:32,440
Speaker 3: or problems, challenges, threats, and to establish goals to avoid

782
00:38:32,440 --> 00:38:35,160
Speaker 3: those things and motivate ourselves to avoid those. If you

783
00:38:35,200 --> 00:38:37,719
Speaker 3: don't have both circuits, you're in trouble. The brain needs

784
00:38:37,760 --> 00:38:40,240
Speaker 3: to be motivated to seek out stuff, but also needs

785
00:38:40,239 --> 00:38:43,319
Speaker 3: to be motivated to avoid the bad stuff. And the

786
00:38:43,360 --> 00:38:46,960
Speaker 3: circuit that was overactive in these stroke patients, or so

787
00:38:47,000 --> 00:38:49,440
Speaker 3: to speak, or was the one that was the so

788
00:38:49,480 --> 00:38:53,000
Speaker 3: called non reward circuit, whose job it was to be

789
00:38:53,040 --> 00:38:57,480
Speaker 3: motivated to essentially to generate negative motivations.

790
00:38:58,640 --> 00:39:01,120
Speaker 1: It looks like, so you said that was overactive in

791
00:39:01,120 --> 00:39:03,759
Speaker 1: the stroke patients is that there's a specific thing we

792
00:39:03,800 --> 00:39:06,080
Speaker 1: think is happening in that circuit, it can enter into

793
00:39:06,080 --> 00:39:07,560
Speaker 1: a feedback loop, right.

794
00:39:07,640 --> 00:39:10,560
Speaker 3: And this is a theory by a professor in the

795
00:39:10,680 --> 00:39:14,239
Speaker 3: UK called Professor Edmund Rules. He'd been studying the orbit

796
00:39:14,280 --> 00:39:17,600
Speaker 3: of frontal cortex region in monkeys and humans for decades

797
00:39:18,560 --> 00:39:21,640
Speaker 3: and he after many years, realized that this circuit tended

798
00:39:21,640 --> 00:39:24,600
Speaker 3: to get stuck in a feedback loop in depression, and

799
00:39:25,360 --> 00:39:29,040
Speaker 3: he proposed what I think is a very lovely theory

800
00:39:29,040 --> 00:39:31,920
Speaker 3: called the non reward attractor theory of depression. So, in

801
00:39:31,960 --> 00:39:34,759
Speaker 3: the non reward attractor theory of depression, you have a

802
00:39:34,800 --> 00:39:38,560
Speaker 3: circuit whose job it is, to what it's functioning properly,

803
00:39:38,680 --> 00:39:41,239
Speaker 3: is to identify threats, so you can then start to

804
00:39:41,280 --> 00:39:44,440
Speaker 3: think about solutions and go and solve them. But if

805
00:39:44,480 --> 00:39:46,279
Speaker 3: it gets stuck in a feedback loop, then you can't

806
00:39:46,280 --> 00:39:48,640
Speaker 3: stop thinking about it even when you're not solving it.

807
00:39:49,080 --> 00:39:52,200
Speaker 3: I think all of us have experienced the sensation at

808
00:39:52,200 --> 00:39:54,480
Speaker 3: times of the difference between you know, working on a

809
00:39:54,520 --> 00:39:56,960
Speaker 3: problem versus just worrying about a problem where you're not

810
00:39:57,000 --> 00:39:58,520
Speaker 3: really solving it, but you're awake at two in the

811
00:39:58,520 --> 00:40:00,319
Speaker 3: morning years thinking about the same thing over and over

812
00:40:00,360 --> 00:40:02,040
Speaker 3: and over again, and you're not really getting anywhere, but

813
00:40:02,120 --> 00:40:03,839
Speaker 3: you just keep going and keep going, and you can't

814
00:40:03,840 --> 00:40:05,840
Speaker 3: get back to sleep, and you really just need to

815
00:40:05,880 --> 00:40:07,719
Speaker 3: stop thinking about it because you're not going to solve

816
00:40:07,719 --> 00:40:09,160
Speaker 3: it right now, and snap out of it and go

817
00:40:09,200 --> 00:40:12,080
Speaker 3: back to sleep now if you can't. And if that

818
00:40:12,120 --> 00:40:14,440
Speaker 3: goes on all day long, you're not functioning because you're

819
00:40:14,440 --> 00:40:17,080
Speaker 3: sitting there ruminating and going round and around on problems.

820
00:40:17,400 --> 00:40:19,200
Speaker 3: Maybe it's a one out of ten problem that your

821
00:40:19,239 --> 00:40:21,080
Speaker 3: brain is treating as a ten out of ten problem.

822
00:40:21,800 --> 00:40:23,440
Speaker 3: Maybe it's a three out of ten problem that your

823
00:40:23,440 --> 00:40:26,239
Speaker 3: brain should be spending five minutes on and spending eight

824
00:40:26,280 --> 00:40:28,640
Speaker 3: hours on. But the point is that while it's doing that,

825
00:40:28,880 --> 00:40:31,800
Speaker 3: you're not getting up, you're not having breakfast, you're not functioning,

826
00:40:31,840 --> 00:40:33,680
Speaker 3: you're not going to work, you're not really you're not

827
00:40:33,719 --> 00:40:52,400
Speaker 3: fully present, you're not doing things.

828
00:40:53,440 --> 00:40:54,680
Speaker 2: I'll give you an example of this.

829
00:40:54,719 --> 00:40:57,960
Speaker 3: There was a woman described in the literature who is she,

830
00:40:58,880 --> 00:41:02,600
Speaker 3: among other things, had she had sought treatment for many

831
00:41:02,640 --> 00:41:04,919
Speaker 3: years for alcohol dependence. So she was somebody who drank

832
00:41:05,160 --> 00:41:08,520
Speaker 3: about ten drinks a day and somehow functioned through this

833
00:41:08,640 --> 00:41:10,640
Speaker 3: recently well. But was drinking ten drinks a day, and

834
00:41:10,680 --> 00:41:13,600
Speaker 3: it sought treatment from physicians for this in a variety

835
00:41:13,600 --> 00:41:14,080
Speaker 3: of different ways.

836
00:41:14,120 --> 00:41:15,320
Speaker 2: Not a boich. You have been successful.

837
00:41:15,760 --> 00:41:19,120
Speaker 3: In her fiftyes, she suffered a stroke and the strength

838
00:41:19,480 --> 00:41:22,200
Speaker 3: was the stroke happened to land. It was a small stroke,

839
00:41:22,360 --> 00:41:25,960
Speaker 3: just in this little circuit, and she immediately found it

840
00:41:26,120 --> 00:41:28,520
Speaker 3: that she no longer had any desire or interest in

841
00:41:28,560 --> 00:41:31,680
Speaker 3: consuming alcohol, and the alcohol, the use that she'd been.

842
00:41:31,560 --> 00:41:33,440
Speaker 2: Trying to get her over for years just kind of

843
00:41:33,440 --> 00:41:33,920
Speaker 2: went away.

844
00:41:34,239 --> 00:41:36,120
Speaker 3: Other people with strokes in these areas, there are people

845
00:41:36,120 --> 00:41:39,200
Speaker 3: who have obsessed with compulsive disorder and have suffered this

846
00:41:39,280 --> 00:41:41,399
Speaker 3: is a weird thing that they had OCD for thirty

847
00:41:41,480 --> 00:41:42,960
Speaker 3: or forty years, and then one day they have a

848
00:41:42,960 --> 00:41:45,560
Speaker 3: stroke in their old age and the OCD goes away.

849
00:41:45,920 --> 00:41:50,839
Speaker 3: So yeah, So there are situations where this circuit gets

850
00:41:50,840 --> 00:41:53,080
Speaker 3: stuck in a feedback loop and the best thing you

851
00:41:53,120 --> 00:41:54,719
Speaker 3: can do here function is to just get out of

852
00:41:54,719 --> 00:41:58,080
Speaker 3: the feedback loop. Now, losing the circuit altogether is pretty drastic, right,

853
00:41:58,120 --> 00:42:00,279
Speaker 3: That's what we'd rather do is just turn it down

854
00:42:00,280 --> 00:42:03,000
Speaker 3: a little bit, and TMS can be used to do that.

855
00:42:03,520 --> 00:42:06,720
Speaker 3: Back in around twenty sixteen seventeen, I had a patient

856
00:42:06,719 --> 00:42:10,040
Speaker 3: who had come for TMS, and we tried the standard

857
00:42:10,320 --> 00:42:12,960
Speaker 3: TMS of one of these salience network cress and we

858
00:42:13,040 --> 00:42:16,000
Speaker 3: didn't get anywhere. So then we tried another salience network

859
00:42:16,000 --> 00:42:18,080
Speaker 3: cretion and for reasons you know and I've described, that

860
00:42:18,080 --> 00:42:20,680
Speaker 3: didn't do much either. And then she said, well, please,

861
00:42:20,719 --> 00:42:22,960
Speaker 3: I please try something else because I you know, the

862
00:42:23,000 --> 00:42:25,520
Speaker 3: next step normally would have been to go to electroconvulsive

863
00:42:25,560 --> 00:42:28,040
Speaker 3: therapy or shock therapy, and she really didn't want to

864
00:42:28,040 --> 00:42:30,080
Speaker 3: do that. So I said, well, there is this other

865
00:42:30,160 --> 00:42:34,640
Speaker 3: area that's been tried in OCD, and you don't have OCD,

866
00:42:34,760 --> 00:42:37,200
Speaker 3: but you do have a kind of depression that reminds

867
00:42:37,239 --> 00:42:39,600
Speaker 3: us of OCD because you just kind of get obsessed

868
00:42:39,640 --> 00:42:43,440
Speaker 3: with the same negative things about yourself. And when you

869
00:42:43,480 --> 00:42:45,680
Speaker 3: described me what your depression is like, it sounds almost

870
00:42:45,719 --> 00:42:48,759
Speaker 3: like an ocd ish flavor of depression. So if you will,

871
00:42:49,000 --> 00:42:50,799
Speaker 3: like you can come in and I'll give you this

872
00:42:50,920 --> 00:42:53,239
Speaker 3: treatment which has been used for OCD, and we'll say,

873
00:42:53,239 --> 00:42:56,760
Speaker 3: maybe let's see if your OCD ish depression gets somewhere.

874
00:42:57,040 --> 00:42:59,800
Speaker 3: And it was a complete remission. We also had scans

875
00:42:59,840 --> 00:43:02,040
Speaker 3: on her and we were able to show that normally

876
00:43:02,080 --> 00:43:05,239
Speaker 3: when we do TMS, we strengthen this salience network, and

877
00:43:05,280 --> 00:43:07,120
Speaker 3: you can see this connection strengthened.

878
00:43:07,440 --> 00:43:08,000
Speaker 2: In her case.

879
00:43:08,040 --> 00:43:10,560
Speaker 3: We scanned her before and after, and when she got better,

880
00:43:10,600 --> 00:43:13,239
Speaker 3: it had nothing to do with the salience network. Instead,

881
00:43:13,320 --> 00:43:17,319
Speaker 3: we had suppressed the over connection between this orbit of

882
00:43:17,320 --> 00:43:20,520
Speaker 3: frontal region and its little loop of activity down into

883
00:43:20,560 --> 00:43:21,520
Speaker 3: the reward circuitry.

884
00:43:21,800 --> 00:43:23,440
Speaker 2: So what happened to her after was what was what

885
00:43:23,520 --> 00:43:24,359
Speaker 2: was it like for her?

886
00:43:24,440 --> 00:43:28,120
Speaker 3: What she said was that essentially she was now free

887
00:43:28,120 --> 00:43:31,759
Speaker 3: of ruminations. I'll give you, and we had other people

888
00:43:31,800 --> 00:43:33,319
Speaker 3: come and do it, So I'll give you a really

889
00:43:33,320 --> 00:43:36,120
Speaker 3: illustrative example of one person who had a little bit

890
00:43:36,160 --> 00:43:37,880
Speaker 3: of both. She had a bit of column AN and

891
00:43:37,880 --> 00:43:39,640
Speaker 3: a bit of COLUMNB. So not only did she have

892
00:43:39,680 --> 00:43:42,719
Speaker 3: a tendency to be really obsessive and self critical and ruminative,

893
00:43:43,000 --> 00:43:44,960
Speaker 3: but she also tended to be quite impulsive and a

894
00:43:44,960 --> 00:43:47,600
Speaker 3: bit ADHD like and had difficulty with the cognitive control.

895
00:43:47,680 --> 00:43:48,800
Speaker 2: So she really struggled.

896
00:43:49,800 --> 00:43:51,760
Speaker 3: And she came to us from the eating sort of program,

897
00:43:51,840 --> 00:43:54,799
Speaker 3: and she bring she had blimior nervosa, so she would

898
00:43:54,800 --> 00:43:56,520
Speaker 3: spend a couple of hours a day binge eating and

899
00:43:56,520 --> 00:43:59,359
Speaker 3: then purshing it up and binge eating, and pershing. She

900
00:43:59,440 --> 00:44:01,640
Speaker 3: also had a lot of intrusive thoughts about her body

901
00:44:01,640 --> 00:44:05,040
Speaker 3: image and negative body thoughts. She had PTSD symptoms. She

902
00:44:05,080 --> 00:44:07,319
Speaker 3: had a lot of different things. So we gave her

903
00:44:07,360 --> 00:44:11,000
Speaker 3: the standard TMS and her depression scores went down by

904
00:44:11,000 --> 00:44:14,520
Speaker 3: about half, and she said, well, this is really interesting,

905
00:44:14,560 --> 00:44:17,600
Speaker 3: Like I feel somewhat better, like I noticed, like I'm

906
00:44:17,640 --> 00:44:20,640
Speaker 3: feeling less anxious and less depressed. And you certainly helped

907
00:44:20,680 --> 00:44:23,000
Speaker 3: me with my bolimia because I haven't had any urges

908
00:44:23,040 --> 00:44:25,359
Speaker 3: to beings or pursed, like those impulses are just gone.

909
00:44:26,080 --> 00:44:29,000
Speaker 3: But I still think about suicide every day, and I

910
00:44:29,000 --> 00:44:31,799
Speaker 3: still think about how horrible my body looks every day,

911
00:44:32,000 --> 00:44:36,080
Speaker 3: and I can't enjoy anything. And so we talked about

912
00:44:36,120 --> 00:44:37,920
Speaker 3: it a bit. And when I heard about these obsessions,

913
00:44:37,960 --> 00:44:40,520
Speaker 3: I said, well, you know, we could try going to

914
00:44:40,600 --> 00:44:43,439
Speaker 3: this other area that's typically an OCD area and see

915
00:44:43,440 --> 00:44:45,840
Speaker 3: if these obsessive thoughts you have about body image and

916
00:44:45,840 --> 00:44:48,200
Speaker 3: suicide and so on, let's see what that does. Because

917
00:44:48,200 --> 00:44:50,839
Speaker 3: a couple of other patients have been helped by it.

918
00:44:50,840 --> 00:44:52,160
Speaker 3: It was a while before we could get her in.

919
00:44:52,239 --> 00:44:54,960
Speaker 3: The clinic had a lineup, so we treated her and

920
00:44:54,960 --> 00:44:57,719
Speaker 3: then she came back in. This was lovely about She

921
00:44:57,840 --> 00:44:59,359
Speaker 3: came in and I asked her how she was doing,

922
00:44:59,360 --> 00:45:01,319
Speaker 3: and her scores down to the single dishits she was

923
00:45:01,320 --> 00:45:04,040
Speaker 3: doing really, really well. And I asked her, but what

924
00:45:04,120 --> 00:45:05,960
Speaker 3: was it like? And she said, well, I'll tell you

925
00:45:05,960 --> 00:45:08,680
Speaker 3: what I noticed. It was this past weekend. I was

926
00:45:08,719 --> 00:45:10,759
Speaker 3: playing with my niece and nephew, and I noticed that

927
00:45:10,800 --> 00:45:13,800
Speaker 3: I was smiling, and I noticed I was feeling pleasure,

928
00:45:14,000 --> 00:45:16,520
Speaker 3: like joy, which is weird. I hadn't felt that in

929
00:45:16,560 --> 00:45:18,880
Speaker 3: twenty years. And then I thought about it, and I

930
00:45:18,920 --> 00:45:21,440
Speaker 3: realized I actually hadn't thought about suicide all day, and

931
00:45:21,480 --> 00:45:23,359
Speaker 3: that hasn't happened for twenty And I realized I hadn't

932
00:45:23,360 --> 00:45:26,560
Speaker 3: thought about suicide for days, which hasn't happened.

933
00:45:26,719 --> 00:45:27,919
Speaker 2: I was able to enjoy things.

934
00:45:27,960 --> 00:45:30,359
Speaker 3: And then I realized I'd eaten a hamburger four days ago,

935
00:45:30,680 --> 00:45:32,319
Speaker 3: and normally i'd still be thinking about that.

936
00:45:32,280 --> 00:45:36,480
Speaker 2: Hamburger, regret about you, regret exactly.

937
00:45:36,800 --> 00:45:38,759
Speaker 3: I'd still be thinking like, why did you do that you?

938
00:45:39,480 --> 00:45:42,440
Speaker 3: And I realized that I just wasn't worried about the burger.

939
00:45:42,880 --> 00:45:44,960
Speaker 3: I'd eaten it, and yeah, I was a little upset

940
00:45:44,960 --> 00:45:47,360
Speaker 3: about it, but then I just wasn't thinking about it anymore.

941
00:45:47,600 --> 00:45:50,800
Speaker 3: But this was three or four months after her original treatment.

942
00:45:50,840 --> 00:45:52,400
Speaker 3: She said, but could I come back and have the

943
00:45:52,440 --> 00:45:54,640
Speaker 3: previous one again, because I'm starting to get back into

944
00:45:54,680 --> 00:45:57,319
Speaker 3: my binging and pershing behavior. That's that part is coming

945
00:45:57,360 --> 00:45:59,919
Speaker 3: back again. So you can see it what we would

946
00:46:00,280 --> 00:46:04,960
Speaker 3: in neuropsychology, a double dissociation, where treatment of one circuit

947
00:46:05,040 --> 00:46:07,720
Speaker 3: is helping with the person's impulses and their cognitive control.

948
00:46:07,840 --> 00:46:10,719
Speaker 3: And after treatment there she felt a stronger sense of

949
00:46:10,760 --> 00:46:13,800
Speaker 3: agency of self control with this first set of areas

950
00:46:13,800 --> 00:46:14,880
Speaker 3: around this alience network.

951
00:46:15,200 --> 00:46:16,120
Speaker 2: With the second set of.

952
00:46:16,120 --> 00:46:19,440
Speaker 3: Areas, she was feeling freedom from being trapped in a

953
00:46:19,480 --> 00:46:22,840
Speaker 3: circle of rumination on negative thoughts. But as the first

954
00:46:22,920 --> 00:46:26,120
Speaker 3: one wore off, she was losing that control piece. And

955
00:46:26,160 --> 00:46:28,920
Speaker 3: that highlights the two elements of resilience that come from this.

956
00:46:29,000 --> 00:46:31,880
Speaker 3: That what the ingredients of resilience seed be these two circuits.

957
00:46:31,920 --> 00:46:35,279
Speaker 3: Number one, having more self control or agency or a

958
00:46:35,320 --> 00:46:37,760
Speaker 3: sense of will to snap out of things or control

959
00:46:37,800 --> 00:46:41,279
Speaker 3: what you're thinking about. And number two, the ability to

960
00:46:41,400 --> 00:46:43,480
Speaker 3: not get stuck in a circle of rumination on the

961
00:46:43,480 --> 00:46:46,239
Speaker 3: same stuff, the ability to exit that circle. If you

962
00:46:46,320 --> 00:46:48,040
Speaker 3: have those two things, you're resilient.

963
00:46:49,000 --> 00:46:53,399
Speaker 1: So cut to a quarter century from now when this

964
00:46:53,440 --> 00:46:57,359
Speaker 1: is all very well worked out and every shopping mall

965
00:46:57,520 --> 00:47:01,160
Speaker 1: has a TMS clinic that you can walk into and.

966
00:47:01,120 --> 00:47:01,839
Speaker 2: I hope are there soon.

967
00:47:01,920 --> 00:47:06,800
Speaker 1: Yeah, Okay, The question is how will people know whether

968
00:47:07,840 --> 00:47:10,319
Speaker 1: they should go in and get this stream. It's like

969
00:47:10,360 --> 00:47:12,200
Speaker 1: it's like doing a tune up on your car. But

970
00:47:12,320 --> 00:47:14,680
Speaker 1: how do you know, you know, is there some variety

971
00:47:14,800 --> 00:47:19,879
Speaker 1: that would be useful to have in our society. How

972
00:47:19,880 --> 00:47:22,160
Speaker 1: do you know when you should get it at what level?

973
00:47:22,280 --> 00:47:25,120
Speaker 3: Yeah, it's a really interesting question, particularly because TMS is

974
00:47:25,120 --> 00:47:27,799
Speaker 3: a technology, so it gets better, it gets faster, it

975
00:47:27,800 --> 00:47:30,720
Speaker 3: gets cheaper over time. So you know, it's the example

976
00:47:30,760 --> 00:47:32,680
Speaker 3: of you know, when I was a kid, we talked

977
00:47:32,680 --> 00:47:35,040
Speaker 3: about flying to like space tourists who would go up

978
00:47:35,040 --> 00:47:37,399
Speaker 3: to flying space hotels, and that hasn't happened yet because

979
00:47:37,400 --> 00:47:39,040
Speaker 3: the cost of flying a space would have to come

980
00:47:39,080 --> 00:47:41,160
Speaker 3: down a lot before most of us can afford to

981
00:47:41,200 --> 00:47:44,800
Speaker 3: do that. And likewise, TMS presently is still pretty expensive.

982
00:47:44,840 --> 00:47:46,320
Speaker 3: But you know, the costs are coming down and the

983
00:47:46,360 --> 00:47:49,200
Speaker 3: availability is going up, and so the threshold for and

984
00:47:49,280 --> 00:47:52,960
Speaker 3: TMS happens to have an excellent safety profile, So the

985
00:47:53,040 --> 00:47:55,440
Speaker 3: question would become of when to go and get TMS.

986
00:47:55,560 --> 00:47:59,640
Speaker 3: Right now, it is an FDA cleared technique, and it

987
00:47:59,719 --> 00:48:02,080
Speaker 3: is the FDA is the cleared to be a prescription treatment,

988
00:48:02,160 --> 00:48:04,440
Speaker 3: so one one does go to a physician and obtain

989
00:48:04,480 --> 00:48:06,800
Speaker 3: a prescription to get TMS.

990
00:48:07,520 --> 00:48:08,000
Speaker 2: And in the.

991
00:48:08,000 --> 00:48:11,120
Speaker 3: Past, most insurers and pairs would require people to have

992
00:48:11,200 --> 00:48:13,600
Speaker 3: tried three or four or five or six different medications

993
00:48:13,600 --> 00:48:16,319
Speaker 3: before they often four medications or more before they were

994
00:48:16,840 --> 00:48:19,800
Speaker 3: allowed to apply for coverage for TMS. Now those numbers

995
00:48:19,800 --> 00:48:22,359
Speaker 3: are coming down and people are able to go earlier on.

996
00:48:23,520 --> 00:48:28,520
Speaker 3: So I think what we'll see is that it may

997
00:48:28,600 --> 00:48:32,120
Speaker 3: be that you'll be able to go for TMS to

998
00:48:32,280 --> 00:48:35,520
Speaker 3: enhance your functional capacity. Just knowing that we have these

999
00:48:35,520 --> 00:48:39,000
Speaker 3: two target circuits, people will be able to go in and.

1000
00:48:38,760 --> 00:48:40,800
Speaker 2: Across a wide variety of disorders.

1001
00:48:40,800 --> 00:48:43,200
Speaker 3: So at the moment, TMS is FDA cleared in depression,

1002
00:48:43,239 --> 00:48:46,200
Speaker 3: it's FDA cleared in OCD, and in chronic pain a

1003
00:48:46,200 --> 00:48:48,960
Speaker 3: couple of other conditions. But what might happen is it

1004
00:48:49,040 --> 00:48:51,640
Speaker 3: might be cleared across a wide basket of different conditions.

1005
00:48:51,680 --> 00:48:54,719
Speaker 3: And because the TMS really isn't what's interesting is we

1006
00:48:54,840 --> 00:48:56,760
Speaker 3: discovered the TMS isn't treating the depression.

1007
00:48:57,160 --> 00:48:58,960
Speaker 2: It's indirectly treating that by just.

1008
00:48:59,000 --> 00:49:03,040
Speaker 3: Generally enhancing your self control and allowing you to not

1009
00:49:03,040 --> 00:49:05,200
Speaker 3: get stuck in rumination. And that turns out to be

1010
00:49:05,280 --> 00:49:07,400
Speaker 3: useful not just for depression, but for lots of things.

1011
00:49:07,719 --> 00:49:10,759
Speaker 3: So where I hope we end up in hopefully a

1012
00:49:10,800 --> 00:49:12,920
Speaker 3: lot less than twenty five years, maybe in five years,

1013
00:49:13,800 --> 00:49:16,120
Speaker 3: would be in a situation where people can come in

1014
00:49:16,320 --> 00:49:20,040
Speaker 3: across a wide variety of conditions and maybe not waiting

1015
00:49:20,080 --> 00:49:22,520
Speaker 3: until they're extremely severe and until they've tried lots of

1016
00:49:22,560 --> 00:49:24,799
Speaker 3: other things. But you know, there may even be a

1017
00:49:24,800 --> 00:49:26,960
Speaker 3: world where you know, even and this is one thing

1018
00:49:27,000 --> 00:49:30,120
Speaker 3: people are working on, is even before going to medications,

1019
00:49:30,120 --> 00:49:32,360
Speaker 3: where people might be able to go and pursue this

1020
00:49:32,400 --> 00:49:35,960
Speaker 3: treatment right away. As you know, So when a person

1021
00:49:36,000 --> 00:49:39,640
Speaker 3: first starts to realize that they're encountering significant difficulty functioning

1022
00:49:39,719 --> 00:49:42,239
Speaker 3: because of the severity of their anxiety or depression or

1023
00:49:42,239 --> 00:49:44,439
Speaker 3: whatever it be, that they can go in and get

1024
00:49:44,560 --> 00:49:46,200
Speaker 3: essentially a top up of resilience.

1025
00:49:47,640 --> 00:49:48,879
Speaker 2: The thing that we all wish we had.

1026
00:49:49,440 --> 00:49:51,640
Speaker 3: That comes back to a dinner conversation we had ten

1027
00:49:51,719 --> 00:49:54,200
Speaker 3: years ago where I was sitting with some friends and

1028
00:49:54,360 --> 00:49:57,440
Speaker 3: as a dinner conversation starter, we said, okay, let's go

1029
00:49:57,440 --> 00:50:00,160
Speaker 3: around the room and let's say you had the abilit

1030
00:50:00,280 --> 00:50:03,240
Speaker 3: to just rub a magic lamp and a genie would

1031
00:50:03,360 --> 00:50:05,880
Speaker 3: would you could say one word and then everyone in

1032
00:50:05,920 --> 00:50:06,640
Speaker 3: the world would.

1033
00:50:06,440 --> 00:50:08,760
Speaker 2: Be gifted that thing. So what would you?

1034
00:50:08,800 --> 00:50:10,560
Speaker 3: And we all went around the table, and the one

1035
00:50:10,600 --> 00:50:13,320
Speaker 3: I chose was happened to be resilience. I said, the

1036
00:50:13,400 --> 00:50:14,920
Speaker 3: world would just run better if we could all have

1037
00:50:14,960 --> 00:50:17,080
Speaker 3: a little bit more resilience. So I would love to

1038
00:50:17,080 --> 00:50:19,040
Speaker 3: get to a world where we just generally have this

1039
00:50:19,120 --> 00:50:23,359
Speaker 3: treatment that enhances one's ability to be resilient, And if

1040
00:50:23,360 --> 00:50:25,799
Speaker 3: we could get that out to everybody with you know,

1041
00:50:25,880 --> 00:50:26,960
Speaker 3: a relatively short.

1042
00:50:26,719 --> 00:50:28,320
Speaker 2: Treatment, not that we shouldn't.

1043
00:50:28,360 --> 00:50:30,839
Speaker 3: Also, you know, people can go and do mindfulness and

1044
00:50:30,880 --> 00:50:33,080
Speaker 3: cognitive therapy and all these other things, and that.

1045
00:50:33,280 --> 00:50:35,200
Speaker 2: That takes time and skill set.

1046
00:50:35,239 --> 00:50:37,440
Speaker 3: It's it's like piano lessons, You've got to put putting

1047
00:50:37,440 --> 00:50:40,000
Speaker 3: your time and your hours to do it. But I

1048
00:50:40,000 --> 00:50:42,359
Speaker 3: think those piano lessons will go faster for people if

1049
00:50:42,400 --> 00:50:46,319
Speaker 3: we can use if we can drop on their inner strengths.

1050
00:50:46,760 --> 00:50:49,120
Speaker 3: Let's pull out your maximum because we all have these

1051
00:50:49,120 --> 00:50:53,399
Speaker 3: circuits and we all have neuroplasticity. So every human being

1052
00:50:53,480 --> 00:50:56,360
Speaker 3: has every human beings brain, as you've discussed many times,

1053
00:50:56,400 --> 00:50:59,320
Speaker 3: has the ability to rewire and change itself, and every

1054
00:50:59,360 --> 00:51:02,160
Speaker 3: human being has somewhere in though theo's circuits that allow

1055
00:51:02,239 --> 00:51:05,240
Speaker 3: us to do cognitive control and to escape from rumination

1056
00:51:05,320 --> 00:51:07,719
Speaker 3: and so on. These are all innercapacities that are hit

1057
00:51:07,920 --> 00:51:09,640
Speaker 3: that are within all of us, and some of them

1058
00:51:09,680 --> 00:51:12,200
Speaker 3: it's on the surface the highly resilient people, but in

1059
00:51:12,239 --> 00:51:14,879
Speaker 3: people who aren't feeling resilient, where people do have these

1060
00:51:14,920 --> 00:51:18,120
Speaker 3: access one disorders, it's not that they don't have that capacity,

1061
00:51:18,120 --> 00:51:21,120
Speaker 3: it's just it's latent, it's hiding, and we're now having

1062
00:51:21,160 --> 00:51:26,520
Speaker 3: a capacity by combining targeted brain stimulation with neuroplasticity enhancement,

1063
00:51:27,040 --> 00:51:29,600
Speaker 3: we can bring out the person's inner strengths. And I

1064
00:51:29,640 --> 00:51:33,000
Speaker 3: think that's something that is just would be I wish

1065
00:51:33,040 --> 00:51:34,920
Speaker 3: if we could have everybody listening to is just no

1066
00:51:35,000 --> 00:51:37,439
Speaker 3: one thing, is that all of us have these inner

1067
00:51:37,440 --> 00:51:40,120
Speaker 3: strengths inside us, and some of us has been hidden

1068
00:51:40,360 --> 00:51:43,279
Speaker 3: en dormant for a long time. But I think every

1069
00:51:43,320 --> 00:51:45,680
Speaker 3: one of us those abilities are there and we can

1070
00:51:45,760 --> 00:51:46,720
Speaker 3: bring them to the surface.

1071
00:51:49,880 --> 00:51:52,560
Speaker 1: That's beautiful. Let me just ask one last question I

1072
00:51:52,640 --> 00:51:57,520
Speaker 1: wanted to come back on, which is the influence of

1073
00:51:57,560 --> 00:52:00,000
Speaker 1: our social lives on resilience.

1074
00:52:00,920 --> 00:52:03,799
Speaker 3: That's beautiful and I'm really glad you brought that up,

1075
00:52:03,920 --> 00:52:06,239
Speaker 3: because up until now, everything we've been talking about with

1076
00:52:06,360 --> 00:52:10,520
Speaker 3: resilience is are like are like. The human atom he's

1077
00:52:10,520 --> 00:52:13,520
Speaker 3: just started for individuals in isolation is one human brain

1078
00:52:13,719 --> 00:52:16,000
Speaker 3: just by itself, a bunch of circuits inside a skull.

1079
00:52:16,600 --> 00:52:18,799
Speaker 3: But we don't live as little atoms. No, no human

1080
00:52:18,840 --> 00:52:19,480
Speaker 3: as an island.

1081
00:52:19,560 --> 00:52:20,040
Speaker 2: We all have.

1082
00:52:20,520 --> 00:52:23,919
Speaker 3: We live within a broad social fabric. And I think

1083
00:52:23,960 --> 00:52:26,439
Speaker 3: you can delve into any number of beautify written books

1084
00:52:26,480 --> 00:52:28,680
Speaker 3: on resilience, we'll talk about one of the greatest and

1085
00:52:28,719 --> 00:52:32,800
Speaker 3: most important things supporting a person's resilience is the social

1086
00:52:32,840 --> 00:52:36,480
Speaker 3: supports and fabric that they have around them. Most challenges

1087
00:52:36,680 --> 00:52:38,960
Speaker 3: can be faced if they're not faced alone.

1088
00:52:40,600 --> 00:52:41,320
Speaker 2: I think most of it.

1089
00:52:41,600 --> 00:52:43,160
Speaker 3: I talked to a colleague of mind, and he talked

1090
00:52:43,200 --> 00:52:45,600
Speaker 3: about how his favorite part of medical training was actually

1091
00:52:45,640 --> 00:52:47,920
Speaker 3: in medical school, which some people see is the toughest part.

1092
00:52:48,040 --> 00:52:49,840
Speaker 3: So but the thing is, I had these two buddies,

1093
00:52:50,200 --> 00:52:52,080
Speaker 3: and the three of us we did all our studying together.

1094
00:52:52,080 --> 00:52:53,960
Speaker 3: We worked through it was all we were these comrades,

1095
00:52:53,960 --> 00:52:55,560
Speaker 3: and we felt like when we faced the world, we

1096
00:52:55,560 --> 00:52:58,200
Speaker 3: were unstoppable. Like you know, it's a very stressful thing

1097
00:52:58,239 --> 00:53:00,000
Speaker 3: going through training in medical school, but as long as

1098
00:53:00,200 --> 00:53:04,160
Speaker 3: I have my two buddies with me, we could face anything. Yeah,

1099
00:53:04,200 --> 00:53:05,960
Speaker 3: and I think a lot of us have that experience.

1100
00:53:06,080 --> 00:53:08,600
Speaker 3: So there's been is, you know, a tremendous amount of

1101
00:53:08,600 --> 00:53:11,120
Speaker 3: research done on the importance of social fabric and social

1102
00:53:11,160 --> 00:53:12,880
Speaker 3: supports and a strong social network.

1103
00:53:12,920 --> 00:53:14,960
Speaker 1: Well, what would you recommend for people? What do you

1104
00:53:15,040 --> 00:53:18,640
Speaker 1: recommend for people in terms of building a social life.

1105
00:53:18,760 --> 00:53:20,279
Speaker 2: Well, it's I mean, it's tricky.

1106
00:53:20,560 --> 00:53:22,200
Speaker 3: I think there's certainly been a shift over the last

1107
00:53:22,280 --> 00:53:24,719
Speaker 3: decade in terms of, you know, how people spend their time,

1108
00:53:24,760 --> 00:53:27,080
Speaker 3: and if everybody else is just locked away on, you know,

1109
00:53:27,200 --> 00:53:30,239
Speaker 3: in solitary activities of one type or another, then it's

1110
00:53:30,280 --> 00:53:31,879
Speaker 3: harder and harder to go out there and find people

1111
00:53:31,920 --> 00:53:35,440
Speaker 3: to do social things with. But I find that the

1112
00:53:35,440 --> 00:53:39,440
Speaker 3: way people build social communities is often either through mutual

1113
00:53:39,480 --> 00:53:43,040
Speaker 3: connections or through mutual activities. So you can meet friends

1114
00:53:43,040 --> 00:53:45,839
Speaker 3: through other friends, and you can and so friends are

1115
00:53:45,840 --> 00:53:48,839
Speaker 3: good at introducing other friends, and activities are also good

1116
00:53:48,920 --> 00:53:50,399
Speaker 3: at introducing and connecting people.

1117
00:53:50,480 --> 00:53:50,800
Speaker 2: Together.

1118
00:53:51,640 --> 00:53:53,520
Speaker 3: So one way you can kind of get two birds

1119
00:53:53,520 --> 00:53:56,760
Speaker 3: of one stone is you know, running clubs have become

1120
00:53:56,800 --> 00:53:59,720
Speaker 3: incredibly popular, just to take one random example of ways

1121
00:53:59,719 --> 00:54:02,280
Speaker 3: that people have decided to sort of quit dating apps

1122
00:54:02,280 --> 00:54:03,759
Speaker 3: and instead of just go out and go on these

1123
00:54:03,760 --> 00:54:05,839
Speaker 3: big running clubs. And this is how young singles are

1124
00:54:05,920 --> 00:54:07,920
Speaker 3: kind of meeting each other is by finding some kind

1125
00:54:07,920 --> 00:54:10,319
Speaker 3: of activity in common. But whether you fall into that

1126
00:54:10,360 --> 00:54:13,839
Speaker 3: category or not, I think there are I think a

1127
00:54:13,960 --> 00:54:16,040
Speaker 3: variety of different websites and so on out there, like

1128
00:54:16,120 --> 00:54:18,320
Speaker 3: meetup dot com is an old one that's been around forever.

1129
00:54:18,719 --> 00:54:20,319
Speaker 3: I thought it was quite clever, the idea that you

1130
00:54:20,520 --> 00:54:22,920
Speaker 3: just have various activities and people could connect over an

1131
00:54:22,960 --> 00:54:25,560
Speaker 3: activity or an interest that they had in common. So

1132
00:54:25,600 --> 00:54:28,080
Speaker 3: I think whether it's reaching out to a faith community

1133
00:54:28,080 --> 00:54:30,640
Speaker 3: if you're somebody who follows a particular faith, or whether

1134
00:54:30,640 --> 00:54:33,520
Speaker 3: it's an interest group, or whether it's a physical activity

1135
00:54:33,520 --> 00:54:37,120
Speaker 3: like exercise or running, I think finding activities to connect

1136
00:54:37,120 --> 00:54:40,080
Speaker 3: with other people who have that common interest is a

1137
00:54:40,200 --> 00:54:43,040
Speaker 3: really really great way of strengthening your connections with other people.

1138
00:54:43,120 --> 00:54:46,400
Speaker 2: Finding common purpose among cultures.

1139
00:54:48,040 --> 00:54:50,240
Speaker 3: It's interesting if you go read up on the culture

1140
00:54:50,239 --> 00:54:54,759
Speaker 3: of Okinawa Okinawa's for various is identify as one of

1141
00:54:54,800 --> 00:54:57,480
Speaker 3: these blue zones where people live unusually long and so on.

1142
00:54:57,719 --> 00:54:59,319
Speaker 3: But one of the interesting things that they talk about

1143
00:54:59,400 --> 00:55:03,000
Speaker 3: is the unusual psychological resilience of people in Okinawa and

1144
00:55:02,400 --> 00:55:07,120
Speaker 3: the concept of which I was introduced to recently. I'm

1145
00:55:07,239 --> 00:55:09,759
Speaker 3: probably going to say it wrong, but eke guy is

1146
00:55:09,800 --> 00:55:12,520
Speaker 3: a there's a word, eke guy. I'm probably going to

1147
00:55:12,600 --> 00:55:14,759
Speaker 3: butcher this, but as I understand it, it is the

1148
00:55:14,800 --> 00:55:16,960
Speaker 3: idea of having a purpose or a calling or a

1149
00:55:17,000 --> 00:55:20,960
Speaker 3: cause and part of the culture there is that you know.

1150
00:55:21,000 --> 00:55:23,160
Speaker 3: And it could be something incredibly small, it's like literally

1151
00:55:23,239 --> 00:55:25,320
Speaker 3: like breaking a beach and keeping it tidy, or it

1152
00:55:25,360 --> 00:55:27,319
Speaker 3: could be or it could be something lars like trying

1153
00:55:27,360 --> 00:55:30,600
Speaker 3: to save the world from a resilience deficit.

1154
00:55:30,600 --> 00:55:31,719
Speaker 2: It could be anything whatsoever.

1155
00:55:33,040 --> 00:55:37,919
Speaker 3: But the idea that part of resilience involves in making

1156
00:55:37,960 --> 00:55:39,840
Speaker 3: sure that your life is imbued with meaning and that

1157
00:55:39,920 --> 00:55:41,840
Speaker 3: you have some kind of compass or some kind of

1158
00:55:41,880 --> 00:55:44,200
Speaker 3: guidance to it. And so I think if you can

1159
00:55:44,200 --> 00:55:46,399
Speaker 3: find that activity that you choose with the people around

1160
00:55:46,480 --> 00:55:48,560
Speaker 3: you to be a meaningful activity, something you find that

1161
00:55:48,560 --> 00:55:50,919
Speaker 3: gives you purpose and meaning in life, that carries eke guy.

1162
00:55:51,440 --> 00:55:52,960
Speaker 3: And if on top of that it's not just a

1163
00:55:52,960 --> 00:55:54,839
Speaker 3: personal meaning, but if you can then use that as

1164
00:55:54,880 --> 00:55:58,160
Speaker 3: a nucleus to build a community of other people around

1165
00:55:58,160 --> 00:56:02,680
Speaker 3: that common purpose, there incredibly resilience to be had and

1166
00:56:02,880 --> 00:56:05,359
Speaker 3: being a member of a community of other people, all

1167
00:56:05,400 --> 00:56:08,160
Speaker 3: of whom are dedicated to a common and meaningful cause.

1168
00:56:09,000 --> 00:56:11,080
Speaker 3: And I think if you don't have access to a

1169
00:56:11,080 --> 00:56:13,279
Speaker 3: TMS machine, I think that's certainly the compass that I

1170
00:56:13,320 --> 00:56:14,040
Speaker 3: would lean into.

1171
00:56:18,719 --> 00:56:24,520
Speaker 1: That was my conversation with Jonathan Downer. So what is resilience.

1172
00:56:25,040 --> 00:56:28,600
Speaker 1: We've long thought about it as a psychological trait. We

1173
00:56:28,640 --> 00:56:33,640
Speaker 1: talked about grit or determination or optimism. But what today's

1174
00:56:33,680 --> 00:56:38,239
Speaker 1: conversation hopefully makes clear is that resilience has a physical

1175
00:56:38,280 --> 00:56:41,440
Speaker 1: footprint in the brain. It's not just about what you

1176
00:56:41,600 --> 00:56:45,719
Speaker 1: choose to think. It's about how your networks are operating.

1177
00:56:46,320 --> 00:56:51,719
Speaker 1: It involves a carefully orchestrated interplay between brain areas involved

1178
00:56:51,719 --> 00:56:55,120
Speaker 1: in emotion and reward and control and so on. And

1179
00:56:55,200 --> 00:57:01,080
Speaker 1: these brain networks can dip the balance between breaking down

1180
00:57:01,520 --> 00:57:04,319
Speaker 1: and bouncing back. And I think this is some of

1181
00:57:04,320 --> 00:57:09,080
Speaker 1: the most exciting and practical work happening in neuroscience. People

1182
00:57:09,080 --> 00:57:13,959
Speaker 1: are identifying these circuits and they are influencing them using

1183
00:57:14,040 --> 00:57:19,080
Speaker 1: tools like PMS, and this can, when it works, enhance

1184
00:57:19,200 --> 00:57:24,480
Speaker 1: a person's ability to function across a whole spectrum of disorders.

1185
00:57:25,120 --> 00:57:28,960
Speaker 1: And so one lesson that emerges is that resilience isn't

1186
00:57:29,000 --> 00:57:33,480
Speaker 1: just something we summon after disaster strikes. It's something we

1187
00:57:33,520 --> 00:57:37,200
Speaker 1: can build ahead of time. It's something we can cultivate

1188
00:57:37,280 --> 00:57:41,720
Speaker 1: in the brain like a form of mental infrastructure, one

1189
00:57:41,760 --> 00:57:45,640
Speaker 1: that helps us face whatever is coming down the pike next.

1190
00:57:46,440 --> 00:57:50,320
Speaker 1: And as our knowledge improves and the technology improves, this

1191
00:57:50,400 --> 00:57:54,760
Speaker 1: all may eventually lead to a paradigm shift in mental health.

1192
00:57:55,080 --> 00:57:59,400
Speaker 1: Instead of treating one disorder at a time, like depression

1193
00:57:59,520 --> 00:58:04,480
Speaker 1: or anxiety PTSD, what if we focused upstream, What if

1194
00:58:04,520 --> 00:58:09,160
Speaker 1: we try to increase resilience itself across the board. Of course,

1195
00:58:09,200 --> 00:58:13,280
Speaker 1: biology is only part of the story. Social support, culture,

1196
00:58:13,520 --> 00:58:18,360
Speaker 1: personal meaning. These are all powerful factors and addressable factors

1197
00:58:18,600 --> 00:58:22,080
Speaker 1: when we're thinking about resilience in our lives. But it's

1198
00:58:22,120 --> 00:58:25,800
Speaker 1: amazing to realize that even in the hardest moments, the

1199
00:58:25,880 --> 00:58:30,200
Speaker 1: exact state of the networks in your brain matters for

1200
00:58:30,320 --> 00:58:33,840
Speaker 1: the degree to which you can be an active participant

1201
00:58:33,880 --> 00:58:38,920
Speaker 1: in recovery. Maybe if we come to understand resilience in

1202
00:58:38,960 --> 00:58:42,919
Speaker 1: the brain and psychologically and socially, we can help more

1203
00:58:43,000 --> 00:58:46,440
Speaker 1: people to thrive. So thanks for tuning in today. If

1204
00:58:46,480 --> 00:58:50,760
Speaker 1: this episode moved you or challenged you, or sparked questions,

1205
00:58:51,080 --> 00:58:53,440
Speaker 1: I'd love to hear from you. Pop me an email

1206
00:58:53,560 --> 00:58:56,760
Speaker 1: at podcast at eagleman dot com and if you ask

1207
00:58:56,840 --> 00:58:58,920
Speaker 1: me to, I can pass your note on to Jonathan

1208
00:58:59,040 --> 00:59:02,320
Speaker 1: as well. And if this episode made you think about

1209
00:59:02,360 --> 00:59:06,280
Speaker 1: someone in your life who embodies resilience, please share this

1210
00:59:06,360 --> 00:59:10,160
Speaker 1: episode with them. Science is catching up to something that

1211
00:59:10,480 --> 00:59:13,080
Speaker 1: people have known in their bones for a long time.

1212
00:59:13,800 --> 00:59:18,160
Speaker 1: The mind can bend without breaking, and sometimes in that

1213
00:59:18,280 --> 00:59:22,840
Speaker 1: bending it gets stronger. So until next time, take care

1214
00:59:22,880 --> 00:59:25,840
Speaker 1: of your brain so you can take care of each other.

1215
00:59:29,560 --> 00:59:32,480
Speaker 1: Go to Eagleman dot com slash podcast for more information

1216
00:59:32,600 --> 00:59:36,680
Speaker 1: and to find further reading, and check out and subscribe

1217
00:59:36,680 --> 00:59:40,000
Speaker 1: to Inner Cosmos on YouTube for videos of each episode

1218
00:59:40,040 --> 00:59:43,920
Speaker 1: and to leave comments. Until next time, I'm David Eagleman

1219
00:59:44,080 --> 00:59:52,760
Speaker 1: and this is Inner Cosmos.