Hey, Dr. Maldberg, what's going on?
Uh, not much.
Not much in the life going on? Well, I think today we're going to talk about what you can have going on in your life beyond the normal, what we consider medical treatments for any mental health condition, you know. Obviously, medications and psychotherapy are evidence-based. We know they work. They're effective. We want people to be doing that. But what can you do beyond that for your treatment?
Yeah, and I think that's so important. I think a lot of people find that they're... This is something I think we're going to be talking about, treatments beyond medications. But a lot of people go to a psychiatrist thinking that they're just going to fix their mental health problems. And I think... in how it actually it's not that psychiatrists are the best at mental health problems is that they're probably the best at medications to be honest and there are a lot of treatments that aren't medications that are really good and that some patients don't necessarily need medications if they're able to engage in these
things I mean you know I think it's an unfortunate reality of how treatment is working today and how training is working today If you've listened to us on other episodes, you probably know that I disagree that that's what a psychiatrist should be doing. I think a psychiatrist should be working with patients on every treatment, especially the ones we talk about today, because they're pretty much no cost.
At least the cost isn't money. The cost is effort and time.
Yeah, and it's hard because a part of my training is jumping to medications right away. So it's very rare that I'll say like, hey, we should try these other things first. And if they are... they don't help or we're not able to implement them, then we can consider medications. That's unfortunately not a part of the average psychiatrist's algorithm.
Yeah, I can definitely agree with that. It's not what people have been taught to do most recently. I believe it was certainly taught a long time ago, considering that the The field of psychiatry has been around long before the psychiatric medications have been around. But whether I tell patients, I say the medications are not going to solve your problems. OK, medications don't do that. They're just going to help you solve your problems.
And what do you have to do? Well, first, there's the first pillar of the treatment, and that's the things that I recommend you do medically. from medications to avoiding substances the second thing is things that you do about your own mind your psychology and that's usually psychotherapy and then the third column is changes that you can make in your life that's going to help you get better and that's what we're talking about today
Absolutely. Yeah. And, you know, you do see, I guess not the changes part, but in most treatment algorithms, like therapy is number one and medications are number two. And a lot of times it's like, well, they're equivocal, so you can technically start with both. But we don't really see that conversation happening a lot. A lot of times it's just go straight to medications and the therapeutic slash the third column is secondary.
Yeah.
Yeah. And, you know, I'll say, and even though supposedly the quote top of your license is medications, ultimately you're a consultant to the patient about what to do for their mental condition, for the mental disorder, for the mental health. And so I think it's part of the duty to be encouraging, coaching and following up on the treatment recommendations of psychotherapy and lifestyle changes. So what's the first most applicable universal lifestyle change that you'd like to talk about?
Well, you know, we have a small list. I'm not going to say that they're in order of the best to the worst. They're kind of just in a random order. But to me, we're going to start with exercise.
Oh, yeah. I mean, this is a big one to the extent that I would say there are at least there used to be memes on the Internet lampooning this as a potential treatment for, say, depression. Why don't you just exercise? They would say mockingly of the people recommending that. Well, the fact is it helps and the evidence shows that it does help. Now, is it easy? No.
Even without having depression or having some kind of a mental health issue, it's hard to get people to exercise. This is 2025 in the United States. It's not really built into our lives.
Yeah, you bring up a great point. And we're not just saying, I guess to emphasize, we're not saying exercise, that's going to treat your depression. The truth is these things are difficult. And I liked what you had said in an earlier podcast is that, yes, exercise is difficult and you should... still like you should be taking medications and exercise is helpful um so you know these these things yes they're challenging and when patients are experiencing high depression high anxiety getting up and exercising may be impossible it may not be something that's that's possible and that's that's why medications are a part and we're not saying exercise is going to replace these things um but It has such a crucial role in every aspect of mental health.
Exercise helps mood. It helps anxiety. It helps sleep. It just is such a crucial pillar of your health.
Yeah, and not just mental, right? It's obviously fundamental for your physical health. So it's sort of win-win if you can do it. Now, common perils and pitfalls, I would say setting your goals too high. I recommend that people just go as low and as easy as they're willing to do at start. I don't care if it's five to ten minutes of walking outside. once or twice a week to begin with, or even once a month.
What's more important is getting used to new habits, I think, in terms of getting there. And once you make a change, you can make more changes, slowly but surely.
Yeah, you bring up a great point that... A lot of times what you see, I mean, especially around New Year's, people will go and they'll do an hour and a half physical routine and it's horrendous and their body is in so much pain afterwards and they're so punished for what they had done that it's an activity that they're not going to keep up. And the important thing is regularity.
I would rather a patient do a two-minute walk outside five days a week then do something that's not sustainable.
That's right. And so, you know, I think a very related recommendation then to the exercise issue is behavioral activation. And the approach to behavioral activation can also help people with getting to a little more exercise.
Yeah. I guess let's... So behavioral activation, which is one of our core tools for helping in our list, let's put it inside of our exercise. So can you tell me a little bit more about what behavioral activation is?
I mean, you can have an academic or official definition of this, and if you want that, you can look it up in the various manuals or workbooks. But in short, I would describe it as setting small goals to either get you back to the activities that you were doing before, or getting you to new activities that you would like to be doing. And even... Before the activity issue, I think the most important part of behavioral activation is the practice of setting up goals and then achieving them.
OK, I know it sounds silly, but even doing that can be an encouraging process. It's a process that can give someone who's been chronically demoralized a sense of capability, power. you know, hope. And that's why I think it's really important to start small and ramp up because in most situations, when someone's at the point that they're coming to a clinic for treatment, they've been having a lot of problems and they don't have a lot of hope or they maybe they grew up in an environment where people are not giving a lot of validation in general.
It's not something that they're used to. So whatever you can do to support growth in terms of making small goals, keeping them and achieving them, it'll help move people along.
Yeah. And, you know, in regards to how I think of behavioral activation, to me, the crux is that what we do in our behaviors has a huge impact on how we feel. So when we get depressed or when we're anxious, our brain tells us our brain is like in a mode that wants to isolate. It's almost like a hibernation mode where you want to just stay in your room under your covers and Now, the problem with that is that when you stay in your bed under the covers, you're not doing things that bring you joy.
By not doing activities you enjoy, you're making yourself more depressed. So it creates a feedback loop where you're depressed, so you stay in bed. You're in bed, so you get more depressed. And behavioral activation is trying to break that feedback loop. And what it's trying to do is it tells you... You know, on a normal state, you go like, oh, you know, once I'm once I'm feeling better, I'm going to go outside or once, you know, it's Friday night and it's, you know, I don't feel good.
I had a bad week. I'm just going to stay inside. Well, behavioral activation is trying to tell you that you're not going to it's not that you wait to feel better before you do things. It's you have to do things to start feeling better. So it's really flipping the script in that. You decide you're going to engage in activities and take on activities before the motivation kicks in.
You're going to do and then the feeling will come later.
Yeah. Yeah. Psychologically, it's normal, right? It's human to feel that. So the way around that our behaviors are preceded by feelings yet. Feelings are also preceded by behaviors. You can flip it on its head and you can do differently. Now, one area that I recommend also is that a lot of reasons, one big reason why people don't act is because they expect something bad is going to happen and that can be simply in terms of how they relate to themselves right a lot of people are going to judge themselves or feel negatively if they plan to do something and they don't do it or if they don't do something quite as well as they hoped that they would right so not only should you set small achievable goals to begin with i also encourage patients to act anticipating failure.
I want you to plan these goals with the understanding that you may not follow through with them, and that's okay. Simply putting the goal down is the first step. And then maybe you only walk for five minutes instead of 30 like you wanted to. And that is an achievement. The point isn't to get to the outcome, but to engage in that process of setting goals and trying them and then feeling the things that you feel, but then continuing regardless.
Yeah, that's great. And, you know, emphasizing that part really shows that you're trying to break that cycle and that it's, yeah, it's not going to be as simple as going out and getting everything perfect. It's just kind of getting outside of the bad things that your depression is telling you you should be doing. Or not bad things, the unhelpful things that your depression or anxiety is telling you that you should be doing.
Yeah. Yeah. It's more about changing the process of thinking and feeling than achieving a specific outcome.
Yeah. Okay, so you mentioned that you feel like this should precede talks about exercise.
Oh, well, not necessarily. I just mean that it's extremely related. I mean, they're basically the same thing. The way I operate clinically is that I began to talk about both at the same time. I suggest exercise, whether that's getting outdoors for some light exposure early in the morning or just some short walking around as one possibility. But whatever goal they're willing to do, whatever activity they're willing to do is fine with me.
And I'll ask questions like, what did you used to enjoy before you felt this way in the past? And if there's no good answer there, what would you like to enjoy? What would you like to be doing? Those are the kind of things that we can ask in order to figure out reasonable goals or endpoints for the behavioral activation.
Yeah, and trying to get people to do the things that align with their values is a part of the behavior. There's a really good, which I'll link, PDF for behavioral activation that sort of outlines the things that you're talking about.
And that probably leads us to the next thing, socialization.
Well, I think we should finish up. We should talk a little bit more about the exercise and some little tidbits in regards to why exercise is helpful. I think one thing that's crucial, and we kind of talked about it, is finding an exercise that you find enjoyable and that is entertaining in some regards. I think a lot of people think of exercise as, oh, I need to go out and run, or I need to go to the gym, and it's going to be an hour of just difficult, difficult stuff.
And I think it's so much more important to have a regular routine of something that you enjoy. And finding... And I talked about this earlier and it's sort of related to behavioral activation is paying attention to how you feel afterwards with these exercises. Like if you go for, if you do a round of yoga, of light yoga, or go for a walk outside, paying attention to how you feel before and after.
And a lot of times if it's something that fits, you feel much better after these things.
You know, it's a great it's a great piece of advice if it's achievable. Right. If people enjoy it. That being said, I I guess I'll differ a little bit. I don't want to set people up to expect to enjoy things at all. I hope they enjoy it. But I want them to act without the expectation of enjoyment. So I just I just base it off. What are you willing to do?
What are you willing to make a change about? What are you willing to do that's different than before? And yes, ideally, if you have implicit enjoyment, that's really good. I like them to find the enjoyment on their own rather than setting up the expectation of it. But yes, you know, walking around outside, it's not just the physical movement that can be enjoyable, right? It could be the sunlight, it could be what you see around you, the people or the animals that you see, the nature, depending on where you live.
Exercise might not just be enjoyable from the endorphins that you get from the gym. It could also be that sense of achievement. So, you know, anything that anyone is willing to do, that's what I go for. And on the topic of socialization, you know, there's also the possibility of increasing your socialization in conjunction with exercise or other behavioral activations.
Yeah, and I was actually about to jump into that. I was going to make two points. The first is, you know, sometimes people ask, like, what's the optimal exercise I should be doing? Should I be doing cardio? Should I be doing weightlifting? And to me, like, I'm sure you could find research giving you the perfect thing you should be doing. I don't think you should be doing that.
I think you should be doing the thing that kind of you said that you're willing to do and that you I know you mentioned the enjoy, but the thing that you find the most enjoyable or the most thing that's easiest to get done. Yeah. It's so much better to go for a walk five times a week than it is to plan to get that perfect exercise, but it's not actually going to get done.
Yeah, as they say, never letting perfection be the enemy of the good.
Absolutely. And to your point about socialization, the only thing that allowed me to keep up with an exercise routine was was an exercise partner and it's not you know so i have a friend that we don't go and exercise together but we made a plan i mean i'll just say exactly what we did so first we said this week we need to run six miles and then we would just text we would send a picture every time we ran any amount and at the end of that week You know, we complained together.
We got, you know, pumped up together. We shared music. We listened together. Then at the end of that week, we said, what should we go for this week? And we set the goal for six because we barely made it. And it's something we've kept up for months. It's such an enjoyable thing to have someone to complain to, to have someone to celebrate your wins on weeks that I'm like, I'm not going to get it done this week.
He motivates me and vice versa on weeks that he's not motivated. And it really... uh helped deepen our friendship uh which was a you know a secondary aspect of of that process but uh it's been one of the most fulfilling things i've ever done in my life is just plan to run a small number of times each week with a friend yeah i
mean that's a very nice uh clear and concrete example of why socialization is important right uh it not only reinforces or helps support um certain healthy behaviors there is a reward in itself the relationship And I think it's tricky because when we talk about socialization, I think we have to acknowledge that for a lot of people who are out there in mental health care, a lot of that is because that for much of their lives or in their current lives, the relationships are not necessarily where they should be or where they can be.
You know, they're not necessarily getting what they need out of the relationships. So what do I recommend? I recommend that if your existing or past relationships were not safe enough or not giving you what you need, then the work has to be done eventually to find new relationships or build new ones. One way to do that is through shared activities, right? Volunteering, exercise. It doesn't really matter.
But I will say it's a challenging one. But ultimately, human beings are fundamentally social animals, you know, as babies without a loving relationship from a parent. I'm not talking about food and warmth. Without love, even if you give the material necessities to the baby, the baby will die. There will be failure to thrive. So it's a fundamental need of human beings, other people. And a lot of our changes that we need in our mental health and our lives cannot be achieved without the interaction of another person.
Yeah, and to expand a little bit about what you're talking about, before it used to be thought that human needs were drinking, eating food, and that attachment was really just a secondary thing that was a nice little add-on. John Bowlby's work showed that the attachment system and the need to attach and have relationships is, as you mentioned, a human need. It's not just an add-on thing. You know, we are social animals and we need to like we function.
Depression is an is almost a guaranteed consequence of a lack of socialization. I also like Panksepp's work who he talks about. the different emotional systems of human beings. And he formulates depression as an over-activation of the grief system. And that depression occurs when the system that's supposed to be activated when you're separated from a loved one or a that depression is an overactivation of that system, even in the absence of a tangible social loss.
Isn't this just Freud's mourning and melancholia? Yeah. Exactly. Except in a behavioral framework.
Well, you know, that's what we do. We repeat history, but it's a good point. In whatever language you put it in, I believe there's a lot of truth to that concept that depression is about loss, loss of something, especially and usually other people.
Yeah. So you talked a little bit about the difficulties of implementing you know like it's not you can't just prescribe socialization um so yeah what are things in your clinical experience that have worked to increase
socialization yeah i mean again it has to go off willingness and this is a real challenge for people with trauma disorders right because uh their real experiences and the trauma disorder work together to discourage other people but that is an element of the disease And this is the case also for things like anyone with social anxiety or people who have had just other difficulties in their lives where they've had difficult experiences with others.
So what can we do? Well, the number one thing is I want them to identify for themselves something that is objectively safe, that they trust effectively. The people to be at least basically not aggressive and basically OK to spend time with. And it's just anything with other people. I wanted to look at volunteering. I want to look at support groups, group therapies, anything, anything, you know, any religion of your choice, any religion.
Sport club, anything. So there's no direct recommendation I will ever make. I may suggest those categories to sort of jog the thinking of a patient, but it needs to be something that they can find themselves, decide upon, and feel comfortable with.
You know, all the things you brought up were things that, like in med school, I had to do some volunteer work. And in residency, I had to run groups. And before both those things, it was like, oh, I hate it. Like this stuff, what a pain. Like I just want to be studying and getting my work done. And I loved both experiences. The depth and relationships that you can develop in groups or, you know, the gratification in volunteer work and talking to people that, you know, in my day-to-day life I don't typically talk to was so gratifying.
Yeah. And, you know, it's kind of, I have noticed, I think there's a Automatic protective effect because of the baked in socialization for people who are engaged with work and school, you know, it's sort of in there for you that you can socialize. Uh, they don't even notice it necessarily, right? And it can even feel negative at times. And yes, real socialization is going to have negative experiences alongside the positive ones.
But if you're not in a place in your life where that's a regular thing for you, in-person socialization, then unfortunately you will have to find something. But I think that as long as it's safe and it's something that you feel is manageable, it's going to be beneficial. This is, of course, an extra challenge post-pandemic and in our increasingly digital and isolated world. But try and find in-person activities with other people.
You'll find, I think, that it's going to be different and it's going to help.
Yeah, and I don't want to go too far off the rails with this comment, but something that, and I'm not sure this is going to apply to everyone, but that was a part of me getting older and, I think, maturing, and that was really challenging for me, was... Letting go of old friends that I didn't feel connected to anymore to make room for new friends. Which is something that was really challenging for me was, you know, having old friends that I didn't feel that sense of connection with, even if I was spending time with and I felt distant from.
And it was challenging to... move on from them and develop healthier relationships. And that socialization isn't just spending time with anyone. Quality time matters. I don't know if that's...
Yeah, I mean, I think it is related to something really clinically salient. Right. Let's say some this is, I think, very well understood in substance use disorders. Right. If your past relationships are all with people who habitually use substances, there is a huge risk in engaging in that kind of relationship again, unfortunately. And it may be something that you have to change about your life. You will have to find new friends, make new connections if you hope to successfully remain sober.
And we can't discount the difficulty of that. That's still a loss. That's still a loss of people. And that's why we're alive, other people. So it's challenging, but it's something that, can be done, should be done, and that you can work on clinically. It's not just how's the Prozac treating you.
Yeah, yeah. And then one last personal anecdote. The socialization that's been the most gratifying in my life recently was me and three friends that are similarly minded decided to do a Zoom session every Thursday night where we just talk about everything and anything. Yeah. It's such an impactful thing to see people with regularity and to feel like there are people that are rooting for you, people that are willing to listen to whatever the grievances are of your week, that can offer advice.
That regularity has so many benefits in regards to, I don't know, just everything. So, at first it felt very unnatural. It felt very cheesy. It felt very like silly group therapy esque. Uh, but we kind of got the flow of things and it's something that like we all look forward to immensely every single week is just sitting and talking about nothing. Sometimes we talk about really intense stuff, you know?
Yeah.
Yeah. Yeah. Anything that can be done to get you, the patient or your patient, the person to, uh, an experience with regularity with other people that is as close as possible to in-person that's what we want you know chatting commenting social media doesn't count zooms much closer right uh but whatever you can get to a group experience i
think is important yeah um you know before we jump to the next thing uh I don't know if this is something to include, but avoiding substances as one of the major things that can improve.
Yeah. I mean, I guess you could file that under... the medical side, I do in my head. But you could also say that's not something that I'm prescribing you, but it's something that you have to make a change in your life. And yeah, you know, even occasional substance use may be detrimental to the process of recovery or the effect of medications, you know. Let's take the most popular ones today, cannabis and alcohol, right?
Alcohol, very well-demonstrated in its ability to cause depressive problems um any kind of over gaba inhibition i suspect slows the process of change and emotional reconsolidation and socialization uh and then cannabis you know there's arguments one way or the other but i think that with more data data coming out about heavy use It's generally not a particularly helpful thing. At the minimum, using it at high doses essentially puts you into an intoxicated state of delirium where you're not going to be able to consolidate your memories or put your thoughts together in the way that you normally do.
And those are sort of the tasks that you need to do day to day in order to get better.
Yeah, and the impact that these substances have, this is, I'm doing a lot of oversharing today. In my 20s was a pain, but in my 30s I found was actually really helpful. I'm super sensitive to sleep changes in that anything that impacts my sleep impacts my my my mood and well-being so much that it's not worth it and alcohol and cannabis they have a major impact on your sleep yes you take that and take them and you're able to fall asleep right away so sometimes subjectively people think that it's helping their sleep but the it affects your sleep quality drastically Which has a major impact on mood, well-being, anxiety.
Yeah.
Alcohol, you know, Z-drugs, benzos, cannabis, I would all put in the same category as things that make people feel as if they're getting better or sleeping when they're not really necessarily getting better or sleeping in the way that we're supposed to be sleeping in terms of brain waves and brain activities.
Yeah, so that should bring us to one of our next, you know, treatments beyond medications. I think we can almost group it together. Sleep slash sunlight.
So I believe, you know, to be honest with you, I can't keep straight things like this podcast and my teaching at different institutions. Have we talked about how I'm asleep for a psychiatrist? Yeah, we did a sleep episode. Oh, sorry, everyone. There was an entire episode on sleep.
No, no. But let's let's assume let's assume not everyone listens to everything.
OK, fair enough. I'm asleep for a psychiatrist. I think you're going to find that if you stabilize sleep for a patient, they're going to get a lot of their mental health better on their own because there's a lot you can't do in terms of the other activities we just talked about if you're not sleeping correctly. So anything that can disrupt your sleep needs to be mitigated or removed from your life.
And if there is something medical that needs to happen to help the sleep, that's also something really important. Now, that's covered extensively with things like sleep hygiene and sleep medications in a separate episode. But, you know, it's just the day-to-day cycle, right? You need to be sleeping at night. And how can you help the sleeping at night? You also need to be active during the day. And that includes biological issues such as light exposure, right, which we know regulates the sleep-wake cycle.
So if you can get some light exposure and activities at the same time, especially early in the morning, that's going to be really a boost.
I've never heard the expression sleep for a psychiatrist. I do like that. Yeah. And the impact of light and regulating your circadian system is such a big one that's really underappreciated. Just the impact going outside for a short period, especially in the morning, can have on someone's mood. Andrew Huberman, this podcast, it's almost like a meme at this point where It's like 15 minutes of sunlight within some time waking up.
Such a massive impact on well-being.
And, you know, it's because what do I do here? I like to recommend things that weave into other things. I like to recommend treatments that are already accessible and are low harm and low cost and light exposure. can therefore be weaved into your sleep regulation and your behavioral activation and your exercise. You can do them all at the same time. Fantastic.
Everything is weaving into everything. Integration. Oh, I forgot. We haven't integrated in a while. Yeah, so I think... Yes, getting outside, getting sunlight... You look better. You feel better. It's an important thing.
Yeah. Did we have another one on the list for this brief overview?
Yeah. Meditation and mindfulness.
Oh, yeah. This one probably feels a little more esoteric to most people. But, you know, if you're not already aware and you might be. Mindfulness and related practices have been integrated into and basically evidence has been gathered for its effectiveness in psychological treatment since around the 80s.
Yeah, and one thing I don't like in terms of what I would see with how it was utilized when I was in the hospital, it felt like it was like this cutesy thing. Like, oh, let's all close our eyes and imagine we're at Cancun and feel better for a second. And to me, it's such a different practice than just like relaxing and feeling better.
Yeah, I mean, that's because of the that's because it has been framed and researched as relaxation. to some degree. And it's just written about and published about and practiced so differently from group to group, person to person that I think there's a lot of confusion. So I believe we are planning to do a mindfulness specific episode later on, but we'll do the short version today. I guess a lot of people come to mindfulness today with sort of baggage, right?
Uh, they maybe tried it before they were sold something like an app that was going to do mindfulness or they think it's listening to a YouTube video, um, with ocean sounds or guided meditation. Uh, mindfulness is actually something that's a lot more specific and technical, but also a lot simpler and accessible than I think people give it credit for. Uh, In short, it's deliberate attention to the present moment without judgment.
Any activity that you do that can facilitate that can potentially be mindfulness practice. So that can be sitting, that can be walking, that can be noticing things. There's so many different ways that this can be done. But to avoid people getting too worked up about it, I would say that Don't expect it to make you feel good, because if you do, that's putting pressure on yourself. And don't expect yourself to try it in a way and do it perfectly.
Expect to fail. And also try to do it just briefly and with some regularity. Once or twice a week, five minutes to start. Don't overexert yourself. So I know I'm saying a lot of the same things I did with the exercise, but I think they also apply to starting mindfulness practice.
Yeah. And to me, you know, a big part of mindfulness is just understanding how our mind works. You know, I think before having a relatively regular mindfulness practice, your thoughts come and your thoughts and emotions come and it feels like they're factual truths and things I need to respond to. And to me, mindfulness is developing more of a relationship with just the observer. Michael Singer has this little exercise where you close your eyes and you say, hello, hello, hello.
And I'm probably going to butcher this, but the part of your consciousness that receives the hello, that is the observer. Yeah. And by developing a closer relationship with the observer and not the objects of consciousness, not with the thoughts, the urges, the emotions that pop up in that observing space, you develop just a little bit of space between your responses and you get a lot more degrees of freedom with how you respond to those things.
It's played such an important role in regards to relationships. You know, I still... The anger gets the better of me or bitterness and I do stupid things following those emotions. But through a mindfulness practice, I'm able to occasionally observe those things as objects of consciousness and get some space from them and respond in ways that are more aligned with my values.
I think part of the problem is that there are so many different mindfulness practices, even if they all have the same core basic idea. And then there are ones that are kind of related to mindfulness and our types of meditation that are often lumped in together, even if they work differently and are different. And in terms of the effects, the effects are actually pretty broad, right? You might find yourself having more of an observing ego, as you mentioned.
You might find that you have less of a running internal monologue. You might find that you begin to feel more emotions or feelings about yourself or others that are either positive or something else. So it's a really broad category, you know. Similarly to exercise, you know, there's a marathon and there's walking around the block for 10 minutes with mindfulness. There's paying deliberate attention to the present moment with breath counting for five minutes.
And there's going to a three day silent retreat. Right. There are degrees. You don't need to be going to the expert level stuff. Just need to find something that works for you under certain parameters and is relatively either rewarding or just at least not terribly painful.
yeah definitely um i'm curious uh in in your clinical practice how have you um broached or provided like psychoad surrounding mindfulness yeah i mean speed is key
right when you have a mostly medication management type uh practice they don't allow you to get more time with patients so what do i do um i think the simultaneously most concise and also uh diverse set of mindfulness type exercises are available within the dbt framework dialectical behavior therapy their mindfulness module has a lot of different things that you can do that are of different types and since everybody's a little different in how they respond to certain activities then i tell patients go through this list try all them out see what works for you and i want you to and i teach them about mindfulness what it means how it works perils and pitfalls we'll do that in another episode and i say Can you start doing this for about five minutes a week?
What day of the week, what time works best for you? Sometimes you're not going to be too stressed out. Sometimes that you're not going to be, uh, you know, bothered and don't do this to feel better. Do this simply to do it. That's kind of the short version. And, um, I just track that like I would any other non-medication goal the next time I seem like, so how'd that go?
What was that like for you? How did that feel? Oh, you didn't quite do it. That's all right. Would you be willing to try again before the next visit? Build that into your schedule. Small things like that.
Sorry, just to get into the specifics. So you mentioned like going through the DBDs. Are you talking about the – do you tell them to get the DBT skills training manual, like a DBT workflow?
Well, no, not the training manual because they're not clinicians. It's going to be too detailed. The DBT skills training manual does have a set of handouts that you can give patients. So I might give them those handouts. I've done that. If they want or need something a little bit more directed, there are DVD skills workbooks, tons of different ones. You can look through them yourself as a clinician and figure out which one you like best.
Yeah, one or the other. Basically, DBT has four modules and the mindfulness module, the core module, can easily be a quick introduction, accessible introduction to mindfulness practice. But I'm sure there are many other options. You can pick which one appeals to you as a clinician.
Gotcha. Yeah, so what I meant to ask was, do you do like the Marshall Linehan handouts and worksheets or do you do like the DBT workbooks that are...
The answer is both. I probably prefer people do a workbook, even if it's Linehan workbook. There is a Linehan workbook under the main, I believe, under the main DBT publication. But, you know, it's all the same skills, whatever they can get their hands on. And if they can't get their hands on anything, then I'll say, OK, use these handouts and we'll work through them together to some degree.
Okay. So, yeah, to recap so far, we've talked about exercise, behavioral activation, socialization, sleep slash sunlight, avoiding substances, mindfulness slash meditation. Last one is self-help books. Yeah. Do you have any that you particularly like and how do you kind of think about self-help books?
Yeah. I mean, this is clinically oriented for the self-help self-help and workbooks. There are now tons of workbooks that are based on the principles of various individual psychotherapies that are on Amazon at your local library, maybe. And certainly on certain less reputable websites where you can obtain the legal things. So I don't usually recommend a workbook unless I have gotten a good idea diagnostically of what's going on with a patient.
I still need to have a pretty good working idea of what their core problem is. But I can mention what I recommend to different types of patients. For melancholic depression, I like feeling good, which is now feeling great from David Burns. Um, for people who I feel like have a depressive problem and also maybe be, uh, they might be feeling a little bit lost or need direction or it could benefit from mindfulness.
I'll go for get out of your mind and into your life, which is a act text. Um, for OCD, I like to recommend freedom from obsessive compulsive disorder from Grayson or the self, I believe it's called the self-compassion workbook for OCD. Mm-hmm. And let's see, oh, for executive dysfunction of any kind, and ADHD. There's Mastering Your Adult ADHD or the Executive Functioning Workbook for Adults. There's probably more that I'm not thinking of here, but yes, I basically go for problem-focused.
If I've identified a specific clinical issue and I think there is a suitable workbook, I'll encourage people to work through it alongside the work that we do in sessions.
I think it's funny that we have almost the... Like, independently have come up with the exact same book recommendations. Very similar. So, yeah. For... I really like the David Burns feeling great. It is a little difficult... to get through. Someone has to be really motivated. And with all these workbooks, you get out of it what you put into it. And they're not that easy to put a lot of effort in, especially if you're feeling depressed.
But I recommend them a lot for friends and family that aren't seeking medications and that need a little bit, are asking for recommendations for mild anxiety or mild depression. I also like my ACT go-to book is The Happiness Trap. I don't know if you've come across that one. That one's really, really good. I think of ACT as a little bit, it integrates a lot more mindfulness. I find it to be a little bit more, you know, about self-compassion.
And it's a little bit, I'm trying to think of the word. like gentler than cbt in my opinion my opinion um for panic attacks david burns when panic attacks is great it's not too dissimilar from feeling great similar principles um the ocd workbook i typically go to is the one with it's just called the ocd workbook it's got like orange on the top uh i think it's hyman is the the author um um adhd yeah mastering adhd is excellent um i actually made a video that kind of goes through summarizes all the um recommendations um one kind of pro tip by the
way if your patients um find it a little bit dry or difficult to get through some of these workbooks many of the workbooks not all of them i know get out of your mind into your life has this they have a version for teens okay it's got pretty much the same content and even if you're an adult okay i think it's a lot more fun to read it because it's kind of cute you know the way it's written it's geared towards teens to give you little teen scenarios it's like it's just lighter reading honestly i i find the One for teens, get out of your mind and into your life personally.
I like it more than the adult one. I think Hayes is a little dry. He's a brilliant guy, but he's pretty dry.
That's a very funny recommendation. I like that. All right. So our last recap, we talked exercise, behavioral activation, socialization, sleep slash sunlight, avoiding substances, mindfulness, and then self-help books. Let's see. So our list is about seven.
Yeah. I mean, there's probably more. Right. And ultimately, I think the fact is that all mental health conditions are sufficiently complex that our whole person in our lives are implicated. And so you can't just settle on one medical treatment, medication or psychotherapy. You got to make sure that whatever is going on The positive effects from those aspects are being carried through into deliberate changes that you're making in your life.
So that's basically a take home here. It's the biggest pillar of the three pillars in a way.
Yeah, and another big, big takeaway is that our body loves, like, we evolved in rhythms. We evolved in that there's a night and a day. There's seasons. The, you know, the tides. Like, everything has rhythms and regularity. And our body loves rhythm. patterns our body loves uh keeping things consistent um a lot of these things has to do with developing like patterns and and and rhythms to your day um that's you know i think that's such a crucial overarching thing across all these kind of
things that we've talked about definitely um i guess then i'm gonna end based on that with a famous quote um For everything there is a season and a time for every purpose under heaven. Well, I hope this was a helpful one for people. As always, like, subscribe, comment, share, etc. We'll see you next time. Awesome.
All right. Thank you for listening. We'll see you next time.