Therapy, Treating Trauma & Other Life Challenges | Dr. Paul Conti

1. 0:00 – 2:30

   Dr. Paul Conti, Trauma & Recovery

   1. AHAndrew Huberman0:00

      (uptempo music) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today my guest is Dr. Paul Conti. Dr. Conti is a psychiatrist who did his training at Stanford School of Medicine, and then went on to be chief resident at Harvard Medical School. He now runs the Pacific Premier Group, which is a collection of psychiatrists and therapists focusing on solving complex human problems, including trauma, addiction, personality, and psychiatric disorders. Today we discuss trauma in detail, and the therapeutic process in detail. For instance, we discuss, what is trauma? How do you know if you have trauma? Dr. Conti shares with us, for instance, that not every experience that we think is traumatic is necessarily traumatic, and yet many people might have trauma without even realizing it. We also talk about the therapeutic process generally. For instance, how to pick a therapist, how to best approach and go through therapy, and how to evaluate whether or not therapy and your relationship to the therapist is working or not. We also talk about self-therapies because we acknowledge that not everyone has access to or can afford therapy, and we talk about drug therapies, for instance, antidepressants, antipsychotics. We talk about alcohol, cannabis, ketamine, and the psychedelics including psilocybin, LSD, and we talk about the clinical use of MDMA and what the future of that looks like. The reason for bringing Dr. Conti onto this podcast is because I see him as the person who has the greatest and most holistic view of therapy, trauma, drug therapies, talk therapies, and how self-therapy and work with others can be integrated for both healing and growing from difficult circumstances. Dr. Conti is also the author of an exceptional book entitled Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal from It. That book describes trauma and its many features, and many tools, some of which we discuss on the podcast today. So whether or not you have trauma or not, by the end of today's episode you will have a much deeper understanding about what trauma is. In fact, I'm confident that you will gain insight into whether or not you have trauma or not, whether or not people close to you have trauma or not, and the various paths to recovering and indeed growing from trauma that we can all take. As you will soon learn, Dr. Conti is an exceptional communicator and has a unique window into the trauma and therapeutic process that

2. 2:30 – 7:00

   ROKA, InsideTracker, Blinkist

   1. AHAndrew Huberman2:30

      I know that all of us can benefit from. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is ROKA. ROKA makes eyeglasses and sunglasses that are of the absolute highest quality. The company was founded by two All-American swimmers from Stanford, and everything about ROKA eyeglasses and sunglasses was designed with performance in mind. I've spent a lifetime working on the visual system and I can tell you that our visual system has to contend with a lot of different challenges. For instance, when you move from a shady area to a brightly lit area, your eyes and your brain have to adjust in order for you to be able to see clearly. 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I've long been a believer in getting regular blood work done, for the simple reason that many of the factors that impact our immediate and long-term health can only be measured and assessed with a quality blood test. And nowadays, with the advent of modern DNA tests, we can also get insight into, for instance, our biological age and see how that compares to our chronological age. And, of course, despite what our birthday cake screams back at us, it is our biological age that really matters. If you're going to get blood tests or DNA tests, however, you need to be able to interpret the data, and that's really where InsideTracker stands apart. A lot of companies will give you a DNA test or a blood test, they'll send you values of hormones, metabolic markers, et cetera, but you don't know what to do with those data. InsideTracker has a very easy to use platform, so when you get the numbers back you can click on any of the numbers that either are in range or out of range, too low, too high, et cetera, and it will direct you towards specific behavioral tools, so lifestyle factors, nutritional tools, supplement tools, et cetera, that can help you bring those numbers into the ranges that are best for you, which is really an exceptional tool that makes all the blood tests and DNA tests really exceptionally powerful. If you'd like to try InsideTracker, you can go to insidetracker.com/huberman to get 20% off any of InsideTracker's plans. That's insidetracker.com/huberman to get 20% off. Today's episode is also brought to us by Blinkist. Blinkist is an app that has thousands of non-fiction books condensed down to just 15 minutes each of key takeaways that you can read or listen to to extract the most important knowledge from those books. I love reading physical books, literally physical hard copies of books, and I like listening to audiobooks. However, I also like to revisit books that I've read or listened to, and sometimes I just want to get the key points or the key takeaways from a book that I've never read or listened to. Blinkist is terrific for all of that. For instance, when researching our episodes on sleep, one of the books that I read and found very valuable is Matt Walker, professor at UC Berkeley's book, Why We Sleep. I've read that book, but then I wanted to also make sure that I hit the key takeaways. Blinkist was essential for that.Other books that I've read before and that I own and enjoy, but I listen to the Blinkist version of from time to time are things like Tim Ferriss's 4-Hour Body or Tim Ferriss's 4-Hour Chef book, which is, both of which are excellent. Or Nassim Taleb's The Black Swan. And there are many other titles as well. 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3. 7:00 – 14:05

   Defining Trauma

   1. AHAndrew Huberman7:00

      Dr. Paul Conti. Paul, thank you so much for being here today.

   2. PCDr. Paul Conti7:03

      Oh, thank you so much for having me.

   3. AHAndrew Huberman7:05

      I've been looking forward to this and received a ton of questions about trauma, about therapy, about how to assess where one is in their own arc of problems and-

   4. PCDr. Paul Conti7:18

      Mm-hmm.

   5. AHAndrew Huberman7:19

      ... addressing familial issues and relationship issues and so forth. If we could just start off very basic and just get everyone oriented.

   6. PCDr. Paul Conti7:27

      Sure.

   7. AHAndrew Huberman7:28

      How should we define trauma? We all have hard experiences. Some of them we might ruminate on more than others.

   8. PCDr. Paul Conti7:36

      Mm-hmm.

   9. AHAndrew Huberman7:36

      But what is trauma?

   10. PCDr. Paul Conti7:39

       I think to make the definition relevant, I think we have to look at trauma as not, oh, anything negative that happens to us, right? But something that overwhelms our coping skills and then leaves us different as we move forward. So, it changes the way that our brains function, right? And then that change is evident in us as we move forward through life.

   11. AHAndrew Huberman8:02

       So, how do we know if we have trauma or not? I've heard before everyone has trauma. For instance, I've heard that if we are a child or when we are a child and we request love from a parent or attention from a parent, if they dismiss us, that that's a microtrauma.

   12. PCDr. Paul Conti8:21

       Right.

   13. AHAndrew Huberman8:21

       Is that overstating or unfair to the real issue of trauma? Do we all have trauma? What are microtraumas? What are macrotraumas?

   14. PCDr. Paul Conti8:30

       Right. I think traumas that we might categorize as disappointments, right, or- or things that, uh, are- are negative, but not deeply impactful, I think is- is not, is not a helpful definition, right? I think the helpful definition is something that rises to the magnitude of really changing us, and something that we can see both i- in how we behave. We can see it in mood, anxiety, behavior, sleep, physical health. So we, so we can identify it, and we can also see it in brain changes. So the, so the fact that we become, say, more hypervigilant, right? More vigilant, and then we can see that different parts of the brain are more active. So- so that definition, that definition captures how trauma, if it rises to a certain level, like what we would say, trauma that makes a post-trauma syndrome, right? Leaves us different, I think is the helpful definition of trauma, because it's a clinical definition, right? It's changes in us as people, and we can, we can map those changes to identifiable shifts in our brain function.

   15. AHAndrew Huberman9:34

       So, how do we know if we've been changed by something? Um, I mean, I can think back to childhood events where some kid on the playground or in the classroom said something I didn't like, something negative about me.

   16. PCDr. Paul Conti9:48

       Mm-hmm.

   17. AHAndrew Huberman9:48

       I think most people can do that. We have a great memory for the kid that said something awful or the parent or teacher that said-

   18. PCDr. Paul Conti9:55

       Right.

   19. AHAndrew Huberman9:55

       ... something awful that really felt like it hurt us or at least stuck with us. So clearly, uh, one's brain, my- my brain in this example, has been changed by the, that event, such that I remember it. But how do we know if something has actually changed the way that we are? Because of course, we don't know how we would be otherwise.

   20. PCDr. Paul Conti10:14

       Right, right. That's- that's difficult, right? It- it's doable, but it's difficult because the response... So if the trauma rises to the level of changing our brains, and- and I don't just mean like we have a new memory, right? So we could have memories of something that was negative, right? And in that sense, it changes the brain, because now there's something we can call to mind. But it doesn't change the functioning of the brain, right? If the, if trauma rises to the level of changing the functioning of our brains, then there is almost always a reflex of guilt and shame around the trauma that can lead us and often leads us to bury it, right? To avoid it, right? To- to feel that now there's something negative inside of me and i- it feels shameful or it feels like no one else would accept it, right? So- so what happens is people tend to avoid looking at the change in them, right? Which is exactly the opposite of what needs to be done, right? The idea of, in a viral pandemic, right? We want to stay away from one another and isolate, right? But- but with the trauma epidemic, we need, we need to communicate with other people. We need to communicate and put words to what's gone on inside of us. And- and very often a- a person knows. I mean, I've done so much clinical work over about 20 years that- that has focused on trauma, and a lot of the times the person knows, right? But they're not admitting it to themselves because they're afraid of it, right? They don't know what to do. But if they start talking, then they'll- they'll talk about the event or the situation. It could be something acute or it could be something chronic that really has been harmful to them, right? And then they feel different afterwards. Like, "Oh, after that, I started thinking differently, feeling differently." But that doesn't always happen. Sometimes it's a process of exploration, you know, through dialogue, right? Whether- whether it's written or whether it's spoken, of- of the person sort of exploring the changes inside of themselves. Maybe changes to their self-talk inside, changes to their thoughts about the world and whether they can navigate safely and readily in it, and, you know, it anchors... As I talk about this, the example I'll use at times is the example of my own life, where, you know, when I was...... much younger, in my early 20s, my younger brother took his life by suicide. And the, you know, the response of guilt and shame and, and hiding all of it inside of me, was, was it says very dramatic, but, but I wasn't acknowledging it, right? Because I didn't know what to do about it, and I felt guilty, and I felt responsible, and I felt ashamed, so there was a- an avoidance inside of me, and then I wasn't saying to myself, "Hey before this, like, you thought that you could be effective and you could make your way in the world, and, you know, if you were a good person and you worked hard, you could make a difference," right? And then afterwards, I thought, "I can't get anywhere. The w- the world's against me." And, you know, I, I felt like, oh, my, my options are all gone. And, you know, I was like 24 years old, right? So, so I didn't see that the change was in me, but I was taking care of myself poorly. Like, there was enough going on that was unhealthy that I couldn't avoid the realization that like, hey, I'm different now, and in these ways that are automatic. You know, my reflex to, can I make my way in the world? Can I have a good life? Can I be happy? W- my reflexes to that were all different, and they were coming through the lens of heightened anxiety, heightened vigilance, a sense of guilt, a sense of shame, uh, and a sense of non-belonging in the world, and, and was ultimately good and helpful people around me, um, and my own realization, and, hey, things are not going well, right, that led me to, to then get some help and to be able to talk about it and realize like, oh my gosh, like I need to face these things that are going on inside of me.

   21. AHAndrew Huberman14:01

       From a, uh, psychoanalytic, psychological, and maybe even

4. 14:05 – 21:38

   Guilt & Shame, Origins of Negative Emotions

   1. AHAndrew Huberman14:05

      a neuroscience perspective, two questions. Why do you think that when we experience trauma, these things that we call guilt and shame surface? Uh, you know, everything you're telling me is that, in the end, that's not adaptive.

   2. PCDr. Paul Conti14:22

      Mm-hmm.

   3. AHAndrew Huberman14:22

      W- why would we be built that way? (laughs)

   4. PCDr. Paul Conti14:26

      Right, right.

   5. AHAndrew Huberman14:26

      Um, so that's the first question.

   6. PCDr. Paul Conti14:27

      Yes.

   7. AHAndrew Huberman14:27

      And then the second question is, you know, how should we conceptualize, you know, guilt and shame? You know, I think that we hear guilt, we hear shame. Um, you know, how should we think about it? I mean, th- those emotions, um, must exist in us for some reason.

   8. PCDr. Paul Conti14:45

      Mm-hmm.

   9. AHAndrew Huberman14:45

      Um, but in this case, it seems like they, they don't serve us well. So, um-

   10. PCDr. Paul Conti14:49

       Right.

   11. AHAndrew Huberman14:49

       ... maybe i- in that order or in reverse order, you know, what i- what is guilt really? What is shame really?

   12. PCDr. Paul Conti14:55

       Mm-hmm.

   13. AHAndrew Huberman14:56

       And why is it that we seem to be reflexively wired to feel guilty and feel ashamed when that's the exact opposite of what we need to do in the case of trauma?

   14. PCDr. Paul Conti15:06

       Right, right. No, I think these are great questions. And I mean, I don't think anyone knows the answers for sure, but my read of all of that is that there's something adaptive that has happened in us through evolution that now becomes maladaptive in, in the way we live in the modern world, right? So if you think of through most of human development, you know, people weren't living that long, right? And the idea was to survive and reproduce, so, so traumatic things that happened to us, it would make sense for them to stay with us, right? So, you know, if you ate a new food and got really, really sick, it's like, you better remember that, right? You know, if you see someone from the group of people, you know, a couple miles away, right, and one of those people attacks you, right? It's like, you better remember that. So, so the traumatic things that are sort of emblazoned in our brain are built to last, right? Things that are positive will generate some emotion inside of us, but things that are profoundly negative are much more likely to stay with us. And I think that that was adaptive, right, when all of that was about survival, right? And I think the same thing is true with, with, say, shame, right? So I, I think here it makes sense that to, to talk a little bit, and actually I'm interested if your- your thoughts about this, right, that, that the limbic system, right? So the- the system often is called the emotion system, right, in our, in our brains has actually, of course, varying function, right? And one aspect is affect, right? So affect is aroused in us, which, which I think the, the meaning then is it's created in us without our choice, right? So if, if we're walking down the road and someone jumps in front of us or pushes us, right, then there's a response of fear, anger, right? Heart starts beating faster, you know, more blood to the muscles, you know, we, we're getting ready to, to fight, right, or, or run, right? And then we become aware of it, right? So, so the aroused affect in us is also about survival, and it has a very deep impact upon us. And shame is an aroused affect. So, so it, it can be raised in us without our choice, and it's very powerful, which if you think about that, is an extremely strong deterrent, right? So if you had, you know, imagine a, a tribe or a group of people, right, that are sheltered together and, you know, someone eats half the food at night or something, right? (laughs) And like, there's a very negative response, right? And that person feels shame because shame is so powerful to, to control behavior, right? So the way that trauma can change our brains and, and stay with us in a way that says, "Be more vigilant, look at the world in a different way, act more defensively," right? And, and how that links to shame and to guilt, and then guilt in, in- but guilt becomes what gets called feeling, technically, where we relate the aroused affect to ourselves, right? So, so shame, the aroused affect, and guilt, the next step, right, when we- when the shame gets related to self, are such profound behavioral interventions and, and deterrents, right, that you can see, I think, how evolutionarily kind of all makes sense. If we're fighting for survival, you know, and we're an elder statesman if we make it to 20, right? This makes sense, but it doesn't make sense...... in a world where we live much longer, right? We navigate in all sorts of different ways, and there's so much coming at us that can be traumatizing. I mean, if you think about the news, right? I mean, how many times have I written a prescription for someone that says, "No more news," right? (laughs) Or like-

   15. AHAndrew Huberman18:43

       You've actually written those prescriptions?

   16. PCDr. Paul Conti18:44

       Oh, yeah.

   17. AHAndrew Huberman18:45

       Yeah?

   18. PCDr. Paul Conti18:45

       Yes. W- or, so glance at the news. Like, look at the news for news. Anything going on I need to know, right? But what, what are people doing is they're looking at it, and they're clicking, and they're clicking, and there's a, there's a sense of being, like, enthralled in a very frightening way with the horrors that are in front of us. And, and it, it shows how, yes, trauma can come through acute things that happen to us. Trauma can come through chronic things, chronic denigration, whether it's based upon socioeconomic status, immigrant, immigration status, um, uh, race, religion, sexuality, gender identity. The, the, these chronic traumas, right, of being denigrated by the society around us or treated as less than can change the brain, but vicarious experiences can too, right? And we know this is not theoretical. We know that the changes in the brain can come from vicarious experiences too, which is why people who are glued to the news and then feeling like, "Oh, my goodness, like, what is happening?" You know, the, the mothers in the Ukraine who've, you know, lost babies in the war, and, like, there are things that are so terrifying that if we spend so much time with that, it has a similar effect. So our brains are built to change from trauma, but not in the way we experience trauma, and not in the way that we live life in terms of the nature of living life and the duration of life in the modern world, where these traumas that happen to us are often so bad for us, because they, they change how our brain is functioning, and then our entire orient- orientation to the world is different, and that could be for, you know, years and years and decades and decades. It brings so much misery and suffering, and at times it brings death. If you think about 100,000 overdose deaths in this country in a year. 100,000. I mean, where is a l- is so much of that arising from? As a person who's treated addiction very intensively over many years, I think the... well, I feel sure that the majority of addiction that I see and treat arises ultimately, the roots of it are in trauma, and are in trying to soothe something that's stuck inside that the person isn't letting outside because of the guilt and shame, but it's running around in their head, and they're so tormented by it, and, and now there's a pull for, for these drugs or sometimes medicines to soothe. So, you know, the, the opiates that were given after a minor surgery, right, are, are, like, okay, yeah, they help the pain from the minor surgery, but what they're really helping is the pain inside, right? But that very quickly turns into addiction, danger, risk, and we see that over and over again, and, and, and not, and not in a theoretical way. Like, I see that in people who have been in my practice w- with addiction, th- arising from trauma who have subsequently died. So it's sort of writ large in our existence in the modern world.

5. 21:38 – 28:23

   Repeating Trauma, the Repetition Compulsion

   1. PCDr. Paul Conti21:38

   2. AHAndrew Huberman21:38

      Incredible to me that this is the way it works. Uh, and what it, what I mean by that is this idea that I've heard about before, I think it was a f- Freudian concept of a repetition compulsion.

   3. PCDr. Paul Conti21:51

      Yes.

   4. AHAndrew Huberman21:52

      That, um, you know, this is, this is what boggles my mind as I'm hearing this, is something happens to us or we observe s-

   5. PCDr. Paul Conti21:58

      Yeah.

   6. AHAndrew Huberman21:58

      ... something traumatic, and instead of acknowledging that and trying to distance from it, there seems to be a reflex of shame and guilt in many cases, and-

   7. PCDr. Paul Conti22:09

      Yeah.

   8. AHAndrew Huberman22:09

      ... stuffing it away, and then a repetition of behaviors to continue to try and just stuff it away.

   9. PCDr. Paul Conti22:16

      Yes.

   10. AHAndrew Huberman22:16

       Like, you're trying to pack... I don't know, I, recently, I was packing a home and trying to get the, uh, sleeping bag back into the bag. It's-

   11. PCDr. Paul Conti22:23

       Uh-huh. (laughs)

   12. AHAndrew Huberman22:23

       (laughs) ... it's-

   13. PCDr. Paul Conti22:23

       Yeah.

   14. AHAndrew Huberman22:23

       ... it seems like it's always trying to mushroom out the top.

   15. PCDr. Paul Conti22:25

       Yeah.

   16. AHAndrew Huberman22:26

       This kind of thing. It takes a lot of ongoing effort. And at the same time, that if this thing really exists, this repetition compulsion, people will return over and over again to the kinds of scenarios or at least the kinds of emotional states that look just like the trauma-

   17. PCDr. Paul Conti22:41

       Yes.

   18. AHAndrew Huberman22:41

       ... or resemble it in some way. So the, the question I have for you is, is the repetition compulsion a real thing?

   19. PCDr. Paul Conti22:48

       Mm-hmm.

   20. AHAndrew Huberman22:48

       And w- why would w- we be wired that way? My understanding of this concept of the repetition compulsion is that we all want to solve our traumas, and-

   21. PCDr. Paul Conti22:58

       Yes.

   22. AHAndrew Huberman22:58

       ... it allows us to put ourselves into micro or, um, again, macro versions of that over and over again. We get to run the experiment again and again-

   23. PCDr. Paul Conti23:08

       Right.

   24. AHAndrew Huberman23:08

       ... in an attempt to solve it.

   25. PCDr. Paul Conti23:09

       Right.

   26. AHAndrew Huberman23:09

       In the case of taking a drug that it's clear, uh, you know, certain drugs like opioids, it's clear how that would not allow us to deal with it, right?

   27. PCDr. Paul Conti23:17

       Yeah.

   28. AHAndrew Huberman23:17

       It's just masking-

   29. PCDr. Paul Conti23:18

       Yes.

   30. AHAndrew Huberman23:18

       ... the, the emotional state. But why is it, for instance, that somebody who experiences sexual trauma then places themselves into circumstances of more sexual s- trauma? Why is it that somebody who is in an abusive relationship goes on to have a second and third or fourth-
6. 28:23 – 37:17

   How to Deal with Trauma & Negative Emotions/Arousal

   1. PCDr. Paul Conti28:23

      away its power.

   2. AHAndrew Huberman28:25

      I keep hearing in this narrative that so much of our reflexive response to trauma, both emotional and in rep- the repetition compulsion in terms of behaviors is about some very deep attempt to change the past.

   3. PCDr. Paul Conti28:42

      Yes.

   4. AHAndrew Huberman28:44

      And in fact, in an offline conversation, I, I recall you saying something about this, that, you know, the number of behaviors and thoughts and avoidance of behaviors and avoidance of thoughts that human beings put in to try and change the past is-

   5. PCDr. Paul Conti28:59

      Right.

   6. AHAndrew Huberman29:00

      ... is remarkable and eerie and maladaptive, it's-

   7. PCDr. Paul Conti29:04

      Yes.

   8. AHAndrew Huberman29:04

      ... it sounds like.

   9. PCDr. Paul Conti29:06

      Yes.

   10. AHAndrew Huberman29:06

       And that really stuck with me, because I think we all want to feel like we're in control of our future and-

   11. PCDr. Paul Conti29:13

       Right.

   12. AHAndrew Huberman29:13

       ... how we feel in the moment. And to some extent it, it works for a brief while, you know? There's this thing that happened, and it just... It, it evokes some internal arousal, and then you have to know what to do with that arousal. And I think, uh, for many people, including myself, there's this, this fundamental question. Okay, the, the thought about the thing, the event-

   13. PCDr. Paul Conti29:35

       Mm-hmm.

   14. AHAndrew Huberman29:35

       ... or events, plural, evokes this arousal, this internal state. Makes some people feel sleepy and exhausted, other people feel really anxious, other people feel angry. I mean, the arousal has all these different dimensions-

   15. PCDr. Paul Conti29:47

       Yes.

   16. AHAndrew Huberman29:48

       ... as you, as, uh, you know. And then there's this question about what to do with it.

   17. PCDr. Paul Conti29:52

       Yes.

   18. AHAndrew Huberman29:52

       And, and I'd love to hear a, maybe even just a, a top contour prescriptive of what do I... What does one do? I'll even just put myself in it. What, what do I do? So I'm feeling upset about something. Should... I feel like my options are healthy catharsis, like I tell the story, feel it. I could, um... I can pack it down. We hear that it's bad to pack it down, but of course one has to be functional in life-

   19. PCDr. Paul Conti30:18

       Mm-hmm.

   20. AHAndrew Huberman30:18

       ... um, and deal with things, and we have responsibilities at work and relational responsibilities, etc. We need to sleep at night. So catharsis, healthy catharsis, packing it down at the other extreme. Um-... telling the story, and yet I think a lot of people are afraid to tell the story because it's al- in that telling, there's a, perhaps a reemergence of the arousal.

   21. PCDr. Paul Conti30:42

       Yes.

   22. AHAndrew Huberman30:42

       The arousal can become greater. I mean-

   23. PCDr. Paul Conti30:43

       Yes.

   24. AHAndrew Huberman30:44

       ... i- is that what people mean when they say things are going to get worse before they get better? I mean, so I guess the, the simple version of this long-winded question is, it's clear we need to confront these things. We can't change the past by... A reflexive response isn't going to do that efficiently. And so how do we deal with arousal? How does one take what they feel inside about something shameful? What do you do with it-

   25. PCDr. Paul Conti31:08

       Yeah.

   26. AHAndrew Huberman31:08

       ... in a moment? And does that have to be done in the presence of a skilled, trained-

   27. PCDr. Paul Conti31:12

       Yeah.

   28. AHAndrew Huberman31:12

       ... therapist? Or as I'm driving to work in the morning and something comes up, "I can't deal with this right now" comes to mind, what do I do? Do I deal with it right then? I know this is a big-

   29. PCDr. Paul Conti31:23

       Right.

   30. AHAndrew Huberman31:23

       ... multi-dimensional question-
7. 37:17 – 45:30

   Processing Trauma, Do You Always Need a Therapist?

   1. PCDr. Paul Conti37:17

   2. AHAndrew Huberman37:17

      It seems to me in hearing this that there's this w- weird wiring that we have, because what I'm hearing is when traumas happen to us or we observe them, what we need to do most is to confront those and the emotions around that directly.

   3. PCDr. Paul Conti37:32

      Yes.

   4. AHAndrew Huberman37:32

      But instead, our system defaults to guilt, shame-

   5. PCDr. Paul Conti37:35

      Yes.

   6. AHAndrew Huberman37:35

      ... and trying to hide it.

   7. PCDr. Paul Conti37:36

      Yes.

   8. AHAndrew Huberman37:37

      And this repetition compulsion of placing us back into things similar to those traumas, or even maybe even worse traumas-

   9. PCDr. Paul Conti37:45

      Yes.

   10. AHAndrew Huberman37:46

       ... in an attempt to resolve it. It's like the most maladaptive-

   11. PCDr. Paul Conti37:49

       Mm-hmm. Yes.

   12. AHAndrew Huberman37:49

       ... wiring diagram I could possibly think of.

   13. PCDr. Paul Conti37:52

       Yes.

   14. AHAndrew Huberman37:52

       Emotional and presumably physiological (laughs) wiring diagram.

   15. PCDr. Paul Conti37:56

       Yes.

   16. AHAndrew Huberman37:56

       And this notion of trying to change the past by doing things now, when the exact opposite is what's going to be beneficial, (laughs) also seems like the-

   17. PCDr. Paul Conti38:05

       Yes.

   18. AHAndrew Huberman38:05

       ... complete, the whole system seems completely backwards. And I'm, I'm chuckling as I say this, not because I'm amused, it's because I'm just baffled once again at how our wiring can often not serve us well.

   19. PCDr. Paul Conti38:16

       Mm-hmm. Mm-hmm.

   20. AHAndrew Huberman38:18

       But it raises a im- what I think is a, an important and interesting question, which is, earlier you were talking about how, you know, people will seek out media that's really disturbing. They'll traumatize and re-traumatize themselves on a daily basis.

   21. PCDr. Paul Conti38:32

       Mm-hmm.

   22. AHAndrew Huberman38:32

       So that could be viewed as the repetition compulsion, where the person will have the same relationship with seven different-

   23. PCDr. Paul Conti38:38

       Mm-hmm.

   24. AHAndrew Huberman38:39

       ... same abusive relationship with seven different partners in sequence.

   25. PCDr. Paul Conti38:42

       Mm-hmm.

   26. AHAndrew Huberman38:43

       Seems terrible, and yet, as I say this, it also is becoming clear to me how this almost seems like a, uh, a poor but desperate attempt to resolve it-

   27. PCDr. Paul Conti38:53

       Yes.

   28. AHAndrew Huberman38:54

       ... in some way. And so the, the fork in the road, if I understand correctly, is to really get to the seed incident, really get to the thing that started it all, as opposed to repeating it all.

   29. PCDr. Paul Conti39:07

       Yes.

   30. AHAndrew Huberman39:10

       Does that have to be done in the presence of a therapist? Is, is there benefit to taking a walk and thinking about these things, breaking down and crying, if that's what's necessary, or feeling angry, if that's what comes up? The, the reason I ask it this way is because I worry, uh, I'll just speak to my, my own experience, I worry that in reactivating or, or touching into the emotions around something, that that is itself a form of the repetition compulsion, because you're feeling it all over again.
8. 45:30 – 51:10

   Internal Self-talk, Punishing Narratives & Negative Fantasies

   1. AHAndrew Huberman45:30

      Do you think that people can start to have negative fantasies? I mean, you mentioned this woman who would take these long drives to berate herself. Um, I'm not familiar with that, but I'll, I'll give a little bit of personal disclosure here. I've felt, um, several times in my life that I will start to s- um, create a narrative about something that ha- truly hasn't happened about something terrible that somebody is going to do.

   2. PCDr. Paul Conti45:55

      Yes.

   3. AHAndrew Huberman45:55

      That's going to upset me.

   4. PCDr. Paul Conti45:57

      Yes.

   5. AHAndrew Huberman45:57

      And for the longest time, I, I would wonder, "Why am I doing this?" And, and I have, uh, a couple ideas about why. One is that I was attempting to just avoid thinking about other things. It's just, you know, anger is such a- an attractive emotional force.

   6. PCDr. Paul Conti46:13

      Yes.

   7. AHAndrew Huberman46:13

      And, and it's- it's an attractant. Uh, it's not attractive. We don't like it, and yet oftentimes, um, anger is a great way to replace feeling some- something else.

   8. PCDr. Paul Conti46:21

      Yes.

   9. AHAndrew Huberman46:21

      Um, feeling sad or having to come up- or to do work or to do (laughs) something useful.

   10. PCDr. Paul Conti46:26

       Yeah.

   11. AHAndrew Huberman46:26

       Um, so it has this kind of a- um, a like, gravitational force to it. That was one idea. Uh, the other idea was in imagining kind of worst outcomes than actually that relationship were- could actually see them a lot better in reality.

   12. PCDr. Paul Conti46:41

       Mm-hmm. Mm-hmm.

   13. AHAndrew Huberman46:42

       It's almost like creating this negative contrast. (laughs)

   14. PCDr. Paul Conti46:44

       Yes.

   15. AHAndrew Huberman46:45

       It's like, "Oh, well, then, it's not that bad." And, and then the third possibility is I have no idea why, but it seemed like a reflex, and I spent some time thinking about it.

   16. PCDr. Paul Conti46:53

       Mm-hmm.

   17. AHAndrew Huberman46:53

       I can't say I've resolved it completely, but why would somebody, um, have a narrative, uh, default narrative when driving or when walking of, "I'man- I'm just going to spend some time and, and think about how terrible this thing is going to turn out?"

   18. PCDr. Paul Conti47:06

       Right.

   19. AHAndrew Huberman47:06

       Or how someone's going to upset me or harm me or how terrible I, I am. Um, it, it seems, again, like maladaptive thinking, maladaptive wiring, and yet I have to assume that it serves some purpose.

   20. PCDr. Paul Conti47:18

       Yeah, yeah, I mean, I think there are three factors there, and they're all bad. And I th- I think you spoke to at least two of them, right? They're- they may, I think, speak so powerfully to how insidious trauma is and how these are real brain changes inside of us, so, so I would say the, the three factors: punishment, avoidance, and control, right? So, so the trauma inside of us that- that makes the guilt and shame so often, so often leads to a desire to punish oneself, right? And the idea that, "Oh, that was my fault," or, "I deserve that," well, what- what do we do if s- something is someone's fault and someone now deserves punishment, right? I mean, we, we, we punish them, right? We send them to jail. We give them a fine, right? We punish them, and so what, what we do is punish ourselves, right? We- if we tell ourselves we're a loser or this awful thing is going to happen, right? Then part of what we're doing is saying to ourselves, "See?" Right? "You deserve that. You're not going to have anything better," right? It's a, it's a negative. It's a very negative way that the brain...... tries to, to make us, in a sense, do better by hurting us more for the things that we couldn't and shouldn't have been able to, weren't expected to be, to control in the first place, right? The second is distraction. As you said, anger, that kind of fantasy can distract us from, from, um, affect, feeling an emotion that can be much more negative. You know, anger can be more gratifying than, than certainly than guilt or shame. Although guilt or, and shame can serve a punishment purpose, but if anger is directed also towards ourselves, right? Then it can serve punishment too. So punishment, avoidance, and the sense of control that if you think ahead to something awful that you're imagining is going to happen, well, maybe that will let you avoid it, right? I mean, you can see the brain here, in a sense, really confused. I mean, part of the brain wants to punish, part of the brain doesn't want to think about it at all, and part of the brain wants to make it better. And, and then how all of that resolves if we're not aware that, hey, this is in the context of our brains being deeply impacted by trauma, so what's going on here is all maladaptive, right? 'Cause these negative fantasies of the future, they may help us feel better about something in the present, but they don't help us make anything better, right? They don't help us make anything better, so this is the kind of the sequela. This is where trauma and all this reflexive stuff that happens after trauma ultimately lead us, and you can see how we get lost, how I've seen over and over again in my own life, in the lives of other people, how, man, we get stuck in those situations, and that's why I see people sometimes, this has been going on for 30 years, 40 years, right? And it's just been going on over and over and over again, because there's no natural end to any of this, right? Unless we- we look at it in a different way, that we have knowledge and information like, "Whoa, this isn't the way it has to be. Let me bring a novel perspective to this." It doesn't change on its own.

   21. AHAndrew Huberman50:22

       I'm, uh, struck by your statement that these thoughts or behaviors can make us feel better, but they don't actually make anything better. In that way, it, this mode of imagining terrible outcomes starts to immediately seem like taking opioids. It, you know, you feel better in the moment, but it doesn't actually make anything better, and it-

   22. PCDr. Paul Conti50:43

       Right.

   23. AHAndrew Huberman50:43

       ... probably makes things worse.

   24. PCDr. Paul Conti50:45

       Yes.

   25. AHAndrew Huberman50:45

       And, and just this question of, um, how, how much worse and, and, and in what direction.

   26. PCDr. Paul Conti50:52

       Yes.

   27. AHAndrew Huberman50:54

       And so I just, I want to just pause on that, on that concept because I think that concept of makes us feel better but doesn't make anything better, I think, um, it answers an earlier question about the, this, what seems to be a totally maladaptive wiring diagram,

9. 51:10 – 53:22

   Short-Term Coping Mechanisms vs. Long-Term Change

   1. AHAndrew Huberman51:10

      you know? We need to confront the thing, but we don't want to go into the repetition compulsion, so there's a, there's a, it's a, it's a knife edge there-

   2. PCDr. Paul Conti51:16

      Right.

   3. AHAndrew Huberman51:16

      ... to navigate through trauma.

   4. PCDr. Paul Conti51:18

      Yes.

   5. AHAndrew Huberman51:20

      Working with a, a very skilled clinician like yourself I think is the ideal circumstance for, for people, um, and of course there are people who can't access support from somebody for whatever reason. Uh, you've talked about, uh, journaling.

   6. PCDr. Paul Conti51:35

      Mm-hmm. Yes.

   7. AHAndrew Huberman51:36

      Um, as a useful tool, um, could you maybe you highlight some of the other, uh, things that people can do on their own? And then I'd also like to talk about what makes for a good therapist. What should people look for-

   8. PCDr. Paul Conti51:48

      Yes.

   9. AHAndrew Huberman51:48

      ... for those that are, are seeking therapy, especially nowadays when a lot of therapy is being done remotely? But let's just start with the, the, uh, let's just call them, um, self-generated or zero-cost, um, sorts of things, uh, journaling being the first, and then what are some of the others, and, and what kind of structure would you recommend someone put around journaling? Um, carry a journal around all day and jot things down as they come up, or sit down and spend an hour writing in complete sentences, for instance?

   10. PCDr. Paul Conti52:14

       Mm-hmm. Yeah, if I could, uh, add something to what you had just said before the question, right? That, that we have these short-term coping mechanisms in us, right? And in a way it makes sense, right? We find ourselves in just terrible situations, you know, then a short-term coping mechanism can get us through them, right? So our, our brains are built that way, and that's part of survival too, right? And whether now in the modern world, whether it's, it's food, it's drugs, it's sex, it's alcohol, right? Or it's negative thoughts, right? This is short-term soothing. Even the negative thoughts or the anger is short-term soothing at the expense of long-term change, right? And that's where, you know, addictive pathways can come into play, and, and that's where, again, our, how we're built evolutionarily for survival doesn't help us, you know, in the way humans have evolved. Like, we haven't lived this way throughout, you know, 99.9-something percent of human history, right? So, so we're not adapted to this. So I wanted just to make a point of saying that about the short-term soothing at the expense of any, of long-term change,

10. 53:22 – 57:00

    Tools: Processing Trauma on Your Own, Journaling

    1. PCDr. Paul Conti53:22

       you know? And then the, the question you had asked about, say, journaling or what can we do that's outside of, uh, professional, I think the hallmark of it has to be bringing new eyes to it, right? Like, thinking about self with a curiosity instead of just a simple automaticity or repetition, right? Like, why am I thinking about this? When did this start? Why is this in me, right? That, it's that that whether it's words or whether we're writing that's so important. So I think for journaling, it depends on the person, you know? I mean, we don't want somebody carrying around a journal all day if then there's a compulsion to, "I need to write about everything that's going on in my mind," right? Like, that might be good to, okay, write a little bit at night, right? Or someone who might think, "You know, sometimes this really comes into my mind in a strong way, and it could be unpredictable," right? I want to have the, the journal with me, so, ah, that thing is back in my mind now. You know, let me write about it, right? Because then putting words to it and then being able to read those words, right? A- and when people read, even do a little bit of journaling and they read, like-...oh, I, I thought again about how I'm a terrible person who can't have a good life because, uh, because I was in such a bad car accident, or because that person attacked me, or because when I was in school, I was bullied because I look different than everyone else, right? Or I acted different from everyone else. Wow. You know, to actually see that written out, it's, you know, it's a little bit, uh, uh, of that, you know, it's a little bit of that, like, when you're saying it to someone as if it were someone else, right? Because now there's enough distance from it. Like, I'm looking at the words I wrote, right? That we get some distance and we can start to integrate some of the, not just the compassion, but integrating compassion and logic, right? Of like, okay, I feel a sense of compassion. Oh wait, what does this mean? What really happened here? Right? And gosh, I did start thinking differently after that, and I started to, that's where this came from, right? That's why I'm saying this. It's those kind of revelations that we can have through, again, the written or spoken word. A- and I think, again, that involves a trusted other, uh, you know, or writing, right? And I think tha- those are ways we can do this, where we bring some de novo perspective to something that often has been bouncing around inside of us, and it's amazing to me that, you know, I can see such intelligent, empathically attuned people who've had the same thing running over and over again in their mind for years, and it just points out that our brains don't automatically say, "Hey wait a second, you know (laughs) , I've been spinning wheels here for a long, long time. Like, was there another way to look at this?" We need something from the outside which can just be knowledge, right? Whi- which is why I think what we're doing here, or the reason I wrote the book that I wrote was, was, like, apprehending this, like, amazing surprise to me, right? Which is like, wow, like, some huge percentage of everything I'm treating is rooted in trauma and the opacity of trauma, right? Which is why we don't see that, oh, the depression, the panic attacks, the life change, the addiction, the, you know, the maladaptive choices, like, oh, th- this is all coming from trauma because it hides itself in that, in that opacity. So we need a de novo perspective if we're doing it on our own, and we need that if we're doing it in therapy, which might link to, like, finding the right therapist, right? Which is also part of your question.

    2. AHAndrew Huberman56:45

       Yes. Yeah, I definitely want to know about how to assess and find the right therapist. Before, uh, we, uh, cover that however, um, something came up, um, in the course of your answer.

    3. PCDr. Paul Conti56:56

       Mm-hmm.

    4. AHAndrew Huberman56:57

       Um, I can immediately relate to this idea

11. 57:00 – 1:02:34

    Sublimination of Traumatic Experiences

    1. AHAndrew Huberman57:00

       that, you know, certain behaviors are, are really maladaptive and are, are, um, stuffing things down or avoiding the topic, um, is problematic, and bringing a curiosity and an introspection and almost a third person-ing of the, um, experience, uh, that we've had in order to try and address it from a- through a new- from a new- truly from a new perspective.

    2. PCDr. Paul Conti57:20

       Mm-hmm.

    3. AHAndrew Huberman57:21

       It occurred to me as, as we were discussing this however that some people, and, and yes, maybe I'm talking a little bit about my own experience. We, we have a sense of our own identity and our, and how people view us and our ability to be functional in the world in ways that we like.

    4. PCDr. Paul Conti57:37

       Mm-hmm.

    5. AHAndrew Huberman57:37

       Effective at work or a good brother-

    6. PCDr. Paul Conti57:39

       Mm-hmm.

    7. AHAndrew Huberman57:39

       ...or a good mother or father or human being in the world. We have relationships. And I think that one thing that I have heard, um, and maybe I've experienced, is that sometimes those, um, maladaptive thoughts or behaviors, the things that generate a kind of a, a repetition of anger or of arousal or activation or sadness, that we have some internal process where we, we funnel that into a functionality in the world. So we-

    8. PCDr. Paul Conti58:07

       Uh-huh.

    9. AHAndrew Huberman58:07

       Um, I'll give a more concrete example. Um, so in thinking about things that have upset me in the past and in imagining bad outcomes in the future-

    10. PCDr. Paul Conti58:16

        Uh-huh.

    11. AHAndrew Huberman58:16

        ...there's a certain internal state of arousal that comes about, and for many years I was able to use that.

    12. PCDr. Paul Conti58:23

        Mm-hmm.

    13. AHAndrew Huberman58:23

        Not to feel angry but rather to work an extra three hours a day.

    14. PCDr. Paul Conti58:27

        Right. Right.

    15. AHAndrew Huberman58:27

        Or to, um, pack my schedule with, um, work and social engagement so I could show up w- in a way that I, you know, hopefully was a very good brother to my sister, for instance.

    16. PCDr. Paul Conti58:37

        Right.

    17. AHAndrew Huberman58:37

        So in a way it, was a, um, it was a transformation of something negative inside of me-

    18. PCDr. Paul Conti58:42

        Yes.

    19. AHAndrew Huberman58:42

        ...into a functionality in the world that was actually very rewarding and beneficial.

    20. PCDr. Paul Conti58:47

        Yes.

    21. AHAndrew Huberman58:47

        And yet in, in describing it I can immediately see how it would be wonderful if I could source from something else.

    22. PCDr. Paul Conti58:54

        Mm-hmm.

    23. AHAndrew Huberman58:54

        And yet I, you can imagine and I, and I can imagine how one would be, um, reluctant, maybe even terrified of giving up that source.

    24. PCDr. Paul Conti59:02

        Yes.

    25. AHAndrew Huberman59:02

        It's a fuel.

    26. PCDr. Paul Conti59:03

        Yes.

    27. AHAndrew Huberman59:04

        And I, and I think in knowing some of the, uh, traumas of other people and their reluctance to work through those, uh, obviously I'm not a therapist, I, I sense this over and over again, that one's positive identity-

    28. PCDr. Paul Conti59:17

        Mm-hmm.

    29. AHAndrew Huberman59:17

        ...can often be linked to something difficult in their past.

    30. PCDr. Paul Conti59:20

        Yes.
12. 1:02:34 – 1:07:20

    Tool: Finding a Good Therapist

    1. AHAndrew Huberman1:02:34

       typically this, in my experience, this is done by word of mouth. You know, there's this person, you might want to work with them, they're really great. But what are some of the characteristics that one should look for, and, um, should we take into account whether or not we are a person who, you know, for instance, uh, I've heard this from, from listeners, uh, although I'm clear- I'm definitely not talking about myself here and cloaking something. Some people will say, "You know, I want to work with a somatic therapist because..." I've actually heard someone say, "I think in feels. They, you know, I feel stuff in my body, so I want to work with someone who can really acknowledge that." Or someone else will say, um, "You know, I want to work with somebody who has this orientation or that orientation, or is, um, open to my particular lifestyle, or isn't going to tell me that I have to leave my relationship," you know? I feel like people already show up to the question of who to work with, with all these, you know, things internally.

    2. PCDr. Paul Conti1:03:28

       Right.

    3. AHAndrew Huberman1:03:28

       Some of which are voiced and some of which aren't. So I'd love for you to talk about maybe some of the, the core features of a really good therapist, and then how to, how to look for a therapist, and also how to think about oneself in looking for a therapist because of these kind of predispositions.

    4. PCDr. Paul Conti1:03:43

       Right, right. Well, there's a lot of data about this over, over the years that if you look at what are the top 10 important factors to find in a therapist, just repeat rapport 10 times, right? I mean, that's the key. And if you think about that, that's pretty amazing, right? Because therapeutic modalities can be so different, right? And I think what, what that's telling us is in a way something very obvious, right? Like what does rapport mean? Like, you know, it's somebody's paying attention, right? It's trust. It's a back and forth. It's, it's like, yeah, even though I'm doing, I'm doing something difficult, I'm doing it with someone who's really helping me, someone who's in it with me, right? Someone who's really paying attention, wants me to be better. That's indispensable. I mean, it's just indispensable. And I write in the book, if someone, a therapist is not making eye contact or this is the way they do it, right? And, you know, you got to fit into the box of the way they do it, that is not going to be helpful. And, and then what I, what I think about that is the different modalities, it doesn't actually tell us that, oh, the modality is irrelevant. I think that's not true. I think that good therapists are not pigeonholed by a certain modality. They, they may, you know, come at the world largely through a psychodynamic or a CBT or a DBT lens. There's lots of different, you know, ways to do therapy, but when you really talk to those people, really good, experienced therapists, it's all coming through the vehicle of the rapport, but they're practically shifting to what the person needs. You know, I, I don't understand the i- the idea that like, oh, I just do this, right? I don't do that. And wh- when people are pigeonholed that way, I don't think they help their patients very well, right? We, we have to be diverse enough to say, "Hey, I want all the arrows in the quiver," right? And, and even though there might be one that I favor and that's the lens I see things through, no, I can be versatile. I can shift. I can adapt to what this person needs. And I think if, if you have that, you've got a... If you have that, you've got a winning combination.

    5. AHAndrew Huberman1:05:42

       Great. So people should perhaps try a few therapists and maybe have a session or two or three to see if they, the rapport feels like it's taking root. Is that...

    6. PCDr. Paul Conti1:05:50

       Yeah.

    7. AHAndrew Huberman1:05:50

       Do you think I have that right?

    8. PCDr. Paul Conti1:05:51

       Yeah, and I think that's why word of mouth is important, right? If someone you trust tells you, "Hey, this is a good person," that says a lot, right? It already makes the pre-test probability, you know, as quite high. Um, but yes, it's interesting to see when people, uh, have a therapist or they called their insurance and they're assigned a therapist, this thought that like, "Oh, that's the person I have to have now." And it's like, no, you should look at that like anyone you'd be interviewing, right? (laughs)

    9. AHAndrew Huberman1:06:15

       Mm-hmm.

    10. PCDr. Paul Conti1:06:15

        For, you know, for a job, right? But, but you got to bring, again, the right...... set of thoughts to that to- t- it's to be helped, right? Which is like, I want someone who's g- has rapport with me. I don't want someone who's going to make it easy, right? Who's like, "Well, it's, gosh, it's kind of pleasant," because then that means they're not talking about the difficult things, right? So if one brings, "Okay, I know this isn't going to be easy, I got to talk about difficult things," right? Even if one doesn't recognize, "Oh, I gotta talk about the trauma in me," right? But to go to therapy thinking, no, it's, I mean, sometimes it's enjoyable, but a lot of times, right, it's not, right? It's hard work. It can be excruciating. We can cry doing it. But to say, right, that that's how I'm gonna be helped, and I want someone who's going to do that with me, you know, who- who's really looking at what's going on inside of me, how do we help me, and I can feel sort of the robustness of that. If one brings that approach and then looks at the therapist through that lens, you're- you're very likely to then move on from someone who's not a good choice, right? And really stick with someone who is, even though that doesn't mean it's always, like, pleasant and enjoyable. I mean, it has to not be that sometimes.

    11. AHAndrew Huberman1:07:19

        Right.

13. 1:07:20 – 1:14:51

    Optimizing the Therapy Process, Frequency, Intensity

    1. AHAndrew Huberman1:07:20

       W- well, maybe we could drill a little deeper into the mechanics of therapy. Um, I put out a few questions to audience, um, asking what they want to know about therapy and it was amazing. I got hundreds, if not thousands, of responses saying, "How should I show up to therapy?" So, for instance, should people take a five-minute, uh, meditative drop-in before or-

    2. PCDr. Paul Conti1:07:39

       Mm-hmm.

    3. AHAndrew Huberman1:07:39

       ... should they just show up cold and-

    4. PCDr. Paul Conti1:07:41

       Mm-hmm.

    5. AHAndrew Huberman1:07:41

       ... let it emerge? Um, during therapy, uh, is it a good idea to take notes or to not take notes?

    6. PCDr. Paul Conti1:07:47

       Mm-hmm.

    7. AHAndrew Huberman1:07:48

       Um, and then post-therapy, uh, how should clients, patients, um, as they're sometimes called, one or the other, I never know which, how should they process that information? Should they take some designated time afterwards and, you know, in an ideal world, take a 30-minute walk afterwards and think about the material or should they set it aside and come back to it? Of course, there are constraints, uh, work and family-

    8. PCDr. Paul Conti1:08:10

       Right.

    9. AHAndrew Huberman1:08:10

       ... etc., but, you know, we, there's a lot of knowledge out there about how to best show up to a workout. Uh, warm-

    10. PCDr. Paul Conti1:08:16

        Right.

    11. AHAndrew Huberman1:08:16

        ... up for five-

    12. PCDr. Paul Conti1:08:17

        Right.

    13. AHAndrew Huberman1:08:17

        ... 10 minutes, then do this, etc., and then the cool down. I mean, here we're talking about hard psychological work aimed at bettering-

    14. PCDr. Paul Conti1:08:25

        Mm-hmm.

    15. AHAndrew Huberman1:08:25

        ... oneself. So, um, to my knowledge, I've- I've not ever, um, seen this information anywhere. It'd be very useful to hear, hear your thoughts on this.

    16. PCDr. Paul Conti1:08:31

        Yeah.

    17. AHAndrew Huberman1:08:32

        Yeah.

    18. PCDr. Paul Conti1:08:32

        Well, I'm not trying to duck the question, but- (laughs) but- but I think it varies so much by person. So if you think about the- the first part of your question, I think was how to show up to therapy, right? And I think the answer would be whatever lets you be fully present when you're in therapy. Now, for some people, there's going to be, "Hey, I- I show up early," you know, "I sit, I calm myself, I meditate a little bit." I mean, that's how then they're present, right? For other people, you know, they just, they show up, walk into the room, they can stop and now they're present, right? So it's whatever works for that person so that they're really there. Their thoughts, their energy is really in what's going on. And the same thing applies on the other end. You know, there are people who, eh, are really well served by, you know, going for a walk if they can or sitting quietly after therapy, kind of putting that in order, right? Otherwise, they lose some of it, right? Or, like, some of the ah-has, right? Or the, oh, that's an interesting thought, that they really need to put it in order. Maybe that involves taking some notes during therapy, right? For other people, they need to do the exact opposite. They need to, like, leave, not think about that at all, and then they can reflect on it later and learn from it. So, you know, we're so different. Uh, human beings, there's such a diversity in us that, that I think there's no hard answer to that. It's like being present when it's happening and then being able to sort of consolidate and- and retain what's been gained is most important, and I think we have to figure that out person by person. I mean, I try and do that in the work of, like, wha- what's serving this person best? And sometimes we, you know, sometimes it evolves and sometimes we talk about it, but it varies so much.

    19. AHAndrew Huberman1:10:04

        Mm-hmm. If someone were thinking about embarking on therapy or more therapy to- to address trauma or just g- general issues of life, what is the frequency that you recommend? I could imagine two extreme models. One is, okay, I'm gonna finally tackle this trauma. I'm going to do therapy three times a week, but for a shorter period of time, you know?

    20. PCDr. Paul Conti1:10:24

        Right.

    21. AHAndrew Huberman1:10:24

        Six months, it, you know, over and out, um, versus this open-ended model of once a week typically, uh, for as long as it takes.

    22. PCDr. Paul Conti1:10:34

        Right. Right. I think that also varies. Um, and I work with people in varied ways from, oh, someone who's doing well and, like, we meet for a half hour every six months, right? To doing week-long hourly sessions to spending three intense days with someone in a row, right? So I- I think as far as, like, kind of guiding principles, what I have found i- in my own life 'cause I- I've- I value my own therapy, uh, tremendously, so I've found in my own life and in my own clinical work that if it's less than once a week, then it's hard for us to retain really. You know, we- we spend a lot of time kind of catching up. Okay, what's happened? Let's get back to the place we were at before, right? Which is why I think if we're really gonna get somewhere, we're not just trying to maintain something, right? Then I think once a week e- for an hour is really kind of the minimum, right? Um, but more intensive work, it's like the more intense it is, it's- it's- it's not linear, right? It's an exponential gain. Like we- we do a lot of intensive work, right? Where- where someone will come and- and do 30 clinical hours with us over the course of a week. So five or six different clinicians, 30 clinical hours, and, you know, we've found that the benefits of doing that are immense. It's like, it's like a year's worth of therapy consolidated and you think, well, 30 hours, let's say, you know, we go almost every week, maybe that's 45 or 50 hours, but 30 hours with that kind of intensity, um, is worth probably 60 hours, you know, done in a different way, um, because then it- it's- it's in us in an active way, right? It's in the therapist in an active way. It becomes very, very dynamic. So I think turning up the intensity if there's something that we really need to process absolutely makes sense, and I do that in my own life. There's something now it's like, whoa, it's really, something is really distressing me and it's linking into prior trauma, and I can see what's going on in me. Now I start to have ruminative thoughts, you know, with negativity, I'm like-I got to go more, right? Because I got to do that processing so I can get to the place that I am. Which is not that, it's not that the trauma has no impact on me, right? It's that the impact is much less than it was before the therapy and that I most often, more often than not, have an ability to see when it's now intruding into my thoughts and it's taking me away from, like, what I really think and believe or being able to draw logic and emotion together and make good decisions. Turning up the intensity then absolutely makes sense.

    23. AHAndrew Huberman1:13:08

        This, uh, very deep, um, intensive work of 30 hours in a week, uh, what brings somebody to some, uh, t- the type of work, um, of that sort? Um, is it a suicide risk or an a, a severe addiction situation? I mean how, how does one gauge how much therapy they, they ought to be, um, doing, uh, and, uh, should it always be on the therapist to decide that frequency?

    24. PCDr. Paul Conti1:13:32

        Mm-hmm.

    25. AHAndrew Huberman1:13:32

        Um, wha- you know, what, what would bring someone to, to a situation of five therapists and 30 hours a week-

    26. PCDr. Paul Conti1:13:38

        Yeah.

    27. AHAndrew Huberman1:13:39

        ... uh, in one week?

    28. PCDr. Paul Conti1:13:40

        Right.

    29. AHAndrew Huberman1:13:40

        Um ...

    30. PCDr. Paul Conti1:13:40

        Right. Yeah, it's, it's usually a, a person who is really distressed by something, you know, whether that's it's, it's so negatively impacting their life, their life. Or sometimes a person comes to a realization, "I just can't take this anymore," right? Or, "I'm, I'm sick of this cyclical depression and I can't, I got to stop having panic attacks. Like, I, I need help." Right? But it's, it's usually some, you know, crisis point with the idea of, of crisis in the meaning of, okay, something comes to a head and after it things are going to be different, right? Not a crisis and things are going to be negative afterwards, but a point where, where then that, that cognitive flexibility comes to the fore of like, "Wait, I need to do something different," right? So that, that's often what brings us. You know, sometimes it's other people pointing it out or if somebody's had an intervention somewhere or, yes, that person's been hospitalized after a suicide attempt or they've gone back to, to rehab again, uh, for the third or fourth time and their life is really in danger. Sometimes it's that and sometimes it's a person realizing, "Yeah, I just want to, I want to look at myself. I want to understand myself better." You know, "I know that what's going on in me isn't as good as it can be." Right? So, so I think people can come to it for all sorts of different ways. Um, and I think,

14. 1:14:51 – 1:16:35

    Tool: Self-Awareness of Therapy Needs, Mismatch of Needs

    1. PCDr. Paul Conti1:14:51

       yes, I think a lot of times it would be the therapist to say, like, more work- you know, more intensive work or, can make a, a difference, but I think the person also needs to, you know, take ownership, right, of their own therapy and say, "If I don't feel helped enough, well, I have to think about that," right? And, and talk to the therapist about that 'cause it may be, it may be that therapist isn't a match, right? Or maybe you talk to the therapist and the therapist can change his or her approach, right? Or maybe you talk to the therapist and increase the frequency, right? But the i- idea is to, to be aware of it, right, and if one's needs aren't being met, to acknowledge that, right? 'Cause people can get into a rhythm of therapy where it's really not helping them, right, but they either feel sort of nihilistic about it, like, "Oh, I'm no better and I'm going to therapy," right? Or sometimes there's a sense that, "Well, I'm in therapy so I'm kind of checking that box of doing something for myself, but it's not really getting me anywhere," and then the part of the brain that's controlled by the guilt and shame and avoidance thinks that's a great idea, right? So again, this ability to observe ourselves and like, "What's going on? Am I being helped in the way I, uh, do I feel helped," right? "Am I in some ways even, even like happy that I'm not feeling helped 'cause I don't have to face this thing I don't want to face," right? Or am I too afraid to say, "I need more help"? Right? So we really need to look at ourselves. And this is where the insurance systems often are very difficult 'cause it's hard sometimes for a person to say, "Well, I need more therapy" 'cause that may not be possible, right? So, so there, there are sort of negative factors in the world around us, but ultimately, I think the answer to the question comes down to observing ourselves and taking ownership of like what's going on in us and how we're feeling and, and, and feeling that, that, um, commitment to self or to self-care to say, "I need to go change this."

Episode duration: 2:24:28