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

Episode 75 Jun 6, 2022 2h 22m 36 insights
My guest this episode is Dr. Paul Conti, M.D., a psychiatrist and expert in treating trauma, personality disorders and psychiatric illnesses and challenges of various kinds. Dr. Conti earned his MD at Stanford and did his residency at Harvard Medical School. He now runs the Pacific Premiere Group—a clinical practice helping people heal and grow from trauma and other life challenges. We discuss trauma: what it is and its far-reaching effects on the mind and body, as well as the best treatment approaches for trauma. We also explore how to choose a therapist and how to get the most out of therapy, as well as how to do self-directed therapy. We discuss the positive and negative effects of antidepressants, ADHD medications, alcohol, cannabis, and the therapeutic potential of psychedelics (e.g., psilocybin and LSD), ketamine and MDMA. This episode is must listen for anyone seeking or already doing therapy, processing trauma, and/or considering psychoactive medication. Both patients and practitioners ought to benefit from the information. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Understand True Trauma Definition

Understand trauma as an experience that overwhelms coping skills and fundamentally changes brain function, leading to observable shifts in mood, anxiety, behavior, sleep, and physical health, rather than just any negative event.

2. Identify Trauma by Internal Shifts

To identify if you have trauma, look for persistent changes in brain function, mood, anxiety, behavior, sleep, or physical health following an overwhelming event, especially if accompanied by feelings of guilt, shame, and avoidance.

3. Communicate to Address Trauma

Actively communicate and verbalize internal experiences related to potential trauma, as burying or avoiding these feelings due to guilt and shame is counterproductive and prevents healing.

4. Confront Original Trauma Directly

Instead of repeating maladaptive patterns (repetition compulsion), identify and directly confront the original ‘seed incident’ or core trauma to resolve it.

5. Introspect with Genuine Curiosity

Approach self-reflection and trauma exploration with genuine curiosity, asking ‘why’ and ‘when did this start’ to gain new perspectives rather than passively repeating old thought patterns.

6. Prioritize Basic Self-Care

Prioritize fundamental self-care practices—adequate sleep, healthy eating, natural light exposure, positive social interactions, managing negative interactions, and living in supportive circumstances—as these are essential building blocks for overall well-being, regardless of other luxuries.

7. Question Poor Self-Care Motivations

Introspect and question underlying beliefs that might link poor self-care to functionality or success, recognizing that these beliefs can be maladaptive and hinder true well-being.

8. Address Trauma for Functionality

Address underlying trauma directly, even if you’ve been ‘sublimating’ its energy into productive work, as resolving trauma leads to equal or greater functionality and increased happiness, without the limitations imposed by the trauma’s lens.

9. Journal for Trauma Exploration

Engage in journaling to put words to internal thoughts and feelings related to trauma. Reading your own words can create distance, foster self-compassion, and help integrate logic with emotion to uncover the roots of negative self-talk and shift perspectives.

10. Seek Trusted Support (Zero-Cost)

If professional therapy isn’t accessible, talk to a trusted friend, family member, or clergy member, or write down your thoughts. These zero-cost methods can help process trauma by engaging different brain mechanisms and providing external perspective.

11. Limit Excessive News Consumption

Limit news consumption to essential information, avoiding excessive exposure to frightening or traumatic content, as vicarious trauma can also alter brain function and contribute to distress.

12. Distinguish Short-Term vs. Long-Term

Recognize that short-term coping mechanisms like negative thoughts or anger provide temporary soothing but hinder long-term change; prioritize addressing underlying issues for lasting resolution.

13. Seek Help for Suicidal Thoughts

If experiencing suicidal thoughts, thoughts of death, or feelings of undeserving to be alive, immediately seek professional help and do not attempt to manage these severe symptoms on your own.

14. Choose Therapist by Rapport

When choosing a therapist, prioritize strong rapport and a sense of trust, as this is the most crucial factor for effective therapy, more so than specific therapeutic modalities.

15. Seek Versatile, Adaptable Therapists

Seek therapists who are versatile and adaptable, willing to shift their approach to meet your individual needs rather than being rigidly confined to a single therapeutic modality.

16. Interview Potential Therapists

Treat the process of finding a therapist like interviewing for a job; don’t settle for the first one assigned, but actively seek someone who is a good fit.

17. Approach Therapy Realistically

Approach therapy with the understanding that it will involve difficult, hard work and may not always be pleasant; seek a therapist who is willing to guide you through challenging emotions and introspection.

18. Prepare for Therapy Sessions

Before therapy sessions, engage in practices (e.g., arriving early to meditate, or simply walking in ready) that help you be fully present and focused on the therapeutic work.

19. Process Information Post-Therapy

After therapy, find a method that helps you consolidate and retain insights, whether it’s taking notes, going for a reflective walk, or setting the material aside to process later, as individual needs vary.

20. Aim for Weekly Therapy

For effective therapeutic progress beyond just maintenance, aim for at least once-a-week, hour-long sessions, recognizing that more intensive work can yield exponential gains.

21. Take Ownership of Therapy

Take ownership of your therapeutic journey by regularly assessing if your needs are being met and communicating openly with your therapist if you feel therapy isn’t helping enough or if you need more intensive support.

22. Use Language Carefully, Specifically

Use language carefully and with specificity, especially when discussing sensitive topics like trauma, to ensure clear communication and avoid diluting the meaning or severity of terms.

23. Medication for Specific Diagnoses

Consider medication for specific diagnoses like Bipolar Disorder, OCD, or ADD, as these conditions often warrant pharmaceutical intervention to stabilize brain function, ideally in conjunction with therapy.

24. Use Medication to Enhance Therapy

Consider using certain medications, like antidepressants, not just to treat symptoms, but to increase distress tolerance, which can help you engage more productively in therapy and confront difficult traumas or stressors.

25. Question Polypharmacy

If prescribed multiple medications, question whether they are all necessary and if some might be counterproductive or treating side effects of other drugs, advocating for a more streamlined approach focused on underlying issues.

26. Consider Short-Term Medication Use

Understand that medications can be used as short-term tools to achieve specific therapeutic goals, such as increasing distress tolerance during initial trauma work, with the intention of tapering off when appropriate, rather than assuming indefinite use.

27. Seek Accurate ADHD Diagnosis

If experiencing attention deficits, seek a thorough diagnosis to differentiate between true ADHD and other causes like anxiety, depression, poor sleep, diet, stress, or trauma, as medication for ADHD is only truly helpful when ADHD is the underlying condition.

28. Avoid Non-Prescribed Stimulant Use

Avoid using stimulants (e.g., Adderall, Ritalin) without a proper ADHD diagnosis, as long-term non-prescribed use carries significant risks including addiction, impaired judgment, heightened anxiety, impulsivity, and even psychosis.

29. Avoid Alcohol for Coping

Do not use alcohol as a coping mechanism for stress or trauma, as it is generally ineffective and carries significant risks.

30. Use Cannabis Cautiously

Use cannabis cautiously and for specific, limited purposes like aiding sleep by narrowing attentional focus and gating out intrusive thoughts, but do not consider it a treatment for depression, anxiety, or trauma, as it can also intensify negative focus in high-distress states.

31. Respect Powerful Therapeutic Modalities

Approach powerful therapeutic modalities like psychedelics and MDMA with immense respect and under strict clinical guidance, acknowledging their potential for both profound benefit and significant risk if misused.

32. Supplement with Athletic Greens

Take Athletic Greens once or twice a day to cover basic nutritional needs, address deficiencies, and support microbiome health.

33. Supplement Vitamin D3 and K2

Supplement with Vitamin D3 and K2, as D3 is essential for brain/body health (many are deficient even with sun) and K2 regulates cardiovascular function and calcium.

34. Follow Element Electrolyte Protocol

Dissolve one packet of Element in 16-32 ounces of water and drink it first thing in the morning, and also during physical exercise, for proper hydration and electrolyte balance.

35. Use Waking Up App

Use the Waking Up app for meditation, mindfulness training, yoga nidra, or NSDR sessions of varying durations (e.g., 10 minutes) to restore cognitive and physical energy and explore different mental states.

36. Consider Low-Dose Antipsychotics

Be aware that low doses of certain antipsychotics can be used to intervene in negative pathways related to distress, hypervigilance, and avoidance, even without psychosis, to aid in therapeutic work.