March 26, 2025 • 26 mins
If you ask almost anyone about the time of year that people feel the most down, the time people are most at risk for depression, suicide, and increased substance use, they will answer winter. Surprisingly, perhaps, the research shows that it’s actually when spring moves into summer. Joshua Arvidson discusses that research and what can be done to help individuals improve their mental health during challenging times of the year. Joshua is Chief Operations Officer for Alaska Behavioral Health. He is a licensed clinical social worker and an expert in trauma informed care for children who established the Alaska Child Trauma Center at Alaska Behavioral Health. He serves on the Steering Committee for SAMHSA’s National Child Traumatic Stress Network and is the Principal Investigator for the Military Family Child Trauma Program. He’s also on the Editorial Review Board for the Journal of Child and Adolescent Trauma and has presented on childhood trauma at over 100 conferences, including the International Society for Traumatic Stress Studies. Joshua serves on the Board of Directors for FOCUS and has designed and taught courses on clinical practice with children and adolescents and childhood trauma for the University of Alaska Anchorage. Joshua has published in the journals Child Welfare 360, Child Maltreatment, the Journal of Child and Adolescent Trauma, and Trauma, Abuse and Violence. Alaska Behavioral Health, its resources, and its programs can be reached at https://alaskabehavioralhealth.org/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Mike (00:12):
Welcome everyone.
This is Avoiding the AddictionAffliction brought to you by Westwords
Consulting and the Kenosha CountySubstance Use Disorder Coalition.
I'm Mike McGowan.
What time of year do you thinkpeople feel the most down, the most
at risk for depression, perhapssuicide, increased substance use?
Well, if you're anything like me,the answer just might surprise you.
(00:32):
We're going to talk about that today anda lot more with my guest, Joshua Arvidson.
Joshua is the Chief OperatingOfficer for Alaska Behavioral Health.
He's a licensed clinical social worker.
and an expert in trauma informed care forchildren and established the Alaska Child
Trauma Center at Alaska Behavioral Health.
He serves on the steering committeefor SAMHSA's National Child
(00:55):
Traumatic Stress Network and isthe principal investigator for the
Military Family Child Trauma Program.
Joshua is also on the Editorial ReviewBoard for the Journal of Child and
Adolescent Trauma and has presentedat over 100 conferences on childhood
trauma, including the InternationalSociety for Traumatic Stress Studies.
He serves on the Board of Directors forFOCUS and has designed and taught courses
(01:18):
on clinical practice with children andadolescents in childhood trauma for
the University of Alaska Anchorage.
He's also published numerous articles.
Just an expert all the way around.
Thanks for joining us today, Joshua.
Joshua (01:32):
Thanks.
Thank you, Mike.
It's wonderful to be here.
Mike (01:34):
I was reading an article, the reason I called ya, I was reading an
article about mental health and thechange of seasons, and it used a term
for the change of seasons up in Alaska.
They called it Spring Breakup.
Is that accurate?
Joshua (01:50):
Yeah, that's what we call it.
Mike (01:52):
And because, I'm assuming I know, but
Joshua (01:55):
Yeah, the breakup itself is a specific thing that happens, and in the
wintertime, our rivers, in most of Alaska,our rivers freeze over pretty solid.
It's actually kind of interesting,in some ways, the rivers in parts
of rural Alaska serve as kind oflike highways that people use.
We call them snow machines here,snowmobiles in the lower 48.
There's snowmobiles toget to get to and from.
(02:17):
And then in the springtime as it warmsup, when those rivers thaw, there's a
strong current underneath that ice, right?
All winter is still flowing.
So you got this big, big ice on topand as it melts at a point when it
kind of breaks up, it literally willlike crumble and you'll have this huge,
there's can be like ice damming andflooding and all this kind of stuff.
(02:40):
So it's quite an event.
It's not like a lake thawingout where the ice just slowly
recedes when when a river thaws.
It's a it's quite a force of nature whenall that's unleashed, so that's what we
mean by the breakup in a kind of literalsense and then we just use that term to
talk about the spring season here which Inmost of alaska involves a lot of melting
snow, a lot of mud (laugh), a lot of dirt.
(03:03):
What you guys call spring,with flowers and stuff.
We call that summer.
(laugh)
Mike (03:09):
Well, I'm in Wisconsin and we're at the what we would
call the dirty time of the year.
Joshua (03:14):
Yeah.
Mike (03:15):
Where the snow is melting and whatever crud was
under there now gets exposed.
By the way, in case you'relistening along, these are all
metaphors for mental health too.
I assumed forever, and I've worked inthis field for a long time, the midwinter
when darkness is the deepest and longestwas the height of all of the things
(03:35):
I talked about in the introduction.
But according to research, not so.
Joshua (03:42):
That's really interesting and it is kind of counterintuitive, isn't it?
You would think that, you know, depressionand anxiety and the most common mental
health conditions would be at theirkind of peak during the dark months of
winter and for us here in Wisconsin,I'm in Alaska, during the during the
cold months of winter social isolationhard to get around that kind of stuff.
(04:02):
But yeah, I started to become aware ofthat research about 15 years ago, that
that's actually in the springtime that wesee kind of the peak of people's distress.
If you look for seasonal patterns,and I think the most important
thing is scientists can eversay is we don't really know.
Mike (04:18):
Yeah, right.
Joshua (04:19):
I mean, we have to have humility in this, right?
And so as scientists, we reallyneed to always be asking questions.
We have some ideas about why that mightbe but it's still a bit of a mystery.
Mike (04:30):
What are the ideas?
Joshua (04:32):
Yeah, so there's, there's a lot of things, like I said, intuitively
you would think it would be wintertime.
I'll talk about some biologicalthings we think are happening and some
psychological and then some social.
So on the biological side the fartheraway you get from the equator the bigger
adjustment your body has to deal within terms of the amount of light that
you're exposed to throughout the year.
And light is this really, I think,understudied and not well enough
(04:56):
understood component of mentalhealth and behavioral health.
As is sleep.
I think sleep and light arereally big, big factors.
And, where I live here in southcentral Alaska at latitude 61, in
the dark of winter at the wintersolstice, we're getting about
five hours of sunlight a day.
And it's not like the sun'sgoing over really quick.
It's actually just like dipping...actually I'm at home right now.
(05:18):
It actually doesn't even come abovethe mountain next to my house.
So it's like, it'sliterally like twilight.
And then it's dark again.
So it's, you know, it's pitchdark at 9:30 and then it's pitch
dark again by, by 3:30 or 4.
And so when you're living in thatenvironment, it has a huge impact on
your mental health, but I think a lot ofpeople kind of hunker down in the winter.
And then as the spring comes,we're close to the equinox, right?
(05:41):
Which means everyone will be getting12 hours of each, so we've gained,
we've doubled the amount of lightthat we have in the here in South
Central Alaska in just a couplemonths, and I think our bodies have
a lot of trouble adjusting to that.
So I think that's part of thebiological piece in our circadian
rhythms, melatonin production, allthose things that our body does.
We're diurnal mammals were builtto be around up during the daytime.
(06:04):
I know society gets in the way ofthat with night shifts and crying
babies and all these other things,but we are built as daytime creatures.
We're not owls or bats.
We don't see in the dark.
So I think our bodies are adjustingto have a lot of biology behind that.
And then I think the other piece thepsychological piece, like I said, I
think people sometimes hunker downin the wintertime and as springtime
comes and there's more light and peopleare up and moving around and excited.
(06:25):
If you're really depressed oranxious or really struggling with
your mental health, it can actuallyalmost be harder as everyone's kind
of like getting going for the summer.
I'm going to play softball.
I'm going to do all these things.
And if you really feel stuckand in distress, you kind of
can feel a little left behind.
I see a lot of clients whofeel that in the springtime.
Mike (06:43):
And of course, as people interact more and have more interactions, that's
going to affect your mental health.
And we're leaving a part out,at least here in the Midwest, as
you socialize a little bit more,the drinking tends to go up.
Joshua (07:00):
That is true.
That is true.
There's a lot around substance usepatterns that can change in the
springtime that I think has a big effect.
And there is some biology too, aroundwhen people are in the darkest depths
of like, for example, depression, asthey start to feel more energy that
actually may open the door to someadditional, like thoughts of self harm
(07:22):
or other things that can happen, becausewhat we see, what we know, is that
suicide rates hit their peak in Apriland May in the springtime, and that's
really true throughout North America.
Mike (07:34):
And they're higher in northern latitudes, are they not?
Joshua (07:38):
That's correct, that's correct.
Yeah, and I think a lotof that is the biology.
Your body just is really strugglingto deal with major changes in light,
which disrupts sleep and sleep isan emerging science in both mental
health and substance use recovery.
Sleep is the foundation of wellnessand as sleep gets disrupted, it
(07:58):
really can have a cascading effect.
Mike (08:01):
Wow.
And then crime and violence goalong with that, I would think.
Joshua (08:05):
Yeah, that's another piece as well.
Our patterns of socialinteraction change a lot during
the springtime and into summer.
And yeah, while you would think itwould be, you know, kind of coming
out of the darkness and, you know, theeasiest time of year, it's actually,
it's actually quite the opposite.
Mike (08:20):
I think there's a lot of people that say they have seasonal affective
disorder without ever having itdiagnosed, but my mood definitely
improves with being outside and light.
Joshua (08:30):
Yeah.
Yeah.
I think that's a big piece.
Here in Alaska, a lot of folks,really try to power through the winter
by leaning into it, going skiing.
I got into fat tire bikinga couple of years ago.
My skiing days are probably over, butdon't let the ski sweater fool you.
I'm not a skier anymore, but.
But I got into fat tire bikingand I've been really disciplined
about it the last two years.
It doesn't matter what the weather is.
(08:51):
I'm going every night.
And so I'm out there in the dark.
That was pretty warm right now, actuallyhere at South central, but, you know,
there'll be nights where it's belowzero and I got my dogs with me and I'm
just, it's pitch dark and but I justkind of got to lean into it cause it's
the only way I can get through that 18hours of darkness, 20 hours of darkness.
Mike (09:07):
I can't do that.
I bike a lot and I've tried thefat tire, but biking when it's cold
and windy, what do you, I got it.
We're going to take a tangent here, folks.
What are you, what are you wearing?
Joshua (09:20):
Well, I think this is a good metaphor for mental health.
In the farther north you get, themore common the saying, there's no
bad weather, there's just bad gear.
And that is something I think about alot as a mental health professional,
like we're dealing with these changesin daylight or whatever the stressors
are in our environment, in our life.
But there are things we can do.
There are things we can do.
(09:41):
So, you know you can fat tire bikeat zero if you've got the right gear
on, half the time I'm getting sweatyhalfway through because I've got a
great gear on, but you really do haveto prepare and kind of brace yourself
and insulate yourself from all thestressors and buffers that are coming.
So yeah, I think there's a lot to that.
Mike (09:57):
What a great lead in.
Talk about Alaska behavioral health.
You have tons of programs across Alaska.
Joshua (10:03):
Yeah, it's a really exciting place to work.
We just celebrated our 50th anniversary.
I've been there for almost half of that.
We're the largest behavioralhealth provider in Alaska.
And because we're in Alaska, you know,this huge state with a relatively
small population, we do a lot ofdifferent things to try to meet all the
community needs so we kind of really doeverything below hospital level care.
(10:23):
So we have day treatment, partialhospitalization, day treatment
programs, which you are like highintensity treatment for people
with really acute distress.
You get the same level of care that youwould get in a hospital in many ways.
But you go home at night and so forfolks who have a safe place just to sleep
in a situation where they can do that.
That's the highest level of careadult mental health residential,
(10:45):
which is similar in some ways allthe way to outpatient clinics.
Psychiatry, primary care.
Over the last seven years whatwe've been really focused on,
you know, I'm a clinical nerd.
I love to talk about all our differenttreatments, trauma focused, CBT and
CBT cognitive behavioral therapy,but the most important thing that
we provide is a c c e s s access.
It's it's gonna get care topeople when they need it.
(11:08):
It doesn't do you any good to havethe best science based care if people
can't get it when they need it.
And mental health conditionsand substance use conditions are
progressive So the earlier wecan get people care, the better.
So that's what we've been reallyfocused on the last five, six years.
We've done so from serving 2000Alaskans a year that this year
we will serve 10,000 Alaskans.
(11:28):
It's a lot of growth, but you know,it's really good because when you
can eliminate things like wait listsand people can get into treatment
when they want it and when they needit and when they're ready for it.
Treatment so much more effective.
I've been a therapist for over 20 yearsand the most common thought I have when
I'm meeting with someone for the firsttime is I wish you would have come in a
couple months earlier before it got this.
(11:50):
There's still stigma.
There's still these barriers.
We don't think of mental health carethe way we think of primary care.
If you're sick, go to the doctor.
You know, if you call yourfriend who's a doctor, you
think, I think I might be sick.
I think I should, you know what they'regoing to say, go to the doctor (laugh).
And they're not just, you know,doing that for liability reasons.
I mean, really, they're like,you should get it checked out.
If you think you should get itchecked out, get it checked out.
(12:11):
We need to think about mental healthand behavioral health care that way.
Get it checked out and gettreatment as quickly as possible.
And we've been doing some excitingthings the last couple of years.
Adding primary care into our system sopeople can get all their health care
needs, behavioral health related needs andpsychiatry and primary care kind of all
through, kind of more streamlined system.
(12:32):
We even have in house pharmacies inAnchorage and Fairbanks so that people
can get kind of those needs met becauseit's not just about convenience.
What we really think, what I've seenin my career is it's not just about
making it convenient, but what it isabout is if there's barriers to people
getting care, they won't get it.
They've got a lot going on in their life.
And so going from three different placesto get your therapy and your medication
(12:56):
management and fill your prescriptionsand do those things in the life of an
average family, that's just too much.
Not to mention when it's dark 20 hoursand there's snow on the road and all that.
Mike (13:06):
Well, given that, and it may be difficult sometimes, do you offer
telehealth and teletherapy as well?
Joshua (13:12):
We do.
About 10 percent of ourappointments are telehealth.
And so that's been a goodaccess strategy for us.
A lot of clients prefer in personwhen they can do it, but we do do
telehealth to provide access out intoour hub communities and rural areas.
And then for some of our folks,they may live like an hour
away from one of our clinics.
(13:33):
And so they're able to come in personsometimes and then do sessions in between
those in person sessions via telehealth.
Kind of like a hybrid model thatactually has become pretty common
in our South Central and Fairbanksclinics and our Mat Su clinic.
Mike (13:46):
There's a pretty big emphasis in your website and even in your
introduction on the military.
They present some uniqueissues along the way.
Joshua (13:55):
Yeah, Alaska has the highest portion of veterans in
our population of any state.
If you look at a globe, it makes sense.
There's a lot of militaryinstallations in Alaska for really
important strategic reasons.
And so we have a lot ofservice members here.
Two miles that way is joint bearbase air Elmendorf Richardson, which
is a joint air force and army base.
And F 22 is fly over my house every day.
(14:17):
So it's just a reminder.
We live in a state where there'sa big military presence and
they're part of our community.
And so as a community provider servingthe folks who serve our country is really
important to us and serving the veterans.
So we have some specialty clinics.
specifically for servicemembers and veterans.
And then we serve family members andmilitary service members and veterans
across all of our 12 locations.
Mike (14:39):
Awesome.
When I was reading your bio I've workedmy entire life with youth, adolescents.
And you're an expert in childhood trauma.
This is not an easy time for youth.
We're seeing mental health issuesthrough the roof is probably a little
bit over, but they're dramaticallyrisen in the last dozen years.
Joshua (15:02):
Yeah, I think there's so many likely factors driving that.
But we have seen that.
I mean, as I said, we've grownfrom being able to serve about 2000
Alaskans a year to almost 10,000.
And what we've seen iswe've needed to do that.
The demand and the need forfor mental health services is
has increased in our state.
And I think that's that's true nationwide.
Mike (15:22):
So how do adolescents present in a more unique way than working with adults?
Joshua (15:28):
Adolescence, there's a lot going on.
Adolescence is such an amazing again,thinking about start with biology,
think about what it is like to bea sixth grader and in 10 years, you
might be raising your own children.
(laugh)
So think if you have a sixth grader athome, think about the fact that she might
be a mom or he might be a dad or youknow, I mean, that's, that's in a decade.
(15:49):
I'm not going to go throughthat kind of change in the next
decade of my life, for sure.
So that's incredible.
The social kind of development that'sgoing on, the biological development
that a child is becoming an adult.
And so there's so much going on.
And then if you experience asemotional and mental distress as
you're going through that, allthose rapid changes, I think it
(16:10):
can present some unique challenges.
The flip side though is adolescence.
Because they're growing so quickly.
And their biology is wired forgrowth and development and learning.
Treatment with adolescentsalso can be really fast.
I mean, they're ready for change.
I often think like my third sessionwith an adolescent who's experiencing
generalized anxiety disorder feelslike my 15th session with them.
Mike (16:35):
(laugh)
Joshua (16:35):
They are ready.
They're ready.
They're growing.
They're changing.
They're open to new experiences in waysthat people in our age cohort maybe have
more challenges with so yeah, I reallyenjoy working with adolescents and
they're a big part of the population thatwe serve at Alaska Behavioral Health.
We have done some innovativethings to try to reach them because
sometimes adolescents are a littlebit of a missing population when
(16:57):
you look at your demographics.
We really saw that actually.
When you're 10 and you really strugglingyour parents bring you in for treatment
when you're 35 you bring yourself in.
When you're 17, how do you get there?
So we've had to do some strategies to makesure that adolescents have good access.
Part of that's partnering withschools and other systems that are
already working with adolescents,so that they can get into treatment.
(17:18):
But you know, one thing that'schanged in my career, I've been doing
this for a while is adolescents areleading the way on stigma reduction.
Mike (17:24):
Yes, they are.
It's awesome.
Isn't it?
Joshua (17:27):
It's so cool.
20 years ago, the typical, myfirst meeting with an adolescent,
they'd have their arms crossed.
I was told I have to be here.
I don't want to be here.
That's not how most adolescents are today.
They're leading the way.
They've really flipped the switch.
Mental health care is just health care.
Mental wellness is just wellness.
It's just a type of health care.
And they actually, you know,it's flipped 180 degrees.
(17:47):
The adolescents coming into ourclinics often have a lot less stigma
and presumptions about mental healthtreatment than other generations.
It's really cool to see.
Mike (17:59):
I do a lot of presentations at schools, and I have for a long time.
And you're right, 20 years ago, they wouldbe receptive, but then afterwards they
would say, can I talk to you for a minute?
And now it's not unusual to see a handgo up and say, Well, I was talking
to my therapist about my depression,in front of everyone, and it's
awesome because it leads the way.
(18:19):
Right, Joshua.
It's it says to everybody.
It's just what I got.
It's like having asthmaand having an inhaler.
It's not that big a deal.
Joshua (18:28):
Yeah.
It's incredible.
Young people have really kindof led the charge on that.
And it's an awesome thing to see.
Mike (18:35):
What should people do?
I did this deliberately rightnow because we're right in
that change of seasons, right?
So what should people do if they'restarting to experience that sensation?
Because I know what people get, right?
When spring comes like this, they'regoing to get poo pooed a little bit more.
It's like, well, what areyou complaining about?
The weather's starting to get nice.
And so what can we do to takecare of ourselves if we start to
(18:56):
feel ourselves doing that dip?
Joshua (18:58):
Again, if we think about it kind of biological, psychological, social, then
I think we can break it down a little bit.
There's some concrete things we could do.
So on the biology side, sleep.
Sleep is the most important thing thatwe can really pay attention to all year
round, but especially when the seasonsare changing and if you're in northern
latitudes where you're dealing withreally dramatic changes in light, it
(19:19):
can throw off your circadian rhythms.
And there's some concretethings that are really helpful.
And some of these things Iuse myself because I live in
a really northern climate.
So one thing that can be helpfulis light therapy or light boxes.
You know, you talk to your doctorto kind of make sure you get the
right one, that it's healthy for you.
But those are commonly used in themorning to help people, especially
during the darkest months to kindof help people reset their clocks.
(19:42):
What it does is basically tellsyour body it's daytime, which
gets your melatonin productionand other things kind of in line.
Again, something to talkwith your physician about.
Is it's really common to for Alaskansto experience vitamin D deficiencies
and other things related to you'rejust not getting any sunlight on
your skin for six months of the year.
I'm not a physician, but I talkedto my physician about that.
(20:03):
I encourage my patients to.
So those are some of the biologicalthings you can attend to making
sure your eating patterns are good.
You really managing your use of alcoholor other substances in addition to
the challenges that addiction canlayer on to someone's life, there's
a lot of emerging science around theharmfulness of alcohol when it comes
to sleep patterns and restorativesleep, too, because how you sleep is
(20:25):
as important as how much sleep you get.
So there's a lot of data thatdepressants like alcohol and some sleep
aids that are used may help peoplego to sleep, but that sleep itself
isn't as restorative as it would bewithout those substances on board.
So those are some of thethings you can do concretely.
I think exercise is a big piece.
And sometimes people think aboutexercise in terms of like calories
(20:49):
and this and that, but it really just.
It has so many cascading benefitsbeyond those commonly thought of
cardiovascular benefits, like in termsof your just hormones and sleep patterns.
So those are some things Ithink in the social realm.
Yeah, it can be hard.
It's like kind of everyone'sgetting going in the spring.
And, you know, here in Alaska, peopleare out and about more is to really pay
(21:11):
attention to your social connectionsand try to build a lot of, as much
meaningful interaction with otherpeople as you can into your life.
Those social connections are really big.
And then on the treatment side, ifsomeone's really struggling there are
especially, for example, for with sleepCBTI, cognitive behavioral therapy for
insomnia, the science on it's really good.
(21:31):
It outperforms medicationsover the longterm.
And it doesn't have any of the sideeffects that medications can have.
So I got trained a couple of years agoin CBTI, I find it to really be almost
like magic for people to experience.
And there's a lot you could gointo in that, but stimulus control
around your sleep, which is like.
You don't want blue lighthitting your eyeballs.
(21:52):
Basically, after about 5 p. m. ifyou want to be in bed by 9 or 10.
And so there's things you cando around that, limiting your
screen time that kind of stuff.
Even using blue light blocker glasses.
I actually have a pair of those I useif I'm if I'm working late at night.
So I think all those things canbe really helpful in buffering
folks and building in resilienceas you go through this transition.
(22:14):
And then I encourage people, likeI said, if you feel like you need
help, I encourage you to get it.
As someone who's been atherapist for 23 years.
The best thing you can do is seekhelp as soon as you think you need it.
And sometimes people have these thoughtslike, oh, someone needs it more than me.
I encourage you not tohave those thoughts.
They're not really, you know, asa therapist, I say one, probably
not true to definitely not helpful.
(22:36):
And the other thing is, youknow, access is a virtuous cycle.
So people get into treatment whenthey need it, the treatment's
more effective and it's faster.
And if your treatment's faster, thatbenefits the next client who comes to
my clinic, because you're going to beoff living your life and potentially not
need as long or as intensive treatmentactually creates room for the next
(22:57):
client who walks through the door.
So I actually flip it around a little bit.
If you're like, well, you know,someone else needs it more than
me, the quicker you get treatment.
The quicker it works, the better itworks, and that creates more access for
the next person to walk through the door.
So I encourage people to kindof flip that thinking around.
Mike (23:13):
Places across the country are stretched thin.
Even though we deal with mentalhealth, you deal with mental health.
Do you have to remind your staffto practice what we preach?
Joshua (23:24):
Oh, yeah.
Oh, yeah.
I have to remind myself (laugh).
To really pay attention.
As a healthcare provider, we do talkabout this, when you get in the airplane
and you're traveling with a child andthey say if the oxygen mask dropped
down, you got to put on yours first.
Because if you pass out, you'renot helping anybody else.
So yeah, we do have to pay attention tothat a lot as mental health practitioners.
And as healthcare providers in general,attend to our own stress and wellness.
(23:47):
Yeah, and engage in thiswork in a sustainable way.
Mike (23:50):
In the article that I was referencing earlier, I read that
Alaskans have a term for the footwearthat they wear during the spring.
Joshua (24:01):
Yeah.
Break up boots.
Mike (24:02):
Break up boots.
Joshua (24:04):
Yeah.
Yeah.
Mike (24:06):
Meaning?
Joshua (24:07):
Yeah.
So it's really common.
I'm not trying to sell a particular brandhere, but in most Alaskans wear Xtratufs.
Somewhere bogs.
There's a little debate about that.
Mike (24:17):
(laugh)
Joshua (24:18):
But some version of Xtratufs or like that you'd call them
galoshes if you were in Britain.
But these rubber boots that are almostknee length, they make different
lengths, but and, you know, it isan interesting metaphor because
it's like, like I said, there's, youknow, we have this thing, there's no
bad weather, there's just bad gear.
It is kind of this attitude in the springwhere it's like, yeah, it's muddy out.
(24:39):
Yeah, there's like even right nowit's late February here in Anchorage.
Normally, we would have eightfeet of snow on the ground.
But we didn't have very snowywinter and it's been pretty warm.
So it's been off and on muddythe last couple weeks here.
And you just put on yourboots and you keep going.
Like in some ways you get outside asmuch as you can and it's muddy and
it's sandy and there's puddles Andyou put on these knee high waterproof
(25:01):
boots and you just go out and do it.
And you'll see Alaskans walking around inthe store and the grocery store and the
health care clinic with their Xtratufson and they just keep them on all day.
And yeah, it's kind of a coollittle anomaly in this wet, cold,
slushy environment that we have.
(25:22):
But to me, it is kind of a powerfulmetaphor of like, do the best
you can to prepare yourself andget outside and do what you can.
In therapy, we always like to come up withcomplicated terms for simple concepts.
So, we call that behavioral activation.
Which means what you do changeshow you feel and you think.
(25:42):
If you're feeling really sad or anxiousand I just tell you, Hey Mike, don't
feel so sad, don't feel so anxious.
That's not helpful!
It's not going to do anything.
So what we do is we thinkabout your thoughts because
you can change your thoughts.
Thoughts are really, they are changeable.
And you can definitelychange your behavior.
And what you do if you put on your yourbreakup boots and you get out there and
(26:02):
you walk your dogs and you go to thestore and get what you need for food
and cook good meal and all those things.
That's going to change yourfeelings more than me talking
about your feelings and you and Italking about your feelings, right?
So we call that behavioralactivation because we like
to come up with fancy terms.
But it's a really important concept.
Mike (26:18):
What a great place to leave it.
Joshua, thank you so muchfor being with us today.
This is so instructive and it'ssuch a great reminder for all of us.
I'm going to put links, as youall know, who listen to Alaska
Behavioral Health and Joshua'scontact information on the podcast.
We invite you to listen in whenever you'reable to until we talk to you next time.
(26:39):
Stay safe and lace up your breakup boots.
Welcome everyone.
This is Avoiding the AddictionAffliction brought to you by Westwords
Consulting and the Kenosha CountySubstance Use Disorder Coalition.
I'm Mike McGowan.
What time of year do you thinkpeople feel the most down, the most
at risk for depression, perhapssuicide, increased substance use?
Well, if you're anything like me,the answer just might surprise you.
(00:32):
We're going to talk about that today anda lot more with my guest, Joshua Arvidson.
Joshua is the Chief OperatingOfficer for Alaska Behavioral Health.
He's a licensed clinical social worker.
and an expert in trauma informed care forchildren and established the Alaska Child
Trauma Center at Alaska Behavioral Health.
He serves on the steering committeefor SAMHSA's National Child
(00:55):
Traumatic Stress Network and isthe principal investigator for the
Military Family Child Trauma Program.
Joshua is also on the Editorial ReviewBoard for the Journal of Child and
Adolescent Trauma and has presentedat over 100 conferences on childhood
trauma, including the InternationalSociety for Traumatic Stress Studies.
He serves on the Board of Directors forFOCUS and has designed and taught courses
(01:18):
on clinical practice with children andadolescents in childhood trauma for
the University of Alaska Anchorage.
He's also published numerous articles.
Just an expert all the way around.
Thanks for joining us today, Joshua.
Joshua (01:32):
Thanks.
Thank you, Mike.
It's wonderful to be here.
Mike (01:34):
I was reading an article, the reason I called ya, I was reading an
article about mental health and thechange of seasons, and it used a term
for the change of seasons up in Alaska.
They called it Spring Breakup.
Is that accurate?
Joshua (01:50):
Yeah, that's what we call it.
Mike (01:52):
And because, I'm assuming I know, but
Joshua (01:55):
Yeah, the breakup itself is a specific thing that happens, and in the
wintertime, our rivers, in most of Alaska,our rivers freeze over pretty solid.
It's actually kind of interesting,in some ways, the rivers in parts
of rural Alaska serve as kind oflike highways that people use.
We call them snow machines here,snowmobiles in the lower 48.
There's snowmobiles toget to get to and from.
(02:17):
And then in the springtime as it warmsup, when those rivers thaw, there's a
strong current underneath that ice, right?
All winter is still flowing.
So you got this big, big ice on topand as it melts at a point when it
kind of breaks up, it literally willlike crumble and you'll have this huge,
there's can be like ice damming andflooding and all this kind of stuff.
(02:40):
So it's quite an event.
It's not like a lake thawingout where the ice just slowly
recedes when when a river thaws.
It's a it's quite a force of nature whenall that's unleashed, so that's what we
mean by the breakup in a kind of literalsense and then we just use that term to
talk about the spring season here which Inmost of alaska involves a lot of melting
snow, a lot of mud (laugh), a lot of dirt.
(03:03):
What you guys call spring,with flowers and stuff.
We call that summer.
(laugh)
Mike (03:09):
Well, I'm in Wisconsin and we're at the what we would
call the dirty time of the year.
Joshua (03:14):
Yeah.
Mike (03:15):
Where the snow is melting and whatever crud was
under there now gets exposed.
By the way, in case you'relistening along, these are all
metaphors for mental health too.
I assumed forever, and I've worked inthis field for a long time, the midwinter
when darkness is the deepest and longestwas the height of all of the things
(03:35):
I talked about in the introduction.
But according to research, not so.
Joshua (03:42):
That's really interesting and it is kind of counterintuitive, isn't it?
You would think that, you know, depressionand anxiety and the most common mental
health conditions would be at theirkind of peak during the dark months of
winter and for us here in Wisconsin,I'm in Alaska, during the during the
cold months of winter social isolationhard to get around that kind of stuff.
(04:02):
But yeah, I started to become aware ofthat research about 15 years ago, that
that's actually in the springtime that wesee kind of the peak of people's distress.
If you look for seasonal patterns,and I think the most important
thing is scientists can eversay is we don't really know.
Mike (04:18):
Yeah, right.
Joshua (04:19):
I mean, we have to have humility in this, right?
And so as scientists, we reallyneed to always be asking questions.
We have some ideas about why that mightbe but it's still a bit of a mystery.
Mike (04:30):
What are the ideas?
Joshua (04:32):
Yeah, so there's, there's a lot of things, like I said, intuitively
you would think it would be wintertime.
I'll talk about some biologicalthings we think are happening and some
psychological and then some social.
So on the biological side the fartheraway you get from the equator the bigger
adjustment your body has to deal within terms of the amount of light that
you're exposed to throughout the year.
And light is this really, I think,understudied and not well enough
(04:56):
understood component of mentalhealth and behavioral health.
As is sleep.
I think sleep and light arereally big, big factors.
And, where I live here in southcentral Alaska at latitude 61, in
the dark of winter at the wintersolstice, we're getting about
five hours of sunlight a day.
And it's not like the sun'sgoing over really quick.
It's actually just like dipping...actually I'm at home right now.
(05:18):
It actually doesn't even come abovethe mountain next to my house.
So it's like, it'sliterally like twilight.
And then it's dark again.
So it's, you know, it's pitchdark at 9:30 and then it's pitch
dark again by, by 3:30 or 4.
And so when you're living in thatenvironment, it has a huge impact on
your mental health, but I think a lot ofpeople kind of hunker down in the winter.
And then as the spring comes,we're close to the equinox, right?
(05:41):
Which means everyone will be getting12 hours of each, so we've gained,
we've doubled the amount of lightthat we have in the here in South
Central Alaska in just a couplemonths, and I think our bodies have
a lot of trouble adjusting to that.
So I think that's part of thebiological piece in our circadian
rhythms, melatonin production, allthose things that our body does.
We're diurnal mammals were builtto be around up during the daytime.
(06:04):
I know society gets in the way ofthat with night shifts and crying
babies and all these other things,but we are built as daytime creatures.
We're not owls or bats.
We don't see in the dark.
So I think our bodies are adjustingto have a lot of biology behind that.
And then I think the other piece thepsychological piece, like I said, I
think people sometimes hunker downin the wintertime and as springtime
comes and there's more light and peopleare up and moving around and excited.
(06:25):
If you're really depressed oranxious or really struggling with
your mental health, it can actuallyalmost be harder as everyone's kind
of like getting going for the summer.
I'm going to play softball.
I'm going to do all these things.
And if you really feel stuckand in distress, you kind of
can feel a little left behind.
I see a lot of clients whofeel that in the springtime.
Mike (06:43):
And of course, as people interact more and have more interactions, that's
going to affect your mental health.
And we're leaving a part out,at least here in the Midwest, as
you socialize a little bit more,the drinking tends to go up.
Joshua (07:00):
That is true.
That is true.
There's a lot around substance usepatterns that can change in the
springtime that I think has a big effect.
And there is some biology too, aroundwhen people are in the darkest depths
of like, for example, depression, asthey start to feel more energy that
actually may open the door to someadditional, like thoughts of self harm
(07:22):
or other things that can happen, becausewhat we see, what we know, is that
suicide rates hit their peak in Apriland May in the springtime, and that's
really true throughout North America.
Mike (07:34):
And they're higher in northern latitudes, are they not?
Joshua (07:38):
That's correct, that's correct.
Yeah, and I think a lotof that is the biology.
Your body just is really strugglingto deal with major changes in light,
which disrupts sleep and sleep isan emerging science in both mental
health and substance use recovery.
Sleep is the foundation of wellnessand as sleep gets disrupted, it
(07:58):
really can have a cascading effect.
Mike (08:01):
Wow.
And then crime and violence goalong with that, I would think.
Joshua (08:05):
Yeah, that's another piece as well.
Our patterns of socialinteraction change a lot during
the springtime and into summer.
And yeah, while you would think itwould be, you know, kind of coming
out of the darkness and, you know, theeasiest time of year, it's actually,
it's actually quite the opposite.
Mike (08:20):
I think there's a lot of people that say they have seasonal affective
disorder without ever having itdiagnosed, but my mood definitely
improves with being outside and light.
Joshua (08:30):
Yeah.
Yeah.
I think that's a big piece.
Here in Alaska, a lot of folks,really try to power through the winter
by leaning into it, going skiing.
I got into fat tire bikinga couple of years ago.
My skiing days are probably over, butdon't let the ski sweater fool you.
I'm not a skier anymore, but.
But I got into fat tire bikingand I've been really disciplined
about it the last two years.
It doesn't matter what the weather is.
(08:51):
I'm going every night.
And so I'm out there in the dark.
That was pretty warm right now, actuallyhere at South central, but, you know,
there'll be nights where it's belowzero and I got my dogs with me and I'm
just, it's pitch dark and but I justkind of got to lean into it cause it's
the only way I can get through that 18hours of darkness, 20 hours of darkness.
Mike (09:07):
I can't do that.
I bike a lot and I've tried thefat tire, but biking when it's cold
and windy, what do you, I got it.
We're going to take a tangent here, folks.
What are you, what are you wearing?
Joshua (09:20):
Well, I think this is a good metaphor for mental health.
In the farther north you get, themore common the saying, there's no
bad weather, there's just bad gear.
And that is something I think about alot as a mental health professional,
like we're dealing with these changesin daylight or whatever the stressors
are in our environment, in our life.
But there are things we can do.
There are things we can do.
(09:41):
So, you know you can fat tire bikeat zero if you've got the right gear
on, half the time I'm getting sweatyhalfway through because I've got a
great gear on, but you really do haveto prepare and kind of brace yourself
and insulate yourself from all thestressors and buffers that are coming.
So yeah, I think there's a lot to that.
Mike (09:57):
What a great lead in.
Talk about Alaska behavioral health.
You have tons of programs across Alaska.
Joshua (10:03):
Yeah, it's a really exciting place to work.
We just celebrated our 50th anniversary.
I've been there for almost half of that.
We're the largest behavioralhealth provider in Alaska.
And because we're in Alaska, you know,this huge state with a relatively
small population, we do a lot ofdifferent things to try to meet all the
community needs so we kind of really doeverything below hospital level care.
(10:23):
So we have day treatment, partialhospitalization, day treatment
programs, which you are like highintensity treatment for people
with really acute distress.
You get the same level of care that youwould get in a hospital in many ways.
But you go home at night and so forfolks who have a safe place just to sleep
in a situation where they can do that.
That's the highest level of careadult mental health residential,
(10:45):
which is similar in some ways allthe way to outpatient clinics.
Psychiatry, primary care.
Over the last seven years whatwe've been really focused on,
you know, I'm a clinical nerd.
I love to talk about all our differenttreatments, trauma focused, CBT and
CBT cognitive behavioral therapy,but the most important thing that
we provide is a c c e s s access.
It's it's gonna get care topeople when they need it.
(11:08):
It doesn't do you any good to havethe best science based care if people
can't get it when they need it.
And mental health conditionsand substance use conditions are
progressive So the earlier wecan get people care, the better.
So that's what we've been reallyfocused on the last five, six years.
We've done so from serving 2000Alaskans a year that this year
we will serve 10,000 Alaskans.
(11:28):
It's a lot of growth, but you know,it's really good because when you
can eliminate things like wait listsand people can get into treatment
when they want it and when they needit and when they're ready for it.
Treatment so much more effective.
I've been a therapist for over 20 yearsand the most common thought I have when
I'm meeting with someone for the firsttime is I wish you would have come in a
couple months earlier before it got this.
(11:50):
There's still stigma.
There's still these barriers.
We don't think of mental health carethe way we think of primary care.
If you're sick, go to the doctor.
You know, if you call yourfriend who's a doctor, you
think, I think I might be sick.
I think I should, you know what they'regoing to say, go to the doctor (laugh).
And they're not just, you know,doing that for liability reasons.
I mean, really, they're like,you should get it checked out.
If you think you should get itchecked out, get it checked out.
(12:11):
We need to think about mental healthand behavioral health care that way.
Get it checked out and gettreatment as quickly as possible.
And we've been doing some excitingthings the last couple of years.
Adding primary care into our system sopeople can get all their health care
needs, behavioral health related needs andpsychiatry and primary care kind of all
through, kind of more streamlined system.
(12:32):
We even have in house pharmacies inAnchorage and Fairbanks so that people
can get kind of those needs met becauseit's not just about convenience.
What we really think, what I've seenin my career is it's not just about
making it convenient, but what it isabout is if there's barriers to people
getting care, they won't get it.
They've got a lot going on in their life.
And so going from three different placesto get your therapy and your medication
(12:56):
management and fill your prescriptionsand do those things in the life of an
average family, that's just too much.
Not to mention when it's dark 20 hoursand there's snow on the road and all that.
Mike (13:06):
Well, given that, and it may be difficult sometimes, do you offer
telehealth and teletherapy as well?
Joshua (13:12):
We do.
About 10 percent of ourappointments are telehealth.
And so that's been a goodaccess strategy for us.
A lot of clients prefer in personwhen they can do it, but we do do
telehealth to provide access out intoour hub communities and rural areas.
And then for some of our folks,they may live like an hour
away from one of our clinics.
(13:33):
And so they're able to come in personsometimes and then do sessions in between
those in person sessions via telehealth.
Kind of like a hybrid model thatactually has become pretty common
in our South Central and Fairbanksclinics and our Mat Su clinic.
Mike (13:46):
There's a pretty big emphasis in your website and even in your
introduction on the military.
They present some uniqueissues along the way.
Joshua (13:55):
Yeah, Alaska has the highest portion of veterans in
our population of any state.
If you look at a globe, it makes sense.
There's a lot of militaryinstallations in Alaska for really
important strategic reasons.
And so we have a lot ofservice members here.
Two miles that way is joint bearbase air Elmendorf Richardson, which
is a joint air force and army base.
And F 22 is fly over my house every day.
(14:17):
So it's just a reminder.
We live in a state where there'sa big military presence and
they're part of our community.
And so as a community provider servingthe folks who serve our country is really
important to us and serving the veterans.
So we have some specialty clinics.
specifically for servicemembers and veterans.
And then we serve family members andmilitary service members and veterans
across all of our 12 locations.
Mike (14:39):
Awesome.
When I was reading your bio I've workedmy entire life with youth, adolescents.
And you're an expert in childhood trauma.
This is not an easy time for youth.
We're seeing mental health issuesthrough the roof is probably a little
bit over, but they're dramaticallyrisen in the last dozen years.
Joshua (15:02):
Yeah, I think there's so many likely factors driving that.
But we have seen that.
I mean, as I said, we've grownfrom being able to serve about 2000
Alaskans a year to almost 10,000.
And what we've seen iswe've needed to do that.
The demand and the need forfor mental health services is
has increased in our state.
And I think that's that's true nationwide.
Mike (15:22):
So how do adolescents present in a more unique way than working with adults?
Joshua (15:28):
Adolescence, there's a lot going on.
Adolescence is such an amazing again,thinking about start with biology,
think about what it is like to bea sixth grader and in 10 years, you
might be raising your own children.
(laugh)
So think if you have a sixth grader athome, think about the fact that she might
be a mom or he might be a dad or youknow, I mean, that's, that's in a decade.
(15:49):
I'm not going to go throughthat kind of change in the next
decade of my life, for sure.
So that's incredible.
The social kind of development that'sgoing on, the biological development
that a child is becoming an adult.
And so there's so much going on.
And then if you experience asemotional and mental distress as
you're going through that, allthose rapid changes, I think it
(16:10):
can present some unique challenges.
The flip side though is adolescence.
Because they're growing so quickly.
And their biology is wired forgrowth and development and learning.
Treatment with adolescentsalso can be really fast.
I mean, they're ready for change.
I often think like my third sessionwith an adolescent who's experiencing
generalized anxiety disorder feelslike my 15th session with them.
Mike (16:35):
(laugh)
Joshua (16:35):
They are ready.
They're ready.
They're growing.
They're changing.
They're open to new experiences in waysthat people in our age cohort maybe have
more challenges with so yeah, I reallyenjoy working with adolescents and
they're a big part of the population thatwe serve at Alaska Behavioral Health.
We have done some innovativethings to try to reach them because
sometimes adolescents are a littlebit of a missing population when
(16:57):
you look at your demographics.
We really saw that actually.
When you're 10 and you really strugglingyour parents bring you in for treatment
when you're 35 you bring yourself in.
When you're 17, how do you get there?
So we've had to do some strategies to makesure that adolescents have good access.
Part of that's partnering withschools and other systems that are
already working with adolescents,so that they can get into treatment.
(17:18):
But you know, one thing that'schanged in my career, I've been doing
this for a while is adolescents areleading the way on stigma reduction.
Mike (17:24):
Yes, they are.
It's awesome.
Isn't it?
Joshua (17:27):
It's so cool.
20 years ago, the typical, myfirst meeting with an adolescent,
they'd have their arms crossed.
I was told I have to be here.
I don't want to be here.
That's not how most adolescents are today.
They're leading the way.
They've really flipped the switch.
Mental health care is just health care.
Mental wellness is just wellness.
It's just a type of health care.
And they actually, you know,it's flipped 180 degrees.
(17:47):
The adolescents coming into ourclinics often have a lot less stigma
and presumptions about mental healthtreatment than other generations.
It's really cool to see.
Mike (17:59):
I do a lot of presentations at schools, and I have for a long time.
And you're right, 20 years ago, they wouldbe receptive, but then afterwards they
would say, can I talk to you for a minute?
And now it's not unusual to see a handgo up and say, Well, I was talking
to my therapist about my depression,in front of everyone, and it's
awesome because it leads the way.
(18:19):
Right, Joshua.
It's it says to everybody.
It's just what I got.
It's like having asthmaand having an inhaler.
It's not that big a deal.
Joshua (18:28):
Yeah.
It's incredible.
Young people have really kindof led the charge on that.
And it's an awesome thing to see.
Mike (18:35):
What should people do?
I did this deliberately rightnow because we're right in
that change of seasons, right?
So what should people do if they'restarting to experience that sensation?
Because I know what people get, right?
When spring comes like this, they'regoing to get poo pooed a little bit more.
It's like, well, what areyou complaining about?
The weather's starting to get nice.
And so what can we do to takecare of ourselves if we start to
(18:56):
feel ourselves doing that dip?
Joshua (18:58):
Again, if we think about it kind of biological, psychological, social, then
I think we can break it down a little bit.
There's some concrete things we could do.
So on the biology side, sleep.
Sleep is the most important thing thatwe can really pay attention to all year
round, but especially when the seasonsare changing and if you're in northern
latitudes where you're dealing withreally dramatic changes in light, it
(19:19):
can throw off your circadian rhythms.
And there's some concretethings that are really helpful.
And some of these things Iuse myself because I live in
a really northern climate.
So one thing that can be helpfulis light therapy or light boxes.
You know, you talk to your doctorto kind of make sure you get the
right one, that it's healthy for you.
But those are commonly used in themorning to help people, especially
during the darkest months to kindof help people reset their clocks.
(19:42):
What it does is basically tellsyour body it's daytime, which
gets your melatonin productionand other things kind of in line.
Again, something to talkwith your physician about.
Is it's really common to for Alaskansto experience vitamin D deficiencies
and other things related to you'rejust not getting any sunlight on
your skin for six months of the year.
I'm not a physician, but I talkedto my physician about that.
(20:03):
I encourage my patients to.
So those are some of the biologicalthings you can attend to making
sure your eating patterns are good.
You really managing your use of alcoholor other substances in addition to
the challenges that addiction canlayer on to someone's life, there's
a lot of emerging science around theharmfulness of alcohol when it comes
to sleep patterns and restorativesleep, too, because how you sleep is
(20:25):
as important as how much sleep you get.
So there's a lot of data thatdepressants like alcohol and some sleep
aids that are used may help peoplego to sleep, but that sleep itself
isn't as restorative as it would bewithout those substances on board.
So those are some of thethings you can do concretely.
I think exercise is a big piece.
And sometimes people think aboutexercise in terms of like calories
(20:49):
and this and that, but it really just.
It has so many cascading benefitsbeyond those commonly thought of
cardiovascular benefits, like in termsof your just hormones and sleep patterns.
So those are some things Ithink in the social realm.
Yeah, it can be hard.
It's like kind of everyone'sgetting going in the spring.
And, you know, here in Alaska, peopleare out and about more is to really pay
(21:11):
attention to your social connectionsand try to build a lot of, as much
meaningful interaction with otherpeople as you can into your life.
Those social connections are really big.
And then on the treatment side, ifsomeone's really struggling there are
especially, for example, for with sleepCBTI, cognitive behavioral therapy for
insomnia, the science on it's really good.
(21:31):
It outperforms medicationsover the longterm.
And it doesn't have any of the sideeffects that medications can have.
So I got trained a couple of years agoin CBTI, I find it to really be almost
like magic for people to experience.
And there's a lot you could gointo in that, but stimulus control
around your sleep, which is like.
You don't want blue lighthitting your eyeballs.
(21:52):
Basically, after about 5 p. m. ifyou want to be in bed by 9 or 10.
And so there's things you cando around that, limiting your
screen time that kind of stuff.
Even using blue light blocker glasses.
I actually have a pair of those I useif I'm if I'm working late at night.
So I think all those things canbe really helpful in buffering
folks and building in resilienceas you go through this transition.
(22:14):
And then I encourage people, likeI said, if you feel like you need
help, I encourage you to get it.
As someone who's been atherapist for 23 years.
The best thing you can do is seekhelp as soon as you think you need it.
And sometimes people have these thoughtslike, oh, someone needs it more than me.
I encourage you not tohave those thoughts.
They're not really, you know, asa therapist, I say one, probably
not true to definitely not helpful.
(22:36):
And the other thing is, youknow, access is a virtuous cycle.
So people get into treatment whenthey need it, the treatment's
more effective and it's faster.
And if your treatment's faster, thatbenefits the next client who comes to
my clinic, because you're going to beoff living your life and potentially not
need as long or as intensive treatmentactually creates room for the next
(22:57):
client who walks through the door.
So I actually flip it around a little bit.
If you're like, well, you know,someone else needs it more than
me, the quicker you get treatment.
The quicker it works, the better itworks, and that creates more access for
the next person to walk through the door.
So I encourage people to kindof flip that thinking around.
Mike (23:13):
Places across the country are stretched thin.
Even though we deal with mentalhealth, you deal with mental health.
Do you have to remind your staffto practice what we preach?
Joshua (23:24):
Oh, yeah.
Oh, yeah.
I have to remind myself (laugh).
To really pay attention.
As a healthcare provider, we do talkabout this, when you get in the airplane
and you're traveling with a child andthey say if the oxygen mask dropped
down, you got to put on yours first.
Because if you pass out, you'renot helping anybody else.
So yeah, we do have to pay attention tothat a lot as mental health practitioners.
And as healthcare providers in general,attend to our own stress and wellness.
(23:47):
Yeah, and engage in thiswork in a sustainable way.
Mike (23:50):
In the article that I was referencing earlier, I read that
Alaskans have a term for the footwearthat they wear during the spring.
Joshua (24:01):
Yeah.
Break up boots.
Mike (24:02):
Break up boots.
Joshua (24:04):
Yeah.
Yeah.
Mike (24:06):
Meaning?
Joshua (24:07):
Yeah.
So it's really common.
I'm not trying to sell a particular brandhere, but in most Alaskans wear Xtratufs.
Somewhere bogs.
There's a little debate about that.
Mike (24:17):
(laugh)
Joshua (24:18):
But some version of Xtratufs or like that you'd call them
galoshes if you were in Britain.
But these rubber boots that are almostknee length, they make different
lengths, but and, you know, it isan interesting metaphor because
it's like, like I said, there's, youknow, we have this thing, there's no
bad weather, there's just bad gear.
It is kind of this attitude in the springwhere it's like, yeah, it's muddy out.
(24:39):
Yeah, there's like even right nowit's late February here in Anchorage.
Normally, we would have eightfeet of snow on the ground.
But we didn't have very snowywinter and it's been pretty warm.
So it's been off and on muddythe last couple weeks here.
And you just put on yourboots and you keep going.
Like in some ways you get outside asmuch as you can and it's muddy and
it's sandy and there's puddles Andyou put on these knee high waterproof
(25:01):
boots and you just go out and do it.
And you'll see Alaskans walking around inthe store and the grocery store and the
health care clinic with their Xtratufson and they just keep them on all day.
And yeah, it's kind of a coollittle anomaly in this wet, cold,
slushy environment that we have.
(25:22):
But to me, it is kind of a powerfulmetaphor of like, do the best
you can to prepare yourself andget outside and do what you can.
In therapy, we always like to come up withcomplicated terms for simple concepts.
So, we call that behavioral activation.
Which means what you do changeshow you feel and you think.
(25:42):
If you're feeling really sad or anxiousand I just tell you, Hey Mike, don't
feel so sad, don't feel so anxious.
That's not helpful!
It's not going to do anything.
So what we do is we thinkabout your thoughts because
you can change your thoughts.
Thoughts are really, they are changeable.
And you can definitelychange your behavior.
And what you do if you put on your yourbreakup boots and you get out there and
(26:02):
you walk your dogs and you go to thestore and get what you need for food
and cook good meal and all those things.
That's going to change yourfeelings more than me talking
about your feelings and you and Italking about your feelings, right?
So we call that behavioralactivation because we like
to come up with fancy terms.
But it's a really important concept.
Mike (26:18):
What a great place to leave it.
Joshua, thank you so muchfor being with us today.
This is so instructive and it'ssuch a great reminder for all of us.
I'm going to put links, as youall know, who listen to Alaska
Behavioral Health and Joshua'scontact information on the podcast.
We invite you to listen in whenever you'reable to until we talk to you next time.
(26:39):
Stay safe and lace up your breakup boots.
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