Microtherapeutics

Episode Transcript
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Speaker 1 (00:08):
This is the Anxiety Bites podcast and I am your host,
Jen Kirkman. Welcome to another episode of Anxiety Bites. I'm
your host, Jen Kirkman. I'm so excited about our guest today,
Dr Nina Vawson. She is so brilliant and so enthusiastic
and so kind and it was just wonderful talking to her.

(00:31):
And she addresses things that we haven't really talked about
on the podcast before, which is what does the future
brain for treatment of anxiety and other mental health issues?
Where where are we falling short and and where are
the spaces that need to be filled? And what I

(00:52):
love about my conversation with Dr Boston is there are
so many solutions that she gives and the science to
back it up. And y'all are going to get something
for free. So don't you fast forward this little intro.
I'm gonna give it to you right now and we'll
get into you'll hear in the episode more about what

(01:15):
it is that Dr Vosson works on. But she is
the chief medical officer of a company called Real And again,
you're about to get something free, so keep listening. It's
a mental health care company that's building a new therapy model.
Through a monthly membership, Real provides care to members that
they're able to access anonymously on their own terms, at

(01:36):
a price that is more affordable than other therapeutic approaches.
Through modernized therapist designed programs, they're improving the quality of
mental health care and making it accessible to more people,
especially the nearly of people that are left out of
the current traditional one to one therapy systems. So right
now there is a code you will get a free

(01:58):
month of membership on a monthly membership offering valid through
May thirty one. Okay, so you've got a month. The
steps to redeem it are go to join dash real
dot com. Select Join Now at the top, select the
monthly option, and proceed to their member info at the paywall,
where it asks you to input your credit card. There

(02:20):
will be a selection for a coupon code promo and
you will enter anxiety bites. Click and complete, and now
you have one month of a free monthly membership to
Reel and you can download the app to continue member
on boarding and ultimately picking a pathway to get started.
And so you may ask, well, what is this real?
What are you talking about? You'll see when you go

(02:41):
to the website. But basically what Dr Vasson does she
leads something at Stanford University called brain Storm and it's
a lab. So the Stanford Lab for Mental Health Innovation

(03:01):
otherwise known as Brainstorm, focuses on trying to solve the
mental health crisis through entrepreneurship. Right, So basically, there's a
really depressing statistic that over the course of a lifetime,
fifty of Americans will have a diagnosable mental health disorder. However,
if we optimized all the therapists in the United States,

(03:23):
we'd only have enough therapists to treat seven percent of
the American population. Again, despite the fact that of Americans
will have a diagnosable mental health disorder. So sometimes people
need solutions. And what Nina's student, one of her students
from her Brainstorm lab did was that that that's what

(03:47):
they do with the the Stanford Brainstorm Lab is they
come up with ways that young people can become entrepreneurs
in ways that help people with mental health. So one
of her or students is now the CEO and founder
of Real which is one solution to mental health. And

(04:08):
what Dr Voston works on with a lot of online
companies like Pinterest, or TikTok is something known as micro therapeutics,
which is a tool kit of exercises that are based
in cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment
therapy translated into two or three minute things that you
can do online for free and actually feel better in
just a few minutes. It's it's a compassionate experience. That

(04:30):
is the opposite of when you log onto a website
and something pops up and tries to sell you something,
or you see a negative comment. It's literally the opposite.
It's it's information that kind of just comes to you
and it gives you things you can do right in
that moment. Because, as I learned from Dr Boston, the
average person who suddenly feels a symptom of anxiety or

(04:52):
any kind of mental health issue, it takes up for
some eleven years before they decide to set foot into
a therapist office. So imagine, you know, and that was
my story as well as Dr boston stories. It took
almost a decade to go get help. And so imagine
if in that time, uh that you know, imagine if
in those ten years you have little tools along the

(05:12):
way to help you in the moment with your symptoms.
It would certainly alleviate all of the things we do
that are you know, not great choices to alleviate our anxiety,
right over, eating drugs, alcohol, maybe even just you know,
taking our anger out on other people, sleeping all day whatever.
It is just maladaptive behaviors that you know, we do

(05:35):
because we're self soothing, we're self medicating. We don't know
how to fix this, and you know, imagine doing things
that help here and there on the way to your
journey to finally walk in the door of a therapist office.
And so I just found this conversation today so fascinating.
I learned so much that although it seems like everybody

(05:56):
is having mental health issues and it seems overwhelming, how
are we going to get everyone this help? It is possible.
And I love the idea that people are going to
college and learning about ways to become an entrepreneur, not
so they can sell us more lotions and and leggings,
but so that they can find a way that that

(06:19):
mental health solutions can be integrated into our you know,
we're already online life. So again I hope you will
sign up for the free offer for a month of
real and again all of that will be in the
show notes, so you can just click there and get
on it. So again, today I talked to Dr Boston

(06:41):
about the fact that she is someone that had anxiety
and still has anxiety and depression as she still is this,
you know, brilliant doctor. It happens to the best of us.
And we talked a little bit about, you know, our
COVID habits and what she's doing to make changes. She
explains the biopsycho social model that is how we diagnose

(07:06):
and treat anxiety, and she just has a lot of
great facts about what actually helps alleviate our anxiety. And
again there's no magic pill, and you're going to hear
a lot of the same things that you've heard in
other episodes about mindfulness and sleep and exercises because that

(07:27):
stuff works. But what I love the Dr of Boston
does she will actually write things like that on a
prescription ban. Anyway, let me just let me just start
the episode. You don't need to hear me describe what
we talked about. Let's just go there now. Well, let
me let me of course brief you on again who
I'm chatting with. Dr Nina Vasston is the chief medical

(07:50):
officer of Real, a mental health care company building a
new therapy model. Outside of her work at Real, she
is a psychiatrist and professor at Stanford, where she is
the founder and executive director of Brainstorm, the Stanford Lab
for Mental Health Innovation. She has served as a healthcare
advisor to the United Nations, the World Health Organization, and

(08:10):
the Obama and Biden presidential campaigns. Dr Vasson earned an
a b in Government from Harvard College, graduating as one
of Glamor magazine's top ten college women, m D from
Harvard Medical School, NBA from Stanford Graduate School of Business,
and completed psychiatry residency at the Stanford School of Medicine,

(08:30):
where she was Chief Resident. Oh my god, Uh, I mean,
I think she's pretty qualified to tell us what to do. Me.
On the other hand, I got a Bachelor of Arts
in modern dance. So so don't take don't take my
word on anything. Just just let's just listen to Dr Boston. Okay,

(08:51):
Dr Vosson, thank you for doing the show. And you know,
everyone just heard in the intro your credentials and how
um acclaimed and brilliant you are. But you're still a
human and I would love to hear your experience with
anxiety past and present. You know, how did it manifest

(09:12):
in your life, how did you cope? What what does
it look like on the day to day Now, First
of all, thank you Jeds so much for having me
and and let me take a step back, thank you
for having this podcast. Thank you for talking about mental
help with so many people. It's incredibly you know, important,
and I just really appreciate the platform that that you
created here. Oh thanks, It is the joy of my life.

(09:34):
I could do this all day. So it's really easy
to do because I love it. I love that. I
absolutely love that. And to answer your question, so actually
on my LinkedIn, the very first thing that I share
before any credential, before any title, is UM, that is
my now twenty plus history with both anxiety and depression,

(09:56):
and going back, I think starting in as a teenage Jeer,
I had pretty bad social anxiety as well as general anxiety,
both kind of emotional and physical manifestations of that. And
just to give you some examples, UM, I was a
math nerd in your growing up and one of the
things I remember is before any math competition, I would

(10:17):
get like nausea, upset stomach, have to go to the
bathroom multiple times in the morning. We we go to
like other other schools and like I go to their
their bathrooms like for like twenty minutes before the competitions
would start. Had no idea what that meant. Oh, it
took like ten years to finally figure out we know
why that was always happening and that this was a pattern.
And you know, sweaty palms, those were sort of the

(10:38):
physical manifestations I would get pretty regularly before before things
like that have stake sorts of things in particular. And
then in terms of social anxiety, you know, getting really
really nervous before but before kind of any type of
social event. But moreover, you know, worrying that people were
judging me and um anything that I would say, uh,

(10:59):
be thinking so much about how are people going to
you know, perceive what what that is that I'm saying.
And uh so that that was one of the second thing.
And I think, you know, as a teenager, of both
were the things that definitely manifested. As time has gone on. Um, luckily,
I think that both of those have certainly gotten better. However,
I do still struggle with anxiety today, um, you know,

(11:19):
twenty years later, and I think different manifestations of it. Um.
It shows up in certainly in various forms. And one
of the these I think is really important to understand
about anxiety is that one is on a spectrum, you know,
from zero to a hundred, if you will, and throughout
our lifetimes that that will change. And even in what
I'm standing, like, the flavor of anxiety can change for

(11:41):
someone and as different you know, life stressors come and go, Um,
things get better and worse and so um. You know.
For me, I think that I've been in treatment now
for I guess probably about ten years, um, meaning both
both medications and various forms of therapy, as well as
some of the things I hope we talked up today,
um you know, doing things like um, gratitude, mindfulness, journaling, exercise,

(12:06):
so many, so many of the kind of things that
we talked about now is lifestyle and wellness and well being,
and um, they've all you know, I would say that
every kind of every type of treatment out there has
definitely helped me a little in different ways. Um. And
but but nothing also has been like a quick fix
or a cure. Uh. Yeah, that one one more thing
I'll share about that is that UM, I think most recently,

(12:29):
certainly I I didn't even, I think, appreciate the extent
of my anxiety until COVID started. And I think a
lot of people have had similar experiences where maybe their
anxiety was kind of under the radar, and then with
COVID they like you know, became an overwhelming thing or
have been something that they dealt with for a long time,
it reached absolute new heights where for some people that

(12:49):
was crippling. They's hard to have panic attacks. UM. For me,
I think what I realized was one, uh, really a
lack of self care. This is very very common that doctors,
while we tell our patients to do all these things
for them so for them, we do not do it ourselves.
And that was something that was really big for me.
But in the in the context of that, UM, really

(13:10):
I think having when I was anxious, UM, for me,
what that meant was often turning to food UM and
and at times also also like having a couple of
extra glasses of wine, you know. And I think that
both of those kind of overeating over drinking are things
that are you know, very very common sort of self
you know self medicating if you will, for anxiety and

(13:32):
and so those are things I actually stopped drinking UM
and I'm now I'm actually right now learning how to
deal with my anxiety and triggers. I said, I'm not
having that extra cookie or you know, calling pizza delivery
at ten pm. UM. But it's something I've stopping with
real for a long time. And I think now what
I realize is it's tart. I'm trying to accept it,
realize I will struggle with it and that's okay, And

(13:53):
let me get the right tools so that I can,
um make things a little bit better on a daily basis.
And just relating to that really quick, just so people
can hear how anxiety is so sneaky. Um. I've had
generalized anxiety order panic disorder undiagnosed since I was probably eight,
diagnosed at age forty seven now, and it moves around,

(14:15):
it changes. I feel like some things are completely mastered.
And so what was interesting is because I had such
a good handle on anxious feelings, panic attack symptoms and
even rumination, I didn't suffer that in the pandemic. However,
I did start. Oh, I'll just have a couple of
drinks every night. Oh, I'll just order food at ten

(14:38):
at night when I should just go to bed. But
I wasn't feeling anything I could identify. I didn't feel nerves,
I didn't feel the onset of panic. I didn't even
feel sadness. I felt nothing. And now I know that
all those coping mechanisms were anxiety. And what it doesn't
actually frighten me. I'm just being verbose. But what is
interesting to note is that unlike all beings IDEA had

(15:00):
in my life, and I thought I was handling the
pandemic so well because I wasn't panicking, is oh, I
didn't even know how to identify it. It was so
it didn't have any symptoms. Honestly, I just had the
the the bad solutions, you know. And I think that's
a little frightening. I guess it is frightening. It is.

(15:21):
You're absolutely right. It is frightening because especially when we're
aware of certain things, and we can tell our emotions
have changed, you know, and we know what to look
for when that goes away, and there's nothing that you
can sense is very frightening. And in this case, I
think what you saw was a change in your behavior
but it was difficult to associate that behavior with anxiety

(15:42):
because those same triggers that you had before weren't coming up, right. Um,
And so I think that exactly what you dealt with,
Jen is what I mean meant, like, you know, millions
of people in our country and and certainly around the
world experienced over the last few years with you know,
and we saw that we saw like you know, weight
gain increased, the amount of substances that people have been

(16:03):
consuming has increased. And so these are very very common
and the easiest accessible things that we know. That kind
of sued us, right and so, um incredibly incredibly common.
And I think that um, as we move forward, the
more we can become aware of what are these things
that we do and how do we cope? Um, that

(16:25):
that will that benefit all of us because exactly like
you said, it's like, oh, I didn't realize that's what
it was. This question just came to me. It maybe
less of a question than a comment. It's so hard
because being a teenager, our hormones are going crazy, We're
experiencing so many things for the first time. We don't
have any life experience to draw, and of course we're
going to have anxiety, So it's really hard to tell

(16:47):
what's situational, you know what I'm a teenager and what's Oh,
I might have an anxiety disorder and this will probably
continue into my twenties and thirties. Do you think it's
more of the way like sort of what the teen
mager does to cope is what causes it to become
an anxiety disorder or not? One. I think that's a

(17:07):
great it's a great question one because it's like, how
do we know for ourselves what's normal and what's not?
And you know, I speak around around the country to
big groups of people, especially now a lot of employers,
will you know, we'll talk to large companies everything, And actually,
one of the most common questions I get, jen is
is kind of I think one of the things you're
referred to is how do I know if this is
normal or something that's actually a disorder? Wherein any to

(17:29):
seek help? And so I think, even as a teenager,
one big important way to distinguish that is how much
does it affect in your life? In the sense that
if we think about anxiety, is it you know, I
get a little nervous before the s A T S
or but you know, Oh there's a cute guy, and
my palms get sweaty, you know, as he's trying to
talk to me. That's what happens to me. But but um,

(17:53):
you know, I think thinking about that versus I'm so
anxious that I'm only sleeping three hours at night or
you know, I I my grades dropped. You know, I
used to be as straight a student and now I'm
getting sees because I can't focus right, that type of
a change where you're not taking care of yourself, like
the goals you have in life for yourself, for sports,

(18:14):
for relationships, for school, like those are all changing. That's
I think the best way to see are you able
to cope and live the life you want to or
is this issue getting in the way. Um. So that's
the first part of that. The second part what I'm
hearing you is saying is like, how do we know what?
You know? Why really is anxiety? Why does anxiety occur?
And what are the things that happen in childhood that

(18:36):
can lead to it being a bigger issue as an
adult versus not? And what that I think it's ays
to is the biopsychosocial model of e mentally list in
particular of anxiety. UM, I'll pause, There is that something
we should talk about? Yeah, biopsychosocial on my list. Well,
let's go there now, and then I want to get
into your um, you know, your academic laboratory and you're

(19:01):
you know, concept of technology and entrepreneurship. But but let's
get into biopsychosocial. So that's a new thing I'm hearing,
and I know the concept is not new, But UM,
I've heard you saying a lot in my research, and
I would love for you to explain what do you
mean when you say that? And how does that? How
does how does that help you help people? Absolutely, So

(19:23):
when we say biopsychosocial, what that refers to is the
way that we think about why any mental health condition,
whether that's anxiety, depression, trauma, obsessive compulsive disorder, why it occurs,
why it manifest in the first place, as well as
then actually it gives us a framework for how to
then treat deep these conditions. So let me explain what

(19:45):
that means. So when we say biopsychosocial, what that means
is that the reason anxiety occurs is actually this combination
of biological, psychological, and social factors. Biologically, that means like
things like our genetics, right, like if mom or dad
was anxious, there's a much higher likelihood that you're going

(20:07):
to be anxious because this stuff gets passed on in
the d n A. From the psychological perspective, that means
how do you talk to yourself and cope with stressors
and um that you know what, what's what's your dialogue
with yourself? That's the kind of psychological what's your resilience
like a component? I think the social component is actually
one of the most fascinating. And when we say social,

(20:29):
that's a mix of I would say two big things.
One is historical, meaning what was your childhood like? You know,
if we think about, for example, now all the kids
who grew up throughout COVID, this will be a part
of their life for you know, for their entire life,
and how will that manifest as you know, as things continue?
And so did you grow up in a household that

(20:50):
was very supportive, encouraging, did you grow up, you know,
in the midst of war, or have immense trauma where
you bullied as a child. All those very much significantly
lead to what anxiety can look like, not only as
a child but also as an adult. And then secondly
we have environment. And so I think the biggest way

(21:11):
to think about the environment just let's think about the
last two years and how everyone's life has changed, and
where the environment that we're living in because of all
these literally like you know, changes to what our home
looks like, what work looks like, what our relationships look like,
all of that, uh increases what you know, in this case,
it increases anxiety. Um And so all of those together

(21:34):
actually help us conceptualize why anxiety occurs. Now, what last
thing will add about that, I think that's really important
and makes is also what I think in a lot
of ways, what makes mental health fascinating and frustrating, maybe
compared to some other areas of medicine, is that in
other areas of medicine, we have a blood test or
you know, you can get an X ray or m

(21:56):
r I and you can really see exactly what they are,
or like you have the number telling you what level
things are in terms of figuring out the severity of disease.
The issue with mental health is that, um, one, you know,
we don't have that, but moreover, we don't really know
right now, how like what percentage of my anxiety versus

(22:17):
your anxiety is biological versus psychological versus social. We can
get a full history and kind of make some guesses like, oh,
you know, my mom also has anxiety, so that certainly
means it's probably and my brother has anxieties. There's probably
a family component. How big is that, We're not quite sure.
Hopefully in the future will start to have more information

(22:38):
to get this, but right now we don't. UM. So
I think really what we should take from this is recognizing,
you know, it's not the kind of old school ways
that people thought about why someone has mental illness. Nothing
that was your fault. It's nothing that like quote someone did. Um.
It is a very real biological part. But and and

(22:59):
also medical station car environment. My listeners have part of
me say this a million times. But the first time
I went to get medication for depression was you know,
early twenties. I don't believe I suffered from depression too
much anymore, but the doctor, you know, was very kind
and normalized it in fifteen minutes just by looking at me.

(23:20):
Explained that I had a chemical imbalance. And I was
so confused because I literally thought I was going to
get a blood test or have electrodes put in my head,
and I just didn't understand, Like, how can you say
chemical but you didn't do anything, you know, And so
I'm learning now that that's kind of like, uh, it's
not a myth per se, because I know that chemicals
are involved, but it would you say that it was

(23:42):
just sort of like they named it badly. I think, yes,
it's that bad marketing is what I would say that
that and what that is is so you know, at
the biological level, what we know is that, for example,
with anxiety and depression, the level of the neurotransmitters things
like sarah tonin dopamine uh nor an efferent the levels

(24:03):
that we have in our brain are different. And so
you and I who have anxiety, who who you know
have also done with depression, we have different levels compared
to someone who doesn't. And moreover, the medications for example
ssr I selective serotonin re uptake inhibitors, medications like UM,
sertraline of lu ox of tine, pro pro prosagne, medications

(24:23):
like that UM. What they do is they block the
debt the breakdown of the serotonin, so that leads to
an increase of serotonin in our brain. Um, and that's
what's trying to do because maybe you and I either
make less or we break it down quicker. And so
the point of the medication is to increase the amount
of that in our body. So technically, yes, at that

(24:47):
level there is a quote chemical imbalance, but I completely agree,
like it's not the right way to talk about it
or think about it, and um, there there's a much
more kind of maybe eloquent or or kind and really
educational way to explain that so people don't feel like
I have wrong chemicals in my body or grain. You know.

(25:09):
I had a psychiatrist used to say, we're gonna have
to play scientists, and I found out for me, I
do better with the UM drugs that are less the
serotonin reuptake inhibitors, but better with the dopamine increasing you know,
UM SMRI s. I think they're called right, Yeah, that's
that's exactly right. And I yeah, and and um, I
think that that's that's also something that I think can
be frustrating. And I say that it's because I think

(25:31):
that one something that's been important to me is actually
trying to educate folks so much about these medications, and
you know, one thing that happens is for a lot
of people, the first medication might not be the right medication,
and it is a little bit of trial and error.
And I can imagine going to a doctorate and being like,
we're going to experiment what but but the reality is
that you know that not only actually is the case

(25:52):
for psychiatric medications, for a lot of other medications. It
is the same thing. We are not sure I like
allergy medication, which allergy medication is going to work really
well for you. We're not exactly sure from the get go.
But that's why oftentimes we have to try a few
and it is important to you know, work with your
doctor to to see what's working, what's not working when

(26:13):
other side effects so bad that they outweigh the positive effects.
And one thing that's really hard about these medications is
that you feel the negative side effects before you feel
the positive um and that makes it really frustrating at times.
But it is really important to give it a try
because you know, I certainly seem both for myself as
a patient as well as for you know, hundreds of

(26:34):
of my own patients, how medication can just give people's
lives back to them. We'll be right back. So the
biopsychosocial Am I wrong in saying that? It sounds like
the social aspect is sort of a newer discovery, or

(26:55):
maybe not a newer discovery, but a newer has more gravitas,
like people are taking it more seriously. I think that's
absolutely right. People are now taking it more seriously and
recognizing just how much and how complex it is. For example,
only now I think we're recognizing how like early childhood
traumas or as I said, you know, things like bullying

(27:16):
can make a tremendous impact later on down the line
in ways that we really didn't appreciate before. And so one,
there's a lot of research now being done on you know,
things from the past that help us see how it
links to things in our present um as well as
then recognizing that, you know, as I said, it's it's relationships,
it's what work looks like, it's what family life looks like,

(27:37):
it's in all these sorts of aspects of environment. So
that that's definitely that's definitely becoming the bigger thing. But
I what I actually think is really exciting about that
is that it gives us so many more opportunities for
intervention and rather for treatment. So you know, it's not
just the when we think about biopsychosocial you know, as
I said, it's not just why disease occurs, but it's

(27:57):
how then we can treat. So what means is that,
you know, we can treat with medication biologically, we can
treat with therapy psychologically. But then when it comes to
environment there's so many different types of treatments that help
from the environmental perspective, everything from working on your relationships
with your parents or with your spouse, exercise, mindfulness, meditation, journaling,

(28:22):
gratitude like so the dozens and dozens of things. And
I find that really exciting, and I hope I find
that that gives hope to people that it isn't just
a pills help. But it isn't just a pill that's
the only answer. There are many many others that help
improve anxiety and moreover, can build up a lifetime of
resilience for you. Absolutely well, that brings me to your work.

(28:46):
So you have an academic laboratory called Brainstorm, and on
the website it says transforming mental health through technology and entrepreneurship,
which then leads us to another project that you're involved
with called Real which I've mentioned in the interest. So
I don't I don't know. I I'm just so fascinated
by that. I was like, I've never had anybody I've

(29:07):
never liked to like, you're the only person doing this.
It's so exciting. How did you come up with mental
health and entrepreneurship like hand in hand. Yeah. Absolutely, I
it's been such a such a passion really almost in
the past decade or so, and I would absolutely like
to to share that. And let me start with you know,
in mental health and in psychiatry, one of the things
that we talk about, it's sort of big, like a

(29:29):
catchphrase for for the field for for years and years
and years, is meet people where they are. And you know,
it's something that we say figuratively around you know, whether
you were just getting diagnosed or you're not sure if
you want to take medication. You know, the way that
you need to talk to people is seeing where they
are right now and and really approaching discussions that way. Now,

(29:52):
if we think about that from the figurative perspective, that's
what that means. If we think about from the very list,
So what just to take a step back as I
think about how solve mental health is a problem, right,
how to make things better? Two billion people around the world,
first of all, have a diagnosable brain or behavioral health disorder.
And I seem diagnosable with with that inflection, because what

(30:14):
that means is that you know, you meet X number
of criteria for depressional for anxiety. But what that also
means is that let's say you're four out of eight
you meet what if you meet three out of eight? Okay,
you might not be diagnosable, but you're still really anxious, right,
and you would still absolutely benefit from treatment, and you're
still really struggling because that so. So I said that

(30:37):
because you know, I think when we talk about statistics,
the official diagnosa is important, but it's also just important
to think about life, right and like the whole spectrum.
Um So, so when you have a problem that big
where it's billions of people around the world, um And
I think the other thing, you know, you mentioned your
mom and sister having anxiety. When anyone has anxiety, it's

(30:57):
not just the person myself who struggles, is their loved
one as well, right, like, and so it's really really
something that goes much broader. So when you have a
problem of that um magnitude and also urgency, especially in
the US now you know, drug overdoses are the number
one leading cause of death for the last few years

(31:18):
for Americans ages eighteen to point five, right, Like, it
is killing our generation of people. Um that is both
prices and you know, and magnitude. So what are we
gonna do about it? Right? And and that's to go
back ten years. I was when I was you know,
in in medical school and just getting into psychiatry. Um.
That that's kind of what I was thinking about. And
at that time it was the first time, you know,

(31:40):
as as physicians, we treat one person at a time
every you know, ten minutes, fifteen minutes, one hour. That's
that's kind of what the traditional medical model looks like.
My own background had really been actually in the nonprofit sector.
I did a lot of work with the American Cancer
Society as a child, and when as a teenager, I
launched a network for a team volunteers for American to Society.

(32:00):
And it's always been really interested in communities and the
much bigger picture scale, like things like how is policy
impact millions of the people at a time, What are
these things that we can do to reach like entire populations.
And so you know, in medicine, the idea of this
kind of one by one when you think that, Okay,
in a week, how many people can I touch? Forty

(32:22):
hundred UM certainly like critically important and the foundation of
our current medical system. And and you know, my father's
a on collegist who does that. I have so much
deep respect and admiration for that. And yet at the
same time, for myself, as someone who was kind of
always interested in that bigger picture UM sort of thing, Uh,
became really fascinated because and just to go back in

(32:43):
medical school, that's the first time that people started to
think about how they use technology UM from the consumer side,
like things that could help if you had diabetes or
high blood pressure, things like that. So it's it's been
out there for other diseases, had been very slow to
get to mental health. So that makes sense. So that
idea of UM, let's train a bunch of entrepreneurial types

(33:07):
to handle these diseases. Right without even realizing it, I
can see that it's been out there. It's out there,
and it's mental health. Yeah, it sounds so new to me. Yeah, right,
you know, but I think you're right, and it's the
idea is, how do we think about all these new
ways to address mental health not just seem like see
a therapist and I'll throw out one statistic. What we

(33:29):
know is that, you know, most people want to think
about mental health, they think about therapy. If we optimize
all therapists in the country to treat Americans, we would
only have enough therapists to treat seven percent of the population.
Oh my god, seven percent. Now the problem there is
that over the course of a lifetime, fifty percent of

(33:49):
Americans will have a diagnosed while mental health disorder. So yeah, clear, clear,
you know, imbalanced there. And so we absolutely you know,
one on one care, traditional medicine, clinical work, com medicine important.
We will never be able to solve the problem unless
we think about other ways that we can reach people.
And that is where technology comes in. So I'm set

(34:11):
at the beginning to meet people where they are. And
to me, what was really fascinating is recognizing, Okay, like
if you think from a literal perspective, where are people
And back in the day, that meant like community medicine.
People who would go in bans to you know, two
different communities and work with the home of population or
go go out there to folks and reach them in
you know, in their homes or even the doctor with
the you know, whould knock on doors and and and

(34:33):
see boats. Today where are people? They're all online and
we all spend you know, like the number of hours
especially like teenagers and kids and young adults that online
is really really big. And so given that we are
like kind of living our lives online and it's this
whole new world that we're living in, if we can
address mental health online both thinking about it's this whole

(34:56):
new community that we're living in, how do we keep
people safe and make it uh environment that's mental health
friendly as well as think about the online worlds as
ways to deliver and provide mental health you know, therapeutic
services education that that is a tremendous opportunity to reach

(35:18):
people in ways that you know, is low cost, scales
can be you know, and and just gets to you.
And in particular because of stigma, it's so hard to
go out and be proactive and even figure out that
I have something I need to go to find a
doctor or get this information. If we can get this
to people as they're already on Pinterest or TikTok or Instagram.

(35:44):
That allows us to really have a tremendous way of
reaching people. And so that that's actually exactly what we
do at Stanford Brainstorm. The biggest part of it is
we work with companies like Pinterest and TikTok. I'll also
work with organizations like but to Pop, Shu Core Foundation,
with Kevin Love Foundation, groups like that that are really
trying to think about how do we leverage technology to

(36:06):
reach populations and also through platforms like like these online platforms.
So to take it back, let's say, Um, you know
you're talking with someone at Pinterest, what exactly would you
be asking of them? Is that the right way to
put it, that is perfect questions. So if we go
back about three years we were speaking with pinterests and

(36:26):
what Pinterest realized as they were looking at what people
were looking for when they came to Pinterest. Most people
come for things like wedding planning or interior design or
searching for recipes. It turned out that the fourth most
common category of search terms was actually related to mental health.
That was really really surprising because it's not a place

(36:47):
that you kind of just think, oh, and let me
go sort of for mental health information there, right, And
they really realized, yeah, and they really realized, like what
can we do about it? Like how can we change
the whole experience people have so that it feels safe
and warm and welcoming to talk about mental health online?
But moreover that you get tools and resources, you know,

(37:10):
and now we're talking about so much like fake news
and misinformation, how do we actually help people get top
quality information that we know comes from doctors and is
evidence based, like you know, not like really the best
types of treatments. And that that's actually how the whole
thing began. And so they're kind of four categories of
things that we worked with them with. The first thing

(37:30):
that we did was what we created what we call
microwth therapeutics, And so basically, what now if you go
to Pinterest and you type in I'm stressed or what
do I do for depression? And these were some of
the types of search terms that people were looking for
before I'm going to do it while I'm talking to you. Yeah, yeah, yeah,
So go go to pints and type in depression for example,
or stress or anxiety. Now what happens is you get

(37:53):
a whole pop up and it's a separate pop up
and importantly it does not link to your home feed,
meaning we're not tracking your UM search or anything. You know,
it's it's it's all private information. So it's very applical
in that way. YU and you get you get to
pop up basically that saides you know, it looks like
you're you're maybe struggling with something. How can we help you?

(38:13):
I just got it. Yeah, So so it shows me.
You know, people have their little memes and they're cute
little UM charts. But then there's a little thing in
blue that says, if you're feeling sadder stressed, here are
some resources, and then you can click take a look,
and it takes you to a separate thing UM suicide
Prevention Lifeline. But then these little things too minute things

(38:35):
you can listen to refocus your attention except your emotions.
This is fantastic, that's exactly so those two many things.
So it's basically all we called the micro therapeutics, and
it's a whole like toolkit of exercises based in common
behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy. These
are the same therapies that we would use with patients
one on one and right and you know over the

(38:57):
course of weeks or months that we would do with patients.
At of what we did was we translated it into
a two minute, three minute thing exercise that you can
do on pinterest thinking about what is the best scientific
evidence tell us that you can uh how to think
the best of these different things, and what can you
actually do online without a doctor in the convenience of

(39:18):
your home, such that the minute you type in stress
or depression you can get something and actually feel a
little bit better ingesting units. I love this, Yeah, I
love this because you know, if someone is typing in
stress depression and they might see a quote or I mean,
which is great, but you so rarely online see something

(39:39):
pop up and interrupt you that wants to help you
rather than sell you something or you know, no, you're
absolutely right, and that's act to something that's really important.
And I'm so like appreciative, Like the CEO of Ben
silvermanut Pinterest like has the best values. When we were
working with him, he said, adamantly, you know this is
not something I want to have ads. This is not
at all something that I want to like, you know,

(40:01):
be related to bringing in more money. This is completely
just something I want to help people. So they're no
ads with this or anything. And it's complete, it's free, right,
So like think about you know the cost of mental
health care so so difficult. It's this is a horde
percent free. You go type you get these resources, you
can access it at any time. Um. And I think
what's really important here is, you know what the problem

(40:21):
with mental health. You know, the average amount of time
from first having a symptom of mental illness to seeking
medical attention in the US is eleven years. Yeah, seven years,
seven years. But my mind to mind too, imagine lighting
out eleven years with you know, I think I am
having a heart attack, you know, exactly exactly. And so

(40:43):
having resources like this that are so easy to access
and free means, you know, even if you have a
little inkling I might be depressed or anxious, if you
can go and actually get some sort of help, um,
that that's really important to get started. And moreover, you know,
the way all these diseases progress is in those early stages.
They're they're small. You have mild disease early on, and
it gets worse as things go along, and so things

(41:05):
like this, especially if you reach people early, can make
a tremendous difference actually, and I think that's really, really,
really valuable. So so that was one big set is
just how do we get more of these things online?
And that's actually what I hope all other platforms start
doing as well, so you know, you're you, you're able
to get this sort of information. UM. The second big
thing though, is uh, the actually term for this whole

(41:26):
thing that we created on pinters is called compassionate search.
And the idea is how do we actually change the
user experience for when you're online so that instead of
feeling like something that into your point is like toxic
or you know, like the Facebook UM whistleblower who you
know talked about eating disorders and how the more time
people spend online, especially kids, we see that rates of

(41:47):
self harm, suicidal ideation increase, body body eating disorder, eating
disorders and body image issues get worse. How do we
actually create a compassionate experience And so in addition to
providing these resources, UM, the other thing we did is
actually change things about the user experience. So one example
is UM with autofill like when you you know you're type,

(42:07):
you're searching for something, if it's something that's dangerous, like
related to self harm, it actually won't auto fill in
the way that you're searching for like you know, for me,
like a navy re velvet couch, it might all right film,
but in this case it won't. And moreover, it won't
push things to you like you know, if you start
to type something then in your inbox you might start
to get a lot of other Navy blue couches. Nothing

(42:28):
that like that would hume if it's something that we
think is concerning. The third thing we did was actually
work with the engineers to change the algorithms um and
so what they were able to do there is actually
by educating them and explaining what is harmful content, the
context of harmful content for who is it harmful, we're

(42:49):
actually able to decrease the amount of self harm content
by a eight percent in about six months. Wow. And
kanyex is so important too, because like a kind of
side example is if you report someone on Twitter that's
harassing you, unless they say these five words, it's not harassment.
So it's it sounds so exciting that you're there is

(43:12):
an ability to apply context too social media. You're absolutely right,
and it's also very cultural to write, you know, like
the work we did. We it was in English and
eventually spread to I think so hard spread to nine
other countries. But you can think that something that's bullying
or harassment or or harmful in the US compared to
in another country. They're tremendous issues there. Based on your age,

(43:36):
based on your you know, your background, based on your gender,
all of those context is really important. We'll continue the
interview on the flip side of a quick message from
our sponsors. You were telling me about a student of

(43:56):
yours that started a company that you're very much an
involved with real and I would love to hear more
about them. Absolutely So I have to say a lot
of my favorite students my part times million, so Arie
Eli Sefira. So with my lab. In addition to you know,
working with companies, I teach courses on how to start

(44:19):
a company and mental health UM and at students for
teaching these courses. And the very first time I taught
this course was I guess around five or six years
ago there was a rock Star UM it's actually graduate
student course that taught at the d School and we
have a lot of business school students and engineering school
students and law school students. There was this rock star

(44:39):
senior undergrad who was studying computer science and math whose
name was Arielli Sepia and Um, and she came to
the class really impressive background. She had been interested in
mental health after one of her close friends had attempted
suicide and it just really, you know, tremendously moved her
and she was just really thinking not only how did

(45:01):
this happen, but what can be done about it? And
looked was really just this incredible student and someone who
wanted to have taken all sorts of information and learn
as much about mental health as she could. So she
went all across the world. Actually she went to the
UK and Um studied at the what's called the one
of the most innovative in patient facilities around mental health.

(45:23):
She worked with IDEO trying to understand how do we
redesign mental health facilities and think about what the patient
care experience looks like. UM, and it's so much stuff
to try to understand more about mental health. And that's
actually what we did in the classes really help people
understand the nuances of mental health. You know, a lot
of companies out there as well as folks who are
doing anything to try to now make an impact in

(45:45):
mental health usually have personal experience, their own experience or
the experience of a friend. And what is really important,
especially on my perspective this clinician, is understanding like the
breath of experiences, because if you're going to create something,
you really need to understand what is it like for
entire populations and what are these things that come up

(46:06):
so that when you're building, you can you know, we
talked about like putting the user first, not like thinking
what's right for the hospital or the clinician, but how
do we actually start with the patient and what the
patient needs and create a solution from their perspective? And
that was that was really critical to you know, what
we teach them, of course, and and what exactly I think,
what what Ariela has done? Um and uh And so

(46:29):
we met in the course and she graduated and uh,
what went on to City Block Health, which is a
company based out of New York that works with the
Medicaid population. Uh And and you know tried multiple things.
You actually thought about becoming a therapist um and then
realized that she didn't want to come a therapy. She
really wanted to change the system and that's what led

(46:50):
to her starting REEL And that's where she started with
with how do we actually start con scratched, Like what
does what does system redesign look like? And what do
we need to offer people to a really impact mental
health in that way? And so you know, we we
would we kind of continue this mentor vntie relationship. We
would talk, you know, talk on the phone and stuff.
And basically over the last three years. I started off

(47:11):
the first time she she quit her job to try
to start this company. She called me get said, I
think I'm gonna do this. I was like, yes, you know,
like a gun gun post work you all the way
um and and little by little, you know, start off
as an advisor and I guess within a year, the
you know, was was thrilled to join her as the
chief medical officer of real UM. And that's what we're doing,
is we're now we're working together as for former professor's student.

(47:33):
Now that you know she she is my CEO and
my boss now and that's which is I love it
and and that's what we're doing. We're trying, we're trying
to build a new therapy model. And it's been I
have to say, it's been really tremendous seeing UM for
grow and how the whole company has grown. We're now
over the UM you know, fifty employees, you know, the
thousands and thousands of members and what to me has

(47:55):
been really impressive. Actually, I'll say one more thing about
Ariella is as we think about mental health, it's not
just how do we change this system? I've actually gone
a step further. It's how do we, you know, change
the way that mental health looks, you know, across really
like even more broadly than that, to thinking about like
what does it look for employee? Like what does it
look like for employees? And I think that actually, especially

(48:17):
now as we think about COVID, the number of employers
I've spoken with were realizing my employees are really really suffering.
What do I do about it? That is one of
the biggest opportunity points that we have to make change
in mental health as adults. The majority of our time
we actually spend in the workplace, and that's actually something
that we've done. It real is you know, in addition

(48:38):
to creating this product that we get out there to
our members, UM we've actually looked to see how do
we change the workplace and make it more mental health friendly.
That starts with things like we have one our breaks
throughout the week of just let's take a pause. We
actually have what we call mental health break where one
week every quarter, the whole company get off. And this

(49:01):
is different from our PTO of time off. Literally the
entire gets off. And it's whatever I tell people that
they're like, you know, I start doing your company yesterday.
But the thing is, like, what we know from COVID
is that people didn't take vacation. And what we also
know is that just like when we sleep, the importance
of why sleep is so important to every human being,

(49:21):
it's important to take time off of work because it
allows us to spend time with family, to rejuvenate, to
master other hobbies, and you know, spend time in nature
and all these things that are so tremendously important for
well being. Um, what we're actually trialing now, just as
it literally started two weeks ago, is we're testing out
the four day work week. This entire quarter, our whole

(49:42):
company is trying the four day work week, and we're
gonna we did the data. We we took surveys before,
and we're gonna take surveys after and try to really
just study to see how that has it made a difference,
How has it made a difference, to to understand what
are other things that we can do because the end
of the day, at one of the things that's most
fascinating to me about mental health is there is no

(50:03):
one solution, right. It's not just one medication, it's not
just one type of therapy. It's policy, it's economics. It's
changing the workplace, it's delivering treatments like real it's changing
the way that we talk to each other. It's having
a podcast called Anxiety by that changes the way that
our society talks about and thinks about and gets to
laugh about mental health. All of those that's what needs

(50:26):
to change if you think about it. I mean, I
know not every school system works this way, but you know,
growing up, you have the summers off and you reinvent yourself, right,
and you come back a whole new person. And you know,
I think we can do that. You wanted to reinvent
ourselves quite as much as we did when we're still
developing kids and teenagers. But I'm just I just mean,
like you get a week off, you get such perspective, right,
you just feel like yourself again. And I love this

(50:48):
as opposed to the old school. Um, we're gonna take
a week and we're gonna go on a group trip
and team build and you know, climb trees. It's like,
I don't want to spend it with people from like
team building, and I think that essent should be as
because honestly, if you take care of the individual, you'll
probably have an easier time relating with others at work

(51:09):
and working well with others. Like it sounds like that
your student who's now your boss is um is solving,
is one person solving the problem or you know, helping
to solve the problem of only seven percent of the
world would be able to see a therapist. So now
like you're saying, they can get smaller doses of help,

(51:30):
and it's not online therapy, it's it's all kinds of things.
It's almost you know, it's like you and I were
talking about we waited, you know, a decade to go
get help. It's not even that like, oh, if only
we've gotten help sooner, but if only we've had little
things along the way to learn to cope, maybe we
wouldn't have gotten into some bad habits you know that
made our anxiety worse or whatnot. So I this is

(51:51):
what I love about it. That is so beautiful. I
will record that and share that with so many people.
You are absolutely right. And also on is that this
happening pretty sententistic. Is actually for the US, it's much
worse when we pay worldwide and even like for I
was like, it's worse. Uh, it's why it's worse In
one one example in Ethiopia, literally the ratio of psychiatrists

(52:12):
to people is one in a million, God right, So
so worldwide, you know, much of much much worse. Um.
So you know when we when we need to do more.
At the same time, I think that what you said is, um,
you know, you absolutely nailed it. And what we're doing
it real is thinking about, you know, when what can
we offer people? Because you're You're right, it's not when
we think about behavior change. Behavior change is tremendously difficult.

(52:36):
At the same time, it is all these little things,
right like when we think about what we need to
do to help with anxiety. The biggest things I'll tell
you when I tell people I write prescriptions off and
actually not just for medication. Oh yes, I'm wanted to
ask you about this and so excited. Yes, yes, I'll
tell you what I've prescriptions for. I write prescriptions for.
And these are the things actually that have the most

(52:56):
scientific evidence for making an impact and xiety across the board,
whether you're severe or mild, or have just a little
bit or and no matter who you are, it's things
like mindfulness meditation. I'll actually give you, I'll give you,
I'll give you ten my top ten ten list. That's
right here we go, mindful mindfulness meditation with deep breathing, sleep, gratitude, nutrition,

(53:23):
substances meaning like alcohol, drugs, the Meryl CBT products, things
like that, exercise. Wait, I'll decrease the substances. Substance, that's
a weird doctor wy decreasing, decreasing substances, decreasing to tobacco use,

(53:43):
decreasing alcohol use as as much as possible or or
none zero to none or or non done too little
um uh. Nature, community and connection, giving an altruism um
sexual pleasure actual are actually our chief therapy for for
real Rachel Hoffman has for PhD and sex therapy, which

(54:03):
one makes our company like the most live company to
work at work at and is great, you know, water
pooler conversation is fantastic. Um, But we to also know that,
you know, sexual pleasure doesn't meense things for making anxiety better.
So those are my top ten um and tave the
best for last. But all of those, right, all of
the nothing is new, right, none of those you're like, oh,

(54:25):
I've never heard of that before, right, Like, but they're
hard and the simplest things are offered to do. And
that's actually also why I write a prescription, because what
I've seen is that there's something about you know, the
patient doctor relationship for a lot of people is very sacred.
And while we know, you know, we all know, I
know I probably shouldn't be eating nutella out of a jar,

(54:48):
but I do that at times. Is it the best
thing for me? It feels like it is. It probably isn't,
I get that, right. But but at the end of
the day, you know, whether it's around you know, health
and exercise and nutrition or gratitude, mindfulness, taking out time
and nature, um, all of these things we know it
to be true, but it's still really hard to make

(55:10):
these little changes. And at the end of the day, it. Actually,
it's not like doing these big grand gestures that makes
the biggest difference. It's doing small little things for example,
like you know, actually have to tell you something. Um.
I even for myself when I go to the gym,
just in the last two weeks, I've been telling myself, hey,
even if you don't have an hour, try to get

(55:31):
on the elliptical or try to run even for twenty
or thirty minutes. Yeah, I'm not doing the best workout ever.
But but what I've really but you know, the consistency
and having getting there every day. Consistency is what leads
to you know, what your life looks like. All those
little behaviors make a big difference. And then the prescriptions. Actually,
there are two things that I've noticed make a big difference.

(55:52):
One is, as I said, just it's almost like when
you get it, you take it so much more seriously
when it's coming as a prescription. The other things I've
noticed I've noticed this actually specifically for women, is that
I think it's almost like it gives you permission to
take care of yourself. And so for so many women,
you know, there's the sense that we take care of

(56:14):
everyone else, but not ourselves, and I actually remember and
that self care can sounds so indulgent, like we're not saying, like,
go to a spa every day. We're just saying, you know,
drink some water, that you're exactly right, you're exactly right.
And I think that the prescription gives them that permission
for self care. I remember having a patient who felt
so guilty about taking time out, even like a few

(56:37):
minutes to go for a walk. And I literally wrote
this prescription thirty minutes in nature, um, you know, three
times a week, and I gave it to her and
she said that she came back the next week and
started crying and saying that she showed it to her
husband and that having that prescription it felt like that
pass that I can go do this for myself. And

(56:58):
how she noted her anxiety got so much better by
being able to be out in nature and walk her
dog and everything, and so little things like that I
just think make a really big difference. And it's important
for all of us to think about what are these
little things, um it might seem with all these things
out there, and let me just maybe say say kind
of one one final way way to think about it. Yeah,

(57:20):
I know a lot of people, even you know some
of my best friends in medicine, they're like, does mindfulness
really make a difference? You know? And then the reality
is is, like you know, every day they're great scientific
studies that come out and and tell us it does.
I think at the at the end of the day,
not everything will work for everyone, but most of these
things actually will work for most of us, and so

(57:43):
it's really important to find what works for you. You know,
even when we say mindfulness and deep breathing, there are
like fifty forms of mindfulness and deep breathing. It can
be diaphragmatic breathing, it can be prayer, it can be
you know, just doing like guided meditation, and those are
quite different. Just like for exercise, if you're ombi eliptical
or growing across fit or or playing soccer, those are

(58:04):
all very different, right, So finding what works for you,
UM that that that's really important and giving herself that commission.
Have you heard this expression? My friend is in a
a and she told me this, and I love it.
It's um none are too dumb for recovery, but some
are too smart. Yes, I have heard that. I absolutely

(58:25):
love that. Yes I do gratitude list every day, and
I was telling someone about it and they're like, but
I don't feel grateful. I go, I don't feel anything
when I make the list. I just write a list
of things I'm mentally aware that I am glad I
have in my life. And then now I have a notebook.
So whenever I'm telling myself lies, which is how my
anxiety starts, I get to look through my gratitude journal
and be like, oh, wow, like I had a friend

(58:47):
this day that said this to me, and this day
I felt good about my body or whatever. I get
to see proof that I actually don't believe the things
I'm thinking. That's all I do it for. I think
you're you're absolutely right and yeah and actually sure. One
of the things that's most fascinating to me is I
I do love the science behind it. Mindfulness, meditation, that
the deep breathing. What we actually know now because people

(59:08):
have done the science and you know, they actually can
tell when we look at the basic cellular level. What
we see is that when people do mindfulness and deep breathing,
there literally are chemical changes at the cellular level that
lead to the cell living longer. Basically, it leads to
a decrease in the enzyme that breaks down the DNA

(59:30):
of cells, and as a result of that, the cell
lives longer. And as a result of that, that's why
we know there's a link between doing mindfulness, meditation, and
deep breathing and longevity and length of life. So like
literally taking a few deep breaths today leads to you
living longer. Like that is mind blowing to me, because,
like you said, like sometimes I feel something, sometimes I don't,

(59:53):
but like the actually it does cause like those chemical changes.
But the thing is, we don't feel chemical changes in
our selves right right. Well, it's yeah, it's not having
a glass of wine where you're like, oh I feel
that right away, you know, it's it's it's just experiential.
It's over time. You look back and go, oh, I
didn't make a total mess in my life this last
year because I wasn't stuffing my feelings down or you

(01:00:15):
know whatever. Then that's the other thing I was going
to say at the beginning is it must be so
hard to diagnose people because and it totally you know,
people come in and they're like, okay, so I have
the worst anxiety ever, and there's no test for it,
and it's like, I know, you think that's the symptom.
Is like you think, you know, you can't jump into
someone else's body and feel what their anxiety feels like.
But I know we all think ours is the worst.

(01:00:36):
You know. Yep, you're absolutely right. You're absolutely right, and ultimately,
you know, all these changes that we're trying to make,
Like you were staying with the Gratitude Journal, you might
not feel it in the moment, but like when you
take a medication, you don't necessarily feel that like the
minute you take it, right, some of these things it will.
You might not notice it in the moment, but then
you might reflect back in like a month and say, actually,

(01:00:58):
you know, maybe I do it a little bit better,
or it is that combination of seeing like a month's
worth of gratitude that makes me feel differently. And at
the end of the day, I know, as someone who
just always starts with the science for me, you know,
all those ten things I mentioned, those are all, as
I said, again, the most scientifically back things that we had.
When we know that all these studies show that like, oh,
we've done it on thousands of people and we literally

(01:01:20):
see that it absolutely makes a significant difference. That's something
for me gives me a little or little a lot
of confidence that even if I don't feel it at
the end of the day, like I know that it's
doing something good and that that helpful lot too. It's like,
maybe that's the faith in science component. Well, it's true,
and you're always framing those things is like not science
because they're not pills or um, you know, cognitive behavioral therapy.

(01:01:41):
But right, they're based in science, Like the success of
them is based in scientific studies or else, you know,
why would you recommend them? Um? So it's so true.
It's framing it for the perfectionist or the type of like, no,
this is as science c as CBT, and I love
looking at it that way. Anxiety Bites will be right

(01:02:01):
back after a quick little message from one of our sponsors. Okay,
so this was something I've heard you say that you
know when this goes back to what we were talking
about earlier with this this chemical amalanced notion that the
discovery that serotonin levels are connected to gut health. Now,

(01:02:24):
how new is this discovery and what does that mean exactly?
What should we do with this knowledge? Us? Everyday people
absolutely great great question. So what we know about serotonin
is it helps modulate your mood. And we were talking
earlier about s s r I serotonin such and serotonin
reuptake inhibitors, one of the most common or the most
common psychiatric medication. That's what they target. Um. What's really

(01:02:47):
interesting about this is there is actually more serotonin in
your gut then there is in your brain. And so
just to take a step back, so if we think
about serotonin, basically there's serotonin in both places. It's the
same molecule, but it's made from different cells. So in
the brain it's made from these neuronal cells that are

(01:03:09):
called the raphite neuron, versus in your gut it's made
by endocrine immune and gut neuron cells. But they both
produce saratonin. However, they function differently in each location based
on what the brain needs and what the gut needs.
But at the end of the day, what's important to
realize here is that what it means is that there

(01:03:29):
is this connection between the brain and the gut. And
people are talking about that like mind body or gut
brain connections acts, these things like that, And just to
give an example, like how to think about what is
this connection. How does this show up? I'll give you
two examples. One is that when people start taking these
medications this SSR eyes, one of the first side effects

(01:03:50):
they will have is actually having some nausea or gas
or intestinal upset. And you know you mentioned earlier about
how uh you know the side effects maybe their differ
for a short amount of time, but don't last forever.
This is actually one of the most common things because
usually for a lot of people, not everyone, for a
lot of people, they'll have like three or four days
of this nausea, upset stomach, but then it completely goes away.

(01:04:13):
And the reason we think why that happens is because
as the medication, basically, what the medication trying to do
is increase the amount of serotonin. What it's not able
to do is just increase the serotonin in your brain.
Because the medication you swallow it, and it works throughout
your entire body. It's not sophisticated enough to just target

(01:04:33):
the serotonin in your brain, got it. But and so
as a result, it also increases the serotonin in your gut.
And because there's more serotonin in your gut than in
your brain, you end up having these in you know,
changes in the serotonin levels in your gut, and so
your guts like, hey, what's going on. Something is different,
and so that's why you actually feel noxious. That's amazing.

(01:04:56):
So it's it's really doing its job. It's not some
signed fact because it's some imperfect medication. It's actually doing
its job. And it just doesn't mean to do it
as much in your stomach, but your stomach will get
used to it. Is that basically what happens. I think
that that's it's a good way to think about it.
That like the stomach. You know, the change is making
of the stomach. It's not for what we know now,

(01:05:17):
it's not hurting or helping necessarily anything related to the
gut function. What it's really we're trying to get it
to do is help those levels in the brain. Um.
But that's like what that relationship is. And and to
go a step further, the other thing is we know
that there's a huge link between gut issues diseases. Even
like irritable bowel syndrome, for example, is more common among

(01:05:40):
people who have anxiety and depression, Meaning issues and diseases
that come up in the gut. There's a higher correlation
when folks have you know, biological issues with with their
their braining is and anxiety depression. So you know, I
muself talked about how I would get these you know,
I would have nausea and stuff before these these math
topic titians. That's actually kind of what we like that

(01:06:02):
that was it's like, UM that you know, having physically
having anxiety but also having you know, kind of other
symptoms as well. And that because we know that there's
this gut brain access and so UM studies have shown
that there are certain types of gut bacteria that are
associated with diseases like anxiety and depression, as well as

(01:06:23):
diseases like autism and schizophrenia. And there's a lot of
emerging research now that's trying to figure out exactly what
this means. It's it is early, it's early research, UM,
and what's really important is what we're trying to figure out.
We know that these can there are these connections. What
we're then trying to figure out is okay, based on that,
how do we use that information to figure out how

(01:06:43):
we can prevent disease, how we can treat disease better.
It's a very exciting area and I think you know
there's more more to come. Certainly it's interest an area
follow um. But that's why even you like a lot
of people talk about probiotics and why probiotics and the
gut microbio can help with your anxiety. That that's why
things like that are really interesting. So if someone has ABS,

(01:07:03):
does it mean that their stomach doesn't have enough serotonin
just in a very basic way that that Yeah, that
that's actually different. It's more that ib S is a
separate condition that is related when so their likelihood if
someone has anxiety, there's higher correlation of having yes and anxiety. Um,
So that the different different councules, but they kind of

(01:07:25):
often go hand in hand. So if someone is not
on any kind of S s R I and they
don't take medication, but they have anxiety, just one of
the things in their tool kit could be taking a
probiotic just to have their gut health be O you know, optimize.
That's exactly right, And I think it just as you said,
you know, I think more and more. It's a fascinating

(01:07:45):
area of research, and every every six months, I'm sure
there will be something that comes out where we learn
more about what we can do with our gut that
will help our anxiety more and more. I even loved
we know now that like there's certain foods that can
increase and decrease anxiety and dean um like you know
that salmon is good and nuts are good, and decreasing
processed foods and sugar like you know. All we were

(01:08:07):
seeing so many relationships between what we ingest and our
mood and anxiety, and similarly we're learning more about our
gut and the same. Lastly, I will ask you and
I've had very different opinions on this podcast, are we,
as everyone keeps saying, in a mental health crisis in
this country. I have heard everything from no, it's always

(01:08:30):
been there, but we just see it because of social media. Um, yes,
everybody has some undiagnosed anxiety disorder. Um that just got
worse with the pandemic. And then I've heard, no, it's
not a mental health that year not everyone has a
diagnosable anxiety disorder, but it's chronic stress and we're not
meant for that. We're meant for acute stress. So what's
your take on what's going on currently? I mean, what

(01:08:52):
is your opinion? Is this a mental health crisis we're
in or is it is it more nuanced? Yeah, I
usally we absolutely are and I certainly I think it
depends how how do you define crisis or when we
say that is that everyone is certain populations. But here's
why I think absolutely it is not. And here's why. First,
you know, I would say that both are true. You
know both we are in a crisis and we have

(01:09:12):
a chronic stress issue. Or maybe it's like all of
the above, right, like you know, it's answer E on
the on the standardizing on the standardsize dies exam. Um,
here's here's the issue. So even before COVID, we were
in a crisis. And just to give you some of
the statistics, on example, substance use sort of drug overdoses
were the leading cause of death for Americans eighteen to

(01:09:35):
forty five. That has only gotten worse. Despite the fact
that you know, both the Trump administration and the Binding
administration have put millions and millions of dollars, if not
even billions of dollars into tackling the opioid epidemic. From
all sorts of perspectives, those numbers only got worse. Okay,
And so again it was a problem before the pandemic

(01:09:56):
made it worse, but it was still a problem, right,
and the problem loneliness. We were in the midst of
the loneliness epidemic where everyone from elderly folks who like
some who never see anyone for weeks at a time,
all the way through, you know, all of the two
teenagers who we are seeing changes in the UH in
when teenagers hit certain social milestones and their growth and

(01:10:19):
development because of all the kind of they spend online,
that their ability to make relationships and form relationships in
the way that you and I did growing up because
we did not have our devices with us, you know,
seven that we were able to do. This current generation
is not able to do in the same way. And
we're seeing seeing very real changes in the way that
they form relationships and and in their own you know,

(01:10:39):
kind of growth, growth and development. Just just two examples
their loneliness and and substantius the suicide rates have increase
in suicide rates were increasing in teenagers even before the pandemic.
Since the pandemic has gotten worse. Was even more interesting
and and concerning is how these rates have gotten worse
for those who are already most marginalized. Sorry about that,

(01:11:04):
All good, All good, I'm just getting an alert, I
wanted alert. I'm in Brooklyn. I'm getting a wanted alert
for the guy that did the subway shooting. UM a daylight.
I think this alert is coming in. But okay, sorry,
but that well, there you go. There's a real life
I'm gonna keep that in the podcast. Is a real
life My phone just stared at me that there's a

(01:11:27):
shooter on the loose. I mean, you know, adding to
our mental health crisis? Is this kind of stress? You're
absolutely right, Yeah, I'm sorry, no, but no, but not
is the example, right? But because actually know that was
a perfect example, because to get at the point that
there are all these other things going on and then
something that that happens, right, and so even if you're

(01:11:48):
able to get by, then you reached the threshold and
you're at another level. And I think that you know,
so when I was I was talking right before the
before the alert um and how you know and how
and how tragic um, But that you know before the
alert um that what's really concerning, even most concerning is
as for example, when since the pandemic started, the levels

(01:12:09):
of depression, anxiety, substance use, trauma have in some case
some cases doubled in certain populations even like quadrupled. And
what specifically we see is that those who were already
most marginalized, both because of their ability to get resources
the way that they engage with the healthcare system, those

(01:12:30):
are the populations for whom the rates have increased them most,
so specifically in women in the black and Latin X populations,
in UML, the LGBTQ populations, right and so for one,
just example, were for kids were teenagers were saying that
suicide rates for girls increased by about fifty percent over

(01:12:53):
the first of pandemic for boys for for four percent,
four versus fifty percent. So that what that gets that
is what that's what what what do we do about it? Right? Like?
And I think that's what we always need to be
thinking about, is there are so many things that need
to get done and so so on one, you know,

(01:13:13):
I think all of those statistics show that, you know,
when it comes to mental health, there are spectrum of issues,
right There is anxiety, there's depression, there's trauma, there's self harm,
there's there's a substance use, like all of these things
and all and there's all these numbers are getting worse,
and they're getting worse for the people who are already
the most disadvantaged. That makes sense. That makes sense, right,

(01:13:36):
because it's like, already things are hard and then it's
hard to get help. And I think what all that
leads to is number one, UM, I want to actually
sort of end on on a hopeful note, is that
Number one. I think what I'd like to actually shape
the conversation around is treatment. And and let me go
back one step to say that throughout the pandemic, what

(01:13:58):
myself and I think all colleagues in the field have
felt like is the silver lining from the mental health
perspective has been the tremendous increase in people talking about
mental health. The absolutely like the improvement in stigma and
the way that mental health has changed, um in terms
of who's talking about how they're talking about it has

(01:14:20):
increased so much. It's where I thought it would be
like five or ten years from now. And it's everything
from the news media and the number of articles and
stories out there about mental health. There literally now every
day there's like a front page story or a big
story on something like to mental health. It's it's it's
in your world, right The entertainment world. Um, one of
my best friends is an emergency room position, like brilliant,

(01:14:42):
trained at Harvard at Stanford, and she actually works with
her name is Jennifer, and she has this company called
med Consults for Page, Stage, and Screen, and she works
with writers who are working on scripts and how to
make them more medically accurate. And there's the emergency room position. Yeah,
it's it's really it's really really cool. Actually she's an
emergency room position and so a lot of her work,

(01:15:04):
you know, in the past, had been how do we,
you know, get get this word right, or when someone
is having a surgery or an accent, how do we
make sure it shows up correctly. What you told me
is like over the last couple of years, the number
of scripts that get to her around mental health where
people want to have mental health storylines, has like gone
up tremendously, UM. And I think that's amazing because the

(01:15:26):
more that the media is talking about this and really
presenting these issues with much more like more reality based. Um.
It really that that's what leads to all this culture
change and gets people getting to the doctor earlier than
eleven years. And you know, like that that all of
that is so important. So that's this little religning, is
that stigma's gotten better. We're talking about it so much better.
I think the next big step is it needs to

(01:15:48):
be around treatment. It's not just that we're talking about
it and saying, hey, I had this too, but that
all of that needs to lead to everyone seeking how
do I get better as early as possible, and that
we're making it safe and supportive, that parents and children,
that school, that employers are creating time for people to

(01:16:09):
take a month off or to you know, get proactive help,
that that that that they're able to you know, to
get and not interfere with Where all of these are
really really important. Um And I think that what's amazing
is that no matter who you are who's listening to
this podcast, there is actually probably some way, based on
what you're doing, that you can make an impact in this.
You know, if if you're again, I'll just go back,

(01:16:32):
like Jen, the fact that you've created this podcast, What
that does, How that changes the dialogue, How that changes
who even recognizes this is an issue, and that whether
it means they themselves recognized earlier now that they have
something and they can get help tremendously important. Whether they realize, oh,
they actually work in a field that they can maybe
make some change, Like they work in HR and they
can change the benefits that the that their company gives people.

(01:16:55):
That is huge. That is huge. Maybe they're a teacher
and they want to change the way that they talked
about invited their kids. That would be life changing for
an entire generation, you know. So there's so many things
that can be done. And um and I think that
I like end on that level of hope it real
We say celebrate therapy. We want to celebrate the experience

(01:17:17):
and champion and make you proud of the fact that
you got help and that you're getting help. You just
gotta be super pumped up. I hope you're feeling as
pumped up as I am about the future. And I'm
going to get into our takeaways today. There's so many.

(01:17:37):
I love it. I love it when a guest just
downloads information into my brain and don't forget. If you
go to join dash reel dot com j O I
N dash r e a l dot com, select to
join now at the top. Once you get to the paywall,
you are going to select the coupon code and the
promo and enter anxiety Bites all caps, all one word,

(01:17:59):
and Anxiety Bites again. You can just go to the
show notes, follow along and get your free month. And
here are the takeaways from this episode. Now, don't forget.
Please send me an email Anxiety Bites Weekly at gmail
dot com. Let me know what you've learned from listening
to the show. If you have any hot tips of
your own that you have come up with that help

(01:18:20):
your anxiety, please share it with me. I'll share it
with our listeners and if you have any questions, it
could be answered on an upcoming listener email episode. So
please do that again. Anxiety Bites Weekly at gmail dot
com would love that. All right, let's get into the
takeaways from this episode. The first thing that Dr Vaston

(01:18:41):
has on her LinkedIn bio before any credential, is her
twenty year history with anxiety and depression due to COVID,
many people whose anxiety was under the radar, they came
overwhelming or reached new heights. Many people turned to overeating
and alcohol in order to self medicate. So this sounds
like you. It's normal. Even Dr Vasson herself did this.

(01:19:05):
Dr Vasson has accepted that she may struggle daily with anxiety,
and that's okay. She's got the right tools and is
making things a little bit better for herself on a
daily basis. Sometimes we can have a change in our
behavior due to our anxiety, even though we didn't feel
any of our usual anxiety triggers that led to the

(01:19:25):
change in behavior. If you're a teenager, how do you
know if you're super intense feelings your anxiety is something
normal because you know you're a teenager and you've got
all those hormones, or if this is going to be
a disorder. The first thing you need to do is
distinguish how much are these feelings and sensations affecting your life?
Is your sleep disturbed, have your grades dropped? Are you

(01:19:47):
having trouble focusing? Or are you able to cope and
live the life you want? Or is the anxiety getting
in the way? Why does anxiety even occur in some
people in the first place. What's known as the biopsychosocial
model in anxiety is a threefold explanation that helps to
understand why it manifests in the first place and gives

(01:20:09):
a framework for how to treat mental health conditions. So
biosocho biosoco biopsychosocial, all one word means that the reason
for anxiety is a combination of biological, psychological, and social factors.
The biological is our genetics, like did family members have anxiety?
It's passed down in our d n A. The psychological

(01:20:30):
means how do you talk to yourself? How do you
cope with stressors? The social component is a mix of
historical what was your childhood like, was your household growing
up supportive? Where you bullied? And the second component to
social is our environment what's going on currently in our
home life, our work life, or our relationships. The issue

(01:20:51):
with mental health right now is that we don't have
a way to measure, you know, say, like the way
you could measure other diseases using a blood test. There's
no way to measure what percentage of our anxiety is
biological versus psychological versus social. We can get a full
history verbally from a patient and from there make some
educated guesses. But with this biopsychosocial model, the old way

(01:21:15):
of thinking about mental illness is over. Nothing is your
fault and it's nothing someone did. Anxiety has a very
real biological part, and it's also a manifestation of our
current environment. In regards to taking medication for anxiety, it
does take a bit of trial and error. For example,
even with allergy medication, doctors aren't sure from the get

(01:21:36):
go what will work for patients. There is serotonin in
our brain and in our gut, and a lot of
antidepressant hills are what's known as ss R eyes, and
one of the side effects of these antidepressants can be
stomach upset for the first week or two because it's
affecting the serotonin level in your gut, but it should

(01:21:58):
eventually subside again. Trial and error with any kind of medication.
With any mental health medication, you will feel the negative
side effects before you feel the positive ones. But if
you stick with it, medication can absolutely give people back
their lives who need it. The social aspect of the

(01:22:19):
biopsychosocial model is being taken more seriously these days, as
people recognize whoops, why is my phone ringing that this
whole thing is complex. We can appreciate now how early
childhood traumas or things like bullying can make a big
impact later on down the line, and this gives therapists
and doctors more opportunities for treatment There are so many

(01:22:43):
different types of anxiety treatments that help from an environmental perspective,
from working on relationships with people, exercising, mindfulness, meditation, journaling, gratitude,
and so much more. Two billion people around the world
have a diagnosable mental, brain or behavioral health disorder. But
even people who don't meet all of the criteria for

(01:23:04):
a mental health diagnosis may still struggle with anxiety and
could absolutely benefit from some kind of treatment. If we
optimized all of the therapists in the United States, we
would only have enough therapists to treat seven percent of
the American population, despite the fact that over the course
of a lifetime, fifty percent of Americans will have a
diagnosable mental health disorder. The average amount of time from

(01:23:28):
someone first having a symptom of mental illness to seeking
medical attention in the United States is eleven years. Dr
Vauson's lab at Stanford Brainstorm, the Stanford Lab for Mental
Health Innovation, focuses on trying to solve the mental health
crisis through entrepreneurship. We won't be able to solve the
problem of getting people mental health care unless we think

(01:23:51):
about other ways to reach people, which is where technology
comes in. Dr Vowson's goal is to help foster entrepreneurs
who find ways to address mental health online, as well
as think about online worlds as ways to deliver and
provide mental health therapeutic services and education to reach people
in ways that is low cost and just gets right

(01:24:12):
to you. One example of how Brainstorm has changed things
online has been working with a company like Pinterest to
get their users tools and resources that comes from doctors
and is evidence space treatment from mental health known as
micro therapeutics. Micro Therapeutics is a whole tool kit of
exercises based in cognitive behavioral therapy, dialectical behavioral therapy, acceptance

(01:24:37):
and commitment therapy translated into two or three minute things
that you can do online and actually feel a little
bit better in just a few minutes. It's a compassionate experience.
Dr Vosson's former student, Ariella Sophia, is now the founder
and CEO of Real and Real is a website and
community that is a team of innovators, clinicians, and technologists

(01:25:00):
on a mission to not just normalize mental health care,
but celebrate it. They integrate empathy, creativity, and design to
build a progressive mental health care experience while also improving
the quality of care itself. Dr Vawson is the chief
medical Officer. There is no one solution to mental health.

(01:25:21):
It's not just one medication or one type of therapy.
It's also policy and economics, and it's also about changing
the workplace, and it's about changing the way we talk
to each other. Dr Vauson's top ten prescriptions that she
actually will write on a prescription pad for patients for
treating anxiety. Mindfulness, meditation with deep breathing, sleep, gratitude, nutrition,

(01:25:44):
reducing substance use like alcohol, drugs, tobacco, to use as
little as possible, zero to none or none to little, exercise, nature,
community and connecting, giving and altruism and sexual pleasure. It's
not about big, grand gestures that help alleviate anxiety. It's
doing small things and doing them regularly. And there is

(01:26:06):
scientific evidence that things like journaling and getting outside actually
help our brain. Studies have shown that mindfulness and deep
breathing bring about chemical changes at the cellular level that
lead to a cell living longer, which means that there's
a link between mindfulness, meditation, and deep breathing and longevity.

(01:26:27):
The length of your life all right, and if you
want to read these takeaways, you can always go to
my website, Jen Kirkman dot com and then click anxiety
Bites again. That link will also be in the show notes.
Thank you so much for listening and remember anxiety Bites,
but You're in control. For more podcasts from My heart Radio,

(01:26:53):
visit the I heart Radio app, Apple podcast, or wherever
you listen to your favorite shows.

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Episode Transcript

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.css-r6mb8g{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:1;overflow:hidden;}New Heights with Jason & Travis Kelce

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