diff --git "a/Data/transcripts/4RFEkGKKhdE_20241225194907.txt" "b/Data/transcripts/4RFEkGKKhdE_20241225194907.txt"
new file mode 100644--- /dev/null
+++ "b/Data/transcripts/4RFEkGKKhdE_20241225194907.txt"
@@ -0,0 +1,3508 @@
+welcome to the huberman Lab podcast
+where we discuss science and
+science-based tools for everyday
+[Music]
+life I'm Andrew huberman and I'm a
+professor of neurobiology and
+Opthalmology at Stanford School of
+Medicine my guest today is Dr Victor
+Kion Dr Victor kerion is a professor and
+the vice chair of Psychiatry and
+Behavioral Sciences at Stanford
+University School of Medicine he is one
+of the world's foremost experts on
+post-traumatic stress disorder in
+particular the treatment of
+post-traumatic stress disorder in
+children and adolescen although his
+knowledge and today's discussion
+certainly extends to adult PTSD as well
+Dr Karen is also the director of the
+Stanford early life stress and
+resilience program and today's
+discussion focuses on the psychological
+and the neurobiological underpinnings of
+PTSD and which treatments are most
+effective for PTSD we focus heavily on a
+particular therapy called Q centered
+therapy that was developed by Dr kerion
+and colleagues that has been shown to
+offset the triggering by words or events
+or memories that often are the
+precursors to PTSD episodes and this has
+been shown to be effective in both
+children and adults today's discussion
+explores the difference between anxiety
+stress and Trauma we talk about how
+those things of course are related but
+how they can be separated out to better
+understand if indeed somebody has trauma
+and how to best approach the treatment
+of that trauma as you'll soon see what
+makes Dr kion's work so unique is that
+it combines the psychological the
+neurobiological but also practical tools
+such as mindfulness it relates
+mindfulness and cognitive behavioral
+therapy to the underlying biology and
+what's known about the Psychiatry and
+psychology of PTSD at its different
+stages depending on the trauma the age
+of the person Etc today Dr Kon clearly
+explains all of that so that by the end
+of today's conversation you'll really
+understand what PTSD is and is not and
+of course the best ways to treat it
+before you begin I'd like to emphasize
+that this podcast is separate from my
+teaching and research roles at Stanford
+it is however part of my desire and
+effort to bring zero cost to Consumer
+information about science and science
+related tools to the general public in
+keeping with that theme I'd like to
+thank the sponsors of today's podcast
+our first sponsor is eight sleep eight
+sleep makes Smart mattress covers with
+cooling Heating and sleep tracking
+capacity I've spoken many times before
+on this podcast about the critical need
+for us to get adequate amounts of
+quality sleep each night that's truly
+the foundation of all mental health
+physical health and performance and one
+of the best ways to ensure that you get
+a great night's sleep is to control the
+temperature of your sleeping environment
+and that's because in order to fall and
+stay deeply asleep your body temperature
+actually has to drop by about 1 to 3°
+and in order to wake up feeling
+refreshed and energized your body
+temperature actually has to increase
+about 1 to 3° eight sleep makes it
+incredibly easy to control the
+temperature of your sleeping environment
+by allowing you to control the
+temperature of your mattress cover at
+the beginning middle and end of the
+night and it turns out the ability to do
+so allows you to get the maximum amount
+of Deep Sleep slow wave sleep and rapid
+eye movement sleep at the different
+stages of the night I've been sleeping
+on an eight Sleep mattress cover for
+nearly 4 years now and it has completely
+transformed and improve the quality of
+my sleep eight sleep has now launched
+their newest generation of the Pod cover
+the Pod 4 ultra the Pod 4 ultra has
+improved cooling and heating capacity
+higher Fidelity sleep tracking
+technology and even has snoring
+detection that will automatically lift
+your head a few degrees to improve your
+air flow and stop your snoring if you'd
+like to try an eights Sleep mattress
+cover go to 8sleep.com Huber
+to save up to $350 off their pod 4 ultra
+eight sleep currently ships in the USA
+Canada UK select countries in the EU and
+Australia again that's 8sleep.com
+huberman today's episode is also brought
+To Us by betterhelp betterhelp offers
+Professional Therapy with a licensed
+therapist carried out entirely online
+I've been doing weekly therapy for well
+over 30 years initially I didn't have a
+choice it was a condition of being
+allowed to stay in school but pretty
+soon I realized that doing regular
+quality therapy is an extreme important
+component to overall health in fact I
+consider doing regular therapy just as
+important as getting regular physical
+exercise including cardiovascular
+exercise and resistance training which
+of course I also do every single week
+there are essentially three components
+to excellent therapy first of all
+excellent therapy should provide good
+rapport with somebody that you can trust
+and talk to about all issues in your
+life second of all it should provide
+support in the form of emotional support
+or directed guidance or both and thirdly
+expert therapy should provide useful
+insights insights that can allow you to
+do better not just in your emotional
+life and relationship life but of course
+also your relationship to yourself your
+professional life and all of your career
+and life goals with better help they
+make it very easy to find an expert
+therapist with whom you can build all
+three of these effective components of
+therapy if you'd like to try betterhelp
+you can go to betterhelp.com huberman to
+get 10% off your first month again
+that's betterhelp.com
+huberman today's episode is also brought
+To Us by waking up waking up is a
+meditation app that offers hundreds of
+guided meditation programs mindfulness
+trainings yoga needra sessions and more
+I started practicing meditation when I
+was about 15 years old and it made a
+profound impact on my life and by now
+there are thousands of quality peer
+reviewed studies that emphasize how
+useful mindfulness meditation can be for
+improving our Focus managing stress and
+anxiety improving our mood and much more
+in recent years I started using the
+waking up app for my meditations because
+I find it to be a terrific resource for
+allowing me to really be consistent with
+my meditation practice many people start
+a meditation practice and experience
+some benefits but many people also have
+challenges keeping up with that practice
+what I and so many other people love
+about the waking up app is that it has a
+lot of different meditations to choose
+from and those meditations are of
+different durations so it makes it very
+easy to keep up with your meditation
+practice both from the perspective of
+novelty you never get tired of those
+meditations there's always something new
+to explore and to learn about yourself
+and about the effectiveness of
+meditation and you can always fit
+meditation into your schedule even if
+you only have two or three minutes per
+day in which to meditate if you'd like
+to try the waking up app please go to
+waking up.com huberman where you can
+access a free 30-day trial again that's
+waking up.com huberman to access a free
+30-day trial and now for my discussion
+with Dr Victor Kion Dr Victor Kion
+welcome thank you thank you so much for
+having me I'd like to talk today about
+PTSD post-traumatic stress disorder in
+particular in young people but also in
+adults but before we do that can you
+educate us on the definition of stress
+and maybe distinguish between short-term
+stress and long-term stress and then
+perhaps we can segue into PTSD that's a
+very good way of starting because in
+reality my main interest was the role of
+stress and the role of stressors and how
+stressors really would
+activate the gene makeup and make us
+vulnerable to things that we might be
+vulnerable um but at the time when I was
+training everything Psychiatry as a
+field was very diagnosis based so you
+needed an anchor and hence I use BTSD to
+communicate what I was really referring
+to but the reality is that the
+experience of stress as we now know is a
+spectrum from beneficial to not
+beneficial to traumatic so it really
+stress operates in our lives as an
+inverted ushaped curve The more stress
+we have the better we perform the better
+we do if we don't care about that exam
+that we're going to have tomorrow we'll
+probably fail so it's good to be so
+muchat stress right vaccines are a
+stress in the system so
+um we'll talk about this uh I hope but
+I'm very concerned also about the
+overprotection of kids to to protect
+them from any type of stress because it
+is through this experience of early
+stress that of us develop our problem
+solving abilities and we become aware of
+our coping mechanisms we become aware of
+our support system how can I manage that
+stress and we can we can manage stress
+because in the same way that through the
+process of homeostasis
+we process um we have a range of
+temperatures right in which we can live
+the same thing with stress we can
+actually cope up to a certain point
+after a certain point it's not
+homeostasis anymore and it turns into
+what we call allostasis when when it
+really starts having a physiological
+cost to the body so in that inverted
+U-shaped curve there's that optimal
+point where your health your happiness
+your performance everything is better
+because of the stress you've been having
+but after that optimal Point all of
+those outcomes Health performance start
+to decline happiness starts to decline
+and it is in that second part of the
+curve where we find traumatic stress
+traumatic stress being a type of stress
+that is not only something you have to
+cope with but it actually puts your
+physical Integrity in gibberty is a
+threat and and you have to manage that
+and when you experience traumatic stress
+many outcomes are possible one is that
+you're resilient and we'll talk a little
+bit about that as well I hope um but
+another one is that you may develop
+symptoms of post-traumatic stress
+disorder and the reason that I didn't
+anchor on the diagnosis right away from
+the outset and I was interest
+in uh studying stressors is because many
+kids we were seeing many kids that that
+had symptoms of PTSD without having the
+diagnosis that were demonstrating
+functional impairment so they were not
+doing well in school they were not doing
+well with their relationships they were
+experiencing distress right so their
+function was affected yet they didn't
+have have the diagnosis so the diagnosis
+is is good and that is there and and it
+it is a behavioral definition that we
+can anchor in but but there's more
+Nuance to that so then that that chose
+the whole the whole spectrum and of
+course we can come out of PTSD and we
+can go back to that optimal point so we
+don't want to get rid of stress but we
+just want to return to that optimal
+point
+and treatment is is available and and
+people can recover from PTSD and
+especially kids can recover from PTSD
+but there's one thing that really gets
+in the way and that's something that in
+my team we call uh we have a phrase that
+we say PTSD feeds on avoidance if we
+pretend that something didn't happen if
+we pretend that it will go away if we
+pretend that treatment is not necessary
+then and that that's when it gets
+complicated and he gets complicated with
+uh substance abuse he gets complicated
+with self-injurious behaviors and then
+at that point it becomes harder to treat
+is it also possible that PTSD gets worse
+if we tend to look at it um over and
+over again ruminate on it in the absence
+of any structured clinical support
+meaning if people perseverate on their
+traumas can the uh negative impact of
+those traumas actually uh root deeper
+into us it's interesting that you use
+the word perseverate because one of the
+characteristics of trauma when it
+affects children is that it robs them
+from play play is something that's
+essential in development is how we grow
+socially emotionally
+physically but when play becomes
+traumatic play it becomes non- joyful
+but it becomes pers
+and repetitive this is the attempt of
+the individual to try to make sense of
+what happened and the reason why it's
+not good to be alone with it and kind of
+perseverate on it by oneself is that
+we're probably not looking at the right
+insult so in our
+experience uh usually PTSD doesn't
+result from that one traumatic event
+we all carry a backpack and we can all
+carry all the stressors that have come
+our way like we were saying before but
+if you're five six seven years old and
+that backpack gets really heavy you can
+fall
+backwards and when you fall backwards
+that's because you don't have the tools
+really to carry that but what I'm saying
+is that that it is the
+accumulation of stressors some of which
+may be trauma atic that cuss the
+symptoms of PTSD so for
+example um some of us went to Haiti
+after an earthquake right and I was
+starting my program at that time I was
+very young already to talk about
+earthquakes and know everything about
+earthquakes it was the last thing they
+wanted to talk about they saw the
+earthquake as an opportunity to talk
+about the violence that had been
+experiencing the poverty the lack of
+education so they were talking to me
+about everything they were carrying that
+led some of them to develop symptoms of
+PTSD I see as you describe these other
+aspects of one's life that can have
+negative impact poverty violence Etc um
+I get the impression that PTSD can be
+caused by a single event or trauma but
+that there's a cumulative aspect to it
+so is it the case that in children
+because their brain is far more plastic
+we know this I mean brain circuits are
+modified even by passive experience in
+childhood whereas in adulthood it
+requires focused attention in order to
+learn unless it's a negative event for
+better or worse um that in kids it takes
+uh far fewer or less intense negative
+experiences in order to create PTSD
+because the brain is so plastic or is
+there a similarity between Youth and
+adult PTSD epidemiological study
+confirm what your assertion children we
+think we we usually you know one line
+that I really don't like is children are
+resilient because children are really
+not they're more vulnerable they have
+the opportunity to become resilient if
+we help them and we tell them what tools
+to use and how to develop and and all of
+that but they are more vulnerable to
+PTSD and part of it might be that
+neuroplasticity and and this is why we
+care for them right this is why we
+protect them and give them safety
+because they are
+vulnerable um by the same token that
+neuroplasticity can work both ways
+because if PTSD is teaching us that the
+environment can have an impact on
+biology that's the only lesson right
+environment can have an impact in
+biology in PTSD is a negative impact
+because of a negative stressor or
+accumulation of stressors
+but that also means that if the impact
+is positive as in a good supportive
+system or as in Psychotherapy that
+recovery can actually happen in an
+easier
+way before we talk about therapeutic
+interventions I'm curious about genetic
+predisposition and a topic that comes up
+a lot anytime the the letters PTSD are
+stated in that order um is transgener
+ational trauma I can imagine at least
+two forms of transgenerational trauma
+one
+is a generation of what are now
+grandparents or great-grandparents or
+parents are impacted by some trauma
+either in the family or maybe in culture
+or you know even broader
+scale and then discussions about that
+pass through generations impact the uh
+children and therefore their adult life
+I could also Imagine and I think this is
+normally what people are referring to
+when they talk about transgenerational
+trauma this idea that somehow The genome
+is modified by the trauma such that even
+if kids are raised by um parents that
+adopted them or they have no contact
+with the grandparents or
+great-grandparents that experiened the
+trauma that somehow they are more
+vulnerable to or in some cases the idea
+has been put forward carry that trauma
+put in air quotes such that their life
+is more difficult even though they never
+had a direct experience of that trauma
+what are your thoughts about
+transgenerational passage of trauma both
+forms both the narrative passage as well
+as the um potential for epigenomic or
+genomic passage of transgenerational no
+this is a very interesting uh subject
+the jury is still out if genomic changes
+that result as a consequence of stress
+can be passed from one generation to the
+other but certain certainly the genes
+that made one generation vulnerable are
+being passed to the Next Generation as
+well that we know so it can be passed
+that way um but what happens is that
+there's also this impact of learning and
+I have treated kids that come to me with
+all of the symptoms of
+PTSD and there's no trauma I cannot find
+the trauma and the parent cannot find
+the trauma and the kid doesn't reported
+trauma but when I'm talking with the
+parent the trauma becomes evident in the
+history of the parent so the parent has
+developed PTSD and behaves in a way that
+has been learned by the new generation
+ways like avoidance or
+re-experience or hyper vigilance or lack
+of trust you know things like that so
+certainly there are Pathways in which it
+can go from one generation to the other
+and and we know that the battle between
+nature and nurture is pretty much over
+right we know that that they both
+influence uh vulnerability and that they
+both interact and I imagine that's
+what's happening in in some of these
+situations in terms of stress you know I
+always think of stress as both a
+response within the brain and a response
+within the body and I'm not alone in
+that belief I I think uh we know that
+adrenaline epinephrine is released from
+the adrenals but also from areas of the
+brain like Locus culus so that there's
+this parallel effect of elevated states
+of mind more alert more focused on
+narrow locations in space and time and
+the body is also prepared for Action I
+think this is what underlies the
+increased heart rate the you know
+shaking in some cases sweating it's
+essentially a preparation for action
+with PTSD I often hear that some of the
+symptoms are more of the opposite end of
+the Spectrum in terms of autonomic
+arousal right things like
+dissociation fatigue um kind of checking
+out which I realize this dissociation
+but things that uh are more akin to kind
+of parasympathetic right for those that
+don't know the sympathetic
+parasympathetic represents the Continuum
+of autonomic interaction sympathetic
+having nothing to do with emotional
+sympathy it's all about um fight ORF
+flight type responses although at lower
+levels it's what's responsible for us
+being alert here but not in fight ORF
+flight and parasympathetic being more of
+the rest and digest even leading into
+sleep type responses so you know if
+somebody experiences a big stressor a
+trauma or chronic stress to the point
+where it becomes
+PTSD is there a tendency for them to be
+more hypervigilant and you know a start
+response um to uh have their head on a
+swivel all the time looking for danger
+or to be more dissociative or can the
+both sets of phenotypes exist in the
+same person yeah no this is very
+interesting well we're talking about the
+letters let me say that a lot of people
+call post-traumatic stress disorder
+post-traumatic stress injury not
+considering it a disorder but
+considering it something that where our
+fight or flight mechanism the autonomic
+nervous system has been
+desensitized and we need to regulate it
+again uh and it's going to hurt it's
+going to be painful it's just like when
+you break your arm and go to the
+emergency room and it hurts to be placed
+back in place but is the cure is what
+cures it so a lot of people visualize it
+I do as an injury rather than a disorder
+traumatic stress injury injury
+interesting and so what happens so these
+autonomic system gets activated we have
+our fight ORF flight reaction but what
+happens to a young kid because they're
+very little and they cannot fight
+they're also very dependent and they
+cannot
+flight so they're stuck they're stuck
+there so they freeze they freeze and
+that's dissociation it's actually during
+development a
+healthy um defense mechanism but very
+much like a white blood cell that's very
+helpful if you have too much of it you
+develop a leukemia you can develop
+dissociative disorders if that's the
+only thing you have but it does help
+children cope with some of the
+situations pretending this is not real
+or this is not happening to me is the
+only thing they have
+left um and because this arousal system
+is so key in the development of of this
+children um I thought that we should
+look at the hormone cortisol in in in
+the kids and and when I started when I
+was a fellow doing my shell Psychiatry
+Fellowship I was seeing all types of
+kids with all kinds of issues uh some
+had ADHD some had OCD some had PTSD
+symptoms but I was getting a lot of kids
+with notes uh from school saying this
+kid has ADHD please place on rolin right
+a stimulant
+medication and I'm like wow the
+diagnosis has been made there's already
+a treatment plan what am I training here
+for um but in some instances they were
+right you know the kids had ADHD but in
+most cases what happened is that that
+hypervigilance that you're talking about
+was being misinterpreted as
+hyperactivity and the dissociation was
+being
+misinterpreted as
+inattentiveness so the kids were getting
+a diagnosis that was not correct of
+course there are other very complex
+cases where you have both ADHD and pthd
+also ADHD can put you at risk to develop
+PTSD because you're not as attentive as
+to what's happening in your
+environment but there's definitely two
+different conditions and and it was that
+clinical observation that made me think
+well
+people don't know enough about PTSD and
+certainly they don't know enough about
+PTSD in children and we were having some
+research in adult around that time in
+terms of cortisol levels David Spiegel
+who you've had here raciel Yehuda the
+Bronx VA looking at PTSD in adults but I
+said but what how does PTSD look early
+on what's happening in the hypothalamic
+pituitary adrenal AIS that is
+responsible for secreting cortis
+and regulate cortisol uh when these
+children are young because this is a new
+access you know is is is it already not
+working or is it working right and so we
+did a number of studies that
+demonstrated that the normal circadian
+rhythmicity of cortisol was there it was
+higher uh early in the morning which we
+need to jump out of bed and as the day
+progresses it
+decreases uh very helpful it goes up
+when we are stressed like when we have
+lunch after we have lunch cortisol goes
+up right so that we can help manage the
+insult of digestion or or whatever uh
+and this kids were having those levels
+but something was happening uh in a
+number of studies and we noted that the
+pre-bedtime level was higher we were
+measuring it at different times uh in
+the morning pre- breakfast pre- lunch
+pre- dinner pre- bedtime but it was the
+bedtime level that wouldn't come as low
+as the healthy controls it would remain
+high and this was also important
+clinically because many of the symptoms
+these kids were having were happening at
+night anyes right bed wedding nightmares
+not sleeping deep enough not sleeping
+long enough um
+fears at that point I felt
+uh well we don't know anything other
+than the cortisol pret time is elevated
+right maybe they needed to be who knows
+uh but I was concerned about the work by
+sapolsky right and Bruce mchu and his
+mentor demonstrating the neurotoxicity
+that glucocorticoids can have in key
+areas of the brain areas in the lyic
+system and the cortical system where uh
+which interestingly enough have a lot of
+gluc coroy
+receptors so then uh we decided to look
+at brain structure and brain function in
+youth with PTSD symptoms and see how
+this cortisol would relate to that or
+not uh and we did that through MRI
+magnetic resonance imaging let's talk
+about cortisol for a moment it's a topic
+that has not received enough attention
+uh in previous episodes of the podcast
+I'm just going to summarize a little bit
+of what you said and you'll tell me
+where I'm wrong cortisol starts to rise
+just before we wake up in the morning
+assuming a good night's sleep and Peaks
+a maybe I don't know 30 to 90 minutes
+after
+waking for you slow risers like me uh
+probably a little delayed by the way the
+height of that Peak and the acceler the
+uh I would say the steepness of the
+curve can be uh increased uh by viewing
+morning sunlight we know this bright
+light increases that cortisol Peak it'll
+make you a better early riser but in any
+typically the pattern then is that it
+rises um through mid morning and into
+the early afternoon and then starts to
+taper off to lower levels and as you
+mentioned we'll see bumps in cortisol
+post meal if there's a stressor we get a
+disturbing text we get a bump in
+cortisol but these aren't huge Peaks
+unless it's a big stressor correct and
+then by evening cortisol levels in
+healthy individuals are typically low
+and that allows for transition into
+sleep among other things allow for
+transition into sleep but you said in
+these kids with
+PTSD cortisol doesn't come down to low
+levels as much as it does in healthy
+individuals um in the evening and
+nighttime and that I imagine would lead
+to perseverating on stressors from the
+day this kid was mean I have a test
+tomorrow maybe any stressor becomes more
+um intense in our mind and body as it
+were um and that perhaps could lead to
+issues with
+quality or duration of sleep which then
+could perpetuate this cycle do I have
+that correct correct okay so um has the
+direct intervention of just trying to
+suppress evening cortisol ever been done
+I mean certainly there are drugs that
+will do this um has that approach ever
+been taken I thought about that when I
+had those high levels but I I felt that
+we needed to understand better I I think
+I think yes that there were some
+attempts with some medications and I I
+don't think that led to anything uh in
+terms of of helping those kids um or
+just helping individuals in general that
+had high levels of cortisol because of
+of uh traumatic stress um but nighttime
+you're right it is a time when basically
+we fall asleep because we let it go and
+and this kid's hyper arousability does
+not allow them to Let It
+Go um so if these levels are high why as
+I was Finding you know what impact are
+they having in brain development and and
+usually the younger you are the more
+universally distributed receptors are so
+glucocorticoid receptors could be
+anywhere at that point but as as we age
+uh they become more localized and The
+glucocorticoid receptors and cortisol is
+a type of
+glucocorticoid um are more common in
+areas like the hypoc campus and the
+prefrontal cortex which I also found
+interesting because these areas relate
+to the symptoms right that that many
+individuals with PTSD have memory
+anticipation of the future problem
+solving context dependent problem
+solving so on and even those attention
+issues that make them overlap with kids
+that have ADHD as well um so this
+frontal limbic pathway the prefrontal
+cortex community ating with these
+emotional areas of the brain including
+the amydala which is very close to the
+hypoc campus um needed to be
+investigated in in in a pediatric PTSD
+and what I sometimes call Pediatric ptss
+because post-traumatic stress symptoms
+uh because as I mentioned there's a
+group of kids that have post-traumatic
+symptoms do not fulfill criteria for
+dsm5 PTSD
+but their function continues to be inair
+sometimes that's because um of
+comorbidity there's a high incidence of
+comorbidity with anxiety and depression
+so most of our studies that have look at
+PTSD symptoms also look at the impact of
+the interventions that we're doing in
+anxiety and depression as well I'd like
+to take a quick break and acknowledge
+our sponsor ag1 ag1 is a vitamin mineral
+probiotic drink that also includes
+prebiotics and adaptogens ag1 is
+designed to cover all of your
+foundational nutritional needs and it
+tastes great now I've been drinking ag1
+since 2012 and I started doing that at a
+time when my budget for supplements was
+really Limited in fact I only had enough
+money back then to purchase one
+supplement and I'm so glad that I made
+that supplement ag1 the reason for that
+is even though I strive to eat most of
+my foods from Whole Foods and minimally
+processed foods it's very difficult for
+me to get enough fruits vegetables
+vitamins and minerals micronutrients and
+adaptogens from food alone and I need to
+do that in order to ensure that I have
+enough energy throughout the day I sleep
+well at night and keep my immune system
+strong but when I take ag1 daily I find
+that all aspects of my health my
+physical health my mental health and my
+performance both cognitive and physical
+are better I know that because I've had
+lapses when I didn't take ag1 and I
+certainly felt the difference I also
+notice and this makes perfect sense
+given the relationship between the gut
+microbiome and the brain that when I
+regularly take ag1 which for me means a
+serving in the morning or midm morning
+and again late later in the afternoon or
+evening that I have more mental Clarity
+and more mental energy if you'd like to
+try ag1 you can go to drink a1.com
+huberman to claim a special offer right
+now they're giving away five free travel
+packs and a year supply of vitamin D3 K2
+again that's drink a1.com huberman to
+claim that special offer I definitely
+want to get into some of those
+interventions including some of the ones
+that you've developed that are very
+novel and are um being used to great
+success um I want to just circle back
+for a moment on this relationship
+between PTSD and in some cases
+inappropriate diagnosis of ADHD as you
+mentioned these two things can coexist
+in the same person um so we don't want
+anyone who has been told that they have
+ADHD um and PTSD or even just ADHD to
+immediately assume that that diagnosis
+is wrong based on what we're going to
+talk about but it is possible um that
+the a DHD that a child is told they have
+is reflective of PTSD and I imagine that
+if that PTSD arises through something in
+the family structure or dynamic it would
+be even harder to unmask because the
+parent perhaps would be less motivated
+to try and understand that if they
+played some sort of role in it so I
+realize this is a complex problem with a
+lot of layers but um if you were to just
+throw out a number based on your
+experience what percent percentage of
+pure ADHD
+diagnosis would you like to see explored
+for the possibility of a
+PTSD influence let's just keep it kind
+of uh diplomatic that way as opposed to
+saying what percentage of ADHD do you
+think is actually PTSD I firmly believe
+that ADHD does exist um I'm I'm going to
+say two facts that we know in the field
+one are kids getting over medicated it
+the answer is a clear yes they're
+getting more medications that they need
+for ADHD for for anything in general
+kids now in ADHD they're getting
+undermedicated so that's the second fact
+so the first one is that if we look at
+kids overall in the field of mental
+health those that manage to receive
+treatment which access is something else
+we should talk about because like 50% of
+them do not get access to Mental Health
+Services um those that manag to get it
+may end up uh
+with the appropriate treatment right a
+medication or a psychotherapy but
+there's another subset of them that will
+be medicated no matter what they present
+with because they need to be seen fast
+or is a fast solution so there's many
+reasons for that but are kids getting
+overmedicated yes but within those kids
+those the those that truly have
+attention deficit hyperactivity disorder
+are getting undermedicated and that's
+because of that access issue because
+most of them we're not identifying and
+that's a Pity because the first line of
+intervention for ADHD is stimulant
+treatment it does work and it works very
+well uh for children that have the
+correct diagnosis but the first line of
+intervention for children that have a
+history of PTSD be acute or chronic is
+psychosocial it's a psychosocial
+intervention so if you give a kid that
+has PTSD and know ADHD a stimulant
+medication not only is not taking care
+of ADHD because they don't have it but
+it adds to that hyper arousability you
+know that is manifested there from
+before by the way there are clinical
+ways of separating
+hyperactivity from this hyper oability
+and hyper vigilance hyperactivity if you
+see a kid that is not medicated and has
+ADHD and they have the hyperactive
+symptoms and the hyperactive type
+they're going to be hyperactive for most
+of the time that you're with them the
+kid that has hyper arousability it will
+be more of an on and off phenomenon the
+the hypervigilance and Hyper arability
+comes more when they're presented with a
+cue that consciously or unconsciously
+reminds their body of the traumatic
+event or the traumatic
+experiences um what happens though is
+that usually we don't know what those
+cues are right so we just see a kid that
+sporadically becomes um hyper Vigilant
+or
+hyperaroused and then the other thing is
+is hypervigilance something that needs
+to be treated you know I I learned this
+from a mother early in my career she's
+like I was giving some talk in the
+community and she came to me afterwards
+and she said listen uh we live in a
+street that's very dark and it's very
+dangerous and my kid has to pass through
+that every day I want him to be
+hypervigilant and if he has developed
+this trait of hypervigilance this is
+something that could be helpful to him
+and I said you're right I said you're
+right it's not only to him to a lot of
+people it could become very helpful to
+be hypervigilant to assess the
+environment in which they are in so the
+problem is not the hypervigilance the
+problem is knowing when to turn it on
+and when to turn it off having the
+cognitive flexibility right to be able
+to say yes this is a dangerous situation
+and I better respond this way if if I
+can give you an example of of of a kid
+right a kid that experiences domestic
+violence and has Associated that with
+noise in the in the house house learns
+that running and getting into the room
+is is a safe thing for them because
+they're out of the picture right and
+they protect themselves in the room but
+a year later they're in the classroom
+and for some reason the classroom gets
+this level of noise the body without him
+knowing right uh the body reacts by the
+response that was helpful this is
+classical conditioning right so he runs
+out of the classroom but he's missing
+the context the teacher is missing the
+context when the teacher sends him to
+the principal's office the principal
+doesn't have the context right that this
+response was actually adaptive at one
+point and helpful at one point and the
+body has had a hard time letting it go
+to ask that kid to give us the only
+response that he has is not the way to
+help him we need to help him develop new
+competitive responses so that the
+experience of the other responses then
+extinguishes that response that was
+adaptive at one point but now it's
+maladaptive by the way if they are in a
+traumatic situation again we still want
+them to use it right we still want them
+to run and get out of there it's part of
+that hyper vigilance that that's
+protecting them in a way it's so
+interesting uh you said if I understood
+correctly that in kids with genuine ADHD
+the hyperactivity is fairly persistent
+across environments and with different
+people Etc I'm sorry to interrupt but if
+I could add the in attention comes and
+goes because we all know kids that have
+ADHD that you if you give them the right
+video game all of a sudden they become
+attentive right right this is a very
+important Point uh when I did the solo
+episode on ADHD I was um frankly shocked
+to learn but it was validated by the
+literature and certainly by the
+responses from the audience that kids
+with ADHD and adults with ADHD for that
+matter absolutely have the ability to
+sharply attend to something if it's
+something that's very engaging to them
+really exciting something that they
+typically
+enjoy but their ability to direct and
+maintain attention in other environments
+that are required for normal life
+progression school work relationships
+Etc is very diminished compared to those
+without ADHD so what I have in my mind
+is a step function meaning a you know an
+increase in a steady state of
+hyperactivity in a kid with ADHD but
+then a jagged line beneath that of
+attention this is I believe the picture
+we're I'm painting here but that in
+PTSD the hyperactivity is a jagged line
+it really needs a Quee as you said um a
+loud noise or um maybe it's the presence
+of a particular voice I once attended a
+um a trauma um it wasn't trauma release
+as much as it was genuine uh trauma
+Treatment Center out in Florida a friend
+of mine runs this Center and I was out
+there learning about the practices they
+use in order to inform uh potential uh
+experiments for intervention in my lab
+back at Stanford and um and he said
+something really interesting he said you
+know when you bring people into this
+sort of environment and they they've all
+had trauma you see a pretty rich array
+of of responses um to even just the same
+conversation and then at one point
+perhaps because he said that I I noted
+that a woman raised her hand and she
+said that particular tambers of voices
+in the room were really activating her
+you know this was important it wasn't
+just what was being said it wasn't that
+people were yelling at each other or
+even the volume of the voices but that
+even just the the the frequency the the
+lowness or the highness of the voice as
+it were was triggering something in her
+brain that was giving her these bodily
+Sensations and it was a very um
+important insight for her to be able to
+then start to direct interventions so I
+guess we all hear that kind of now um
+stereotypical example of you know the
+the veteran who experiences combat comes
+back and he's a car backfire and then
+they hide that's kind we we read about
+this and hear about this but it seems
+like it's much more subtle than that
+that sometimes the cues for this uh
+hyperactivity this
+hypervigilance is um very much linked to
+something that sometimes even the person
+with PTSD doesn't recognize until they
+start to be put into that environment
+again and again and then they can
+pinpoint it my question now is if they
+can pinpoint what the queue is do they
+stand a better chance of recovery um as
+opposed to somebody that just like feels
+like I'm hyperactive then I'm exhausted
+I'm wired and tired and and now I also
+Imagine That in kids they don't have
+necessarily the verbal proficiency to be
+able to express what's going on for them
+and in fact many adults don't really
+know because we don't have a great
+language for expressing this body mind
+thing in any event a lot of questions
+there but um what are your thoughts
+about the requirement for being able to
+understand what the cues what the
+triggers are in order for a child Andor
+adult to be able to start to make
+inroads into their PTSD uh first a word
+on the Vietnam veteran because there's a
+very important study that was published
+years ago that
+demonstrated that those veterans that
+had a history of child Mal treatment and
+went to war had PTSD at higher
+prevalence than the ones that did not
+have a history of child Mal treatment so
+child maltreatment I see so they were
+traumatized before they went to combat
+and and maybe they did not develop PTSD
+but once again that point of the
+accumulation right of of the stressors
+at different times and I'm just
+mentioning that because you may have a
+veteran and you're waiting to look at
+the classical cues where in fact it
+might be more like a voice like the
+example that you were giving that
+triggers them what triggers an
+individual is very personal so cues are
+usually neutral and they're usually
+related to our senses and I know you
+like senses a lot so what we see what we
+hear you know all of these things the
+senses are really the the window to the
+central nervous system right this is how
+we get information the first time so in
+this state of hyper arousability when
+something traumatizing is happening our
+senses are really acutely aware of
+what's going on and they are making
+sense of the insult but they also are
+registering everything that's related to
+that so these cues usually are neutral
+so they're they're not like a gun for
+example because a gun is not a queue
+it's a threatening it's a threat right
+but it's usually a color so there was a
+red car part near where they were so the
+color red made may be a que maybe a
+trigger it was raining the day that that
+happened so rain may be a queue maybe a
+trigger and to answer your question
+identifying those cues are important
+because they let you know when your
+symptoms are coming they let you know
+that they're not coming out of nowhere
+they let you know that you're not a
+problem or that you're crazy or that
+you're bad which is sometimes the
+messages that kids get when they go to
+that principal's office okay but they
+let you know that they learned
+themselves this is a normal response
+right I've learned through my
+psychosocial intervention I've learned
+that this is a Quee that triggers a
+response from me triggers a response
+that was helpful at one time and through
+classical conditioning and we do teach
+classical conditioning to the kids those
+respon has then
+become uh present become conditioned
+right uh when the queue is there when
+the triggers there so yes to answer your
+question it is important to know the
+cues now what happens are we going to
+know all the cues to everything to all
+of our behaviors and this shift in mood
+that sometimes we have during the day
+and we don't know why right no the
+answer is no we're not going to we're
+not going to know all the cues but the
+beauty of this is that if we can just
+learn about one or two or three cues
+what our response is there's more of a
+forgiveness to ourselves in that when we
+respond inappropriately we can think
+well maybe I was exposed to a queue
+right because I've learned all of this
+about cues and classical conditioning
+maybe that's what What's Happening Here
+Yeah I'm thinking again about
+post-traumatic stress injury the reason
+I like that term even though I realize
+I'm using it
+non-clinically
+is that if we understand that the
+autonomic nervous system the seawing
+back and forth or this Push Pull between
+the sympathetic fight ORF flight and
+parasympathetic rest and digest Loosely
+speaking systems are always at play in
+us when we sleep more parasympathetic
+when we're alert and calm more
+sympathetic and when we're stressed or
+having a panic attack extremely
+sympathetic
+if we understand that as a biological
+system which it is that deploys hormones
+and shapes our patterns of thinking and
+what's available to us in our memory and
+Etc
+then ptsi post-traumatic stress
+injury I I feel like it liberates us a
+bit to understand that yeah this
+autonomic system has been disrupted in a
+way and if I think about the autonomic
+system as a seesaw which I often do and
+I think about
+the Seesaw having a pivot point with a
+with a hinge it's almost like the
+post-traumatic stress injury is to
+create the tendency for that hinge to be
+too
+tight and sometimes that makes it more
+like dissociative and we're exhausted
+and kind checked out and maybe it
+creates the hinge to be too tight such
+that we're more on the sympathetic
+excuse me sympathetic the way I uh for
+those listening I'm using my hands but
+you don't have to to see it to
+understand that the the the alertness
+system is locked in place it's hard to
+get out of that and I almost feel like
+the the injury that is post-traumatic
+stress injury is a tightening down of
+the hinge with the Seesaw tilted too
+much to one or the other side and I I as
+a biologist I I just wish that we
+understood what that
+disregulation uh was or is um chances
+are it's not one location in the brain
+or body it's going to be a network
+phenomenon but um I feel like the word
+disorder the D in PTSD is so critical
+because it highlights the importance and
+the pervasiveness of this thing but that
+the eye in post-traumatic stress injury
+hopefully will give people it certainly
+is giving me some some sense of um uh
+relief or Liberty and understanding that
+like these are nervous system injuries
+that um need treatment and that there
+isn't something wrong or crazy with us
+because of because of the fact that we
+you know suddenly feel like we're having
+a panic attack you know I've had people
+I know close to me in my life say I'm
+having a panic attack like what do you
+mean what what happened like nothing
+happened that's the point well how do
+you sleep well it's okay you know and
+you start doing the the curbside
+diagnosis that neither of us is
+qualified to do right but this is what
+we do as as caretakers for each other in
+our lives and it very well could be that
+their autonomic system just got that
+hinge is just locked in place for
+whatever reason reason maybe it's one
+sip too much of coffee maybe it's one
+sip too little it's probably something
+or a bunch of things does am I am I I
+realize I'm getting outside my expertise
+here because I'm not a clinician but I
+feel like this ptsi thing is is is
+sticky and important for for people to
+hear about it certainly changing the way
+that I think about
+PTSD yes no and I like the
+visualization of your seesaw and the
+example of the hinge because it it it
+reminds me of that cognitive flexibility
+right it's not there it's kind of stuck
+it's kind of tight too tight and and in
+some individuals they just experience
+the dissociation they're like stuck on
+on the bottom right sitting on the
+bottom on the seiso whereas for the
+other individuals they hyper arous all
+the time then you have everything in
+between but but no I that's a very good
+representation of it and I feel like a
+good night's
+sleep allows some recalibration of the
+tightness of that hinge put differently
+anytime we don't sleep well or long
+enough we're not good psychologically a
+good night's sleep is good for
+everything we're finally at the point in
+history where we where everyone seems to
+accept that I really have to tip my hat
+to uh Dr Matthew Walker from UC Berkeley
+for writing the book why we sleep you
+know it was only a few years ago that
+book came out and um he deserves such a
+token of praise for that
+because prior to that there was this oh
+I'll sleep when I'm dead mentality I I
+think people knew sleep was important
+but they didn't really understand and he
+had to come out as kind of the um kind
+of the downer message like listen you
+know this is serious stuff you better
+sleep you better sleep but I think we're
+there now I think in in in 2024 we're
+there I think people understand and I
+think people have their own experiences
+with sleep right we we've all felt that
+c
+that's coming and and if we really sleep
+those eight hours we may be able to
+fight it because we've strengthened our
+immune system if we don't we will get
+sick yeah
+absolutely well let's talk about some of
+the treatments that you use and have
+developed for PTSD in young people and
+maybe we should Define young people are
+we talking about you know the 18 and
+under just because that's typically what
+we think about so in pediatric uh
+Psychiatry we have three different
+populations we have the preschoolers we
+have the school age and we have the
+teenagers and they are all very
+different they all uh have responses and
+defenses that are very different the
+projects that I'm describing happen
+mostly with the school age uh school age
+children so preschoolers are going to be
+essentially I think of kindergarten
+starting at 5 so you're talking about
+zero more to to more or less five or six
+years old as the preschoolers
+kindergartener and then transition Point
+correct um and then for the kids we're
+about to talk about we're really talking
+about what six years old until about end
+of adolescence yeah 15 and and and then
+yeah then their teenagers later on okay
+so I work mostly with the school age the
+school age kids and like I said when
+when we started doing magnetic resonance
+imaging to look at the impact of
+cortisol we have a number of studies
+really demonstrating that those kids
+with higher levels of cortisol had um
+less volume of the hypoc campus uh the
+first study that we did in that was
+cross-sectional and there was no
+difference and it gave me a lot of hope
+that there would be a window of
+opportunity there where we could
+intervene uh because what we were seeing
+in chronic PTSD in adults was that there
+was smaller volumes of the hypoc campus
+which help us process memories and have
+strong connections with the emotion
+center of the brain the amydala and also
+with the prefrontal cortex and um and
+what what we found was that
+cross-sectionally there was not this
+difference but we also follow a small
+sample longitudinally and there we saw a
+correlation between that higher preet
+time cortisol and the smaller hipocampal
+volume uh more impactful was a
+functional Imaging study uh as as many
+of your audience members now with
+magnetic resonance imaging we not only
+can look at the structure but we can
+also give tasks uh of memory for example
+or of executive function and different
+tasks that tap at the at the areas that
+we are interested in looking uh so when
+we look uh when we give a memory task
+and we looked at how children with
+post-traumatic stress symptoms were
+behaving compared to kids that do not
+have symptoms or other Psychiatry
+diagnosis
+we were seeing that the healthy kids
+were activating a lot of more voxels or
+units of the Imaging of the of the haboc
+campus so so there was concern here that
+yes that plasticity that you talked at
+the beginning was really affecting the
+development of the brain of the kids and
+then with the prefrontal cortex we saw
+something uh similar in the uh ventral
+medial area of the prefrontal Al cortex
+so but with other tasks right with tasks
+of executive function or or tasks of
+emotion
+um looking at faces for example
+emotional faces all of this to say that
+they probably have a malfunctioning
+frontal
+striatal pathway and front olymic so
+front olymic I'm sorry so um
+if we think of the amydala for
+example in close proximity to the hypoc
+campus being involved in this
+hypervigilance and we have some data to
+show that the amydala becomes active
+very quickly when you present emotional
+faces uh to young kids um and that that
+hyperactive amydala needs a a break of
+some sort that break comes from the
+prefrontal cortex but if you have a
+prefrontal c cortex that's not working
+that well either then your break is not
+working right so so then the issue came
+here well this is important information
+to know what we need to Target with
+treatment and can we target this with
+psychosocial interventions and the way
+that we provide
+treatment and we decided to begin with
+what we discussed earlier with the cues
+right and uh teaching and having kids
+understand what cues are what classical
+conditioning is
+um talking to them about the impact of
+trauma talking to them about the impact
+of treatment and how recovery is
+possible right so an educational an
+educational piece and something that I
+never thought I would end up doing was
+developing a treatment right I I felt
+I'm here to invest investigate and use
+the treatments that we have but it
+became very clear to me that there were
+a population of kids that still needed a
+form of treatment that was not out there
+so most treatments out there for trauma
+were targeting one traumatic event and
+not TR targeting that backpack that
+allostatic load also and rightfully so
+most treatments
+were
+um requiring that the parents were
+involved in treatment as well I can see
+where that might be problematic when the
+parents perhaps were the source of the
+trauma and also when there's avoidance
+right and also when there's
+practicalities that if they lose one day
+from work they're going to get fired so
+so sometimes the parents are just not
+available and the kids are totally ready
+to begin and do the work so I I wanted
+them to be able to do so so how can we
+devise a treatment that is hybrid and by
+that I mean multimodal that is not only
+cognitive behavioral therapy but that it
+brings other elements that are important
+like
+self-efficacy
+empowerment Insight oriented work and
+give it a structure that uh can be
+tested and that's how we created Q
+Center Q being cue Q centered therapy
+for kids that have PT D SD and we've had
+a number of trials with them and it it
+helps uh decrease symptoms of anxiety
+symptoms of depression and symptoms of
+PTSD and not
+only as uh scored by the student but
+also scored by observers by the parents
+and in one of the trials where we
+measure actually how the parents were
+doing parents that were not
+participating in treatment their own
+anxiety was decreasing as well and
+that's is it to understand right if your
+kid is doing better you're going to do
+better as well um so so that was very
+very good to see but then we wanted to
+see that plasticity too is this some
+doing something to the activation of the
+brain and that's when we brought
+functional near infrared spectroscopy
+into the picture because it's cheaper
+than MRI and it's more portable and it's
+easier to do it only gives you cortical
+information it doesn't get into those
+interesting lyic structure
+so it's um just to uh just highlight for
+a second the fmri fun functional
+magnetic resonance imaging is wonderful
+because it allows a lot of um uh Imaging
+both on the superficial outer parts of
+the brain but also deep into the brain
+my understanding is that and perhaps
+this has changed in in recent years that
+the um spatial resolution can be very
+good you can pinpoint very small areas
+if you have a powerful enough machine
+magnet um the temporal resolution the
+ability to see changes in the neural uh
+circuit activation and deactivation over
+time at one point was somewhat limited
+but now some of those limitations have
+been overcome but then what you're
+talking about near infrared
+spectroscopy is excellent because it can
+be taken to a school right you don't
+have to you couldn't bring an fmri
+machine to a school unless it's a
+medical school where there's the machine
+um it's much less expensive the downside
+is oh excuse me and my understanding is
+that the spatial resolution isn't quite
+as high as MRI but the temporal but the
+temporal resolution is very high which
+is a huge advantage and then there's
+this one disadvantage that you can only
+really image the outer portions of the
+brain but nonetheless there's a lot of
+information there right so a little
+technical lesson for people and these
+outside areas of the brain the cortical
+areas in the prefrontal area were
+helping predict which kids would do
+better only for those kids that were
+having Q Center therapy and another gold
+standard treatment called trauma Focus
+cognitive behavioral therapy when they
+were both compare to treatment as usual
+I'd like to take a quick break and thank
+one of our sponsors function I recently
+became a function member after searching
+for the most comprehensive approach to
+lab testing while I've long been a fan
+of blood testing I really wanted to find
+a more in-depth program for analyzing
+blood urine and saliva to get a full
+picture of my heart health my hormone
+status my immune system regulation my
+metabolic function my vitamin and
+mineral status and other critical areas
+of my overall health and vitality
+function not only provides testing of
+over 100 biomarkers key to physical and
+mental health but it also analyzes these
+results and provides insights from to
+doctors on your results for example in
+one of my first tests with function I
+learned that I had two high levels of
+mercury in my blood this was totally
+surprising to me I had no idea prior to
+taking the test function not only helped
+me detect this but offered medical
+doctor informed insights on how to best
+reduce those mercury levels which
+included limiting my tuna consumption
+because I'd been eating a lot of tuna
+while also making an effort to eat more
+leafy greens and supplementing with
+Knack and acetylcysteine both of which
+can support glutathione production and
+detoxification and worked to reduce my
+mercury levels comprehensive lab testing
+like this is so important for health and
+while I've been doing it for years I've
+always found it to be overly complicated
+and expensive I've been so impressed by
+function both at the level of ease of
+use that is getting the tests done as
+well as how comprehensive and how
+actionable the tests are that I recently
+joined their Advisory Board and I'm
+thrilled that they're sponsoring the
+podcast if you'd like to try function go
+to function health.com huberman function
+currently has a weight list of over
+250,000 people but they're offering
+Early Access to hubman lab listeners
+again that's function health.com
+huberman to get early access to function
+I want to get into the Q centered
+therapy versus cognitive behavioral uh
+versus the uh no therapy um conditions
+you just described but before we do that
+I just want to have a brief uh
+discussion about some of the
+Neuroscience you mentioned because I
+think people will find this very
+interesting and um certainly not just a
+listing off of names of
+structures you said that the
+frontolimbic pathway is important here
+the limic pathway including the amydala
+but other structures as well and my
+understanding and I think the generally
+accepted understanding about these lyic
+Pathways is that they create a response
+State a state of alertness a state of
+relaxation that they um translate
+certain information that impinges on
+them into uh a level of reactivity
+either low medium or very high when I
+say reactivity a tendency to move toward
+or away from something or stay still for
+it put in uh broadly speaking now the
+fronto piece the feed the feeding in of
+information from the frontal cortex
+where context dependent decision-making
+and as you said executive function takes
+place is so critical for all of us as we
+mature even as a I would say if you look
+at a puppy everything's a stimulus and
+then over time they're not going to pick
+up everything in the room that's without
+question largely due to the development
+of these fronto limic Pathways and in
+children and in um in humans that is
+it's the same I can imagine that the
+signals coming from the frontal Pathway
+to the lyic system are going to be
+somewhat cryptic to people that aren't
+familiar with um Psych patry and
+Neuroscience so maybe we could just um
+throw a few of those out there here's an
+example tell me if I'm wrong um but the
+way I think about this is okay uh a kid
+is in a room and they're
+hyperactive and um or maybe something
+set them off and they're particularly uh
+Vigilant and stressed they're in the
+stress response the frontal cortex is
+the pathway by which an internal
+dialogue could be de delivered to quiet
+that lyic pathway the message that would
+perhaps trigger that would be the kid
+recognizing because they learned uh this
+is okay I've had this happen
+before it passes or I'm supported
+there's Dr Kion there's my mom there's
+my dad there's my teacher there's my
+friend I'm supported because we know
+social support is important or it's
+normal to feel stress every once in a
+while so these kinds of thoughts are
+these internal dialogues that we're told
+that we should do for ourselves when
+we're
+stressed I think we can be pretty
+certain that that's the kind of
+information that would trigger this
+front to Olympic suppression and can I
+comment on that dialogue because all of
+those are examples of positive thoughts
+right positive thoughts that are good uh
+but they're not automatic thoughts they
+are thoughts that need to be practiced
+right negative thoughts unfortunately
+that reside in our reptile brain are
+automatic so that hyper response I mean
+danger type of
+situation when we evolved right is
+responsible for our survival so we learn
+the negative thoughts very well I'm in
+danger I have to run I have to get on
+top of this tree the lion might come
+whatever so only 50 million years ago
+when we developed the frontal cortex
+more uh positive thoughts came into the
+picture and they're very helpful for all
+the reasons you're mentioning but
+they're not
+automatic like the negative ones are
+hopefully they will become so what I
+tell the kids is if I if they don't play
+guitar if I give you a guitar right now
+would you be able to play me a song
+absolutely not I have absolutely zero
+minus one musical ability but I love
+music but if you if I gave you a guitar
+with guitar lessons and you practice you
+probably will be able to play a song a
+year from now well me with some degree
+of proficiency but not but everybody
+else yes a support system a support
+system that's right and with enough
+practice hours and enough deter focus
+and determination I'm I'm convinced I
+could um become at least proficient um
+even at 49 years of age so we have a
+slogan in in my team which is practice
+positive thoughts all the thoughts you
+were mentioning are good ones and we
+have to practice them right this is what
+I'm learning no I'm I'm not bad this is
+happening because of the que even when
+the lyic system is not active should do
+you encourage uh your patients to
+practice positive thinking even when
+they're not in the stress response all
+the time interesting it's like it's
+learning a tool so in this Q Center
+therapy one of the lessons is that they
+have an empty toolbox and and this
+toolbox gets filled with tools that they
+learn and practicing positive thoughts
+deep breathing mindfulness all of this
+muscle relaxations are tools that we
+teach them but they decide and here's
+where the empowerment comes in they
+decide what the cues are they decide
+what tools they're going to put into
+their toolbox or they're not going to
+put in the toolbox and by far whatever
+tools they develop that have not been
+taught by me or anybody
+else work better when they develop it
+themselves interesting and you know I I
+I had this case once and and it got
+Illustrated really well when I I was in
+in one of the sessions you teach them
+breathing exercises muscle relaxation
+things that we know help and I'll talk a
+little bit more about how we know that
+they help and um and then they have like
+a week to practice and then they come
+the next week and we see where they are
+and what's in the toolbox and things
+like that
+and the next week when when she came she
+was much much better you know and I said
+I was very proud I'm like oh you've been
+practicing the tools right that we
+discussed last week and she's like no I
+actually don't remember anything you
+said last time but I I came up with this
+thing that when I feel bad I'm I'm
+drinking a glass of orange juice every
+time and at that moment I knew I could
+go both ways I could go no no you must
+practice is my tools or I could say how
+wonderful you've identified a tool that
+helps you to drink a glass of orange
+juice which obviously is what I did and
+then she was able to have that in her in
+her toolbox and and we have multiple
+examples like this so she would drink a
+glass of orange juice in order to quell
+her anxiety yeah if she felt bad and is
+this something that she would do even
+when she wasn't feeling stressed I mean
+it's kind of interesting it suggests and
+it completely squares with everything I
+understand about prefrontal cortical
+limic Pathways which is that they're
+highly subject to contextual learning
+right if any the frontal cortex is this
+incredible feat of evolution that um
+allows us to link essentially any
+stimulus with any um non uh learned
+response in the body right I mean this
+is what allows you know soldiers to
+learn to overcome their fear of Bomb
+Blast and run toward them if if
+necessary I mean I mean it it can cut
+both ways of course um but for me and
+this still needs to be tested is is
+nothing necessarily about the glass or
+even the orange or the vitamin C or
+anything like that it's about the fact
+that she has this message she has sent a
+message to herself I can take care of
+myself because the best tool that I have
+is me it's my own body whatever these
+kids go in the future there's something
+that's always going to be there with
+them which is themselves so they as
+themselves is the best tool they can
+have you know their body the the way
+they think all of these things do you
+think this is why we hear the uh kind of
+classic anecdote about the patient who
+has anxiety attacks whose psychiatrist
+gives them a a couple of pills of
+medication that can help reduce anxiety
+and they decide to keep those pills in
+their pocket should they have an anxiety
+attack and knowing they have those pills
+in their pocket allows them to control
+their
+anxiety yes because it it gives them a
+sense of control right and and they have
+control over this and some people may
+choose to leave them in the fridge and
+some people may choose to put them
+elsewhere but is what they decide is
+that decision they're making that gives
+them uh a sense of control that's
+important it's so interesting the sense
+of agency and control over the um
+non-negotiable stress response you know
+I sometimes
+unfortunately get um in my opinion uh
+incorrectly attached
+to ice baths uh we've talked about cold
+water exposure on this podcast our
+colleague Craig heler at Stanford
+Department of biology phenomenal
+scientist was on this podcast we talked
+about some of the beneficial uses of
+deliberate cold exposure there are a lot
+of arguments does it increase metabolism
+doesn't seem like it does very much is
+it useful for inflammation perhaps um
+but the one thing that everyone agrees
+is that being in uncomfortably cold
+water makes you breathe F faster excuse
+me and stress a bit in other words it
+kind of sucks it's
+uncomfortable and I think one
+non-negotiable fact about deliberate
+cold exposure is that it gives people an
+opportunity to explore their own stress
+response if they're going to do it
+safely right you take a cold shower you
+have some control you can get out
+immediately obviously you don't want it
+so cold that you give yourself cardiac
+arrest you know you have to be care care
+f with deliberate cold exposure but the
+adrenaline response to uncomfortable
+cold is non-negotiable and I believe
+that whether or not somebody decides to
+you know recite the alphabet or think
+about how cold it is or whatever it is
+what they're doing is they are
+practicing this frontal control over the
+lyic pathways it's just sort of a
+general exercise for controlling the
+lyic system through thought but as our
+colleague David Spiegel has said to me
+many times says um you know it's not
+just the state that you're in here we're
+talking about stress as the state it's
+how you got there and in particular did
+you have any control over how you got
+there and whether or not you can get out
+and I think that the kind of stress that
+you're talking about in post-traumatic
+stress disorder or in post-traumatic
+stress injury is typically of the sort
+that people didn't have a choice
+certainly these kids didn't have a
+choice about the initial exposure to the
+trauma or stress
+but that also the stress is showing up
+when they would least want it to appear
+or when it's very inconvenient to appear
+so this this narrative is important is
+an important part of of recovery um but
+we feel that it needs to come after the
+education piece and after learning uh a
+toolbox having defenses because
+sometimes it can get very charged when
+you go through the narrative and you
+want to assess
+many things during the narrative you
+want to assess gaps of memory you want
+to assess potential cues you want to
+assess the emotions that are present so
+and and the narrative should be one that
+covers not only negative events but also
+neutral ones and also positive events
+and and it sounds like a lot right but
+when you're talking about kids that have
+10 11 12 years it is doable you know you
+can really manage it by the way with the
+cold showers I I think you're getting to
+the hinge of that seao I I think the
+cold shower probably does not the cold
+shower what do you call deliberate cold
+it could be from cold shower I always
+say that because oftentimes people think
+oh you know they're just trying to sell
+cold plunges and the truth is you don't
+need that I mean the fact of the matter
+is uh it's uh independent of income
+actually a cold shower will save you
+money on your heating bill I'm not
+saying everyone should take a cold
+shower I I love a nice warm or hot
+shower I sometimes use the cold shower
+as a stimulus and I hate it every time
+but I always learn something each time
+um by the way it feels great when you
+get out so that's nice and it does for
+many hours um especially if you end it
+with some warm water but the uh the
+learning I believe is in recognizing
+just how destabilized our patterns of
+thinking get when we have adrenaline in
+our body which is what uncomfortable
+cold does and it deploys that adrenaline
+in the brain and body and it also is a
+great learning in seeing the return to a
+BAS line just seeing how that affects
+our psychology and I I to my mind I can
+think of no other zero cost or even
+negative cost um meaning saves money
+approach that works the first time and
+every time you know that is safe enough
+right I mean I'm not interested in
+anything that has to do with snakes for
+instance I don't mind spiders I'll pick
+them up with my hands as long as it's
+not a black widow or a particularly
+large spider and I'll put it outside but
+I don't like snakes I don't like
+thinking about them I don't like being
+near them so you know there are other
+stressors that one could use but it's so
+individual whereas cold water seems to
+be uh pretty uncomfortable for everybody
+I think you need some exposure of snakes
+and you're
+cold no interest it's so interesting you
+know these things get so firmly rooted
+but I'd love to talk about this toolbox
+um because first of all it's according
+to your work and um this has been done
+repeatedly It's very effective and and I
+I love the idea that it can be
+customized so the words that come to
+mind is a customized toolbox for
+combating stress and
+PTSD and the fact that it can be
+customized and maybe even covert like we
+can have these tools inside us we don't
+need to share them with anybody if we
+don't want to but that they are very
+effective I think that those are very
+compelling reasons for exploring the uh
+the toolbox approach a bit more here so
+you mentioned one way to go about this
+is to think about or to have in mind
+some negative some neutral and some
+positive experiences and then to think
+about the different tools that one would
+deploy under those different conditions
+correct so so the exercise of the events
+is a Lifeline that we do separate from
+the toolbox we actually work on the
+toolbox first to
+identify um coping mechanisms and coping
+tools that help so what would that look
+like let's say I'm a a nine-year-old I
+come into your clinic and I meet the
+criteria for ptsi or
+PTSD um
+what sorts of questions would you ask
+yes so I the first thing I would say
+when you're
+feeling a certain way whatever way we're
+talking about right agitated anxious
+nervous uh is there anything that makes
+you feel better because the experience
+of having something and they bringing
+something is important too and sometimes
+they do they say I listen to music or
+you know I play the guitar or I go to
+play or my friends or my friends are my
+teammates mostly actually they say
+teammates teammates is pretty popular I
+love that yes there's something about
+sports and and and sports is something
+that comes up a lot when we do the
+toolbox people put in their Sports
+they're doing or talking to their coach
+or talking to their teammates or
+learning a new sport uh sports are big
+so that's an example that they give uh
+talking to
+friends um uh planning a
+sleepover uh listening to
+music uh different things like this are
+there any particular tools for um when
+kids are stuck in a stress response yes
+so because I I myself am familiar with
+um you know the toolkit that I use um
+certainly teammates is is one of them
+and I have others including long exhale
+breathing physiological size these
+things will be familiar to some of the
+listeners but certainly there are times
+when we're stressed about something and
+we don't want to be and we have a hard
+time pulling our thoughts and our
+emotions and the stress response you
+know out so the ones I just mentioned
+are are some ideas that the kids bring
+with them what we always try to do is we
+teach them uh exercises of relaxation we
+have to be very careful with this
+because like like you say it's good to
+be personalized right it's good that
+it's adapted to the kid and that's why
+we don't tell them put this in your
+toolbox we tell them learn it and if it
+helps you you decide if you put it in
+the toolbox or not so when I talk about
+the treatment being not so much about
+the what because there's many components
+here like education
+narrative uh that are common right
+exposure we we can talk about uh it's
+it's not so much about the what but it's
+about the how it's about empowering kids
+to identify those cues to say if a tool
+works or doesn't work to develop their
+own tools so but sometimes they are very
+stuck right and and they need a little
+bit of help so we teach them breathing
+exercises and we have a script for that
+we te Teach them muscle relaxation and
+we have uh something for that we teach
+them the positive thinking for example
+so that's a cognitive uh type of tool um
+and we teach them mindfulness because of
+our other work in prevention that we can
+talk about uh later in in which um
+mindfulness has been helpful and and and
+also yoga very simple yoga exercises so
+so nothing too complicated things like
+the mountain pose for example uh can be
+quite helpful for some kids if anything
+it helps them uh reassess the moment
+and and stop and if we're going to think
+about it in cognitive behavioral terms
+kind of break break that chain of
+negative thoughts that happen one after
+the other which can lead to a panic
+attack right that's many times how a
+panic attack can start well what's so
+interesting to me about the stress
+response is that while it's quick to
+start it's slow to shut off for logical
+reasons related to our evolutionary
+trajectory right um wouldn't it be one
+wonderful if you could stress when
+needed and then it would turn off when
+needed but what we're really talking
+about here is intervening in the stress
+response either before or as it's
+happening but then also making sure that
+the tail of that stress response isn't
+too long we're also talking about
+eradicating stress that causes
+discomfort right and is this causes this
+stress uh not necessarily to live a life
+without stress or to get rid completely
+of stress because that's would be
+impossible
+in certain cultures there are um
+accepted practices that adults use to
+deal with stress things like worry beads
+um and a few years back there were those
+what were those F what were the little
+spinner things that kids had um uh when
+those were popular maybe they're still
+popular Did You observe any reductions
+in stress um you know kids have a lot of
+energy like sometimes I think we confuse
+energy and stress um wouldn't we all
+love to have the kind of energy that we
+had in childhood um
+I was observing this the other day you
+know you'll see a kid sitting
+cross-legged listening in class and then
+all of a sudden it's time to move across
+the room and they'll just pop up and
+move across the room like when was the
+last time any of us like popped up out
+of our chairs unless we were
+particularly excited or scared as adults
+um just that immediacy to action um
+implies that there's a lot of energy in
+the system so I could imagine that
+having some ways to siphon off some of
+that energy through as far as I can tell
+you know um things like worry beads or
+or fidgets or whatever those are called
+I mean they might irritate some adults
+around but really they're pretty
+innocuous when you think about it I like
+that you're not calling it nervous
+energy because it is just what you said
+it's Just Energy it's extra energy uh
+that needs to be placed somewhere and
+they're trying to find out where to
+place it I mean we have colleagues that
+not all of them this is not a
+requirement for being a professor at
+Stanford but I've got colleagues that
+work 80 hours a
+week you could argue that's healthy or
+unhealthy depending on the context and
+their agreements with others but you
+know that requires a lot of energy and I
+know they are not particularly happy
+working less so you know I think
+sometimes we are dismissive or kind of
+um pejorative about you know uh physical
+energy and and shaking and moving but
+you know I I see I know someone in my
+life who bounces her knee while she
+works and it it's it kind of makes me a
+little bit nervous but boy does she have
+a lot of focus and energy you know so I
+mean I think it's wonderful in other
+words yeah yeah and and some of us you
+know choose to have meetings while
+walking rather than being in an office
+that's certainly my preference you know
+I go for a walk sometimes uh when I have
+a meeting so yes so there there is
+increased energy but there's increased
+energy that of of I feel like I need to
+do something and there's increased
+energy that causes a lot of discomfort
+so for this kid that kids that
+experience discomfort then they can look
+at their tool point and say which one
+I'm going to use and and that gives them
+also a choice which goes back to that
+sense of control again earlier meaning
+off microphone we were talking about the
+fact that some people indeed some kids
+have a different tendency to Anchor
+towards thinking or feeling or action
+when under stress and um you were
+describing the four quadrant system uh
+could you share with us this four
+quadrant system because I think it's
+both extremely valuable to children and
+to adults it's certainly something that
+I plan to incorporate into my life yes
+so we have to be careful with uh
+structured uh interventions because
+sometimes a structured interventions can
+break a little bit the
+fluidity uh of the relationship that a
+therapist and a child may have or a
+therapist on on a patient so it's it's
+better to be semi structure and to
+really be attentive to the temperament
+that the kid brings into that
+relationship or into that session and
+certainly with the toolbox as you
+mentioned we see an example of
+that we also add that in Q Center
+therapy by dissecting and examining a
+response so for example a child that
+breaks windows or child that screams or
+a child that lives the classroom running
+we try to understand what's happening at
+that moment and the way that we do that
+is by looking at a square and a square
+is composed of four corners and the Four
+Corners are what you're thinking so it's
+a cognitive side to it uh what you're
+feeling
+emotionally what you're feeling
+physically and what your are uh actually
+doing what the action is and and this is
+your classical triangle of cognitive
+behavioral therapy in terms of what
+you're thinking what you're doing and
+how you're feeling but but we felt it
+was important to add that somatic
+physiological component because for many
+children they don't have the vocabulary
+to talk about all of this they just tell
+you I have a headache or I have a
+stomach ache and and there's no other
+Medical reason that explains it right so
+depending on the kid that comes you're
+going to start examining their response
+through one of those Corners so if the
+kid is really brainy and likes to think
+about the things they think or don't
+don't think you start in the cognitive
+corner you know other kids are very
+attentive to their body and they say I
+feel my heart racing when when I engage
+in this Behavior or in this response and
+you start with that corner the beauty of
+this is that most of the time you don't
+have to work in all of the corners by
+just working in one corner all the other
+Corners change and a new response
+develops okay so if I'm thinking that
+I'm not in danger maybe I don't need to
+leave running maybe I can just tell the
+teacher I'm distressed by the amount of
+noise all of a sudden the kid has
+created a new Square that's another
+Square so hopefully we take that one
+response as a square and build a cube
+right of many potential
+responses so that when the Quee happens
+now there's an armentarium of responses
+and if I'm too distress to think what
+response to do I can bring myself there
+by using my
+toolbox so it it all kinds of starts
+tying together and then as I have more
+responses as I understand cues I can
+begin talking about this narrative that
+I have where I will fix some cognitive
+distortions hopefully like it was my
+fault I made it happen to things
+like no it wasn't my fault somebody else
+was responsible and I'm just a Survivor
+right I'm not a victim I'm a Survivor
+that's another cognitive distortion that
+can be fixed so so all of that we we've
+included all of this in a manual for
+therapist right so we have a manual for
+therapist that is called Q Center
+therapy for youth with post-traumatic
+symptoms published by
+Oxford but I believe that adults that
+want to reexamine their childhood or
+their history or want to think about
+their kids or are interested in trauma
+can get a lot from actually examining
+this manual and studying this manual and
+in fact I believe in so so strongly that
+we are um beginning the first first
+steps of adapting it not only for youth
+but also for
+adults in this four corner system and
+forgive me because I called it a four
+quadrant system but in this four uh
+corners of the square system you said
+there's thinking which is cognitive
+there are
+emotions then there's feelings which are
+somatic physical and then actions so
+actions are straightforward thinking uh
+would be for instance uh if I understand
+correctly I'm in danger um emotions
+would be I'm scared so it's a it's a a a
+a verbal label I'm depressed I'm scared
+I'm sad I'm yeah and it way is cognitive
+too right but it carries an emotion with
+it and then in terms of the physical
+feeling it's you know of the body but it
+could include of the head too like I
+have a headache or my heart is racing or
+I'm I um or something of that sort and
+then actions of course is the action
+that they an action is really fun one
+because you can imagine there are some
+kids that are not psychologically minded
+at all and they don't even want to
+engage in this with me and they're like
+okay what is it that I'm doing I'll do
+something different so they'll they'll
+immediately develop the next Square so
+they cannot things talk too much about
+their emotions or how they're feeling
+physically or look at the negative
+thought but they say oh is the problem
+that I'm running out of the classroom
+well what if I don't and they give you
+another action and and so some kids
+start with that corner so you can really
+start with any of the corners yeah I
+love that earlier you were talking about
+practicing positive thinking even when
+perhaps especially when one is not in
+the stress response or trauma response
+but also of course when one is in the
+trauma response I think that's just so
+vitally important for people to hear
+certainly for for me to hear um I'm not
+claiming to have PTSD it just but as a
+as a novel concept that I've not heard
+raised before you um around these topics
+the other is this four corner system um
+which
+immediately occurs to me is so powerful
+because it breaks down um the kind of
+reflex arc of the stress response into
+its component parts right what's of the
+body what's of the thinking what's of
+the thinking that's emotional and then
+what's the action and you said as soon
+as one um identifies one of these
+corners and starts to kind of look at it
+differently and consider some of the
+optionality that exists an alternative
+that all these other options Cascade
+from that and I believe that in doing
+that you've described what um for
+thousands of years really um but
+recently we've heard a lot about in the
+kind of mindfulness Arena as creating
+space right like like this notion of
+creating space not outer space but
+creating space within us to to uh choose
+better options is something that I think
+until right now as you've described this
+has remained unfortunately very
+mysterious you know people talk about
+okay you um you know you want to be uh
+reactive excuse me you want to be um
+responsive not reactive responsive
+implies some optionality to your
+responses reactive implies kind of a
+reflex arc of just whatever the default
+was but this notion of space is like too
+squishy for me as a biologist to really
+um to really be able to latch on to and
+I I would argue given the prevalence of
+PTSD and stress it's probably too
+squishy for me most people it hasn't
+really LED anywhere specific but I think
+what you're describing is the ability to
+become responsive as opposed to reactive
+um assuming that the word responsive
+includes like some options within it and
+so this four corner system to me is
+genius because it gives us an anchor
+point to start from so could you say
+that if a child or adult is um
+uncomfortably stressed maybe about a
+trauma but just as like caught in the
+stress response that actually pulling
+out a pen or pencil or crayon as it were
+and and write and drawing a square and
+and just really like what am I thinking
+like maybe it's just like this is
+terrible I don't like it writing down um
+I'm embarrassed like I'm not with my
+friends like I'm like not you know I'm
+flush you know my cheeks are flushing
+whatever um I'm feeling like just
+weighed down or something and then think
+well what what are the actions I want to
+remove myself from the situation at that
+point is the suggestion that one find
+what is the the point of entry that
+feels most accessible and to start there
+yes with one
+caveat we usually use um
+Wagner's um emotional thermometer to
+measure where the kid is at and it goes
+from like 0er to 10 or 1 to 10 uh with
+different levels of stress and and it's
+good to use something concrete because
+sometimes we think they are a 10 and
+they're at five or vice versa yeah we're
+very poor at assessing others internal
+states are as our colleague Carl dth
+who's also been a guest on this podcast
+I heard him once say this in a very
+large lecture he said you know we're
+terrible absolutely Dreadful at
+assessing other people's emotions in
+fact most of the time we don't even know
+how we feel yeah he he always says that
+and it's true it's true but I would say
+if the kid is at 10 at that moment the
+best thing is to use a tool from the
+toolbox and not to engage on the Square
+at that moment until they come down a
+little bit and they can pick pay
+attention and they can listen to you
+because then that they will be letting
+the information come in they're so
+emotionally charged right at the moment
+that that may not be the right
+time um which also by the way is the
+same thing as as when you need to talk
+to kids about traumas that are happening
+in our society right sometimes you just
+want to let them know that the door is
+open for communication you may want to
+talk about it at the moment with the kid
+K may not be ready but you can let them
+know Well when you're ready we can talk
+about it here the same when you're ready
+let's go over the square exercise or the
+example if the Kitt is already familiar
+with it or I have something to show you
+right and pick his C curiosity that way
+um but I would say use the thermometer
+to see if that's a good time right if if
+it's 10 98 probably not wait till it's
+like 543
+and then engage in that so the toolbox
+should be used essentially under any
+conditions um and the kid should
+generate their own tools to add to the
+toolbox customize the tools and then the
+square can be used when they are at a
+slightly lower level of stress because
+it requires a certain level of cognitive
+intervention they need to be able to
+think about and and express their own
+State correct okay and is this something
+that you suggest kids only do with their
+therapist or is this something that they
+can do on their own as well assuming
+that they're old enough to to write and
+to think about it yeah well our our hope
+is that after a kid goes through Q
+Center therapy that they can internalize
+a lot of these activities and exercises
+and like I said become their own tool
+like like take those for life and
+continue to use them yeah I'm certain
+that many many adults not just children
+can benefit from these tools I mean I
+mean I would argue that most most of the
+bad things that happen in the world are
+the consequence of disregulated
+autonomic
+function put kind of bluntly Yeah by
+directional right kind of making things
+worse once they happen they impact the
+system even further yeah I mean I think
+most homicides are homicides of of
+jealous rage from what I have read I
+don't know if that's still true but and
+of course then that it's probably also
+true for all the things that are not as
+severe as homicide but still dreadfully
+bad like assault and things like that
+yeah um and and it's interesting that
+you bring that up because I often think
+about we we've been talking about how we
+experience trauma as individuals right
+but we experience trauma in our
+civilization we experience trauma in our
+history we experience trauma in our
+nation and how those in nation heal how
+does a system heal well the steps are
+not that different perhaps this is the
+appropriate time to um give you the
+opportunity to editorialize a little bit
+about um social media and online
+behavior um setting aside really
+aggressive online Behavior bullying and
+things like that which of course exists
+and is really serious
+um do you see the behavior of kids and
+adults online the sort of um just maybe
+even the the addiction to online um
+commenting and reading of comments and
+the kind of battling of issues back and
+forth it clearly isn't going anywhere
+some of it goes someplace functional but
+most of it I would argue especially
+among the adults is going nowhere it's
+just very circular it's my side versus
+your side my side versus your side and
+emotions get really stirred on there
+yeah um do you think that is reflective
+of um a lack of tools for
+self-regulation um do you think like
+what we're seeing is the manifestation
+of of just a lot of challenges in the
+world um and or an outlet for people to
+just vent without the need to address
+their own internal State and what's
+underlying the venting I I know many
+very very intelligent adults who
+eventually just had to quit social media
+in order to have any level of
+functionality in their life it comes
+down to that space you were talking
+about and building that space and
+creating that mindfulness time that you
+need which is also going to be
+personalized it's going to be different
+for different people uh this spring I
+was in Morocco and I visited the Medina
+was staying at the Medina and I was
+overstimulated as you can be and
+enjoying it but I imagine this is the
+state that teenagers are in all the time
+when they are with social media bringing
+them information and different tid bits
+and different things that are happening
+all over the place and very much like I
+found it restful to go to my hotel for a
+couple of hours before dinner uh people
+need to build that space people need to
+create that space what I tell parents is
+that it's important to
+remember that this was also a very
+helpful tool for us when we were in the
+pandemic right the kids were interacting
+socially Academic School was happening
+uh through
+technology so how can something so good
+be at times so harmful and I remind them
+about when they brought hammers to their
+house right and they had little kids
+they had to teach them how to use them
+this is a very important tool when you
+need to nail something or when you need
+to take a nail out this can be dangerous
+right you don't run with scissors you
+you have all these rules around other
+tools we have to have these rules around
+social media as well and and I and I
+think that's what the Surgeon General is
+getting at when when he talks about we
+need some regulations around it um but
+at the family level at the family level
+I think parents need to say there are
+certain boundaries that we are going to
+have for so a dinner time for example in
+this baskets all the phones go into the
+basket and that's what we're going to do
+from now on but it is very difficult
+because when you establish rules like
+that kids watch you like a hawk so you
+have to model the behavior you are
+expecting right the moment that you as a
+parent decide oh no I need to go to the
+basket during dinner because I need to
+check this thing out then it
+breaks so that's what I think I I think
+it can be quite helpful and and I think
+that it can be dangerous we've seen
+examples of that and and it is a tool
+like any other like a knife that we need
+to learn how to use it I think what
+you're describing to my mind uh is a
+situation where the tool has become the
+terrain it's like social media has
+become the landscape in which many
+people live as opposed to the real
+world I mean my original understanding
+of social media is that one would
+experience and do things in the real
+world and then bring those to social
+media that's certainly what I do I teach
+on social media and um I do the learning
+for that teaching the drawing in some
+cases the preparation in the quote
+unquote real world and then bring it to
+social media but I feel like the it's
+almost like the the hammer has become
+the um has become the landscape the
+house or yeah or something like that the
+hammer has become the house yes that's
+much more eloquent and and and
+appropriate um yeah I feel like with
+social media the tool of social media
+has become the terrain in which people
+are living in so that just feels like a
+um a closed loop is sort of an
+engineering uh example just like it
+doesn't go anywhere like you C you can
+never actually get the relief that
+you're seeking and I think we default to
+descriptions about dopamine and dop
+dopamine hits and there's some truth to
+that but the more I look at the
+literature on brain activation during
+social media use it it doesn't really
+speak to dopamine and reward prediction
+error as much as it does just sort of a
+Mindless compulsion and um kind of just
+P passive overuse as opposed to like
+rewards like oh this is so cool and that
+so cool I mean it can be I mean I've
+been watching some of the track and
+field races of the Olympics and there's
+a I mean I was cheering out loud for a
+few of them
+but it's it's usually something quite
+different yeah I I think if if you live
+in a virtual
+world all the time then you're not
+living right you're not in the real
+world so it's like how can you use the
+virt are there ways that the virtual
+world can help you
+live the current world in a better way
+yes so that's that's why I think it's
+helpful um but if you replace your life
+with a virtual life then that's a Pity
+that's very sad I see that in a lot of
+adults as well as kids let's talk about
+risk you know up until now we've been
+envisioning a a treatment situation or a
+study that you're running where a kid
+and perhaps parents as well are brought
+into the laboratory or clinic at
+Stanford and you're talking to them
+assessing them they're developing a
+custom toolbox and that's a wonderful
+opportunity for um kids who sadly have
+PTSD or ptsi um to be assessed and to
+develop tools that can really help them
+that's been proven by the work you've
+and others have done but what about the
+many many millions of kids and adults
+who are at risk either because of lack
+of
+access it could be due to finances
+geography poverty any number of
+different things or they simply don't
+even know what PTSD and ptsi are uh
+their parents don't know um what are
+some of the tools and interventions that
+you think could be implemented at the
+level of schools families or even
+individuals that might help them so here
+we were in my program we had created Q
+Center therapy right we develop a
+training program for it we have a Q
+Center therapy training
+program and I became increasingly
+concerned about my own staff and my own
+team because this is a team as you can
+imagine that are seeing trauma every day
+and are seeing trauma in
+kids I was worried about vicarious
+trauma and the impact that this would
+have in their health so I remember that
+when I was doing my residency I took a
+course in hypnosis and I was really
+struck by how much control one has
+during hypnosis so it's nothing like
+anyone is doing to anybody else is is is
+really kind of having the control to
+relax yourself self-directed hypnosis
+self-directed uh type of hypnosis and
+and I said I would like to bring
+something like that and I met a PhD John
+redger that was a yoga instructor and
+also a mindfulness instructor and I
+brought him to the team and and he had
+other things to do but one of the main
+goals was to take care of the team and
+we started regularly practicing yoga and
+practicing mindfulness as we were seeing
+all these cases and working with trauma
+and so forth and I was able to see
+firsthand how helpful it was for me
+personally and for my team at the time
+we were doing some work in East paloalto
+in some of the schools we're doing some
+prono counseling because this another
+problem many of the schools have no
+counselors right so um and this but this
+was a while back this like 10 years ago
+yeah the East Palo School District for
+those that don't know
+paloalto I guess it could be called West
+paloalto is a separate city and county
+from East paloalto pal Alto is not
+exclusively but is known for at least
+nowadays let's just be frank fairly
+tremendous affluence relative to most
+places in the world put bluntly um East
+paloalto a separate County different
+School District police system has for as
+long as I can remember having grown up
+um in pal Alto
+um has always been stricken with far
+fewer resources and U while there have
+been tremendous efforts to improve the
+um the situation there it is still at a
+um steep disadvantage financially um but
+of course um many uh amazing people
+working there and living there and um
+you know and growing up um there was
+some exchange across uh that um east
+palto west palalo uh border as it were
+uh in the school district but they're
+pretty separate domains when it comes to
+resources and it is not now but many
+years ago it was the number one murder
+capital in the
+US um it's also the place where Facebook
+is now so so in Ikea and there there's
+people that bring some employment to the
+area but also bring some other problems
+yeah that area where Ikea is used to be
+called do you remember it was called
+whiskey Gulch they didn't know for years
+a kind of terrible name right but it was
+a stark contrast to right as you
+literally cross the train tracks heading
+towards Highway 101 um in that case that
+portion of palalo Crescent Park an
+extreme of wealth to an extreme of
+poverty yes in in literally a distance
+of 10
+meters and of course there are uh
+wonderful families there of course uh uh
+that support the kids there's a
+Ravenswood which is also the other name
+for is paloalto Family Health Center uh
+that that really provides a lot of good
+resources to the area and there's a good
+school district but at this time it was
+missing counselors so we had some
+presence there we decided to to bring
+some of the things that that we were
+learning in terms of yoga and in terms
+of mindfulness to two of the class rooms
+at the end of about 3 months I get
+called to the principal's office I have
+to go to the principal's office to
+because the principal was interested in
+finding out what was going on in there
+because none of those kids in those
+classrooms had gone to her office in all
+that time they hadn't gotten in trouble
+they had not gotten in trouble so I
+explained what it was and we decided to
+do you know a bigger scale uh study and
+and eventually we partner with a group
+called Pure power uh pure power inc.org
+uh developing a yoga and mindfulness
+curriculum for students at
+schools at that time we started bringing
+yoga instructors into the classroom but
+we we very quickly learn that the best
+approach to this would be to teach the
+teachers and have the teachers teach the
+students because the yoga instructors
+had no training on how to control a
+classroom and the teachers did and some
+of these poses were so Elemental that
+you know it was okay if they were not a
+yoga
+instructor so anyway we tested this
+curriculum and and there was a piece
+about it in the newsour I think it might
+still be there and I get this uh
+wonderful phone call by uh this family
+in New York that wants to see how they
+can help me spread this further into not
+only the classrooms that I was working
+but uh into the whole school or the
+school
+district and I knew at that point that
+two things were important not only that
+they wanted and I wanted but that the
+school district should want it and also
+that at this time we would need to do a
+very in-depth study to see what our
+intervention was and what the curriculum
+was because mindfulness can be the name
+that you give to many different things
+so we wanted to make sure that our
+intervation of yoga and mindfulness
+exercises that now pure power carries um
+is really what we're being tested so
+they were very very helpful in helping
+sponsor not only the dissemination of
+this curriculum through the school
+district but a randomized control trial
+where we actually had a whole other
+District that would also be trained but
+only after the study was over it was a
+demographically comparison School in in
+San Jose in in the city of San Jose uh
+near enough for us to conduct a study
+but far enough that were there wouldn't
+be uh too much um dissemination from one
+District to the other and it was good
+that we did a a
+districtwide control because if we would
+have done
+done it by classroom or by school it
+wouldn't have worked because there was
+so much diffusion of what the kids were
+learning into the their friends and
+their family and the other classes and
+the other people in the community that
+was beautiful to see but it would have
+ruined a control study so you needed
+literally physical and demographic
+separation so you went with uh what used
+to be called the peninsula the South Bay
+East pal Alto and then San Jose far
+enough apart that the kids weren't
+talking enough to uh blur the the
+treatment groups exactly so we
+demonstrated feasibility you know we
+were able to do it we demonstrated
+acceptability the kids liked it the kids
+would do it some schools actually had a
+a room specifically for them to to go
+and do it even if if the teachers were
+not doing it in the in the classroom and
+it ranged it was like uh twice to three
+times a week for 15 or 50 minutes of
+this curriculum in the in the classrooms
+can I sorry to interrupt but can I ask
+you a little bit more about the
+curriculum um you said five uh you you
+said or 15 to 50 5 Z minutes um two to
+three times per week and did the kids
+have to like change over to their yoga
+clothes the reason I ask is that um I
+could think of a number of real world
+barriers to getting something like this
+implemented I feel like going jogging
+usually you get a little sweaty you need
+running shoes you know there are other
+forms of exercise that require that less
+but um these days there as far as I know
+not every school requires physical
+education when I was growing up and
+through High School you had to literally
+suit up you had to go in the locker room
+put on your your PE clothes as it as it
+were and then you'd run or play
+volleyball whatever the PE teacher told
+you to do had to do if you wanted to get
+a good a decent grade um is the yoga
+being done you said it could be in the
+classroom or at a separate location but
+are the kids basically getting up out of
+their chairs and just right in their
+school clothes doing this for 15 to 50
+minutes so they they stay with the same
+clothes um but we had mats they had mats
+every student had a mat and it's
+interesting that you mentioned PE
+because the first suggestion was let's
+do it during PE class and I'm like no
+that that's you know rowing from Paul to
+to Peter
+um until I learned that PE like you said
+was not happening so sad which I
+couldn't believe and if anything I think
+the study has helped for them to bring
+PE back and the classes which are these
+lessons and yoga movements and
+mindfulness were really taking place in
+the classroom that whatever teacher
+learned it so if it was the math teacher
+she was taking 10 minutes aside to do it
+if it was the p and B was not happening
+there they may dedicate the 50 minutes
+uh to do the yoga and the
+mindfulness so
+um we we have a a number of uh
+assessments that we did and like I
+mentioned yes it was acceptable and and
+it improved mood and and all of that but
+I think the biggest finding that we
+published from that study was that it
+increased 73 minutes of
+sleep uh 73 73 minutes of sleep that's
+EX extraordinarily high on average for
+for the students and it increased the
+depth of sleep so something that we did
+in the study was that we also did
+portable
+polysomnography and it was not in a
+Sleep Center it was in their own house
+so collaborating with Ruth oara from
+from the Department we were able to
+assess their sleep and and deep sleep is
+very important that's where you process
+the events of the day so these kids were
+increasing RM
+total sleep deep sleep doing much better
+and then another thing because of our
+previous studies that we've talked about
+in terms of brain function uh this
+hasn't been published but we have some
+preliminary data demonstrating that
+those kids that went through the
+intervention before and after the
+intervention uh were able to decrease
+the activity of their amydala which was
+very powerful and also very helpful so
+many of these kids adapted this into
+their daily practices after this study
+was over we went to our control group
+and and we taught those lessons there
+and um and now it has served to
+identified even more tools that we can
+put in the toolbox of CCT so so we
+utilize some of the things there in here
+so pure power and our program have been
+collaborating a lot because it covers
+the risk group and the treatment group
+so sometimes when we go to schools and
+we do trainings we um partner with them
+so that we have the yoga and the
+mindfulness and the Q Center therapy and
+and and I by no means mean these are the
+two things that everybody should be
+using I'm saying these are two more
+Tools in fact I think we need more
+development more development of
+interventions both for treatment and for
+intervention and how do we identify who
+needs what and and how is where we're
+moving next wow what spectacular results
+I mean 73 minutes more of sleep is like
+I mean talk about effective medicine you
+know I mean we agreed at the outset that
+sleep is the foundation of mental health
+and physical health and all forms of
+cognitive and physical performance I
+mean it's just me we know this the study
+done at Stanford albe it a small one of
+having athletes just get a bit more
+sleep or even just stay in bed a bit
+longer and know not on their phones but
+just lying quietly with eyes closed and
+resting or sleeping more improved shot
+accuracy in basketball players this has
+been shown in so many domains of
+cognitive and physical it's like not
+even worth spooling off all the examples
+but that is spectacular it also makes me
+think I should start doing some yoga um
+because I I do get enough sleep but
+that's
+significant what do you think are the
+barriers to having this sort of thing
+implemented at national scale and I
+always think about this you know okay so
+the results are in maybe it's one study
+maybe it's two but you're talking about
+a basically um harmless intervention and
+actually it's a very therapeutic
+intervention sure there are some people
+that won't be able to do all the poses
+Etc but there's always something that
+somebody can do um even people that are
+immobilized there are certain forms of
+uh believe it or not um uh cognitive
+yoga and and that friend of mine who
+works with people who are uh
+quadriplegic they can do certain things
+to keep nervous system function online
+but you
+know essentially anyone can do this um
+what are the barriers from taking it
+from this East pal Alto school to a
+study to another study okay San Jose
+school now let's say you get all of
+Santa Clara or um you know neighboring
+counties um you know what does it take
+to get something implemented at National
+scale so that the work can really Ripple
+out and benefit all these kids who of
+course are going to become adults well
+we need to prioritize it right we need
+to prioritize
+education to to for starters right we
+were talking about classes not even
+having physical education or arts for
+example uh and we need to prioritize
+mental health and it needs to start
+early and I think when we work our
+national budget it needs to be
+uh there needs to be ear marks for these
+two areas and that should go to the
+Department of Education the Department
+of Education should make this a a
+priority um teachers are really really
+overwork uh they they are under
+resource and like pediatricians many
+times are responsible for doing somebody
+else's work right everybody tells them
+oh this will only take a minute or this
+will only take two minutes or if you
+make this assessment you know you can do
+that but but it the time is finite right
+and the space is finite so they need
+more space they need more time they need
+more support
+teachers
+uh and then this needs to be a priority
+from districts to really Implement
+programs like this so parents and and
+even non-parents um talk to the teachers
+in the school talk to the principles in
+the school and I've been learning about
+the power of the
+telephone um for lobbying this has been
+around some uh things I've been involved
+with with the veterans community I mean
+the ability to look up and call your
+Congressman or congresswoman and tell
+them that you are really concerned about
+or excited about a particular program
+does have impact I mean I I at first I
+didn't think this was true but I
+realized that when they start getting
+100 a thousand messages about a
+particular topic that people are
+passionate about they pay attention um
+maybe it's because they just want to get
+reelected maybe it's because they are
+genuinely um concerned about helping
+people I I like to think it's the latter
+but regardless of which they run those
+messages up the flag pole uh when they
+bring issues so so let me tell you what
+we just started doing in Puerto Rico I'm
+from Puerto Rico uh but Puerto Rico and
+Puerto Rico
+Puerto Rican students have gone through
+a number of natural disasters that
+started with hurricane Maria and
+continue with other
+hurricanes and and also with earthquakes
+and and this has led to violence and
+there's interpersonal violence so some
+of the cases in Puerto Rico have gone
+through a lot uh but also the whole
+island of Puerto Rico is one of the
+largest school districts in the US uh
+the whole island is one District meaning
+that if you do something like a program
+like the one we're talking about you can
+implement it
+islandwide um currently we are launching
+a project in Puerto Rico where all the
+teachers will be train in the yoga and
+mindfulness curriculum and all of the
+counselors will be trained in Q Center
+therapy the kids are being assessed at
+Baseline then they go through their yoga
+and curriculum and at time too when they
+get assessed to see how they're doing
+after that um we also screen those that
+have uh ptss postraumatic stress
+symptoms that cause impairment and then
+those go through the trained counselors
+and then they get assess again at the in
+the latter part so the the goal is for
+us to although we've talked about the
+two treatments we've never really uh
+have both of them happen
+simultaneously and we want to do it in a
+large scale like this because if if this
+works if if it's sustainable if it's
+feasible we can actually then bring it
+to other large school districts like New
+York like La for example and and start
+disseminating this I'd love your
+thoughts on something you know I'm so
+impressed that you were able to bring
+this from a study or set of studies to a
+much larger scale in Puerto
+Rico I could be wrong here but I feel
+like uh in the United States we have
+such a culture of Fame and popularity
+and reward around people who are extreme
+performers you know we hear about you
+know these NBA stars and right now we're
+seeing a lot about these incredible
+track stars and we're um or we have
+these Tech innovators that found huge
+companies they used to be called unicorn
+companies but all these incredible um
+successes and um I wonder sometimes if
+the hyper emphasis on these extreme
+performers has led to the conclusion in
+young people that unless you're going to
+be Michael
+Jordan or Lebron James or Mark
+Zuckerberg or uh Elon Musk or win an
+Olympic gold medal that the practices
+that feed up to becoming those sorts of
+people like mindfulness meditation or
+becoming a yogi for that matter you know
+I feel like the there's been a push
+towards hyp specialization and
+performance to the point where people
+are writing off the The Incredible
+utility of physical activity mindfulness
+um you know learning math science
+literature and the Arts you know talk
+about the Arts studies music right even
+for people like me you know I mean sure
+they always gave me the triangle cuz I
+could manage that one and I don't want
+to insult the triangle players I'm sure
+it's much more complicated than uh I'm
+giving the impression is but the point
+is that I feel like um there's been a uh
+not so gradual uh disintegration of the
+idea that there is utility indeed
+there's great benefit to doing things
+not with the intention of becoming a
+high performer but just doing them for
+sake of how it enriches us in a number
+of different ways including our mental
+health and I wonder whether or not the
+lack of PE is sort of a well if you're
+not going to run track and try and medal
+or something and you know or go to
+Championship meets then like what's the
+point but I I don't um I certainly don't
+subscribe to that I'm curious what your
+thoughts are
+um well I I think we need to redefine
+success and what it means to be
+successful uh I I think that we are
+currently describing it with the
+examples that you just gave which
+probably was not the way that we were
+describing it in the 60s or the
+70s um
+but it it is harming individuals that
+which is most of us that cannot attain
+that level of uh proficiency in an area
+and in fact the individuals that are
+choosing to have a broader belonging in
+a way are more protected I I worry about
+those other individuals too that have
+that very
+personalized um not personalized but
+very very individualized unique
+component in their life where they
+dedicate everything to that one thing
+they trust me they they often suffer in
+one or more of their other domains of
+life some don't but I would arue most do
+but the the idea of belonging right is
+that you have you belong to many
+different facets of life um you are a
+sports person you're a community person
+you're a student you're a father you're
+you know an ant you're you're different
+things um when you're only one thing and
+that fails your whole identity is gone
+it doesn't even have to fail it has you
+have to perceive that it has fail and
+that's enough to throw you of course and
+so with the current definition of
+success we're not doing a service for
+those that attain that definition and
+those that do not attain that definition
+I think it needs to be broader I think
+belonging needs to be included I think
+the way that we care not only for
+ourselves but for the rest of our
+citizens needs to be included uh
+citizenship is
+important um so
+it is dynamic so far it has been Dynamic
+how we define success and hopefully it
+will change again I I agree
+wholeheartedly let's talk about
+resilience earlier you said you know
+kids are not resilient but you also
+implied maybe you even stated it
+outright that they can become
+resilient what is resilience and what
+are some of the paths to resilience
+resilience is a physical term right it
+means you bounce the coil bounces back
+to where it was I originally I I like to
+think of the word
+adaptation because it means not only you
+bounce back but you bounce back to a
+better place like I like to think that
+we adapted during the experience of the
+pandemic other than we were resilient of
+it yes we were resilient because we
+survived it some of us did not all right
+some of us have to deal with the grief
+of what happened during that
+time um but adaptation means that not
+only we go back to where we were before
+the pandemic but that now we've learned
+from that experience to be in a better
+place now we know very little about
+resilience and we definitely know very
+little biology about resilience we know
+that having a sense of humor is good we
+know that persever perseverance is good
+we know that the presence of an adult in
+a child's life that was there to give
+them opportunity or or to talk to them
+about things they were going through
+that's probably the the best known you
+know resilient
+Factor um but what if it's not the
+presence of of that adult but there's
+something in that child that makes them
+seek and maintain that type of
+relationship right so I feel that we
+need to start looking at the biology of
+resilience and one way that we've done
+that in my program is through a
+collaboration with Alex Urban from our
+department and from genetics and
+Caroline Perman who's in his lab and one
+of his post dogs um they work with
+organoids and I don't know if you've
+mentioned organoids before to your
+audience I have not but um uh one of my
+good friends and uh uh colleagues at
+Stanford Sergio pasca is one of the
+world leaders in organoids and we hope
+to host them on this podcast soon but uh
+please um educate us on organoids they
+are oh so cool and oh so science
+fictiony but they are also real yes as
+well so so we have stem cells that can
+be converted to any type of cell under
+the appropriate nutrients and
+environments that we want to examine uh
+so for a psychiatrist of course the
+interest is to turn them into neurons
+and not only they can grow in a Petri
+dish but they grow suspended so is it's
+almost like a 3D and and Sergio uses um
+the term asem bloid for when he actually
+assembles them further to create build
+uh more organ specific mini brains mini
+brains is the term that I like yes um so
+these mini brains are this neurons that
+are
+growing uh in a in a circle like the
+brain and they communicate with each
+other and they are active with each
+other and we can study so in
+conversations with Alex and now that you
+all know my previous work with cortisol
+and all that I was telling him and
+Carolyn well why would happen if we
+expose some of organoids to
+cortisol um and of course we needed to
+come up with oh what would be the right
+amount you know that would mimic trauma
+so we also involve Robert saoli to help
+us come up with a concentration that
+would be trauma mimetic and so we expose
+a number of organoids to different
+levels of of cortisol for some of them
+it was a trauma for others they were not
+exposed then half of of that amount or
+much less of that amount was a trigger
+the Q right so some had the trauma on
+the Q some had no exposure some only had
+the queue and then we compare what was
+Associated um with really um well the
+first thing that they needed to do was
+identified that these neurons actually
+had these glucocorticoid receptors and
+that they were active and they did have
+them and they were
+active so we looked through epigenetic
+analysis I wi is the Royal Wii right is
+more Alex and Carolyn they look at the
+genes that were change that their
+activity change because of this cortisol
+exposure and through epigenetic analysis
+which is the space you know uh between
+DNA and RNA and there's like methylation
+patterns and all that and some gen
+activity
+changes some turn on some turn off so
+interestingly the majority of the genes
+that we found there were genes that have
+been addressed in the literature as
+potentially being related to post
+trumatic stress disorder things like the
+glucocorticoid receptor genes and things
+that you would think of but there was
+another subset of genes that we identify
+that were novel and I was very
+interested in those because of my
+interest in accelerated aging because of
+stress and those were genes that are
+related to collagen formation and we
+know that atherosclerosis has been
+related to stress for example and as and
+we know that accelerated aging not only
+in BTSD but in mental health conditions
+overall individuals that suffer from
+severe mental illness chronically in
+their life end up dying 25 years Young
+than the rest of the population that's
+very
+significant and um so stress and
+accelerated aging interesting okay so
+these are interesting findings in
+organoids but but when you have those
+what you do is you move on to a
+population study so these kids in Puerto
+Rico that are going through these
+interventions besides me checking on
+their PTSD their anxiety their
+depression
+they're giving me a vocal Swap and in
+the vocal swap those epithelial cells we
+can actually take them through
+epigenetic analysis and see those kids a
+time one that even though they've gone
+through all this trauma may not be
+fairing that much worse as as their
+counterparts and compare them and not
+only that we can actually also look at
+response treatment response for the
+intervention for the yoga and
+mindfulness preventive intervention and
+for the treatment for the Q Center
+therapy so that's the plan that's the
+plan in trying to bring more light into
+what is the biology of resilience and
+how can we understand resilience
+better what a spectacular study goodness
+and if any of you miss some of the
+underlying mechanics I'll just quickly
+recap these organoids are little brains
+in dish that came to be by virtue of
+taking fiber blasts or other cells so
+skin cells essentially put into dishes
+provided four what are called
+transcription factors these are the four
+transcription factors that uh yamanaka
+won the Nobel Prize for identifying that
+reverts those cells into stem cells and
+then a few other goodies molecular
+goodies that then allow them to become
+neurons in particular then they grow
+into little mini brains and then as Dr k
+was explaining are exposed to cortisol
+at appropriate concentrations to mimic
+cortisol exposure in the whole person
+and then from that the genomes of those
+cells and the epigenomes are analyzed to
+identify potential targets the results
+are brought back to these kids in Puerto
+Rico such that the genomes of all these
+kids experiencing different levels of
+stress and yoga mindfulness
+interventions or not maybe they're in
+the control
+group the outcomes can be assessed and
+then one can address hey what are the
+genes that are protective against stress
+AKA what are the genes that are
+protective against high levels of
+cortisol and a bunch of other surely to
+be very transformative and important
+facts about how stress impacts the young
+brain to either give rise to PTSD or not
+I must say as you described that study I
+had three thoughts one wow how awesome
+is this that you can Bridge across so
+many different levels of analysis I mean
+because you're talking about molecular
+genetics all the way up to yoga in
+school children in Puerto Rico and PTSD
+you know it's just a complex disorder I
+was also thinking to myself um wow what
+an incredible Place Stamford is that
+such a collaboration is possible Right
+makes me Delight in the fact that
+colleagues like you exist and Sergio and
+forgive me the names of the other
+colleagues I'm not familiar Urban and
+Caroline Perman thank you and the third
+thing is how important it is to bridge
+across these different levels of
+analysis I think this is the first time
+on this podcast where somebody has
+discussed an experiment that Bridges
+across so many levels of analysis
+literally from fiber blast skin cells in
+a dish all the way to a complex
+psychiatric condition and in an attempt
+excuse me to create novel Therapeutics
+so it's just truly spectacular so if
+people are sensing a um even further
+surge in my energy this is the kind of
+thing that gets me so excited because in
+the landscape of science we often see a
+study or we hear about organoids or we
+hear about a yoga intervention and these
+things tend to exist in silos and
+isolation but the ability to bridge
+across these levels of analysis I
+believe is uh critical and so um yeah
+kudos to you for for being a part of
+this incredible collaboration and
+collaborations are key right because the
+world is so complex now that there's no
+way that a single lab could have all
+this expertise so you're right a place
+like Stanford allows for these
+communications to happen for these
+collaborations uh to happen uh in 28
+years that I've been there I have never
+heard no I'm not interested in that how
+we say at at Stanford especially if two
+scientists um meet for more than 30
+minutes what comes out of that is a
+collaboration as a final question I'm
+going to ask you to limit it to one
+answer but I'm sure that there are many
+um the question is if you had a magic
+wand and you could get any message out
+to the whole world about PTSD and
+ptsi in particular in kids and young
+people but also in adults what is that
+message what do you want people to know
+about post-traumatic stress disorder
+stress and post-traumatic stress injury
+the first thing that comes to mind is
+the importance of of listening and
+listening to to what kids and adults
+have to say about their
+experiencing and really creating a space
+for them where they or us don't feel
+isolated uh that they feel supported and
+that they feel that they can identify
+their own uh
+strengths and their own capabilities of
+of making themselves better
+um you know every everyone knows or has
+heard about psychiatrist and everybody
+thinks oh what would your Psychiatry say
+and psychiatrist have these smart things
+to say to people that help them with
+their life but the best psychiatrist
+that I know actually say very little
+they listen uh so I would say that
+listening to the experience that people
+have is is Key Well thank you so much
+for that and Dr car on vict thank you so
+so much for the work you do thank you
+for having me here yeah it's it's
+spectacular work um at so many levels um
+it's also very bold and brave work to
+tackle such a big problem with such um
+you know focus and to really give people
+agency this notion of a custom toolbox I
+think is profound to give kids and
+adults as it were agency over their own
+interventions in an effort to really
+help themselves um I appreciate you
+coming here today more than I can
+express I know the listeners and viewers
+of this podcast appreciate it as well um
+you are involved with Stanford
+clinically you're involved running uh
+studies clinical studies of you know
+great importance so for you to take time
+to educate us with these tools is
+absolutely spectacular and is really
+appreciated um please keep us updated on
+your progress and please come back and
+tell us more about that progress uh when
+the time is right thank you so much
+thank you for joining me for today's
+discussion about post-traumatic stress
+disorder and its treatments with Dr
+Victor Kion to learn more about Dr
+kion's work please see the links in the
+show note captions if you're learning
+from and or enjoying this podcast please
+subscribe to our YouTube channel that's
+a terrific zeroc cost way to support us
+in addition please subscribe to the
+podcast on both Spotify and apple and on
+both Spotify and apple you can leave us
+up to a five-star review please check
+out the sponsors mentioned at the
+beginning and throughout today's episode
+that's the best way to support this
+podcast
+if you have questions for me or comments
+about the podcast or guests or topics
+that you'd like me to consider for the
+huberman Lab podcast please put those in
+the comment section on YouTube I do read
+all the comments for those of you that
+haven't heard I have a new book coming
+out it's my very first book it's
+entitled protocols and operating manual
+for the human body this is a book that
+I've been working on for more than 5
+years and that's based on more than 30
+years of research and experience and it
+covers protocols for everything from
+sleep to exercise to Stress Control prot
+protocols related to focus and
+motivation and of course I provide the
+scientific substantiation for the
+protocols that are included the book is
+now available by pre-sale at protocols
+book.com there you can find links to
+various vendors you can pick the one
+that you like best again the book is
+called protocols an operating manual for
+the human body if you're not already
+following me on social media I am
+huberman lab on all social media
+platforms so that's Instagram X formerly
+known as Twitter threads Facebook and
+Linkedin and on those platforms I
+discuss science and science related
+tools some of which overlaps with the
+content of the hubman Lab podcast but
+much of which is distinct from the
+content on the hubman Lab podcast again
+that's hubman lab on all social media
+channels if you haven't already
+subscribed to our neural network
+newsletter our neural network newsletter
+is a zeroc cost monthly newsletter that
+includes podcast summaries as well as
+protocols in the form of brief one to
+three page PDFs those protocol PDFs are
+on things like neuroplasticity and
+learning optimizing dopamine improving
+your sleep deliberate cold exposure
+deliberate heat exposure we have a
+foundational Fitness protocol that
+describes a template routine that
+includes cardiovascular training and
+resistance training with sets and Reps
+all backed by science and all of which
+again is completely zero cost to
+subscribe simply go to huberman lab.com
+go to the menu tab up in the upper right
+corner scroll down a newsletter and
+provide your email and I should
+emphasize that we do not share your
+email with anybody thank you once again
+for joining me for today's discussion
+with Dr Victor Kion and last but
+certainly not least thank you for your
+interest in science
+[Music]
\ No newline at end of file