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

安德鲁·休伯曼：

Welcome to the Huberman Lab 播客, where 我们 discuss science 和 science-based tools 对于 everyday life.

安德鲁·休伯曼：

I'm Andrew Huberman 和 I'm a professor of 神经生物学 和 ophthalmology at Stanford School of Medicine. Today my guest is Dr. Paul Conti. Dr. Conti is a psychiatrist who did his 训练 at Stanford School of Medicine 和 then went on to be Chief Resident at Harvard Medical School. He now runs the Pacific Premier Group, which is a collection of psychiatrists 和 therapists focusing on solving complex human problems, including trauma, addiction, personality, 和 psychiatric disorders.

安德鲁·休伯曼：

Today 我们 discuss trauma in detail 和 the therapeutic process in detail. 对于 instance, 我们 discuss what is trauma? How do 你 know if 你 have trauma? Dr. Conti shares 与 us, 对于 instance, 那 not every experience 那 我们 think is traumatic is necessarily traumatic, 和 yet many 人们 可能 have trauma 没有 even realizing it. 我们 also talk 关于 the therapeutic process generally. 对于 instance, how to pick a therapist, how to best approach 和 go 通过 therapy, 和 how to evaluate whether 或 not therapy 和 你的 relationship to the therapist is working 或 not.

安德鲁·休伯曼：

我们 also talk 关于 self-therapies 因为 我们 acknowledge 那 not everyone has access to 或 可以 afford therapy, 和 我们 talk 关于 drug therapies, 对于 instance, antidepressants, antipsychotics. 我们 talk 关于 alcohol, cannabis, ketamine, 和 the psychedelics, including psilocybin, LSD, 和 我们 talk 关于 the clinical use of MDMA 和 what the future of 那 looks like.

安德鲁·休伯曼：

The reason 对于 bringing Dr. Conti onto 这 podcast is 因为 I see him as the person who has the greatest 和 most holistic view of therapy, trauma, drug therapies, talk therapies, 和 how self-therapy 和 work 与 others 可以 be integrated 对于 both healing 和 growing 从 difficult circumstances. Dr. Conti is also the author of an exceptional book entitled "Trauma: The Invisible Epidemic: How Trauma Works 和 How 我们 可以 Heal 从 It." 那 book describes trauma 和 its many features, 和 many tools, some of which 我们 discuss on the podcast today.

安德鲁·休伯曼：

Whether 或 not 你 have trauma 或 not, by the end of today's episode, 你 会 have a much deeper understanding 关于 what trauma is. In fact, I'm confident 那 你 会 gain insight 进入 whether 或 not 你 have trauma 或 not, whether 或 not 人们 close to 你 have trauma 或 not, 和 the various paths to recovering 和 indeed growing 从 trauma 那 我们 可以 all take. As 你'll soon learn, Dr. Conti is an exceptional communicator 和 has a unique window 进入 the trauma 和 therapeutic process 那 I know 那 all of us 可以 benefit 从.

安德鲁·休伯曼：

之前 我们 begin, I'd like to emphasize 那 这 podcast is separate 从 my teaching 和 研究 roles at Stanford. It is, 然而, part of my desire 和 effort to bring zero-cost-to-consumer information 关于 science 和 science-related tools to the general public. In keeping 与 那 theme, I'd like to thank the sponsors of today's podcast. 和 now 对于 my discussion 与 Dr. Paul Conti. Paul, thank 你 so much 对于 being here today.

Paul Conti:

Oh, thank 你 so much 对于 having me.

安德鲁·休伯曼：

I've been looking forward to 这. I've received a ton of questions 关于 trauma, 关于 therapy, 关于 how to assess where 一 is in their own arc of problems 和 addressing familial issues 和 relationship issues 和 so forth. If 我们 could just start off 非常 basic 和 just get everyone oriented.

Paul Conti:

Sure.

安德鲁·休伯曼：

How 应该 我们 define trauma? 我们 all have hard experiences. Some of them 我们 可能 ruminate on 更多 than others, 但 what is trauma?

Paul Conti:

To make the definition relevant, I think 我们 have to look at trauma as not anything negative 那 happens to us, 但 something 那 overwhelms 我们的 coping skills, 和 then leaves us 不同的 as 我们 move forward. It changes the way 那 我们的 brains function, 和 then 那 change is evident in us as 我们 move forward 通过 life.

安德鲁·休伯曼：

How do 我们 know if 我们 have trauma 或 not? I've heard 之前 everyone has trauma. 对于 instance, I've heard 那 if 我们 are a child, 或 when 我们 are a child, 和 我们 request love 从 a parent 或 注意力 从 a parent, if they dismiss us, 那 那's a microtrauma. Is 那 overstating 或 unfair to the real issue of trauma? Do 我们 all have trauma? What are microtraumas?

Paul Conti:

I think traumas 那 我们 可能 categorize as disappointments 或 things 那 are negative 但 not deeply impactful, I think is not a helpful definition. I think the helpful definition is something 那 rises to the magnitude of 确实 changing us 和 something 那 我们 可以 see both in how 我们 behave, 我们 可以 see it in 情绪, anxiety, behavior, sleep, 身体健康, so 我们 可以 identify it, 和 我们 可以 also see it in 大脑 changes. The fact 那 我们 become, say, 更多 hypervigilant, 更多 vigilant, 和 then 我们 可以 see 那 不同的 parts of the 大脑 are 更多 active. 那 definition captures how trauma, if it rises to a certain 水平 ... what 我们 会 say, trauma 那 makes a post-trauma syndrome, leaves us 不同的, I think is the helpful definition of trauma 因为 it's a clinical definition. It's changes in us as 人们, 和 我们 可以 map 那些 changes to identifiable shifts in 我们的 大脑 function.

安德鲁·休伯曼：

How do 我们 know if 我们've been changed by something? I 可以 think back to childhood events where some kid on the playground 或 in the classroom said something I didn't like, something negative 关于 me. I think most 人们 可以 do 那. 我们 have a great memory 对于 the kid 那 said something awful, 或 the parent 或 teacher 那 said something awful 那 确实 felt like it hurt us 或 at least stuck 与 us. Clearly 一's 大脑, my 大脑 in 这 example, has been changed by 那 event such 那 I remember it, 但 how do 我们 know if something has actually changed the way 那 我们 are? 因为, of course, 我们 don't know how 我们 会 be otherwise.

Paul Conti:

Right. 那's difficult. It's doable, 但 it's difficult 因为 the response ... if the trauma rises to the 水平 of changing 我们的 brains, 和 I don't just mean 我们 have a new memory. 我们 可以 have memories of something 那 was negative, 和 in 那 sense it changes the 大脑 因为 now there's something 我们 可以 call to 心智, 但 it doesn't change the functioning of the 大脑. If trauma rises to the 水平 of changing the functioning of 我们的 brains, then there's almost 总是 a reflex of guilt 和 shame 大约 the trauma 那 可以 lead us, it 经常 leads us to bury it, to avoid it, to feel 那 now there's something negative inside of me 和 it feels shameful, 或 it feels like no 一 else 会 accept it. What happens is 人们 tend to avoid looking at the change in them, which is exactly the opposite of what needs to be done. The idea of in a viral pandemic, 我们 want to stay away 从 一 another 和 isolate, 但 与 the trauma epidemic, 我们 need to communicate 与 other 人们. 我们 need to communicate 和 put words to what's gone on inside of us.

Paul Conti:

非常 经常 a person knows. I've done so much clinical work over 关于 20 years 那 has focused on trauma, 和 a lot of the times the person knows, 但 they're not admitting it to themselves 因为 they're afraid of it. They don't know what to do. 但 if they start talking, then they'll talk 关于 the event 或 the situation. It could be something acute 或 it could be something chronic 那 确实 has been harmful to them, 和 then they feel 不同的 afterwards. Like, "Oh, 之后 那, I started thinking differently, feeling differently," 但 那 doesn't 总是 happen. Sometimes it's a process of exploration 通过 dialogue, whether it's written 或 whether it's spoken, of the person exploring the changes inside of themselves, maybe changes to their self-talk inside, changes to their thoughts 关于 the world 和 whether they 可以 navigate safely 和 readily in it.

Paul Conti:

An anchor as I talk 关于 这, the example I'll use at times is the example of my own life where when I was much younger, in my early 20s, my younger brother took his life by suicide. The response of guilt 和 shame 和 hiding all of it inside of me was 非常 dramatic, 但 I wasn't acknowledging it 因为 I didn't know what to do 关于 it, 和 I felt guilty, 和 I felt responsible, 和 I felt ashamed. There was an avoidance inside of me, 和 then I wasn't saying to myself, "Hey, 之前 这 你 thought 那 你 could be effective 和 你 could make 你的 way in the world, 和 if 你 were a good person 和 你 worked hard, 你 could make a difference." Then afterwards, I thought, "I 可以't get anywhere. The world's against me," 和 I felt like my options were all gone. I was 24 years old.

Paul Conti:

I didn't see 那 the change was in me, 但 I was taking care of myself poorly. There was enough going on 那 was unhealthy 那 I couldn't avoid the realization 那, "Hey, I'm 不同的 now, 和 in 这些 ways 那 are automatic." My reflex to "可以 I make my way in the world, 可以 I have a good life, 可以 I be happy?" Well, my reflexes to 那 were all 不同的. They were coming 通过 the lens of heightened anxiety, heightened vigilance, a sense of guilt, a sense of shame 和 a sense of nonbelonging in the world. It was ultimately good 和 helpful 人们 大约 me 和 my own realization 那 "Hey, things are not going well," 那 led me to then get some help 和 to be able to talk 关于 it 和 realize, "Oh my gosh, I need to face 这些 things 那 are going on inside of me."

安德鲁·休伯曼：

从 a psychoanalytic, psychological, 和 maybe even a neuroscience perspective, 二 questions. Why do 你 think 那 when 我们 experience trauma 这些 things 那 我们 call guilt 和 shame surface? Everything 你're telling me is 那 in the end 那's not adaptive. Why 会 我们 be built 那 way? 那's the 首先 question.

Paul Conti:

Yes.

安德鲁·休伯曼：

Then the 秒 question is, how 应该 我们 conceptualize guilt 和 shame? I think 我们 hear "guilt," 我们 hear "shame." How 应该 我们 think 关于 it? 那些 emotions must exist in us 对于 some reason, 但 in 这 case, it seems like they don't serve us well. Maybe in 那 order 或 in reverse order, what is guilt 确实? What is shame 确实? Why is it 那 我们 seem to be reflexively wired to feel guilty 和 feel ashamed when 那's the exact opposite of what 我们 need to do in the case of trauma?

Paul Conti:

Right. No, I think 这些 are great questions; I don't think anyone knows the answers 对于 sure, 但 my read of all of 那 is 那 there's something adaptive 那 has happened in us 通过 evolution 那 now becomes maladaptive in the way 我们 live in the modern world. If 你 think of 通过 most of human development, 人们 weren't living 那 long, 和 the idea was to survive 和 reproduce, so traumatic things 那 happened to us, it 会 make sense 对于 them to stay 与 us. If 你 ate a new food 和 got 确实, 确实 sick, it's like 你 better remember 那. If 你 see someone 从 the group of 人们 a couple miles away 和 一 of 那些 人们 attacks 你, it's like 你 better remember 那. The traumatic things 那 are emblazoned in 我们的 大脑 are built to last. Things 那 are positive 会 generate some emotion inside of us, 但 things 那 are profoundly negative are much 更多 可能 to stay 与 us.

Paul Conti:

I think 那 那 was adaptive when all of 那 was 关于 survival. I think the same thing is true 与, say, shame. I think here it makes sense to talk a little bit, 和 actually, I'm interested in 你的 thoughts 关于 这, 那 the limbic 系统 — the 系统 经常 is called the emotion 系统 in 我们的 brains — has actually, of course, varying function. 一 aspect is affect. Affect is aroused in us, which I think the meaning then is it's created in us 没有 我们的 choice. If 我们're walking down the road 和 someone jumps in front of us 或 pushes us, then there's a response of fear, anger, 心脏 starts beating faster, 更多 血液 to the 肌肉, 我们're getting ready to fight 或 run, 和 then 我们 become aware of it. The aroused affect in us is also 关于 survival, 和 it has a 非常 deep impact upon us.

Paul Conti:

Shame is an aroused affect. It 可以 be raised in us 没有 我们的 choice, 和 it's 非常 powerful, which if 你 think 关于 那, is an extremely strong deterrent. If 你 had ... imagine a tribe 或 group of 人们 那 are sheltered together, 和 someone eats half the food at 夜间 或 something — there's a 非常 negative response. 那 person feels shame 因为 shame is so powerful to control behavior. The way 那 trauma 可以 change 我们的 brains 和 stay 与 us in a way 那 says, "Be 更多 vigilant, look at the world in a 不同的 way, act 更多 defensively," 和 how 那 links to shame 和 to guilt, 和 then guilt becomes what gets called "feeling," technically, where 我们 relate the aroused affect to ourselves.

Paul Conti:

Shame, the aroused affect, 和 guilt, the next step, when the shame gets related to self, are such profound behavioral interventions 和 deterrence 那 你 可以 see, I think, how evolutionarily it kind of all makes sense. If 我们're fighting 对于 survival 和 我们're an elder statesman if 我们 make it to 20, 这 makes sense, 但 it doesn't make sense in a world where 我们 live much longer, 我们 navigate in all sorts of 不同的 ways, 和 there's so much coming at us 那 可以 be traumatizing.

Paul Conti:

If 你 think 关于 the news, how many times have I written a prescription 对于 someone 那 says, "No 更多 news"?

安德鲁·休伯曼：

你've actually written 那些 prescriptions.

Paul Conti:

Oh yes. Yes. Glance at the news. Look at the news 对于 news. "Anything going on I need to know?" 但 what 人们 are doing is they're looking at it 和 they're clicking 和 they're clicking, 和 there's a sense of being enthralled in a 非常 frightening way 与 the horrors 那 are in front of us.

Paul Conti:

It shows how, yes, trauma 可以 come 通过 acute things 那 happen to us. Trauma 可以 come 通过 chronic things, chronic denigration, whether it's based upon socioeconomic status, immigration status, race, religion, sexuality, gender identity. 这些 chronic traumas of being denigrated by the society 大约 us 或 treated as 更少 than 可以 change the 大脑, 但 vicarious experiences 可以 too. 我们 know 这 is not theoretical. 我们 know 那 the changes in the 大脑 可以 come 从 vicarious experiences too, which is why 人们 who are glued to the news 和 then feeling like, "Oh my goodness, what is happening? The mothers in the Ukraine who've lost babies in the war," 和 there are things 那 are so terrifying 那 if 我们 spend so much time 与 那, it has a 相似的 effect.

Paul Conti:

我们的 brains are built to change 从 trauma, 但 not in the way 我们 experience trauma 和 not in the way 那 我们 live life, in terms of the nature of living life 和 the duration of life in the modern world, where 这些 traumas 那 happen to us are 经常 so bad 对于 us 因为 they change how 我们的 大脑 is functioning 和 then 我们的 entire orientation to the world is 不同的. 那 could be 对于 years 和 years 和 decades 和 decades. It brings so much misery 和 suffering, 和 at times it brings death.

Paul Conti:

If 你 think 关于 it, 100,000 overdose deaths in 这 country in a year, 100,00. Where is so much of 那 arising 从? As a person who's treated addiction 非常 intensively over many years. I think 那, well, I feel sure 那 the majority of addiction 那 I see 和 treat arises, ultimately the roots of it are in trauma, 和 are in trying to soothe something 那's stuck inside 那 the person isn't letting outside 因为 of the guilt 和 shame, 但 it's running 大约 in their head 和 they're tormented by it. Now there's a pool 对于 这些 drugs, 或 sometimes medicines, to sooth.

Paul Conti:

The opiates 那 were given 之后 a minor surgery, okay, yeah, they help the pain 从 the minor surgery, 但 what they're 确实 helping is the pain inside. 但 那 非常 quickly turns 进入 addiction, danger, risk, 和 我们 see 那 over 和 over again, 和 not in a theoretical way. I see 那 in 人们 who have been in my practice 与 addiction arising 从 trauma who have subsequently died. It's writ large in 我们的 existence in the modern world.

安德鲁·休伯曼：

Incredible to me 那 这 is the way it works. What I mean by 那 is 这 idea 那 I've heard 关于 之前, I think it was a Freudian concept of a repetition compulsion. 这 is what boggles my 心智 as I'm hearing 这, something happens to us 或 我们 observe something traumatic, 和 instead of acknowledging 那 和 trying to distance 从 it, there seems to be a reflex of shame 和 guilt in many cases 和 stuffing it away, 和 then a repetition of behaviors to continue to try 和 just stuff it away.

Paul Conti:

Yes.

安德鲁·休伯曼：

Like 你're trying to pack, I don't know ... recently I was packing a home 和 trying to get a sleeping bag back 进入 the bag. It seems like it's 总是 trying to mushroom out the top, 这 kind of thing. It takes a lot of ongoing effort. At the same time, if 这 thing 确实 exists, 这 repetition compulsion, 人们 会 return over 和 over again to the kinds of scenarios, 或 at least the kinds of emotional states 那 look just like the trauma, 或 resemble it in some way.

安德鲁·休伯曼：

The question I have 对于 你 is, is the repetition compulsion a real thing, 和 why 会 我们 be wired 那 way? My understanding of 这 concept of the repetition compulsion is 那 我们 all want to solve 我们的 traumas, 和 it allows us to put ourselves 进入 micro, 或 again, macro versions of 那 over 和 over again. 我们 get to run the experiment again 和 again in attempt to solve it.

安德鲁·休伯曼：

In the case of taking a drug 那 ... it's clear, certain drugs like opioids, it's clear how 那 会 not allow us to deal 与 it. It's just masking the emotional state. 但 why is it, 对于 instance, 那 somebody who experiences sexual trauma then places themselves 进入 circumstances of 更多 sexual trauma? Why is it 那 somebody who is in an abusive relationship goes on to have a 秒 和 third 或 fourth verbally 或 physically abusive relationship? On the face of it, 你 just go, 那 makes no sense. Yet, 我们 see 这 over 和 over 和 over again.

Paul Conti:

Yes. The 首先 thing I 会 say, the validity of the repetition compulsion concept is a strong yes. Yes, 我们 see 那 over 和 over. It's not necessarily in everyone, 但 boy, it is in a lot of 人们 who have suffered trauma, 和 I think there's a 非常 good reason. On the surface of it, it makes no sense. 但 then if 我们 think, well, how do 我们的 brains actually function? 我们're trained, at least in Western society, I think, to think of ourselves as logical creatures 那, oh, 我们're logical, 和 ultimately everything in us 可以 just boil down to logic. If 我们 think 关于 it enough, 我们're going to understand how to make the right decisions, which is completely not true.

Paul Conti:

The limbic 系统, the emotion 系统, so to speak, inside of us, 总是 trumps logic. If 你 think 关于 it, does it ever make sense to run 进入 a burning building? Logic says no, 但 if someone 你 love is in the burning building, 人们 run right in 因为 the limbic 系统 says yes. When logic 和 emotion come head to head, emotion wins all the time. If emotion is powerful enough, it 会 总是 win. The limbic 系统 is so 重要, 和 the limbic 系统 does not care 关于 the clock 或 the calendar, 和 那's the answer.

Paul Conti:

和 I'll also say why to the repetition compulsion. The limbic 系统 doesn't know, oh, it's now, it's today, it's May, it's 2022. It just doesn't care at all. How I 会 relate 那 to the repetition compulsion is when 人们 are repeating what they're trying to do, is to make things right, 与 the idea 那 if 我们 可以 repeat the situation 和 make it right, it 会 fix everything, which makes perfect sense. If 我们 think, well, where is 那 concept coming 从? It's coming 从 the emotional part of the 大脑 那 wants relief 从 suffering of the trauma 和 does not understand the clock 或 the calendar. If I 可以 solve something now, I 会 also solve something in the past.

Paul Conti:

Which is why I 可以't tell 你 how many times I've sat 与 someone. Let's say 我们're starting to do therapy. A person 会 say, "Oh gosh, I know. Look, 你 just 可以't help me. My last seven relationships have been abusive." I'll say back something sometimes, like, "Well, look, if 你 tell me 那 你've had seven relationships 那 have been abusive in 不同的 ways, I'll agree 与 你." I only say 那 因为 那's 从不 what someone says. "但 I think what 你're going to tell me is 你've had the same relationship seven times. It's not seven things, it's 一." 那's 总是 ... I don't think 一 time yet 那 has failed to be the case.

Paul Conti:

If 你 think 关于 it, 那's how 我们 start to elucidate what's going on. They made the light bulb 那 goes off. I have not had seven 不同的 abusive relationships. I have had 一 那 I have repeated seven times. 和 now 我们 start getting to what's 确实 going on 和 what needs to happen. 那 person needs to face what happened in 那 original abusive relationship, 和 it 总是 comes down to the same sort of concepts of the person feeling terrified while the abuse was going on, feeling guilty, feeling ashamed, feeling like, oh, they brought it on themselves, they deserve it, they don't deserve anything better, 因为 the 大脑 is trying to make sense of it. 或 "I thought I could make 那 okay, 但 I couldn't." Then there's 更多 guilt 和 更多 shame.

Paul Conti:

If 那's stuck inside of someone, 那's bundled up inside of someone, like a medical abscess inside a person, a walled-off infection inside the 身体, 这 is the same concept in the 大脑, then of course the limbic 系统 is going to want to fix 那. It fixes it by trying to, "Let's recreate 那 situation 和 make it right 这 time." 那's I think 一 of the best examples of how the right approach of how, let's look at 那, let's talk 关于 那. What's 确实 going on there? Wait, who 应该 feel guilty 和 ashamed? Is it the person who was abused 或 the person who was abusing? 我们 可以 get at what's going on inside the person, 和 那's what changes 那, 和 then the eighth relationship 可以 be entirely 不同的 than the 首先 seven.

Paul Conti:

I see 那 all the time. 这 isn't esoteric 或 soft. I see 那 play out clinically over 和 over again. Why do things get better? 因为 我们 go to the trauma 和 我们 unlock it. It's not hidden inside where it 可以 control things. 我们 bring it to the surface 和 then 我们 可以 take away its power.

安德鲁·休伯曼：

I keep hearing in 这 narrative 那 so much of 我们的 reflexive response to trauma, both emotional 和 the repetition compulsion in terms of behaviors, is 关于 some 非常 deep attempt to change the past.

Paul Conti:

Yes.

安德鲁·休伯曼：

In fact, in an offline conversation, I recall 你 saying something 关于 这, 那 the number of behaviors 和 thoughts 和 avoidance of behaviors 和 avoidance of thoughts 那 human beings put in to try 和 change the past is remarkable, 和 eerie, 和 maladaptive, it sounds like.

Paul Conti:

Yes.

安德鲁·休伯曼：

那 确实 stuck 与 me 因为 I think 我们 all want to feel like 我们're in control of 我们的 future 和 how 我们 feel in the moment, 和 to some extent, it works 对于 a brief while. There's 这 thing 那 happened 和 it evokes some internal arousal, 和 then 你 have to know what to do 与 那 arousal. I think 对于 many 人们, including myself, there's 这 fundamental question; the thought 关于 the thing, the event 或 events, evokes 这 arousal, 这 internal state. It makes some 人们 feel sleepy 和 exhausted. Other 人们 feel 确实 anxious. Other 人们 feel angry. Arousal has all 这些 不同的 dimensions, as 你 know. Then there's 这 question of what to do 与 it.

Paul Conti:

Yes.

安德鲁·休伯曼：

I'd love to hear a, maybe even just a top-contour prescriptive of what does 一 do? I'll even just put myself in it. What do I do? I'm feeling upset 关于 something. 应该 I feel like my options are healthy catharsis? I could tell the story, feel it? I 可以 pack it down. I 总是 hear 那 it's bad to pack it down, 但 of course 一 has to be functional in life 和 deal 与 things 和 我们 have responsibilities, work 和 relational responsibilities, et cetera. 我们 need to sleep at 夜间. Catharsis, healthy catharsis, packing it down at the other extreme, telling the story, 和 yet I think a lot of 人们 are afraid to tell the story 因为 it's in 那 telling there's a, perhaps a reemergence of the arousal. The arousal 可以 become greater. Is 那 what 人们 mean when they say things are going to get worse 之前 they get better?

安德鲁·休伯曼：

I guess the simple version of 这 long-winded question is, it's clear 我们 need to confront 这些 things. 我们 可以't change the past by ... a reflexive response isn't going to do 那 efficiently. How do 我们 deal 与 arousal? How does 一 take what they feel inside 关于 something shameful? What do 你 do 与 it in a moment, 和 does 那 have to be done in the presence of a skilled, trained therapist? 或 as I'm driving to work in the 早晨 和 something comes up, "I 可以't deal 与 这 right now" comes to 心智, what do I do? Do I deal 与 it right then? I know 这 is a big multidimensional question, 但 I think it's the 一 那 a lot of 人们 grapple 与. 我们 want to deal 与 things. How do 我们 deal 与 那 internal arousal?

Paul Conti:

我们 so 经常 try 和 change the trauma of the past in order to control the future. What 那 确实 adds up to is the trauma of the past dominates 我们的 present. It doesn't have to be 那 way. Remember, 我们're talking 关于 traumas 那 rise to the 水平 of changing the 大脑. As 你're saying, 那 involves re-experience, it involves hypervigilance, 增加了 arousal, changes in 情绪 states, changes in anxiety, changes in sleep, changes in behavior. 这些 are all changes 那 in a sense push towards dominating 我们的 present. Then 我们're not 确实 living in the present as 我们're trying to control the future. 我们're not going to do a great job of controlling 我们的 future if 我们're not 确实 living in the present. The way to come at 那 ... again in the moment, if 我们're saying ... okay, in the moment if I need to fall asleep, I 可能 say, "Okay, let me try 和 put 那 out of my 心智. Let me try 和 thought redirect." There's short-term strategies 那 可以 let us be functional in the context of 这些 changes, 但 the answer is to go look directly at 那 thing. Look at 那 trauma, explore 那 trauma.

Paul Conti:

Sure, 那 可以 be done 与 a professional, 和 sometimes 那's what makes sense, 但 not 总是. Sometimes it 可以 be done by talking to another person, writing it down. Look at what's going on inside of me 那 my 心智 is so stuck to 这. Let's explore 那, 因为 it's almost as if 我们're so afraid so 经常 of looking at the trauma 那 has changed us 那 我们'll look anywhere 但 at 那.

Paul Conti:

... 那 我们'll look anywhere 但 at 那, right? It's like it's hidden in a closet, 和 我们'll shine the light everywhere else, 但 我们're not going to open 那 door. 和 那's where 人们 会 say the same as I've heard over 和 over, 和 I myself have thought 这 at times, like, "Oh, if I talk 关于 那 I'm going to start crying 和 从不 stop." 或, "I'm going to just fall apart," which is 从不 what happens. No 一 ever starts crying 和 从不 stops. What ends up happening is when the person puts words to it — it could be in writing, it could be talking to a trusted other 或 与 a therapist — things start to change. I mean, just the fact 那 你 可以 talk 关于 it, 你 可以 put words to it, 和 other 人们 don't recoil, right?

Paul Conti:

I mean, how many times has someone said something 对于 the 首先 time, 和 when they're telling me 关于 the trauma, there's such an anxious ... like looking as if I'm going to recoil 从 it, right? Meaning I'm going to recoil 从 them. 和 then there's a sense of surprise if the person says, "Well, I was abused by 这 coach when I was a kid," 和 there's not a response of recoiling. 你 可以 see the change, 和 人们 会 say a lot, like, "Wow, I 可以't believe 你 可以 hear me say 那 和 be okay 与 it." So 你 think 关于 what's going on inside of them, what a sense of shame, a sense of 这 is something awful 关于 me 对于 人们 to recoil 从, 和 it's just not true.

Paul Conti:

但 here's where trauma is. It's insidious 和 it's pervasive, right? 因为 if 那 convinces us to continually hide it away, then how do 我们 explore it? 那 example of the person who says, "Okay, I was abused by a coach when I was a child." I mean, I'm thinking of a couple of 非常 real cases, 人们 那 I've taken care of, 和 once they start talking 关于 it, then they start talking 关于 how they were just innocent kids 和 they didn't know, 和 they 确实 wanted to be on the team where 这 coach was treating them as special. 和 now, they 可以 look at themselves 从 the outside. They 可以 look at themselves like they 会 look at someone else.

Paul Conti:

你 think it's so easy 对于 us to see what's real 和 true if it's someone else. If 你 ask someone, "What do 你 think of someone who's 10, 11 years old who's manipulated 和 abused by an adult? 我们'd say, 'Oh my goodness, I feel compassion 对于 那 person.'" Right? 但 if it's us, then, oh no, it's guilt 和 shame 和 我们 have to hide it away. 和 when the person starts looking at it, they 可以 sort of see it 从 the outside, 和 it starts to take the 能量 out of it, right? Then, well, who 应该 feel guilty 关于 那? Who's done something wrong?

Paul Conti:

和 so now the conceptions come together, which is 经常 a reflexive, "那 was my fault. Oh, I did it. I went back to it. I still stayed on the team. I went back next season. I let it happen again." All the guilt 和 shame inside the person gets juxtaposed to like, what 确实 happened there? 和 then they say, "Right. I was a terrified child. I didn't understand at all." 和 they 可以 come to a place of compassion, 和 now 我们 are working against the guilt 和 shame.

Paul Conti:

和 if the person cries 关于 it, 那's great. I mean, crying is 一 of the best coping mechanisms 我们 have. It doesn't hurt us, 和 it lets us grieve things. 我们 可以't grieve if there's guilt 和 shame inside of us. It just blocks grief, right? It has to be a clean slate, in a sense, in order to feel sadness. 和 then 你 see 那 it shifts 从 anxiety, anger, 和 frustration, usually directed towards the self, guilt 和 shame, towards being able to process it 和 being able to bring to bear some compassion, 和 being able to direct the negative emotions, so to speak, where they're warranted. 和 my goodness, the changes 那 happen. I mean, it's not like 人们 are miraculously cured, 但 it's remarkable how just getting it out there 和 having 一 小时 of talking like 那, like what 我们're talking 关于 now, 可以 leave a person feeling immensely better.

安德鲁·休伯曼：

It seems to me in hearing 这 那 there's 这 weird wiring 那 我们 have, 因为 what I'm hearing is when traumas happen to us 或 我们 observe them, what 我们 need to do most is to confront 那些 和 the emotions 大约 那 directly. 但 instead, 我们的 系统 defaults to guilt, shame, 和 trying to hide it, 和 这 repetition compulsion of placing us back 进入 things 相似的 to 那些 traumas, 或 even maybe even worse traumas, in an attempt to resolve it.

安德鲁·休伯曼：

It's like the most maladaptive wiring diagram I could possibly think of, emotional 和 presumably physiological wiring diagram. 和 这 notion of trying to change the past by doing things now, when the exact opposite is what's going to be beneficial, also seems like ... The whole 系统 seems completely backwards. 和 I'm chuckling as I say 这, not 因为 I'm amused, it's 因为 I'm just baffled once again at how 我们的 wiring 可以 经常 not serve us well.

安德鲁·休伯曼：

但 it raises what I think is an 重要 和 interesting question, which is earlier 你 were talking 关于 how 人们 会 seek out media 那's 确实 disturbing. They'll traumatize 和 retraumatize themselves on a daily basis. So 那 could be viewed as the repetition compulsion, 或 the person 会 have the same abusive relationship 与 seven 不同的 partners in sequence. Seems terrible, 和 yet, as I say 这, it also is becoming clear to me how 这 almost seems like a poor 但 desperate attempt to resolve it in some way. 和 so the fork in the road, if I understand correctly, is to 确实 get to the seed incident, 确实 get to the thing 那 started it all, as opposed to repeating it all?

Paul Conti:

Yes.

安德鲁·休伯曼：

Does 那 have to be done in the presence of a therapist? Is there a benefit to taking a walk 和 thinking 关于 这些 things, breaking down 和 crying if 那's what's necessary, 或 feeling angrier if 那's what comes up? The reason I ask it 这 way is 因为 I worry, I'll just speak to my own experience, I worry 那 in reactivating 或 touching 进入 the emotions 大约 something, 那 那 is itself a form of the repetition compulsion 因为 你're feeling it all over again. It's just 那 你're not seeking out something to evoke 那 feeling.

安德鲁·休伯曼：

So I realize 这 is a little bit of a circular argument 或 question, 但 I think it's 一 那 I 确实 struggle 与 in trying to parse all the outcome-based therapies 那 I hear 关于 和 the recommendations 那 人们 make. I mean, how 应该 我们 conceptualize 这? Something happens. It sounds like 我们 need to deal 与 那 thing directly. Do 我们 need to do 那 与 somebody else? 可以 我们 do 那 on 我们的 own? If 我们 don't have resources 和 我们 have to do it on 我们的 own, 可以't hire someone, 可以't pay someone to work 与 us, how do 我们 do 那 in a way 那 isn't retraumatizing ourself in a major way 或 in a minor way? How do 我们 know where 我们 are in 那 landscape?

Paul Conti:

Right. Again, 那些 are, I think, great questions, 和 I think it starts 与 real introspection. When things are bouncing 大约 in 我们的 minds, 经常 it's 非常 nonproductive, right? It's the same thing over 和 over again, 和 那's not helpful 对于 us. So there's an idea which sometimes gets called an observing ego, the ability to stop 和 look at what's going on inside of ourselves. 和 so if 我们're just thinking 关于 it, 和 我们're thinking in the same way 我们 sort of, in a sense, 总是 think 关于 it, then all 我们're doing is reinforcing the trauma. 但 if 我们 可以 distance enough to be like, "Huh, I'm interested in what's going on inside of me," right?

Paul Conti:

和 think of a certain person who 确实 loves music, 和 at some point in 我们的 therapy work, I learned she was taking long drives 但 the radio wasn't on. 和 I was like, well, what's going on? 和 I asked, 和 what was going on is she was running over 和 over again in her head, "I'm a loser, I'm a loser," 和 she didn't want the music on 因为 the music 会 drown out what she felt she had to say to herself, right? 和 it was 那, wow, 那's interesting. 和 then her ability to observe 那 和 to think, "Why am I doing 那?" when it comes 进入 her 心智. "What does 那 trace to? When did I start doing 那?"

Paul Conti:

Like I say, I'm saying it 对于 a point of exaggeration, 但 nobody comes out of the womb programmed to think, "I'm a loser," right? So 我们 don't think 那 when 我们're born, so where does 那 come 从? Then 我们 可以 think in ways 那 allow us to have new thoughts 那 我们 weren't having. It's not just bouncing 大约 in 我们的 minds. 和 if 我们 speak 或 write, there are even 更多 mechanisms 那 come online in 我们的 brains 那 are then sort of monitoring mechanisms. 我们 think in a 不同的 way if 我们're using words, 和 我们 are better able 经常 to bring in 那 observing ego, like "What's going on inside of me?"

Paul Conti:

So it 可以 be 非常 helpful to think, it 可以 be helpful to talk to someone, to a trusted other, friend, family, clergy; to write. I mean, 这些 are things 那 可以 be done 没有 expending any resources, 和 sometimes it 可以 make 确实 a big difference. "Wait, when did I start thinking 那?" 和 interestingly, in 这 case, 我们 did it in therapy, 但 it became 非常 clear what 那 was rooted to, right? 和 then in the therapy, which was still relatively young, 但 我们'd done several sessions 和 我们 weren't talking at all 关于 what 我们 needed to talk 关于. 但 那's what got us to what 我们 needed to talk 关于. When did 那 start? 和 now 我们're in 那 same place of exploring 那, 和 what was the reflex to it, 和 the sense of guilt 和 sense of shame. 和 it's where all of 那 came 从, 那 just got boiled down to "I'm a loser," right? Which 这 person didn't even have in their 心智, like "I didn't think 关于 myself 那 way."

Paul Conti:

和 it's so interesting 那 我们的 memories don't in 和 of themselves have meaning. It's like they're flat 或 colorless, 和 they're colored in by the emotions 那 我们 attach to them, so the idea 那 certain memories now 之前 the trauma were changed by the trauma. So I tell the story sometimes of a person who won an award when they were in high school 那 they thought was, "Oh my gosh, it shows I 可以 do it. I 可以 get out there," 那 之后 trauma, they saw the award 与 a negative emotion attached to it 那 was like, "Oh, it was given to me 和 I didn't deserve it," 和 almost it was mocking. Like, "那's going to be the greatest achievement in my life, 和 I was 17," 或 something.

Paul Conti:

和 to have someone think ... like 那's not how they felt 关于 那 at the time, it's the trauma 那 changed the self-talk, the internal state going forward, 和, talking 关于 miraculous in a negative way, also changed 那 going backward, right? 和 when 我们 可以 确实 look at 那, where did 那 come 从, 和 我们 可以 start unraveling it, it changes.

Paul Conti:

So in 那些 cases, 经常 it's helpful to have a good therapist. It's not 总是 necessary, 和 certainly it's not 总是 可能, so 我们 need other strategies. 和 some of 那些, I write 关于 some of 那些 in the book, of how 可以 我们 get at trauma 没有 那些 formalized mechanisms? 和 sometimes, if the symptoms are significant enough, 我们 确实 do need to talk to somebody professional who 可以 help us get to the root of the trauma. 和 there's so many times 那's the answer to what's going on 与 人们.

Paul Conti:

人们 I've seen who've had five residential stays, I'm not exaggerating 这, 对于 心理健康 reasons, 对于 substance reasons, 和 no 一's ever taken a trauma history. 和 then when 你 take a trauma history, 你 see, well, 那's obviously where 这 is all coming 从, right? 那's when the drug use started shortly thereafter, the negative self-talk 和 the negative feelings 那 led to the drug use. Then 你 go 之后 the trauma 和 你 可以 change things, whereas trying to change things 没有 looking, introspecting, talking 关于 the trauma, I think, of course was futile.

安德鲁·休伯曼：

Do 你 think 那 人们 可以 start to have negative fantasies? I mean, 你 mentioned 这 woman who 会 take 这些 long drives to berate herself. I'm not familiar 与 那, 但 I'll give a little bit of personal disclosure here. I've felt several times in my life 那 I 会 start to create a narrative 关于 something 那 truly hasn't happened, 关于 something terrible 那 somebody is going to do 那's going to upset me. 和 对于 the longest time, I 会 wonder, why am I doing 这?

安德鲁·休伯曼：

和 I have a couple ideas 关于 why. 一 is 那 I was attempting to just avoid thinking 关于 other things. It's just anger is such an attractive emotional force in ... It's an attractant. It's not attractive; 我们 don't like it, 和 yet oftentimes, anger is a great way to replace feeling something else, feeling sad 或 having to do work 或 to do something useful. So it has 这 kind of gravitational force to it. 那 was 一 idea. The other idea was in imagining kind of worst outcomes, then actually 那 relationship could actually seem a lot better in reality. It's almost like creating 这 negative contrast. It's like, oh, well, then it's not 那 bad.

安德鲁·休伯曼：

和 then the third possibility is, I have no idea why, 但 it seemed like a reflex, 和 I spent some time thinking 关于 it. I 可以't say I've resolved it completely. 但 why 会 somebody have a narrative, 或 a default narrative when driving 或 when walking, of I'm just going to spend some time 和 think 关于 how terrible 这 thing is going to turn out, 或 how someone's going to upset me 或 harm me, 或 how terrible I am? It seems, again, like maladaptive thinking, maladaptive wiring, 和 yet I have to assume 那 it serves some purpose.

Paul Conti:

Yeah, yeah. I mean, I think there are 三 factors there, 和 they're all bad. 和 I think 你 spoke to at least 二 of them, right? They, I think, speak so powerfully to how insidious trauma is, 和 how 这些 are real 大脑 changes inside of us. So I 会 say there are 三 factors: punishment, avoidance, 和 control. So the trauma inside of us 那 makes the guilt 和 shame so 经常, so 经常 leads to a desire to punish oneself. 和 the idea 那, "Oh, 那 was my fault," 或, "I deserve 那." Well, what do 我们 do if something is someone's fault? Then someone now deserves punishment, right? I mean, 我们 punish them. 我们 send them to jail, 我们 give them a fine, 我们 punish them, 和 so what 我们 do is punish ourselves. 和 if 我们 tell ourselves 我们're a loser 或 这 awful thing is going to happen, then part of what 我们're doing is saying to ourselves, "See? 你 deserved 那. 你're not going to have anything better."

Paul Conti:

It's a negative, it's a 非常 negative way 那 the 大脑 tries to make us, in a sense, do better by hurting us 更多 对于 the things 那 我们 couldn't 和 shouldn't have been able to, weren't expected to control in the 首先 place. The 秒 is distraction, as 你 said. Anger, 那 kind of fantasy, 可以 distract us 从 feeling an emotion 那 可以 be much 更多 negative. Anger, it 可以 be 更多 gratifying, certainly, than guilt 或 shame, 尽管 guilt 和 shame 可以 serve a punishment purpose. 但 if anger is directed also towards ourselves, then it 可以 serve punishment too. So punishment, avoidance, 和 the sense of control, 那 if 你 think ahead to something awful 那 你're imagining is going to happen, well, maybe 那 会 let 你 avoid it.

Paul Conti:

I mean, 你 可以 see the 大脑 here, in a sense, 确实 confused. I mean, part of the 大脑 wants to punish, part of the 大脑 doesn't want to think 关于 it at all, 和 part of the 大脑 wants to make it better. 和 then how all of 那 resolves if 我们're not aware 那, hey, 这 is in the context of 我们的 brains being deeply impacted by trauma, so what's going on here is all maladaptive, right? 因为 这些 negative fantasies of the future, they may help us feel better 关于 something in the present, 但 they don't help us make anything better. They don't help us make anything better, so 这 is kind of the sequela. 这 is where trauma 和 all 这 reflexive stuff 那 happens 之后 trauma ultimately lead us, 和 你 可以 see how 我们 get lost, how I've seen over 和 over again in my own life, in the lives of other 人们, how, man, 我们 get stuck in 那些 situations.

Paul Conti:

和 那's why I see 人们 sometimes, 这 has been going on 对于 30 years, 40 years, 和 it's just been going on over 和 over 和 over again, 因为 there's no natural end to any of 这 unless 我们 look at it in a 不同的 way, 那 我们 have knowledge 和 information like, "Whoa, 这 isn't the way it has to be. Let me bring a novel perspective to 这." It doesn't change on its own.

安德鲁·休伯曼：

I'm struck by 你的 statement 那 这些 thoughts 或 behaviors 可以 make us feel better, 但 they don't actually make anything better. In 那 way, 这 mode of imagining terrible outcomes starts to immediately seem like taking opioids. 你 know, 你 feel better in the moment, 但 it doesn't actually make anything better, 和 it probably makes things worse.

Paul Conti:

Yes.

安德鲁·休伯曼：

和 just a question of how much worse, 和 in what direction. 和 so I want to just pause on 那 concept, 因为 I think 那 concept of makes us feel better 但 doesn't make anything better, I think it answers an earlier question 关于 这, what seems to be a totally maladaptive wiring diagram. 我们 need to confront the thing, 但 我们 don't want to go 进入 the repetition compulsion. So it's a knife edge there to navigate 通过 trauma.

Paul Conti:

Yes.

安德鲁·休伯曼：

Working 与 a 非常 skilled clinician like yourself, I think, is the ideal circumstance 对于 人们. 和 of course, there are 人们 who 可以't access support 从 somebody 对于 whatever reason. 你've talked 关于 journaling as a useful tool. Could 你 maybe highlight some of the other things 那 人们 可以 do on their own? 和 then I'd also like to talk 关于 what makes 对于 a good therapist. What 应该 人们 look 对于, 对于 那些 那 are seeking therapy, 尤其是 nowadays, when a lot of therapy is being done remotely?

安德鲁·休伯曼：

但 let's just start 与 the, let's just call them self-generated 或 zero-cost sorts of things, journaling being the 首先, 和 then what are some of the others, 和 what kind of structure 会 你 recommend someone put 大约 journaling? Carry a journal 大约 all 天 和 jot things down as they come up, 或 sit down 和 spend an 小时 writing in complete sentences, 对于 instance?

Paul Conti:

Yeah. If I could add something to what 你 had just said 之前 the question, 那 我们 have 这些 short-term coping mechanisms in us, 和 in a way, it makes sense, right? If 我们 find ourselves in just terrible situations, then a short-term coping mechanism 可以 get us 通过 them. So 我们的 brains are built 那 way, 和 那's part of survival too. 和 whether now, in the modern world, whether it's food, it's drugs, it's sex, it's alcohol, 或 it's negative thoughts, 这 is short-term soothing. Even the negative thoughts, the anger is short-term soothing at the expense of long-term change.

Paul Conti:

和 那's where addictive 通路 come 进入 play, 和 那's where, again, how 我们're built evolutionarily 对于 survival doesn't help us in the way humans have evolved. 我们 haven't lived 这 way throughout 99.9 something percent of human history, right? So 我们're not adapted to 这. So I want to just make a point of saying 那 关于 the short-term soothing at the expense of long-term change.

Paul Conti:

和 then the question 你 had asked 关于 journaling 或 what 可以 我们 do 那's outside of a professional, I think the hallmark of it has to be bringing new eyes to it, thinking 关于 self 与 a curiosity instead of just a simple automaticity 或 repetition. "Why am I thinking 关于 这? When did 这 start? Why is 这 in me?" It's 那, whether it's words 或 whether 我们're writing, 那's so 重要. So I think 对于 journaling, it depends on the person. I mean, 我们 don't want somebody carrying 大约 a journal all 天 if then there's a compulsion to, "I need to write 关于 everything 那's going on in my 心智." 那 可能 be good to, okay, write a little bit at 夜间, right? 或 someone who 可能 think, "Sometimes 这 确实 comes 进入 my 心智 in a strong way 和 it could be unpredictable. I want to have the journal 与 me, so ... ah, 那 thing is back in my 心智 now. Let me write 关于 it," 因为 then putting words to it 和 then being able to read 那些 words, right?

Paul Conti:

和 when 人们 read, even do a little bit of journaling 和 they read, "Oh, I thought again 关于 how I'm a terrible person who 可以't have a good life 因为 I was in such a bad car accident," 或, "因为 那 person attacked me," 或, "因为 when I was in school, I was bullied 因为 I looked 不同的 than everyone else," 或, "I acted 不同的 从 everyone else." Wow. To actually see 那 written out, it's a little bit of 那 like when 你're saying it to someone as if it were someone else, 因为 now there's enough distance 从 it, like I'm looking at the words I wrote, 那 我们 get some distance 和 我们 可以 start to integrate some of the, not just the compassion, 但 integrating compassion 和 logic, right? Of like, "Okay, I feel a sense of compassion now. Now, wait, what does 这 mean? What 确实 happened here? 和 gosh, I did start thinking differently 之后 那. I started ... 那's where 这 came 从. 那's why I'm saying 这."

Paul Conti:

It's 那些 kind of revelations 那 我们 可以 have 通过, again, the written 或 spoken word. 和 I think, again, 那 involves a trusted other 或 writing. 和 I think 那些 are ways 我们 可以 do 这, where 我们 bring some de novo perspective to something 那 经常 has been bouncing 大约 inside of us. 和 it's amazing to me 那 你 可以 see such intelligent, empathically attuned 人们 who've had the same thing running over 和 over again in their 心智 对于 years. 和 it just points out 那 我们的 brains don't automatically say, "Hey, wait a 秒, I've been spinning wheels here 对于 a long, long time. Was there another way to look at 这?"

Paul Conti:

我们 need something 从 the outside, which 可以 just be knowledge, right? Which is why I think what 我们're doing here, 或 the reason I wrote the book 那 I wrote was apprehending 这 amazing surprise to me, which is, wow, some huge percentage of everything I'm treating is rooted in trauma 和 the opacity of trauma, which is why 我们 don't see 那, oh, the depression, the panic attacks, the life change, the addiction, the maladaptive choices, oh, 这 is all coming 从 trauma, 因为 it hides itself in 那 opacity. So 我们 need a de novo perspective if 我们're doing it on 我们的 own, 和 我们 need 那 if 我们're doing it in therapy, which 可能 link to finding the right therapist, which is also part of 你的 question.

安德鲁·休伯曼：

Yeah, I definitely want to know 关于 how to assess 和 find the right therapist. 之前 我们 cover 那, 然而, something came up in the course of 你的 answer. I 可以 immediately relate to 这 idea 那 certain behaviors are 确实 maladaptive, 和 stuffing things down 或 avoiding the topic is problematic, 和 bringing a curiosity 和 an introspection 和 almost a third personing of the experience 那 我们've had in order to try 和 address it 从, truly, 从 a new perspective.

安德鲁·休伯曼：

It occurred to me as 我们 were discussing 这, 然而, 那 some 人们, 和 yes, maybe I'm talking a little bit 关于 my own experience, 我们 have a sense of 我们的 own identity 和 how 人们 view us in 我们的 ability to be functional in the world in ways 那 我们 like. Effective at work, 或 a good brother 或 a good mother 或 father 或 human being in the world. 我们 have relationships, 和 I think 那 一 thing 那 I have heard, 和 maybe I've experienced, is 那 sometimes 那些 maladaptive thoughts 或 behaviors, the things 那 generate a repetition of anger 或 of arousal 或 activation 或 sadness, 那 我们 have some internal process where 我们 funnel 那 进入 a functionality in the world, so 我们 ... I'll give a 更多 concrete example.

安德鲁·休伯曼：

In thinking 关于 things 那 have upset me in the past, 和 in imagining bad outcomes in the future, there's a certain internal state of arousal 那 comes 关于, 和 对于 many years I was able to use 那. Not to feel angry, 但 rather to work an extra 三 小时 a 天, 或 to pack my schedule 与 work 和 social engagement so I could show up in a way 那 I hopefully was a 非常 good brother to my sister, 对于 instance. So in a way, it was a transformation of something negative inside of me 进入 a functionality in the world 那 was actually 非常 rewarding 和 beneficial. 和 yet, in describing it, I 可以 immediately see how it 会 be wonderful if I could source 从 something else. 和 yet, 你 可以 imagine 和 I 可以 imagine how 一 会 be reluctant, maybe even terrified of giving up 那 source. It's a fuel.

Paul Conti:

Yes.

安德鲁·休伯曼：

和 I think in knowing some of the traumas of other 人们 和 their reluctance to work 通过 那些 — obviously I'm not a therapist, I sense 这 over 和 over again, 那 一's positive identity 可以 经常 be linked to something difficult in their past, 和 so 人们 are reluctant to give up 这 fuel 因为 in 那 sense, it's functional. The only thing 那 allowed me to start to address 这, 和 why I'm still so curious 关于 这, 因为 I don't think I've worked 通过 这 process completely, again — a little 更多 self-disclosure there — is 那 I was told 这些 words: "Just imagine how much better it 会 be if 你 could source 从 a 不同的 fuel. A fuel 那 felt better."

Paul Conti:

Mm-hmm. Right.

安德鲁·休伯曼：

Maybe it was 这 sentence, it was, "Maybe 你 could actually be much 更多 effective. Maybe 你 could be 10 times the better brother. Maybe 你 could have 10 times 更多 insight 或 work capacity, et cetera." So it's on 那 hint of a promise 那 at least I was inspired to start looking 进入 这些 things 和 reading 关于 trauma in 你的 book 和 elsewhere 和 started to think 关于 这. So again, I realize 这 is a long-winded question 和 a somewhat complex idea, 但 I think, 或 I hope 那 人们 会 be able to resonate 与 这 idea 那 sometimes 我们 want to stay attached to 这 short-term soothing — the punishment, distraction, 或 control — 因为 it evokes 这 arousal 和 then 我们 可以 apply 那 arousal.

Paul Conti:

Yes, yes. I think what 你're describing maps, I think, clinically to what gets called sublimation. So there's something negative inside of us, 但 我们 sort of transfer 那 能量. 我们 transfer 那 进入 something 那 is adaptive 或 那 is positive. So the idea of the anger, when I think of 那 thing 和 it makes anger in me, I channel 那 进入 harder work, 或 I channel 那 进入 "I'm going to go be nicer to my brother," right? Something like 那.

Paul Conti:

和 there's validity to 那, 但 it 可以 become self-justifying if a person thinks, "Well, look at what 这 is doing 对于 me. I wouldn't work as hard 没有 it." Now, 我们 start to become attached to the trauma, whereas I think what 你 had said is absolutely true, 那 just 因为 我们 可以 sublimate some of the negative effect, feeling, emotion 那 comes 从 trauma 进入 something productive doesn't mean 那 那's best.

Paul Conti:

I mean, 我们 可以 get to 我们的 destination by taking a 非常 circuitous route. 我们 可能 waste an 小时 getting there, 但 我们 get there. 那 doesn't mean 那 那's best. 和 it also doesn't look at all the negative, right? In 这 example, the wasted fuel, the wasted time. 我们 get somewhere, 但 我们 are not optimizing, 和 I have yet to see 一 person who has addressed the trauma 和 become 更少 functional. It's 总是 either they're just as functional, 但 they're happier, 或 更多 functional, 因为 as 你 said, just 因为 我们 may be able to sublimate, well, maybe what's going on 会 be 10 times better if 我们 weren't sublimating, 因为 the sublimation limits us. It limits 我们的-

Paul Conti:

If 我们 weren't sublimating, 因为 the sublimation limits us, it limits 我们的 perspective to only what 我们 可以 see 和 do 通过 the lens of the trauma. 和 那 is 从不 better than the alternative.

安德鲁·休伯曼：

Thank 你 对于 那.

Paul Conti:

你're welcome. Yeah.

安德鲁·休伯曼：

Let's discuss how 一 could 或 应该 go 关于 finding a 确实 good therapist. 通常, in my experience, 这 is done by word of mouth. There's 这 person, 你 可能 want to work 与 them, they're 确实 great. 但 what are some of the characteristics 那 一 应该 look 对于, 和 应该 我们 take 进入 account whether 或 not 我们 are a person who, 对于 instance, I've heard 这 从 listeners, 尽管 I'm definitely not talking 关于 myself here, cloaking something. Some 人们 会 say, "I want to work 与 a somatic therapist," 因为 I've actually heard someone say, "I think in feels. I feel stuff in my 身体. So I want to work 与 someone who 可以 确实 acknowledge 那." 或 someone else 会 say, "I want to work 与 somebody who has 这 orientation 或 那 orientation, 或 is open to my particular lifestyle, 或 isn't going to tell me 那 I have to leave my relationship."

安德鲁·休伯曼：

I feel like 人们 already show up to the question of who to work 与, 与 all 这些 things internally, some of which are voiced, 和 some of which aren't. So I'd love 对于 你 to talk 关于 maybe some of the core features of a 确实 good therapist 和 then how to look 对于 a therapist 和 also how to think 关于 oneself in looking 对于 a therapist 因为 of 这些 kind of predispositions.

Paul Conti:

Right. Well, there's a lot of 数据 关于 这 over the years 那 if 你 look at what are the top 10 重要 factors to find in a therapist, just repeat "rapport" 10 times. I mean, 那's the key. 和 if 你 think 关于 那, 那's pretty amazing right, 因为 therapeutic modalities 可以 be so 不同的? 和 I think what 那's telling us is, in a way, something 非常 obvious. What does rapport mean? It's paying 注意力, it's trust, it's a back 和 forth, it's like, "Yeah, even though I'm doing something difficult, I'm doing it 与 someone who's 确实 helping me. Someone who's in it 与 me, someone who's 确实 paying 注意力, wants me to be better." 那's indispensable, I mean, it's just indispensable. 和 I write in the book, if a therapist's not making eye contact, 或 这 is the way they do it 和 你 got to fit 进入 the box of the way they do it, 那 is not going to be helpful.

Paul Conti:

和 then what I think 关于 那 is the 不同的 modalities, it doesn't actually tell us 那, "Oh, the modality's irrelevant." I think 那's not true. 和 I think 那 good therapists are not pigeonholed by a certain modality. They may come at the world largely 通过 a psychodynamic 或 a CBT 或 a DBT lens. There's lots of 不同的 ways to do therapy. 但 when 你 确实 talk to 那些 人们, 确实 good experienced therapists, it's all coming 通过 the vehicle of the rapport, 但 they're practically shifting to what the person needs. I don't understand the idea 那 like, "Oh, I just do 这. I don't do 那." When 人们 are pigeonholed 那 way, I don't think they help their patients 非常 well. 我们 have to be diverse enough to say, "Hey, I want all the arrows in the quiver. 和 even though there 可能 be 一 那 I favor 和 那's the lens I see things 通过, no, I 可以 be versatile. I 可以 shift, I 可以 adapt to what 这 person needs." 和 I think if 你 have 那, 你've got a winning combination.

安德鲁·休伯曼：

Great. So 人们 应该 perhaps try a few therapists 和 maybe have a session 或 二 或 三 to see if the rapport feels like it's taking root. Do I have 那 right?

Paul Conti:

Yeah. 和 I think 那's why word of mouth is 重要. If someone 你 trust tells 你, "Hey, 这 is a good person," 那 says a lot, it already makes the pretest probability is quite high. 但 yes, it's interesting to see when 人们 have a therapist 或 they call their insurance 和 they're assigned a therapist, 这 thought 那, "Oh, 那's the person I have to have now." 和 it's like, "No, 你 应该 look at 那 like anyone 你'd be interviewing 对于 a job." 但 你 got to bring, again, the right set of thoughts to 那 to be helped, which is, "Look, I want someone who's has rapport 与 me. I don't want someone who's going to make it easy," who's like, "Well it's, gosh, it's kind of pleasant," 因为 then 那 means they're not talking 关于 the difficult things. So if 一 brings, "I know 这 isn't going to be easy, I got to talk 关于 difficult things."

Paul Conti:

Even if 一 doesn't recognize, "Oh, I got to talk 关于 the trauma in me," 但 to go to therapy thinking, "No, I mean sometimes it's enjoyable, 但 a lot of times it's not. Right. It's hard work. It 可以 be excruciating. 我们 可以 cry doing it." 但 to say, "那's how I'm going to be helped 和 I want someone who's going to do 那 与 me, who's 确实 looking at what's going on inside of me, how do 我们 help me?" 和 I 可以 feel the robustness of 那 if 一 brings 那 approach 和 then looks at the therapist 通过 那 lens, 你're 非常 可能 to then move on 从 someone who's not a good choice 和 确实 stick 与 someone who is, even though 那 doesn't mean it's 总是 pleasant 和 enjoyable. I mean it has to not be 那 sometimes.

安德鲁·休伯曼：

Right. Well, maybe 我们 could drill a little deeper 进入 the mechanics of therapy. I put out a few questions to audience asking what they want to know 关于 therapy. 和 it was amazing. I got hundreds if not thousands of responses saying, "How 应该 I show up to therapy?" So 对于 instance, 应该 人们 take a five-分钟 meditative drop-in 之前 或 应该 they just show up 寒冷 和 let it emerge 期间 therapy? Is it a good idea to take notes 或 to not take notes? 和 then post-therapy? How 应该 clients, patients as they're sometimes called — 一 或 the other, I 从不 know which — how 应该 they process 那 information? 应该 they take some designated time afterwards 和 in an ideal world, take a 30-分钟 walk afterwards 和 think 关于 the material, 或 应该 they set it aside 和 come back to it?

安德鲁·休伯曼：

Of course there are constraints, work 和 family, et cetera, 但 there's a lot of knowledge out there 关于 how to best show up to a workout – warm up 对于 five, 10 分钟, then do 这, et cetera. 和 then the cool down, I mean here 我们're talking 关于 hard psychological work aimed at bettering oneself. So to my knowledge, I've not ever seen 这 information anywhere. It'd be 非常 useful to hear 你的 thoughts on 这.

Paul Conti:

Yeah. Well I'm not trying to duck the question, 但 I think it varies so much by person. So if 你 think 关于 ... the 首先 part of 你的 question I think was, "How to show up to therapy." 和 I think the answer 会 be whatever lets 你 be fully present when 你're in therapy. Now 对于 some 人们 那's going to be, "I show up early, I sit, I calm myself, 和 I meditate a little bit." I mean, 那's how then they're present. 对于 other 人们, they show up, walk 进入 the room, they 可以 stop 和 now they're present. So whatever works 对于 那 person so 那 they're 确实 there, their thoughts, their 能量 is 确实 in what's going on. 和 the same thing applies on the other end. There are 人们 who are 确实 well served by going 对于 a walk if they 可以, 或 sitting quietly 之后 therapy, kind of putting 那 in order, otherwise they lose some of it, right?

Paul Conti:

或 some of the ah-ha's, right? 或 the, "Oh, 那's an interesting thought," 那 they 确实 need to put it in order. Maybe 那 involves taking some notes 期间 therapy. 对于 other 人们, they need to do the exact opposite. They need to leave, not think 关于 那 at all. 和 then they 可以 reflect on it later 和 learn 从 it. So 我们're so 不同的. Human beings, there's such a diversity in us 那 there's no hard answer to 那. It's being present when it's happening, then being able to consolidate 和 retain what's been gained is most 重要. 和 I think 我们 have to figure 那 out person by person. I mean, I try 和 do 那 in the work of, what's serving 这 person best? 和 sometimes it evolves 和 sometimes 我们 talk 关于 it, 但 it varies so much.

安德鲁·休伯曼：

If someone were thinking 关于 embarking on therapy 或 更多 therapy to address trauma 或 just general issues of life, what is the frequency 那 你 recommend? I could imagine 二 extreme models. 一 is, "Okay, I'm going to finally tackle 这 trauma. I'm going to do therapy 三 times a 周," 但 对于 a shorter period of time, six months over 和 out versus 这 open-ended model of once a 周, 通常, 对于 as long as it takes.

Paul Conti:

Right. I think 那 also varies. 和 I work 与 人们 in varied ways, 从 someone who's doing well 和 我们 meet 对于 a half 小时 every six months, to doing weeklong hourly sessions, to spending 三 intense 天 与 someone in a row. So I think as far as kind of guiding principles, what I have found in my own life, 因为 I value my own therapy tremendously. So I found in my own life 和 in my own clinical work 那 if it's 更少 than once a 周, then it's hard 对于 us to retain 确实. 我们 spend a lot of time kind of catching up, "Okay, what's happened? Let's get back to the place 我们 were at 之前." Which is why I think if 我们're 确实 going to get somewhere, 我们're not just trying to maintain something right? Then I think once a 周 对于 an 小时 is 确实 kind of the minimum.

Paul Conti:

但 更多 intensive work, it's like the 更多 intensive it is, it's not linear, it's an exponential gain. 我们 do a lot of intensive work where someone 会 come 和 do 30 clinical 小时 与 us over the course of a 周. So five 或 six 不同的 clinicians, 30 clinical 小时. 和 我们've found 那 the benefits of doing 那 are immense. It's like it's a year's worth of therapy consolidated. 你 think, well 30 小时 — let's say 我们 go almost every 周, maybe 那's 45 或 50 小时 — 但 30 小时 与 那 kind of intensity is worth probably 60 小时 done in a 不同的 way 因为 then it's in us in an active way. It's in the therapist in an active way — becomes 非常, 非常 dynamic. So I think turning up the intensity, if there's something 那 我们 确实 need to process, absolutely makes sense, 和 I do 那 in my own life. If there's something now it's like, "Whoa, something is 确实 distressing me 和 it's linking 进入 prior trauma 和 I 可以 see what's going on in me."

Paul Conti:

I start to have ruminative thoughts 与 negativity. I'm like, "I got to go 更多, right?" 因为 I got to do 那 processing so I 可以 get to the place 那 I am, which is not 那. It's not 那 the trauma has no impact on me, it's 那 the impact is much 更少 than it was 之前 the therapy. 和 那 I most 经常, 更多 经常 than not, have an ability to see when it's now intruding 进入 my thoughts 和 it's taking me away 从 what I 确实 think 和 believe, 或 being able to draw logic 和 emotion together 和 make good decisions. Turning up the intensity then absolutely makes sense.

安德鲁·休伯曼：

这 非常 deep, intensive work of 30 小时 in a 周. What brings somebody to the type of work of 那 sort? Is it a suicide risk 或 a severe addiction situation? I mean, how does 一 gauge how much therapy they ought to be doing? 和 应该 it 总是 be on the therapist to decide 那 frequency? What 会 bring someone to a situation of five therapists 和 30 小时 a 周 in 一 周?

Paul Conti:

It's usually a person who is 确实 distressed by something, whether 那's so negatively impacting their life, 或 sometimes a person comes to a realization, "I just 可以't take 这 anymore. I'm sick of the cyclical depression. I got to stop having panic attacks. I need help." 但 it's usually some crisis point, 与 the idea of crisis in the meaning of something comes to a head 和 之后 it things are going to be 不同的, not a crisis 和 things are going to be negative afterwards, 但 a point where then 那 cognitive flexibility comes to the fore of like, "Well, I need to do something 不同的." So, 那's 经常 what brings us. Sometimes it's other 人们 pointing it out, 或 if somebody's had an intervention somewhere 或 yes, 那 person's been hospitalized 之后 a suicide attempt 或 they've gone back to rehab again 对于 the third 或 fourth time 和 their life is 确实 in danger.

Paul Conti:

Sometimes it's 那 和 sometimes it's a person realizing, "I just want to look at myself, want to understand myself better. I know 那 what's going on in me isn't as good as it 可以 be." So I think 人们 可以 come to it 对于 all sorts of 不同的 ways. 和 I think yes, I think a lot of times it 会 be the therapist to say it, "更多 intensive work 可以 make a difference." 但 I think the person also needs to take ownership of their own therapy. 和 so if I don't feel helped enough, well, I have to think 关于 那 和 talk to the therapist 关于 那 因为 maybe 那 therapist isn't a match, 或 maybe 你 talk to the therapist 和 the therapist 可以 change his 或 her approach, 或 maybe 你 talk to the therapist 和 增加 the frequency. 但 the idea is to be aware of it 和 if 一's needs aren't being met, to acknowledge 那, right?

Paul Conti:

因为 人们 可以 get 进入 a rhythm of therapy where it's 确实 not helping them 但 they either feel sort of nihilistic 关于 it like, "Oh, I'm no better 和 I'm going to therapy." 或 sometimes there's a sense 那 "Well, I'm in therapy," so I'm kind of checking 那 box of doing something 对于 myself, 但 it's not 确实 getting me anywhere. 和 then the part of the 大脑 那's controlled by the guilt 和 shame 和 avoidance thinks 那's a great idea. So again, 这 ability to observe ourselves 和 like, "What's going on? Am I being helped in the way I ... Do I feel helped? Am I in some ways even happy 那 I'm not feeling helped? 因为 I don't have to face 这 thing I don't want to face," right? 或 "Am I too afraid to say I need 更多 help?"

Paul Conti:

我们 确实 need to look at ourselves, 和 这 is where the insurance 系统 经常 are 非常 difficult 因为 it's hard sometimes 对于 a person to say, "I need 更多 therapy," 因为 那 may not be 可能. So there are negative factors in the world 大约 us. 但 ultimately I think the answer to the question comes down to observing ourselves 和 taking ownership of what's going on in us 和 how 我们're feeling. 和 then feeling 那 commitment to self 或 to self-care to say, "I need to go change 这."

安德鲁·休伯曼：

和 对于 那些 那 maybe don't have the means 或 insurance 或 access to do even 一-天-a-周 therapy, in the journaling model, could 一 perhaps take an entire 天, as awful as it 可能 seem, to do a lot of journaling 和 thinking 和 walking? Do a self-generated intensive. Do 你 think there's utility to 那?

Paul Conti:

I mean there could be, 但 again it depends by person 因为 there could also be something negative 关于 那. If it's someone who's not at the point, not ready 对于 那. I mean 我们 don't come at directly, at the trauma immediately, at least most of the time 我们 don't do 那, 和 我们 经常 don't explore it in depth. 这 idea 那, "Oh, 那 person now has to go 通过 every 秒 of the trauma," is actually not true. I mean sometimes it is, 但 那's not the common situation. 更多 经常 那 person has to acknowledge, like the example of, "I was sexually abused." 和 if they acknowledge 那 和 say, "Okay, gosh, what has 那 done to me?" 那 doesn't mean, "Well let's parse out every moment of how 那 was 和 the terror of 那." So 那 可以 lead 人们 to a worse place.

Paul Conti:

So I think the idea of biting off small pieces, so to speak, where a person is writing 或 is talking. 但 I think if 一 is writing, it is good to communicate 与 another, another trusted person. 和 if there's not someone in 一's personal life, there are clergy members. Even if 一 isn't affiliated 与 an organized religion, 你 could probably go places 和 get a clergy to want to help 你. I mean there are 人们 out there who want to help other 人们. So, 你 say, "What if someone has no 一?" I mean, almost 从不 do 我们 have no 一. 因为 我们 could probably go find someone, 但 我们 need to take 那 in pieces. So there's some risk to trying to do the intensive thing on 一's own.

Paul Conti:

和 那's where I 会 put in, if a person's having suicidal thoughts 或 even thoughts of death, of not wanting to be alive, "I don't deserve to be alive," I mean 这些 are warning signs 对于 确实 getting help. So there are some signs 那 say, "Hey, don't try 和 do 那 on 你的 own. Go try 和 find a resource." 和 it's things 那 get to 那 水平 of severity, 和 经常 a person knows 那. I mean, "Am I in a place where I know I'm not healthy 和 I'm having scary thoughts?" then 我们 need 那. 那's a person who 确实 shouldn't be doing 那 on their own.

安德鲁·休伯曼：

Great, thank 你 对于 那.

Paul Conti:

Yeah, 你're welcome.

安德鲁·休伯曼：

So 我们've been talking a lot 关于 talking, 和 now I'd like to talk a little bit 关于 chemistry. Drugs. So maybe 首先 我们 could talk prescription drugs. I mean 你're a psychiatrist, so 你're approved to, 和 presumably do, prescribe medication where appropriate. I mean 这 is a vast landscape, of course. 我们've got ADHD, 和 I 应该 just tell 你, I get 更多 questions 关于 ADHD 和 the drugs related to ADHD 和 多巴胺 than any other topic, any other topic. So there's ADHD, there's OCD, there's depression, there's antidepressants 和 so forth. Is there some way 那 我们 可以 wrap 我们的 arms 大约 all of 那 as a way of wading 进入 这 drug question 和 just address how does 一 decide when medication is useful? 因为 in the end, the dissection tool 那 the psychiatrist 或 therapist has is language. 和 at some point, 一 has to make an assessment 关于 多巴胺 或 serotonin 或 whether 或 not a given drug 会 help.

安德鲁·休伯曼：

和 most therapies, I believe, don't involve putting someone in a 大脑 scanner. 和 to my knowledge, there still is not a 非常 good 血液 test to assess, "Oh, is 这 person's 多巴胺 low 或 high?" Correct me if I'm wrong. 和 ultimately 那 — 和 I know there are companies out there, so I'm not trying to undermine 那些 companies. 但 if I happen to do 那 in 这 statement: if 你 take a 血液 test 和 find 那 你的 serotonin metabolites are low, my understanding is, it's 可能 那 你 are too low in serotonin in the 大脑. 但 那's a 非常 indirect window 进入 what's 确实 going on. So how do 你 think 关于 prescription drugs in the context of treating trauma 和 other conditions? 和 then maybe 我们'll drill 进入 some of the 更多 具体的 conditions.

Paul Conti:

I mean, I 会 首先 comment 那 there aren't tests 对于 这些 things. 和 I think the tests 对于 metabolites ... I mean things are so 不同的 — by the time what 我们're talking 关于 has been metabolized, 经常 to some 非常 significant extent, left the 大脑, now it's in the peripheral 血液, 那 我们 确实 don't learn 从 那. I think 那 我们 tend to utilize medicines in 这 country 因为 我们 have a healthcare 系统 那's so based on throughput 那 我们 want to polish the hood when there's a problem in the engine. So 我们 overutilize medicines, 经常, as an endpoint, right? "Oh, 我们're going to make 那 person's depression better 与 an antidepressant." Well, I mean maybe, right? 但 most of the time 对于 the person's depression to 确实 get better 和 stay better, they need to unravel what's driving the depression, right? So the 首先 step is ... I think there are 二 steps to it.

Paul Conti:

The 首先 assessment step is, is there a diagnosis 那 the vast majority of the time, if not sometimes all the time, 确实 warrants a medicine? So the bipolar disorder, OCD, ADD, right? 这些 are diagnoses 那 我们 understand 更多 关于 them 和 what's going on in the 大脑 和 how medicines 可以 treat 或 stabilize them. Which doesn't mean the medicine is necessarily, it's not a substitute 对于 therapy, 但 sometimes the medicine 和 therapy 可以 go hand in hand. So 对于 OCD, 对于 example, warrants therapy, 但 it almost, not 总是, 但 it almost 总是 warrants medicine too. So 那 你 可以 ease the 系统 那 are making the rigidity 和 the repetition in the 大脑. So the 首先 kind of branch point 可以 be, what is the diagnosis? What is the 水平 of severity? 和 I think 那's 非常, 非常 重要. Where I think it's a little 更多 maybe even interesting is using medicines to help the person engage in the therapy as productively as 可能.

Paul Conti:

和 here's where I think 我们're so limited by how 我们 categorize medicines 和 这 sort of pharmaceutical insurance-driven medical 系统 我们 have 那 I think throws us off in tremendous ways. So 你 think 关于 how medicines are categorized, so antidepressants, 和 the vast majority of 人们 who are helped by antidepressants, they don't have clinically severe depression. 那些 medicines create 更多 distress tolerance in us. 和 if 你 think 关于 how helpful 那 可以 be. Now 你're going to do something difficult where 你're going to bring 那 trauma 或 the stressors to the surface, 和 你're going to process 和 你're going to try 和 make life change. If 我们 可以 make 更多 distress tolerance in us, 那 可以 be so much better. 和 think 关于 the category of medicines 那 are called antipsychotics, which 确实 puts 人们 off. 但 most of the prescriptions 对于 antipsychotics are not 对于 psychosis.

Paul Conti:

和 there are ways in which low dosing of some of 那些 medicines 可以 help intervene in negative 通路, in 通路 那 are 关于 distress 和 sending out 那些 tendrils of neurons 那 are 关于 hypervigilance 和 avoidance in 我们的 大脑. 和 我们 可以 经常 get at 那. 和 if 你 可以 改善 someone's distress tolerance 和 你 可以 use medicines 那 take away what clinically is rumination, not the standard meaning of 那 word, 但 the clinical meaning of it where there're distress centers in 我们的 大脑 那 are overactive, 和 then 我们 get stuck in 这些 maladaptive negative 通路 where 我们 think 关于 something over 和 over 和 over again 与 no real chance of solving it 因为 那's not what's going on inside of us. So medicines 可以 help 那, 但 我们 have to have some flexibility 大约 their conception 和 the modern medical 系统 of 15-分钟 visits to a psychiatrist 那 are 周 apart, I mean, I don't understand how 那 goes well.

Paul Conti:

In the vast majority of times I think it doesn't go well 因为 it's not enough time to do the therapy, to even generate the understanding. So then medicines get thrown at the person. 这 is how 我们 use, I think, approximately five times as much medicine across the board as, say, the Dutch population. 和 I think, well why is ... five times 更多 is a lot 更多 medicine. 和 they have a healthcare 系统 和 a cultural 系统 那, to the best of my understanding, is 更多 rooted in taking responsibility 对于 oneself. So if a person comes in 和 cholesterol is high, the 首先 order of business is, "Hey, 你 could take better care of yourself." 这 person 确实 needs to lose some weight, 运动 更多. They're not just jumping to, "Let me give 你 a medicine," 和 shift 你 通过 the healthcare 系统 和 out the other side of the door.

Paul Conti:

和 the same thing is true in 心理健康. 和 I'm not trying to be critical to the psychiatrists 或 the nurse practitioners 或 人们 who are practicing in 那 way, 因为 oftentimes there is no choice. If they're working in a healthcare 系统 那 the standard is highly spaced apart 15-分钟 visits, what alternative is there? 但 to look at, "Okay, I'm going use medicines 因为 I don't have another tool to bring to bear." So I think the healthcare 系统 和 its 专注 on throughput 和 its short-term — 我们 talk 关于 short-term response. They're short-term soothing at the expense of long-term health. 和 I think 那 is the metaphor 那 applies to 我们的 healthcare 系统, where if 我们 are going to try 和 treat a symptom in a short term, 我们're going to do it in a 15-分钟 visit, then 我们're going to do it in a way 那 maybe it soothes a symptom, maybe it doesn't, 但 it does not get at the problem.

Paul Conti:

我们 need to invest 更多 resources to get at the problem. 和 I think 那's where a sort of protest, if 人们 as a society, 我们 say "Look, 我们 don't like the way 我们的 healthcare is going. 我们 need 更多 专注 on what the actual problems are." 那 yes, 我们 会 spend 更多 money treating 人们 和 taking care of 人们 因为 it's 更多 human time, 但 ultimately 关于 更少 suffering, 更少 death, 和 ultimately 更多 productivity. I think as an economy, 我们 会 save so much money if 我们 spent money on the human aspects of mental healthcare 因为 人们 会 be 更多 functional. They're spending 更少 time in the hospital. They're 更多 productive when they're working. There's 更少 entry 进入 the criminal justice 系统. So I think medicines get overused, in part 对于 systemic reasons, in large part 对于 systemic reasons, 和 also 对于 some of 这些 categorization reasons.

Paul Conti:

"那 person meets some technical criteria 对于 depression. 我们've got to give them 这 medicine." Instead of 确实 thinking, "Wait, what's going on in 这 person?" 和 I see 这 over 和 over again. I see someone is on seven medicines, 和 they're on seven medicines to treat seven 不同的 symptoms, 和 now they have side effects 从 all 那些 seven medicines. Maybe 二 of them are to treat the side effects 从 the other five 和 那's bad. 和 if 你 确实 get at what's going on in them, now they're doing much better 和 maybe they're on 二 medicines. So, I don't know if 那's a helpful answer to 那.

安德鲁·休伯曼：

It is. It's a 非常 helpful answer. I mean, I think at least in the spheres 那 I run 这些 天, I hear a lot of negative statements 关于 antidepressants. I think I'm old enough to remember the book "Listening to Prozac." 和 I remember when Prozac 和 things like it 首先 started showing up 和 the excitement. 和 then nowadays I hear 更多 关于 the problems 与 all 这些 drugs. 和 maybe 那's just 因为 I have arms in both the scientific 但 also in the kind of wellness community, where 人们 think a lot 关于 behavioral change. Fortunately, I think, 那 they do 那. 但 of course 这些 drugs, as 你 mentioned, 可以 have enormous utility as well. I'd like to just pick up on 一 theme 那 I haven't heard a lot 关于 anywhere else, which is the short-term versus the long-term use of 这些 drugs.

安德鲁·休伯曼：

因为 I could imagine someone feeling like they're finally going to tackle something 那's been inside them 对于 a long time. Either 因为 they're 确实 struggling 或 因为 they're just done 与 not working it 通过 和 they decide to start a medication 那 会 give them higher 水平 of distress tolerance 对于 a short while. I mean, is there anything to say 那 someone couldn't take a properly prescribed medication 对于 a 周 或 对于 the 首先 三 months of the work 和 then know 那 they 可以 come off it? 因为 I think 那 the black-和-white model of, "Okay, 你're either going to start 这 drug 和 stay on it forever 或 be taking some drugs forever, 或 你're not going to take anything." I mean 那 just seems to ... Does life have to work 那 way? Is there short-term use 那 可以 be effective?

Paul Conti:

Absolutely yes. In American medicine, 我们 are so much better at starting medicines than 我们 are at taking them away. 和 part of 那 I think is driven by such a strong presence of the pharmaceutical industry, 和 the pharmaceutical industry does a lot of 非常 good things. 但 there's such a thing as too much of a good thing. 和 then as a society, when something seems positive, 这 I think also is human nature. 我们 可以 overinvest in it. So if 你 think 关于 when Prozac 和 那些 kinds of medicines came out, they were safer medicines. They're billed as antidepressants, 和 the thought was, "Well, they're going to fix depression," 和 it's not how 那 works. So if 我们 look at them as tools, then 我们 可以 deploy them sometimes 对于 the longer term, 因为 sometimes 那's necessary, 但 absolutely 对于 the shorter term, I mean absolutely.

Paul Conti:

If 我们 thought of Prozac 和 那些 kind of medicines, not as, "Oh, they're antidepressants." Look, what they do is they seem to make there be 更多 serotonin in certain 回路 那 are 重要 对于 情绪 regulation, anxiety regulation, distress tolerance. So 那些 medicines 可以 确实 help somebody if they're 非常 severely depressed 和 我们 want to get them feeling better. They 可以 also help someone if they could use 更多 distress tolerance in a discrete period of time. When 我们 think 关于 them 那 way, 我们 think 关于 them as tools 那 我们 could apply 对于 short term 或 long term. 我们 don't see them as fixes, 和 我们 don't see them as then substitutes 对于 the human-to-human work 那 needs to be done.

Paul Conti:

... institutes 对于 the human to human work 那 needs to be done. I mean, I've been in my 训练 at times in healthcare 系统, 和 I've seen in many other circumstances 那 look at medicines as answers, 和 这 idea 那, "Oh, 那 person is a ... " 和 a lot of times there'll be a number, right? 和 the number is the diagnosis 和 那 number gets 这 medicine. 和 I'm not sure 我们 could be 更多 misguided than 那. 和 那's what leads to adding medicines. Adding medicines, it's not working, of course it's not working 因为 no 一's 确实 paying 注意力 to what's going on. So add 更多 medicines 和 then medicines 对于 the medicines.

Paul Conti:

和 I mean, 我们 know 这 is true, 我们 know 这 is true, 但 我们 haven't had the wherewithal as a society to say, like 与 a lot of things in society, to say, look, 这 isn't okay. I mean 我们 need 更多 — give 这些 人们 who are trying to help us, they need 更多 latitude to help us. 我们 need 更多 human-to-human contact to get at what's 确实 going on. 和 yes, 那's an investment of time 和 能量 和 money in the short term. 和 sometimes 那's money 从 the 系统. 但 if 我们 do 那, my goodness, look at the payoff of 那.

安德鲁·休伯曼：

What is 你的 thought 关于 anxiety 和 ADHD as a separate phenomena in terms of medication? Again, ADHD is the thing 那 seems to come up most in questions. I 可以't tell 你 the number of 尤其是 students, 但 also young working professionals 和 even 人们 who are outside 那些 categories who are interested in 或 taking Ritalin, Adderall, modafinil, armodafinil 或 Vyvanse, 因为 they seem to struggle focusing 没有 it. 或, 和 I don't know 因为 I'm not 一 of 那些 个体, 或 因为 they seem to just like how well they 可以 专注 when they do take 那些 compounds.

安德鲁·休伯曼：

和 so my understanding is 这些 compounds mainly 增加 多巴胺能的 transmission in the 大脑, also 肾上腺素, 肾上腺素 in the 大脑. So they're 更多 或 更少 stimulants. At least chemically they look a lot like cocaine 和 amphetamine, 尽管 they're not quite cocaine 和 amphetamine. So 应该 我们 be concerned 关于 这? Is 这 a 不同的 sort of epidemic? 可以 这些 drugs be used to train the 大脑 to 专注, 和 then 人们 可以 withdraw 从 这些 drugs? I mean I think 这 is a huge topic 和 一 那 maybe warrants its own episode entirely. 但 as long as 我们're on the topic, what are 你的 thoughts 关于 medication 对于 ADHD?

Paul Conti:

Sure. I think medication 对于 ADHD 可以 be extremely effective. 和 the 研究 show us 那. They show us 那 if there is ADD, then medication 对于 ADD is 非常, 非常 helpful. 和 那's true in youths. It seems to be true if adults have adult ADHD 或 ADD, 我们 kind of know 那's true. 但 all 注意力 deficit is not 注意力 deficit disorder. 和 then 我们 go to the reflexive 15-分钟 visits, throw medicines at things, right? 注意力 deficit 可以 come 从 many, many places. 和 一 of them is anxiety. There's so many other reasons. Depression affects 注意力, poor sleep affects 注意力. Poor diet 可以 affect 注意力. 压力 in life 可以 affect 注意力, 和 certainly trauma 和 the problems 那 trauma spins off 可以 affect 注意力. So 这 is 确实 the truth 那 ... While teaching once 关于 medicines 和 pharmacology, I was frustrated 关于 how the answer to everything was, "What medicine do 我们 use? What medicine do 我们 use?"

Paul Conti:

As opposed to, 这 is just 一 piece of the puzzle. 和 I told an anecdote, which I think it was a clinical anecdote, what do 你 think is going on? 和 I think 那 if I told 那 to, I don't know, middle school students 或 something, they 会 probably say, "你 just told a story of a person 与 a rock in their shoe," which is the story 那 I was actually telling, 但 several 人们 I was talking to are physicians, right? So ADD. It's like no, every time the person steps down, the rock hurts 和 they're not able to maintain 注意力, 那's what's going on. 但 我们're so programmed to think 关于 medicines 和 inappropriate use of ADD medicines. As 你 said, there's 多巴胺能的 impact, there's 肾上腺素, 去甲肾上腺素 impact. 我们're affecting what are called prefrontal alpha 二 受体 那 确实 need to be helped if there's real ADD.

Paul Conti:

但 if there isn't, 那 is not a good thing to do. Which is why it is quite fascinating 那 when 人们 have ADD, they tolerate generally stimulants 非常 well 没有 the other problems 那 可以 come of stimulants. 和 again, I don't claim to know why 那 is, 但 我们 see 那 phenomenon. 但 when 人们 are being treated 对于 ADD 和 they don't have ADD, which sometimes they know they don't have ADD, 但 the stimulants make them function better. So they go to somebody 和 get the stimulants, 那's not a good thing to do, right?

Paul Conti:

因为 stimulants when they're not needed over time, they do affect 我们的 physical function, they affect 我们的 judgment. There are a lot of negative things 那 come 从 那. They 可以 affect the vigilance inside of us. So yes, it's a valid diagnosis, 但 it gets made when it's not present 非常 经常, which 我们 see 与 a lot of diagnoses 那 你 可以 throw medicine at.

Paul Conti:

我们 see the same thing 与 bipolar disorder. True bipolar disorder is extremely 重要 to utilize medicines effectively. 但 how many 人们 are diagnosed 与 bipolar disorder who ... they absolutely don't have bipolar disorder, 但 it 可以 be a catch-all diagnosis 因为 there's in a sense something to do 对于 it, in quotes, 和 你 可以 throw medicine at it.

Paul Conti:

So I mean, what do 我们 expect, if 我们 have a healthcare 系统 where 你 get 15-分钟 visits 与 你的 psychiatrist, of course 我们're going to throw medicines at everything, 和 then the 训练 paradigms are going to look at it 通过 那 lens. 和 then 非常 经常 — again, I give the example of seeing somebody on seven medicines. I mean the 首先 thought I have is, "How many of 那些 medicines are actually counterproductive?" 和 a lot of the time, it's not like, oh, every now 和 then 一 is counterproductive. No, 那's the case a lot of the time. 和 again, I come back to, if 我们're not putting thought 进入 it, what other result 会 我们 expect?

安德鲁·休伯曼：

Thank 你 对于 那 answer. I'm 非常 curious what constitutes negative effects of stimulants? So if somebody's taking Adderall 或 Ritalin in order to work longer 小时 或 专注 因为 they have 注意力 deficit 但 not necessarily ADHD. 和 again, I'm not recommending anyone do 这, I've just heard the numbers 那 have come back, at least 从 surveys 和 discussions 与 colleagues at Stanford 和 elsewhere, other college campuses, 那 upwards of 75% of college students use semiregularly 这些 drugs, not by prescription, just to 研究 和 to learn. I 可以 imagine sleep issues 因为 这些 are stimulants. What sorts of other issues 可以 they create 对于 人们, problems 那 they 可以 create?

Paul Conti:

I think a touchstone maybe 那's running 通过 我们的 conversation is prioritizing the short-term benefit over solving the long-term problem, which 我们 可能 say is a human tendency. 和 我们 see it across the topics 那 我们're discussing. So short-term use of stimulants, sure, 人们 are 更多 alert, they 可以 stay awake 更多, they 可以 研究 更多 intensely 和 longer. Okay, there's some short-term benefit of 那, even there there 可以 be problems. 但 let's just say 对于 sake of argument 那 in the short term there's something to be gained by doing 那. 但 oh my goodness, there's so much risk to 那. 和 how many times have I seen someone who they're doing 那, 和 they're just doing 那 to 研究, 和 now they're addicted to the amphetamines, 和 their behavior changes 和 they don't know it.

Paul Conti:

Talk 关于 shifting 我们的 大脑 towards a 更多 defensive sort of suspicious outward view of the world, 那 我们 see a lot of 那. So 我们 see judgment impairment, 我们 see heightened 水平 of anxiety, 我们 see 更多 impulsivity in decision making. 和 sometimes it 可以 get to the point of seeing frank psychosis. Now 那's not common, 但 have I seen young 人们 who've done exactly what 你're describing, they're using Adderall 或 they're using Ritalin to 研究, 和 then I see them when they're coming in to the hospital, they're screaming 关于 how someone's trying to hurt them. Boy, then it's the worst-case scenario. 但 it shows 那's where 那 可以 go. 和 how much is there between the "Oh, I'm just using it to 研究," 和 那 severe outcome 那 is actually quite negative 对于 a person. It 可能 change how they think 关于 那 friendship 或 那 relationship.

Paul Conti:

A lot negative happens when 我们 change 我们的 brains 没有 an ability to see what is it actually doing to us? Which is part of my whole theme 关于 trauma. It changes 我们的 brains 和 我们 don't know it. Well, the same is 经常 true of amphetamines used inappropriately. It shifts 我们的 大脑, 和 我们 don't realize 那 我们're a little bit 更多 impulsive in 我们的 decision making, a little bit 更少 trusting. 这些 are significant negative things 那 if 我们 don't know it, the person 会 just say, "Oh, I'm just using it to 研究, I'm using it to work 更多." 那's not 没有 its high 水平 of risk.

安德鲁·休伯曼：

What are 你的 thoughts on cannabis? I've said it many times on 这 podcast 之前, I'll say again. I feel fortunate 那 I've 从不 确实 been attracted to alcohol 或 drugs of any kind, so much so 那 if all the alcohol 和 all the marijuana 和 all the cocaine 和 amphetamine disappeared, I wouldn't notice any change in my life. 和 I feel lucky in 那 way 因为 I know a lot of 人们 feel an attraction to 这些 things, almost a gravitational force 从 their 首先 drink. They just feel ... I once heard it described in 这, I think it was in Augusten Burroughs book "Dry," he was an alcoholic, he said 那 the 首先 drink he had, it felt like 这 magic elixir 那 meshed 与 the physiology of his 血液 in the most seamless way.

安德鲁·休伯曼：

和 as I was reading 这, I thought, "Oh my goodness." 首先 of all, 那's the most foreign experience 对于 me in terms of alcohol. 和 秒, gosh, 那 must be terrible, 但 at the same time 你 could 确实 understand why someone 会 be drawn to 那. So cannabis nowadays is legal 或 decriminalized in many areas of the U.S. A lot of 人们 seem to use the argument it's better than drinking, 或 they only do it 对于 sleep 或 anxiety management. I'm not looking to demonize 或 support cannabis. So what are 你的 thoughts 关于 cannabis 对于 anxiety management, depression, 和 maybe even 对于 ADHD, 对于 那 matter?

Paul Conti:

Sure. If I could make an alcohol comment, the number of times I've seen alcohol having been a good idea 对于 coping 与 something approaches zero. The alcohol 对于 coping is just 从不 good. 和 there's an additional risk factor 那 there's certain genetic profiles where 人们 respond strongly to alcohol, as 你're saying. It's not just, oh, there's a little bit of short-term relief of distress, 但 there's a sort of euphoric response. 和 那些 genetics, 我们 don't understand them completely. They seem to be in Northern European populations, 更多 prevalent as 你 head west in Northern Europe. So 我们 understand where risk factors are demographically, 但 我们 可以't pinpoint 那 对于 any 一 person. 和 there's a tremendous risk of 那, when a person responds so strongly to alcohol 或 habituates coping to alcohol.

Paul Conti:

Cannabis is a little bit of a 不同的 story. I mean, how I have seen 那 play out, 和 again, 这 isn't coming 从 any expertise 大约 the neuropharmacology of it, like how is 这 确实 working in the 大脑. It comes 从 an observation 那 what it seems to do is to narrow 我们的 attentional perspective. So it's why 人们 会 say, well, they want to use cannabis 之前 watching a movie 与 friends 或 something. 和 I think, okay, I think why 人们 are doing 那 is 因为 我们的 cognitive spectrum narrows, 和 then instead of worrying 关于 那 thing at work 或 那 relationship issue, 一 可以 just be present, it gates out other attentional intrusions. So in some ways, I mean I've absolutely seen it be helpful to 人们. I mean, it's been legalized in Oregon, which is where I spend a lot of my time. 和 it's not where all of my practice is. 但 what I have seen is it is at times helpful, say 大约 sleep, 因为 a person 可以 gate out other intrusive thoughts 和 they 可以 just relax 和 go to sleep.

Paul Conti:

但 there 可以 be another side of 那 too, 那 at higher 水平 of distress, at higher 水平 of tension, what it 可以 do is narrow the 专注 of cognition to the thing 那 is negative. So the idea 那, oh, 这 is a treatment 对于 depression, anxiety, trauma is not true. 可以 it be helpful under certain circumstances? I think the answer to 那 is, yeah, I mean, I know the answer to 那 is yes, 因为 I've seen it play out clinically 那 way.

Paul Conti:

但 I think it 可以 also be harmful too. So there again, anything 那 has any power to influence 我们的 brains, 我们 want to be thoughtful 和 careful 关于 it. I mean, do I think 那 it's safer than alcohol? Yes. I mean, 我们 so clearly see 那. Does 那 mean it's just uniformly safe? No. So 我们 want to be respectful of anything 那 可以 change how 我们的 大脑 is working. 和 I think 那 certainly includes alcohol, 和 I think it certainly includes cannabis too.

安德鲁·休伯曼：

I'd love to talk 关于 psychedelics 对于 二 reasons. 一, there seems to be a tremendous amount of interest in psychedelics as a therapeutic clinical tool. I know there's also recreational use. 和 I'll just preface all 这 by saying 那 my stance is, 我们 absolutely know 对于 sure 那 这些 are controlled substances, they're illegal to possess, sell 或 use in most of the country. There are few areas where they are decriminalized. 和 psychedelics is a broad category of course, 和 我们 可以 touch on some of the 不同的 ones. 但 whereas five years ago 或 so, I was truly afraid to say the word psychedelics in any kind of public venue, there are laboratories at Stanford working on ketamine, psilocybin, MDMA, mostly in animal models. There's terrific work going on at Johns Hopkins School of Medicine, 和 Matthew Johnson's Lab 和 others looking at the clinical applications mainly of high-dose psilocybin 和 LSD.

安德鲁·休伯曼：

There's the MAPS trials 与 MDMA. So nowadays it's safe 对于 an academic like me to say the word "psychedelics." 和 I'd love to approach 这 question of psychedelics 从 a place of true exploration 和 curiosity, 但 与 the preface 那 我们're talking 关于 这 in a legal clinical setting, 和 the legality is something 那's now in process. I don't think it's completed, 但 那's my understanding. 但 there are trials. 你 可以 go to clinicaltrials.gov 和 put in MDMA, 和 你'll see a bunch of clinical trials 那 are happening 和 they're recruiting 受试者. So I think it's safe to have the conversation now.

安德鲁·休伯曼：

和 I'd love 你的 thoughts 关于 psychedelics. Maybe 我们 could start 与 psilocybin 和 LSD as a broad category of drugs, 那, at least my understanding is, they touch on mainly the serotonin 系统, some 具体的 受体 activation 和 modulation, tend to change notions of space 和 time, adjust internal state. Maybe 我们 could start there 和 then maybe venture 进入 some of the other ones. So what are 你的 thoughts on 这些 drugs 对于 a therapeutic potential, also potential hazards, et cetera?

Paul Conti:

Yeah, I think if 我们 look at the true psychedelics, so psilocybin 和 LSD, 因为 ketamine 和 MDMA, they're 不同的 categories of medicine, they are 这些 sort of novel tools to bring to bear. 但 if 我们 start 与 psilocybin, LSD, true psychedelics, I think why they have gained so much momentum over the last several years is 因为 the 数据 coming 从 the labs 和 the academic centers is so powerfully positive. 和 as someone who's ... I'm interested in anything 那's potentially helpful, 和 I want to learn 和 understand 那 因为 a lot of things 那 are potentially helpful, 你 go 和 look at the 数据 和 你 see 那 那's not helpful, 或 那 那's harmful.

Paul Conti:

I think what 我们 have seen 与 psychedelics is 那 they're so helpful, 和 the trials are bearing 那 out. 和 of course 这些 are used in professional hands, 和 与 the right kind of guidance are extremely powerful tools, 但 used in the right way by someone who knows how to utilize them in the right setting 可以 have an immense positive impact.

Paul Conti:

和 那's why I think 那 the thought is there across 人们 和 更多 和 更多 人们 feel comfortable saying it 和 talking 关于 it, I mean 我们're in the state of Oregon now where the thought is 我们're moving towards legalization of psilocybin early in 2023. 和 it's part the new 数据 和 how it meshes 与 the older 数据, how it meshes 与 数据 从 the '60s 和 '70s 那 showed such a strong, powerful impact of 这些 medicines. 和 I have a whole set of thoughts 关于 what's happening there, 和 they're conjectures.

Paul Conti:

但 my read of, as best I 可以 try 和 understand the neuroscience 和 the clinical applicability 和 the changes, is what happens is 我们 see 更少 communication, 更少 chatter in the outer parts of the 大脑, in the outer parts of the cortex. 和 I think 那 as human beings 我们 sort of glorify the parts of the 大脑 那 only 我们 have.

Paul Conti:

I mean certainly in my growing up, what did I learn? Even if 你 think 关于 learning 关于 the 大脑 in high school, 和 learn 那, wow, 我们're great as humans 因为 我们 have language 和 other animals don't, 和 我们 可以 use tools, 和 aren't 我们 so great 因为 我们 have 这 part of the 大脑 那 other animals don't, 和 it lets us function. Right? Okay, there's some truth to 那, 那 我们 可以 do things others 可以't do. 但 我们 get lost 经常 in the outer parts of the cortex, which I think are 关于 survival. So 我们 come back to the things 你 和 I talked 关于 early on of, why are 这些 trauma mechanisms in us? So much of what's going on in 我们的 brains is 关于 survival. 和 I think living, so to speak, in the cortex, in the outer part of the 大脑, is consistent 与 a 专注 on survival.

Paul Conti:

So if 你 think, 那's where language is, 那's where vision is, 那's where executive function is, so planning 和 task execution. So much of 那 is 关于 making 我们的 way in the world 大约 us. So 我们 tend to glorify 那 和 think, well, 那's in a sense where 我们的 existence is. 和 I believe 那 is not true. 和 again, 可以 I say 那 对于 sure? Of course not, right? 但 my read of 20 years of doing clinical work 和 thinking 关于 all sorts of medicines, 和 thinking 关于 the psychedelics in a lot of depth, I think 那 what they do is they take us out of the cortex 因为 那's where 我们 run 进入 这些 problems. 那's where 我们 bounce things over 和 over again 那 the distress centers deep in 我们的 大脑, in the 大脑 stem, kind of align 与 the outer parts of the cortex.

Paul Conti:

和 they say, "Wait, 我们're in distress, 我们 want to stay alive." 经常 a lot of us have had trauma 那 makes 这些 changes in the 大脑. 和 then 我们're thinking all the time, like "What 会 I do if there were war? What 会 I do if there's civil war? If someone bombs us? What 会 I do if the economy collapses? What 会 I do if somebody gets sick?" 我们're thinking all 这 future projection 那 is all coming 从 a place of fear. It's all coming 从 a desire to think 关于 things 和 control the future 与 这 part of the 大脑 那 is so uniquely human. 和 I think when 我们 take the neurotransmission out of 那些 places 和 我们 set it in a part of the 大脑, 和, say, the insular cortex, the parts of the 大脑 那 are sort of in the middle, which I believe is where 我们的 humanness 确实 is.

Paul Conti:

So the psychedelics make there be 更少 chatter 或 communication in 这些 other parts of the 大脑. 和 then 我们 become seated in the part of the 大脑 那 I believe is most 关于 我们的 experience of true humanness. Which is why when 你 read 关于 人们 who have experiences, 和 I've heard 关于 them 和 人们 talk to me 关于 这, they've utilized it, they talk 与 me. So whether it's someone telling me their story 或 it's coming 从 研究 数据, it's why 人们 可以 see 与 clarity 那, "Oh, 那 trauma, 那 thing is not my fault." 我们 feel a sense of compassion 对于 ourselves. 我们 relieve ourselves, 释放 ourselves 从 guilt. 和 it's like, why is 这 so helpful to 人们?

Paul Conti:

和 I think it's 因为 it 可以 do what 我们 are trying to get at in good therapy, 但 it 可以 确实 catalyze 那 by just putting a person in 那 part of the 大脑 那 可以 see it 对于 what it is 没有 all 那 chatter in the cortex 关于 how 你 got to think it's 你的 fault 或 你 won't avoid it again. 和 那 makes the repetition compulsion. How do I think ahead to the next thing 那 可能 happen, 和 what else bad 可能 happen?

Paul Conti:

I mean, 我们 don't get anywhere doing 那. 和 I think where 我们 get somewhere is when 我们 seat ourselves deeper in the 大脑, which I think 我们 do if 我们're doing 确实 good therapy 和 我们're in the deep parts of the 大脑. 但 这些 psychedelics, the medicinal value, I believe, is putting us in 那 part of the 大脑 where a person 可以 确实 find truth. 和 那's why I think 那 it's come so far in 这些 few years, 因为 I think 那 is 非常 clinically evident 和 I think 我们're going to see 更多 和 更多 the value of 那 和 what the psychedelics do, 可以 become, I believe, a heuristic 对于 understanding like, wait, how are 我们的 brains 确实 functioning 和 what are the parts 那 确实 matter to 我们的 experience of being human?

Paul Conti:

It's 那些 parts of the 大脑, the deep parts of the 大脑, the insular cortex 和 the areas 大约 it 那, say, light up when a person has an experience of spiritual ecstasy 或 an experience of connection 与 another person. So 我们 kind of have 这些 telltale markers 那 something is going on there 那's 非常 重要 和 非常 special. 和 I think 我们're 更多 attracted to the outer parts of the 大脑, 和 probably 因为 they're easier to 研究.

Paul Conti:

I mean, as 你 know better than I do, 我们 started studying the 大脑 通过 lesion 研究, right? 因为 it was easier to see, if a person got hurt in 这 part of the 大脑 或 had a stroke in 那 part of the 大脑, what changes? So 我们 look at the cortex 因为, 一, it's easier to 研究 和 我们 tend to glorify it. 和 I think 那 has been misguided. 和 I think 那 我们're learning 关于 how 那's been misguided 通过 the 研究 of 这些 novel modalities 从 Western perspectives, 但 of course they've been used 对于 a long, long time in other cultures, 但 novel 从 我们的 perspective.

安德鲁·休伯曼：

Yeah, I'm fascinated by 这 idea 那 in 这些 middle 大脑 structures is where 我们的 humanity lies. 和 as 你 said, I also wonder whether 或 not other animals experience life 更多 从 那 orientation 与 更少 chatter. 我们 可以 only guess, 但 a dog lover 和 being in the presence of animals 那 seem to just be present in what's happening in their immediate environment, not too much anticipation. They're sentient.

Paul Conti:

I mean, what 你're talking 关于 is sentience is 重要, 和 sentience is extremely 重要. 和 if 我们're going to overvalue, say, language, then I think 我们 undervalue sentience. Which is why I think 我们 tend to undervalue animals 和 their suffering, 因为, well, they're not saying anything 关于 it 和 they're not writing 关于 it. So okay, it's easy to ignore. 和 我们 think 关于, again, the hubris of 那, oh, 因为 我们 可以 think 和 talk 和 write, 我们 must be feeling 更多 than species 那 don't do 那. I mean I think 那 is so true 和 那 我们're going to understand 更多 关于 sentience in other species 和 how 那's at the core of existence. 和 my hope 会 be 那 我们 value 更多 humans 和 animals 通过 the evolution of 那 understanding.

安德鲁·休伯曼：

The hallucinations 那 accompany psychedelics like LSD 和 psilocybin have such an attractive force to them as a concept 和 as an experience. 和 so I think most 经常 when 人们 hear hallucinogens 和 psychedelics, they think 关于 hallucinating, it makes sense why they 会. 但 what's so interesting to me is, nothing in 你的 answer 关于 psychedelics, psilocybin 和 LSD focused on hallucinations per se. It was 更多 关于 feeling states, accessing a feeling state 或 a relation to an event 或 to a person 或 to oneself, maybe even, I caught hints of maybe even empathy 对于 oneself 对于 the 首先 time. None of 那 had to do 与 seeing sounds 或 hearing colors, 和 这些 kind of cliche statements 关于 hallucination.

安德鲁·休伯曼：

So I am aware of laboratories, 一 at University of California, Davis in particular, 但 a few others 那 are trying to generate chemical variants of psychedelics 那 lack the hallucinogenic properties, 但 maintain 这些 other properties as therapeutic tools. 和 as I say 那, I realize 那 人们 in the psychedelic community are probably thinking, "Oh, 那's horrible, 那's the dismantling of the core thing." 但 the simple question is, do 你 think the hallucinations are valuable 对于 anything?

Paul Conti:

和 I think 我们're 确实 getting 进入 the philosophical, the ontological. There's 这 sort of "I'm trying to understand being." 和 I don't claim to know the answer to 那. I think 那 at times it seems like the hallucinations have a metaphorical 或 a symbolic way of being helpful, 因为 人们 会 come to understand things 那 they hold dear 和 true 之后 the experience, 那 经常, not 总是, come 通过 the lens of the hallucination. So are the hallucinations necessary? Are 那些 hallucinations sometimes 重要, sometimes not? I mean, I think 我们 don't understand 那, 和 I think 我们 want to be respectful of the mystery of 那. 但 what I think is fascinating is when 你 think 关于 substance abuse 和 what 那 means is, well, 一 aspect of 那 is 那 a person has experiences, thoughts, conceptions of self in the world, 与 the substance 那 没有 the substance they know are wrong.

Paul Conti:

人们 talk 关于 liquid courage, 和 "I feel better 关于 myself 和 I feel courageous 因为 I've had a couple of drinks." Now 之后 那, "I feel like normal 关于 myself," 和 那 was false. 和 我们 see 那, 那's part of what substance intoxication means. 但 what 我们 see 与 the psychedelic medicines is something 那's incredibly 不同的, 那 人们 are having experiences 那 are so delinked 从 我们的 normal experience of reality. 和 then when they come, in a sense, back online in a normal cognitive way, they realize, "Wow, now I'm applying all 那些 mechanisms of trying to understand truth to 那, 和 what I see is 那 it's true, 和 wow, it's true." I mean 我们 hear 那 all the time, which tells me, hey, something 不同的 is going on there. 和 of course 这些 are powerful tools, so misused, 非常 bad things 可以 happen.

Paul Conti:

但 你 think 关于 the clinical utility 和 what does it mean 那 so many 人们 change 对于 the healthier 或 even change their lives 之后 an experience 因为 it so resonates as like, "Oh, now I understand something 那's true 和 it's not something bizarre. It's like, I wasn't responsible 对于 being raped 那 time," 或, "I'm not 更少 than, even though my sexuality 或 my gender identity's 不同的 从 some silly binary concept." 人们 可以 经常 get it, 和 they feel differently 关于 themselves, 和 guilt 和 shame are impacted. So I think 我们're 可能 to see 那 they are powerful antitrauma mechanisms, again, used clinically in the right hands. 和 I think 那 我们're also going to see 那 they're heuristic 对于 understanding 我们的 大脑, 那 goes against what I see as some of the reflexive hubris of "Well, the outer parts must be the best 因为 那's what makes us human 和 other animals don't have it. 和 我们're better 因为 我们're human." I mean, it makes no sense.

安德鲁·休伯曼：

I'd like to talk 关于 MDMA, 和 I'll preface 这 by saying I was a participant, actually technically I'm still a participant in a clinical trial, so I have experience of doing it twice at the ...

安德鲁·休伯曼：

So I have experience of doing it twice. The trial involves 三 separate dosings of 这. I was reluctant to do it outside of a clinical trial, mostly 因为 I was aware there 可以 be some cardiac effects. 和 I like the idea there'd be a clinician on hand. 和 I'll just say 那 I found the experiences to be profound, beneficial, 和 非常 不同的 从 一 session to the next. The 首先 一, felt a whole collection of ideas 和 relational things came up 那 felt 非常 powerful 和 transformative. 和 I do think 那 I learned there, I exported a number of things. My particular experience isn't relevant here, 但 the 秒 time I expected it to be the same way. 和 it was 非常 mellow 和 relaxing 和 was deeply tied to kind of notions of acceptance. So there weren't all 这些 revelations 和 "Wow," new insights. It was 非常 much 关于 of grounding 进入 a calmer state.

安德鲁·休伯曼：

So I have the personal experience of benefiting 从 这些 in ways 那 I think still benefit me 和 was 非常 struck by the power of MDMA, 和 my 非常 crude understanding of the pharmacology 和 the state 那 is being under MDMA is 那 it encourages 或 增加 多巴胺能的 transmission 但 also serotonergic transmission, which is to my knowledge a kind of a rare state 对于 the 大脑 to be in, 那 通常 it's 更多 of a seesaw 多巴胺能的 drive towards external goals 或 更多 serotonergic drive towards 更多 plasticity 或 comfort 与 what 一 already has.

安德鲁·休伯曼：

和 so 与 both 那些 系统 amplified, the only way I 可以 describe it subjectively is 那 it ... Everything sort of funneled back in 和 it was almost like a pursuit of inner landscape. 和 I 可以 only imagine what it 会 be like in the context of doing 这 与 somebody else also taking MDMA. I have no idea what 那's like. 那's my report of the experience. I know 那 the experience 可以 vary. What are 你的 thoughts 关于 the chemistry 和 what sorts of states do 你 think MDMA is creating 那 可以 explain why it's a useful therapeutic tool in some cases 和 what sorts of cases 那些 可能 be?

Paul Conti:

Sure. To clarify, I think part of what 我们're starting 与 is 这 is 非常 不同的 than the psychedelics, which are seating 我们的 consciousness in 这些 deep centers of the 大脑. Whereas what MDMA is doing is sort of flooding 与 positive 神经递质 in certain parts of the 大脑. 和 I think what 那 creates is a greater permissiveness inside to entertain 或 approach 不同的 things. So I think where 我们 see it's ... My read of the 数据 is 大约 potentially, 和 我们're seeing in some of the trials, tremendous benefit 对于 trauma. 和 你 think 关于 what 我们 were talking 关于 earlier, how 这 reflexive guilt, shame, hypervigilance, avoidance. 和 when 这些 系统 are flooded 与 这些 神经递质, it's 更多 permissive to think 关于 那 和 to think 关于 那 没有, again, all the chatter of "那's 你的 fault," 或, "你're 从不 going to get anywhere 因为 of 那," 或, "你 know what 那 means." They kind of go away. 和 then 我们 可以 think 关于 it in a way 那 isn't 通过 the lens of fear. 和 I think 那's the power there is 那 there it is permissive of approaching something, contemplating something.

Paul Conti:

A novelty, as 我们 talk 关于, de novo approach. 和 I think 那's also why the experience 可以 vary 因为 你 could also see how if 你're not thinking 关于 something, so there's not a clinical guidance to it, 你 could be in a state where, "I just feel good. 和 I'm thinking 关于 good things 和 那 可以 feel good." 但 那's not necessarily problem solving. So the clinical guidance says, "Hey, let's take 那 state 和 do something 与 it." Now 那 你're in 这 state, "Hey, let's make hay while the sun is shining." 你're in a state where 我们 可以 look at things 那 are traumatic. 我们 可以 approach them 从 a de novo perspective. 和 I think 那 explains why 你 had 这些 不同的 experiences 从 一 to the other, 因为 你的 大脑 is just in a state 那's conducive to something. 但 if there's not the mechanism to have 那 thing happen conducive to something therapeutic, then 你 可能 go there on 你的 own 或 你 可能 just be in a state where 你 have a sense of well-being 和 你 sit 与 那.

安德鲁·休伯曼：

Which sort of seems like a waste to me. I mean 这 is what I tell 人们 when they ask 关于 MDMA. I said, at least 从 my experience, 那 the potential hazard there is 那 in 那 非常 high 多巴胺能的, serotonergic state, there were moments where I felt like I could get excited 关于 any 一 具体的 concept — 那 I 可能 even just think 关于, 对于 instance, 水 和 how nourishing it is, 和 确实 just go down the path of 水, 和 the world 和 all the 水, 和 你're in a state 那 is 非常 prone to suggestion. Internal suggestion. 和 so the guidance turned out ... The guidance 从 the clinician turned out to be immensely valuable in allowing me to go 进入 my own head 对于 bits of time, 但 then also to resurface 和 share an exchange in a way 那 ... to try 和 确实 get something out of it 那 was useful 和 那 I could export.

安德鲁·休伯曼：

因为 of course, 水 is wonderful, 但 I'm not 确实 interested in growing my relationship to 水. 和 I 确实 felt like in ... I could understand 对于 the ... I 从不 went to raves 或 anything growing up. I 从不 did MDMA recreationally, 但 I understood 对于 the 首先 time how 人们 could get 确实 attached to an environment 和 feel connected to things 因为 I think 与 all 那 serotonin, 你 just feel connected to everything 大约 你. So I think it's a slippery slope there. 和 I don't know what the future of the clinical use of MDMA looks like, 但 I 会 hope 那 whoever's thinking 关于 guiding 这些 sessions is 确实 thinking carefully also 关于 evolving the practice to help 人们 确实 move 通过 in a sequential way so they 可以 leave 与 something valuable.

Paul Conti:

Yes, 100%. 这些 are such powerful tools 和 yes, they're powerful tools, 和 我们're using them 没有 respect 对于 them. 没有 clinical guidance, 我们 incur risk. I mean, getting obsessed 与 水, well, it probably isn't going to hurt 你, 但 if someone is out using it, they're 大约 other 人们, what 一 可以 feel positively 关于 或 become obsessed in the short term 关于 可以 be 非常 counterproductive. There 可以 be a lot of risk to 那. So I think it anchors back to, 这些 are 非常 powerful tools, 我们're coming to understand them much, much 更多. 和 我们're coming to understand 那 they have immense potential to be helpful to us. 但 I think 和 hope 那 那 only also 增加 我们的 respect 对于 那些 modalities 和 what negative 可以 happen if 我们're not respectful.

安德鲁·休伯曼：

这 可以 be 非常 interesting to see where all of 这 goes in the next few years, not just in Oregon, 但 elsewhere. It's ... 一 way 或 another, it's happening. It seems to have a momentum 那 is not going to stop. So 非常 exciting area to be sure.

Paul Conti:

I agree.

安德鲁·休伯曼：

I have a question 关于 language. In 你的 book, 你 talk 关于 how 我们 need to be careful 关于 the use of language 大约 trauma.

Paul Conti:

Yes.

安德鲁·休伯曼：

Maybe problem solving 和 problem describing in general. At 一 extreme 你 hear 那 你的 大脑 和 你的 身体 hear every word 你 say, 和 我们 have to be so careful 与 language. 和 那 actually frightened me 对于 a number of years 因为 I 会 hear 那 和 I thought, "Gosh, if I just think 那 something is bad now, it's going to hurt me worse." Which itself is part of 那 whole packing down of an issue. 非常 hard to avoid thoughts, 没有 distraction. So 那's 一 extreme. On the other hand, I 可以 say tell somebody I love them 与 a tone of hatred. I 可以 tell somebody I hate them 与 a tone of love. So how 应该 我们 think 关于 language in parsing trauma? 和 in 你的 book 你 talk 关于, 你 give some cautionary notes 关于 talking 关于 depression, trauma, 和 PTSD in terms 那 可能 diminish their real severity in some cases.

安德鲁·休伯曼：

和 I was 确实 struck by 那. So maybe just touch on how 应该 我们 talk 关于 这些 things in a way 那 doesn't diminish them 对于 ourselves 或 对于 other 人们. 和 at the same time honors the fact 那 there's a lot of trauma out there, 和 there's a lot of depression out there 和 我们 need to talk 关于 it.

Paul Conti:

I think 这 a 非常 complicated, 和 in many ways convoluted topic. I think it's wonderful 那 我们 have language, 但 boy, language leads us astray 经常 too. When 你 think 关于 how 人们 define words. Someone says a word, what is it? Does a person know what 那 word means" What nuance are they taking 从 it" 我们 just have to be 非常 careful what 我们're saying 和 what 我们're communicating. 和 I think 这 doesn't mean, 因为 there's a sort of phenomenon now where 人们 are trying to control language I think too much. 你 可以't say anything 那 someone else 可能 find hurtful, 或 你 have to refer to 人们 in ways they choose to be referred to, even if 那些 are ways 那 others don't understand, 或 ways they themselves have decided, 或 ways 那 可能 be psychologically 或 clinically unhelpful. So I think the overcontrol of language is not good, 但 I think the specificity of language, of what are 我们 trying to say? How are 我们 defining it? 或 even the word "trauma."

Paul Conti:

我们're talking 关于 trauma, so 我们 want to define what 那 means. It doesn't just mean, "Oh, anything kind of negative." 因为 then 那 dilutes it down to meaning nothing. It also doesn't just mean injury 和 combat. 我们 have to talk 关于 what 那 is. So I think anchoring it to something 那 rises to the magnitude of overwhelming 我们的 coping skills 和 changing us, then at least I define it 那 way. 和 I 可以 communicate 那 to 你 和 我们 可以 understand what 我们're talking 关于. I think 那 another aspect of language, while again 我们 need 这 middle ground, 和 I don't think 那 it is okay 对于 the overcontrol of language to shut down expression, 但 我们 also have to acknowledge how 我们're so much 更少 distant 从 each other 通过 social media. 和 I think social media 可以 do 非常, 非常 good things, as hopefully 我们're doing now. 但 it 可以 also be used to harm 人们 从 a distance.

Paul Conti:

和 how much hatefulness is there out there? 那 I think comes 从 anger 和 frustration in 人们, again, back to trauma. Where 人们 just want to be angry, 和 it's not 确实 issues 那 they're talking 关于, 但 then there's a target of 那 anger 和 人们 feel beleaguered by 那. 和 the words 那 人们 use sometimes are so awful 那 someone reading 那 ... If 你're in the demographic 那's being targeted 和 你're reading 那, I mean, how does a person not feel beset upon, vulnerable? 和 then I think 那 also fuels things like 我们 just had 这 terrible shooting in Buffalo, just hate motivated. 和 I think 那, 因为 那 kind of language becomes 非常 real to 人们 who may take it in, it fuels their hate 和 then they do something to enact it, which of course creates greater fear 和 vulnerability.

Paul Conti:

和 I think there was some civility 和 decorum 那 was in 我们的 world not 那 long ago. I mean, I'm in my early 50s. I'm not 那 old. 但 I remember a time when in political discourse, say, 人们 were civil to 一 another. Now, so much ... I mean, it's not all of it, 但 there's an acceptance of things 那 are just bombastic. It's a circus sideshow sometimes of 人们 being just angry 和 aggressive, 和 it's not 确实 linked to anything, 尽管 it's allegedly linked to something, 但 then other 人们's anger 可以 attach to it. 和 it's not 关于 what it's 关于, 但 it's 关于 aligning 与 the anger. 和 I think 那 there is so much damage 那 comes 从 那. 和 I think, 应该 it be okay 那 人们 sometimes are talking, communicating, using language in ways 那 会 get us suspended 从 middle school? Ways I don't want my eight-year-old to see.

Paul Conti:

I mean, is 那 确实 okay? 或 do 我们 need to take a stand 对于 rational use of language? I don't want my use of language to be overcontrolled by someone who thinks they sort of understand better than the rest of us how to communicate 与 us. I don't want 那, which is stereotypically a sort of idea of the left. At least in 我们的 society. 但 I also don't want language 那 可以 be so angry 和 so aggressive 那 it is perpetuating 或 spreading vulnerability 和 那 it facilitates trauma. 和 I think 我们 could set standards as a society where 我们 say, "Look, I don't want anybody in power who's going to behave 那 way." I don't care if their whole agenda is make Paul Conti's life better. I'm still not going to vote 对于 你. If 你're behaving towards others in a way 那's denigrating, 你're behaving in a way 那 I feel 本质上 ashamed of.

Paul Conti:

和 I feel 那 a lot. I see the politics. I see things play out, it's not 总是 political, of course, not 总是 political. 但 I see things play out 和 I think, "Oh my gosh, I feel embarrassed." 我们're somehow okay 与 这. Well, it doesn't matter which side of the political spectrum it's coming to. 和 I think 那's an indicator 那 what 我们're doing is 确实 hurtful to us. 人们 become 更多 angry. They attach to the anger, 人们 feel 更多 beleaguered, there's 更多 divisions between us. 和 it seems 更多 和 更多 like, "Well, 我们 可以 only 确实 identify 与 人们 who are just like us." 和 what does 那 确实 mean? I mean, the divisions 那 it creates between us. 和 那 promotes so many negative things. I mean, think 关于 ways in which it promotes white supremacy, it's just 一 example. 和 我们've seen 那 play out 那 这 is 确实 bad 对于 us, 和 我们've got to look at 那. I mean, if 我们 don't look at 那, I don't think it's as though something is going to happen. Something is happening. It's happening now.

安德鲁·休伯曼：

和 确实, to my 心智, it 确实 seeps down 进入 the soil of everything 那 我们're talking 关于 on all sides. 人们 are activated, 人们 are upset 关于 一 thing 或 the other. No 一 is 免疫 从 upset, regardless of political affiliation. 和 everybody seems to be upset nowadays. 和 as I was hearing 你 talk 关于 这, I feel a lot of resonance 与 what 你 said, 和 I also am hoping 你 run 对于 office.

Paul Conti:

Thank 你. I don't think I have the gumption 对于 那, 但 thank 你 对于 那.

安德鲁·休伯曼：

Well, 那 会 be wonderful.

Paul Conti:

Thank 你.

安德鲁·休伯曼：

I'd like to talk 关于 a concept of taking care of oneself. 这 comes up in the book.

Paul Conti:

Yes.

安德鲁·休伯曼：

这 is something 我们 talk a lot 关于 on 这 podcast. I mean, I think 人们 have heard me blab endlessly, 和 I'll probably go 进入 the grave telling 人们 to get sunlight in their eyes when they 可以 和 to try 和 get proper sleep 和 to have a few tools 对于 减少 their anxiety in real-time, 和 on 和 on 和 on. 我们 hear 关于 这 concept of taking care of oneself. 和 I think at a surface 水平 it 可以 sound a little bit light. "Oh. Take care, take good care." 但 to me it's a deep 和 powerful concept. 和 I was 非常 happy to see it in 你的 book 和 also to learn a lot of ideas 关于 what 那 确实 looks like.

安德鲁·休伯曼：

因为 whether 或 not somebody is in the early stages of considering whether 或 not they have trauma 或 is in the deep stages of working 那 通过 或 has made it 通过 the tunnel some distance, taking care of oneself is an ongoing process. I'd love 对于 你 to just describe what taking care of oneself means to 你 as a clinician. 和 of course the practices 和 things 那 你 encourage 人们 to do. 但 how 我们 应该 think 关于 taking care of oneself? 因为 on 一 extreme, 你 could imagine massages 或 treats, vacations 和 chefs 对于 hire 那 take care of everything 对于 ourselves. 和 on the other extreme, 你 could say, leaning 进入 life in a way 那 你're paying 注意力 to small things while working 非常, 非常 hard. So it's such a big concept, 但 how do 你 think 关于 taking care of oneself? How 应该 I take care of myself? How 应该 人们 take care of themselves?

Paul Conti:

Sure. I see here what I think is a 非常 fascinating dichotomy 那 in some ways, think 关于 how complex 我们的 brains are, how complex 我们的 psyches, unconscious minds are. There's so much complexity there. 但 on the other hand, psychological concepts 那 are consistent 与 health are 经常 非常 simple. 但 I wish, I don't mean light, 但 simple, straightforward, 和 I think self-care is absolutely 一 of them. I mean, how much is talked 关于 how to take care of oneself 那 just skips over the basics 那 are necessary as a building block 对于 all else. So it doesn't matter how many chefs 或 vacations 或 whatever a person has if the basics of self-care aren't squared away. 和 it's not a light concept to say, "Look, are 你 sleeping enough? Are 你 eating well? Are 你 getting natural light? Are 你 interacting 与 人们 who are good to interact 与? Are 你 accepting negative interactions in 你的 life? Are 你 living in circumstances 那 make 你 feel okay 或 not?" They're 非常, 非常 basic premises. 但 so 经常 我们're not looking at them at all.

Paul Conti:

我们're not looking at them at all 因为 我们 tend to skip over them. 和 我们 tend to skip over them either 因为, again, in some automatic way 那 sometimes is trauma-driven, 我们're not going to look at 那, 和 经常 not taking care of ourselves 可以 have the punishment, distraction. There's so much 那 可以 come 进入 那. 或 我们的 sense of power is tied to not taking care of ourselves. I mean, I'll give 你 an example is I tend to, 对于 whatever reason, do reasonably well 与 非常 poor self-care. 和 那 was 非常 adaptive when I was 进入 medical 训练, 和 I'm like, "Okay, I 可以 eat a lot today. I 可以 not eat. I 可以 sleep 二 小时, I 可以 sleep eight." I mean, overall 那's not good. 和 it hasn't been good 对于 me as I've aged. 但 then I realized some, look, I'm doing all 这些 things 那 make myself healthier, 但 what, I ignore 那? 和 why am I ignoring it? 那 was a key question. Why am I ignoring it?

Paul Conti:

因为 somewhere inside of me, as it was, 和 still to some extent is, 这 idea 那 my ability to be 确实 functional, to generate success in the world 大约 me is tied to my ability to do 那. 但 if I stop doing 那, 和 now I'm eating 和 sleeping regularly, then I'm going to lose some edge. Even, I think 关于 这 all the time, 但 I realize, "Hey, I'm also, I'm not doing it inside." 和 I think it's 确实 grounding to the basics 那 确实 help us of what are the basics of what I'm doing 和 not doing in my life — diet, 运动, sleep, 人们, circumstances, leisure activities. I mean sunlight — I mean, I think immensely 重要 和 dramatically undervalued.

安德鲁·休伯曼：

Well, I want to thank 你 对于 那. 和 I want to thank 你 对于 today's discussion. I found it to be incredibly informative 和 I know 我们的 listeners 会 also ... I also want to thank 你 对于 the work 你 do. I mean, 你 obviously run an incredibly robust clinical practice 那 I'm aware 那 你're constantly trying to 改善, even though it's operating at the highest 水平 already.

Paul Conti:

I appreciate 那.

安德鲁·休伯曼：

I 确实 ... The reason why 你're here today is 因为 I've done a wide 和 deep search 对于 人们 in 这些 areas 和 there are so few who have the background in medical 训练 和 physiology in the psychoanalytic 和 psychiatric realm 和 also have a grounding toward the future, what's coming, 和 who 可以 encapsulate so many 不同的 orientations 和 bring them together 进入 a coherent piece. So I 确实, thank 你.

Paul Conti:

Appreciate 那.

安德鲁·休伯曼：

Yeah. 和 对于 你的 book, which is incredible. I 会 go on record saying I think 这 is the definitive book on trauma. 和 I 确实 encourage 人们 to read it 和 会 continue to encourage 人们 to read it. So many valuable takeaways 和 insights 和 tools there. So on behalf of the listeners 和 myself, thank 你 so much 对于 joining us today.

Paul Conti:

你're 非常 welcome. 和 I take 那 to 心脏, 和 I'm 非常 appreciative of being here. So 你're 非常 welcome 和 thank 你 as well.

安德鲁·休伯曼：

Thank 你. Thank 你 对于 joining me 对于 my discussion 与 Dr. Paul Conti. I also highly recommend 那 你 explore his new book, which is "Trauma: The Invisible Epidemic: How Trauma Works 和 How 我们 可以 Heal 从 It." It's an exceptional resource, both 对于 那些 那 have trauma 和 那些 那 don't have trauma, 或 那些 那 suspect they 可能 have trauma. Again, it's a deep dive 进入 what trauma is 和 offers many simple tools 那 anyone 可以 apply 与 a therapist 或 not, in order to heal 从 trauma. 和 if 你'd like to learn 更多 关于 Dr. Conti 和 the work he does directly 与 patients, please check out his website, pacificpremiergroup.com. 我们've also provided a link to both the book 和 pacificpremiergroup.com in the show note captions. If 你 are learning 从 和 或 enjoying 这 podcast, please subscribe to 我们的 YouTube channel. 那's a terrific zero-cost way to support us.

安德鲁·休伯曼：

In addition, please subscribe to the podcast on both Spotify 和 Apple. 和 on both Spotify 和 Apple, 你 可以 also leave us up to a five-star review. On YouTube, 你 可以 leave us comments 或 suggestions 关于 content 那 你'd like us to cover, as well as suggestions of future guests 那 你'd like us to host on the podcast. 我们 do read all 那些 comments. Please also check out the sponsors mentioned at the beginning of today's episode — 那 is the best way to support 这 podcast. Not so much in today's episode, 但 in many previous episodes of the Huberman Lab 播客, 我们 discuss supplements. While supplements aren't necessary 对于 everybody, many 人们 derive tremendous benefit 从 them 对于 things like improving the transition time 和 the depth of sleep each 夜间, 对于 improving 专注, 对于 managing anxiety, 和 对于 many other aspects of 心理健康, 身体健康, 和 表现.

安德鲁·休伯曼：

对于 那 reason, the Huberman Lab 播客 has partnered 与 Momentous supplements 因为 首先 off, they are of the 非常 highest quality. They also ship internationally, which many other supplement companies do not. 和 我们 wanted to have a 一-stop location where 人们 could find 和 access the supplements 那 are discussed on the Huberman Lab 播客. So if 你 go to livemomentous.com/huberman, 你'll find many of the supplements 那 are commonly discussed on the Huberman Lab 播客. I 应该 just mention 那 the catalog of supplements there 会 be expanding in the 周 和 months to follow, 但 already a number of them 对于 sleep 和 专注 和 other aspects of 心理健康, physical 健康与表现 are already there at livemomentous.com/huberman. If 你're not already following Huberman Lab on Instagram 和 Twitter, please do so. There, I cover science 和 science-based tools, some of which overlap 与 the content of the Huberman Lab 播客, 但 much of which is distinct 从 the information covered on the Huberman Lab 播客.

安德鲁·休伯曼：

我们 also have a newsletter called the Neural Network Newsletter, where 我们 offer distilled information, so lists of 方案 和 key takeaways 从 podcast episodes. If 你 want to sign up 对于 the newsletter, all it requires is 你的 email. Please know 那 我们 do not share 你的 email 与 anybody. 我们 have a 非常 clear privacy policy. 你 可以 find all 那 by going to Huberman Lab.com. There's a menu there where 你 可以 sign up 对于 the Neural Network Newsletter. 你 可以 also immediately get access to some example newsletters so 你 know what the newsletter is all 关于. So thank 你 once again 对于 joining me 对于 my discussion 与 Dr. Paul Conti. 和 last 但 certainly not least, thank 你 对于 你的 interest in science.