ASM179 Ask Hillary McBride (Week 3)

[transcript automatically generated - please help edit to make it better]

we're taking your questions on mental health in this episode of ask hillary mcbride [Music] what a wonderful and sad week we're about to have on ask science mike wonderful because for the third week in a row we have researcher and therapist and phd candidate hillary mcbride on with us to answer your questions about mental health and sad because it's the last of the three of those so next week it'll it'll be back to just me talking alone in a microphone to both my dismay and the audience and um but i i do want to uh take a moment and jokes aside i just remind everyone that we are talking about mental health issues this week uh we're gonna talk about mood disorders we're gonna talk about bullying we're going to talk about abortion um we're going to talk about climate change so we've got some really heavy topics that we're going to talk about and i don't want you in the audience to feel some compulsionary or compulsatory drive to listen to the whole show if at any point it becomes overwhelming or too much i want to remind you right up front that you can always pause this episode and take a break you can skip it entirely you should do whatever you need to do to feel mentally safe and whole and healthy if anything in here is too much for you there is no shame in tapping out and coming back next week when we'll probably talk about particle physics or something so uh take that as a very simple yes a very sincere uh and necessary trigger warning and hillary i'm just so happy to do another episode with you this week uh i've been sincerely looking forward to it um thank you i've gotten so much feedback oh good good uh people people like like where this where this has been going so uh without further ado we got five questions this week uh so we'll jump right into the first one and our first question this week says i myself and several family members have struggled with mood disorders i've observed and experienced that with mania or depression a person's ability to make good decisions or think in ways that are aligned with reality are greatly diminished i've experienced hypomania and the lack of judgment that goes with it i understand how these limbic states affect judgment due to reduced prefrontal cortex activity oh wow but my question pertains to trauma and flight or flight can you talk about how trauma and amygdala activation impact activity in the prefrontal cortex also when someone has been traumatized are they more prone to making poor decisions from fear or anxiety ultimately are people even able to choose well when traumatized thanks mike and hillary for all the work that you do oh boy this one's kind of juicy hey uh i'll yeah a lot of juice juices galore i'll take a swing and then i'd love to hear what you what you want to add in there um so i'm not going to address the part of the question that that mentions hypomania and mania because that's actually different in terms of what's going on in the brain and manic or hypomatic episodes aren't necessarily caused by increased lymphatic activity and decreased activity in the dosar lateral prefrontal cortex although those might be some of the observable effects of mania and hypomania when trauma happens to us it changes our brain and our nervous system there's so much more going on than just amygdala activation but primarily activation in the amygdala also is related to decreased regional cerebral blood flow to certain areas of the frontal cortex so when we would normally be able to think through a whole situation let's just say if we're at rest and we feel emotionally regulated and we can consider all of the factors and slow ourselves down unlike that when we're activated something called an amygdala takeover or an amygdala hijack happens we move into fight or flight response where decisions are being made more on a subcortical level think like instinct and survival not thorough rational evaluation and these decisions although not decisions in the way that we normally think of decisions they're related to our survival and based on what's happening around us and this activation can happen sometimes without us knowing that it's happening or why when the lower brain structures take over and do things without us consciously making the connection that sometimes it feels like we're acting without even really knowing why perhaps think of the the stereotypical example of the vet uh or the veteran who dives under the table when a car backfires not really thinking oh i'm afraid maybe i should get under the table but the body reacting responding to a perceived threat and so perhaps a smell in a room reminds us of a smell we experience during a trauma and before we make the conscious connection these deep brain structures responsible for processing sensory memory as they're related to threatening your traumatic situations those deep those deep brain structures have taken over not always does our thinking or rational brain make that connection though and sometimes it does and that usually happens after the amygdala takeover has ended and regional cerebral blood flow has returned to our frontal cortex and our parasympathetic nervous system is engaged so it is possible to understand after the fact why we did what we did although it's not always the case right sometimes it just feels like the body took over we felt overwhelmed and we did things that we wouldn't necessarily you know quote choose and quote to do if we felt regulated and present now as for your second question if people are more prone to making poor decisions from fear or anxiety when they've experienced trauma or are people even able to choose when traumatized i think your question is a really interesting one because choice is an interesting thing that we've kind of constructed and i actually believe that we have much less choice than we think we do and so much of what we think choice is is actually just a story that'll front our frontal lobe has made up after some subcortical part of our brain has instructed our body our nervous system about what to do but the things that appear as choice when we're at rest might better reflect the kind of person we know ourselves to be and what works in any given context we know that the corpus callosum and the growth and the integrity integrity of that structure is impacted by trauma particularly when trauma happens during development and this can impact our ability to do emotional regulation uh sometimes leaving us feeling dissociated and without emotion or hyper rational as a defense but we know that emotions are really important for decision making and that in research about decision making if we don't have access to emotions we can't actually make decisions so it's not that emotions are bad for choice or that when the emotion centers of our brain are highly active that we're not making good choice it's matter more about how much emotion is there and what structures of our brain are working together or taking over other ones based on what our nervous system thinks is happening in the moment so what i would actually say is that if your body thinks that you are dying or facing threat then whatever your body is doing to keep you alive is not a poor choice your body is doing everything that it needs to to help you be okay in the situation where it becomes a problem is when our body is responding as if we're in a war zone but we're actually just at the grocery store so the choices that we make the things that our bodies do don't always make sense all the time when we're feeling settled um but in moments when we yeah when we're feeling settled and we look back we think wow i would never have done that but in the moment these other structures are really taking over um so to increase choice when we're activated that can happen right activated or triggered or re-traumatized or in a trauma or in a flashback i use those all um in the same way but it can happen by building awareness it's easier to do when our trauma is being treated so that our nervous system is more likely to return to a state of rest and then it's easier for us to notice oh my goodness i feel activated that feels different than how i felt five minutes ago so doing trauma work can help us make choices when we're not activated that then build capacity to maintain some skills during activation like emotionally regulating when we feel dysregulated and we can make choices when we're regulated around accessing resources and paying attention to somatic cues and learning to what to do with our bodies when we feel flooded or when it seems like intensity or these deep brain structures are taking over but that that it's a process over time and usually involves at some point going back to figure out why is my body still think that i'm unsafe or still think that i'm in this dangerous environment so the the question is an interesting one because choice is actually uh quite a quite a difficult thing to wrap our heads around hmm gosh hillary that's well said um i i just was reflecting as i read the question how much it resonated with me um like you i'm not going to go to hypomania and mania but for different reasons i just don't know very much about mania and hypomania psychologically much less neurologically but in terms of this notion of the prefrontal cortex and the amygdala that is so often a framework i've used to understand my own life experience and so like i just resonate with the question um and seeking that balance and i think one thing i'd just like to say if we kind of step out of maybe psychology for a moment and even past neuroscience into evolutionary biology one thing we find that in mammalian and avian brains energy budgets play a huge role in how brains activate and and how much of a given brain can be active at one time and humans are actually really fortunate because we have very very large heads and we have lots of uh of cooling capacity in our bodies we have all these sweat glands and we have a very large and rich circulatory system that includes a lot of surface capillaries so our bodies are actually uncommonly good at cooling off our brains compare that to say some species of bird who arguably have who actually arguably definitely have more dense uh arrangements of neurons in their brains and arguably more sophisticated architectures but their brains can't get much bigger without overheating that that strategy is kind of capped evolutionarily in uh how big those brands can get whereas our brains have had a chance to take a slightly less dense architecture and scale it much larger and that's why we talk about the prefrontal cortex and the amygdala in oppositional terms and blood flow a human brain that ran the prefrontal cortex quote full tilt unquote to radically oversimplify neuroscience and ran the amygdala full tilt at the same time would start to run into some thermal limits and potentially increase the temperature in the brain to a point that is unsafe and unsustainable and that's why architecturally our brain has to make decisions moment by moment about how much blood to send where [Music] in order to keep itself operationally cool it's fascinating for me as someone who studied both brains and microprocessors how often thermodynamics are regulating architectural choices but all that disclaimer aside i don't want you to make them the same mistake that i've made for so long and that mistake is this prefrontal cortex thought equals good amygdala reaction equals bad that's a really oversimplified way of viewing the brain and also like an insufficient way of viewing our body's responses to not just trauma but stimulus day-to-day we have multiple systems involved in emotional regulation and activation and i'm a person who historically my amygdala is pretty dormant because i'm much more likely to to have a moderating dorsal vagal or polyvagal response that makes me sleepy or disengaged or dissociated as hillary said and i've always thought the goal of personal growth was to stop all this amygdala stuff and stop all this polyvagal stuff and just keep my beautiful and glorious prefrontal cortex running all the time and that is a very unsatisfying way to live that's the hyper rational or intellectualizing view on life that is is defensive against our own life experiences i've tried to let go of the notion that rational thinking is good and so-called irrational thinking or unrational thinking is bad as hillary said all the parts of our body and brain are there to help us survive the important rubric i've tried to move towards using is are my actions and my beliefs and my feelings adaptive or are they maladaptive do they help me live in a way that makes me feel content and fulfilled and connected with others or do they make me feel constantly anxious or emotionally activated or disregulated is maybe a better term and do they make me feel distant from others or even in opposition with people who are important in my daily living so i don't care what part of my brain is doing something whether it's emotional or or rational i care about whether it's adaptive or maladaptive in my daily living and when things are maladaptive i don't judge them as bad i don't think of myself as foolish or wrong i know just non-judgmentally towards myself i need to come up with strategies to help my brain body system respond in ways that are more adaptive i need to protect and nurture myself in such a way that allows both my free prefrontal cortex and my amygdala and my anterior cingulate cortex and my thalamus my hypothalamus and hell even my temporal lobes to respond in a way that makes me feel joy when joy is appropriate sadness when sadness is appropriate anger when anger is appropriate and above all intimacy with those in my life who i care for and value may we all become more adaptive thinkers and feelers beautifully said [Music] i'm so thankful to kiwico for sponsoring ask sciencemike and i wanted to tell you what that looks like in our house these days my daughters are 14 and 11 and they love getting their crates but we actually subscribe twice so we get an engineering crate and an arts crate that's age appropriate and when those come in my daughters sit down and negotiate about who's going to work on what each month and they switch back and forth and this month macy built lights for her room that had a lot of artistic choices like a string of lights and she decided to go with this punched foil design with a crepe paper or a tissue paper in there that gave off a really cool blue pattern from the sides and then unfiltered white light directly below while madison worked on a walking robot she built her own robot and what amazes me about kiwi co is how much fun my kids have while learning about science technology engineering arts and mathematics i'm seeing the impact of kiwico on their schoolwork because they have a practical hands-on understanding of these subjects that helps facilitate the work they're doing at school so i think kiwi co and their crate subscription is amazing and kiwi co wants you to be able to try it completely risk-free so if you go to kiwico.com science they're offering every listener of ask science mike a free completely free kit mailed to your home so that your child can have an age appropriate learning experience that's tons of fun and in my experience helps your kids set down their screens and devices and what could be better than that so again if you'd like your child to learn more about science technology engineering arts and mathematics go to kiwico.com science where you can get a free crate uh okay another question here and uh i'm gonna just remind you that we did trigger warning up top this is a question about bullying and i know that for many of us myself included these questions and answers are very difficult here's the question i was a very sensitive child and dealt with a lot of the usual bullying a sensitive boy deals with growing up in a small rural town over time i learned to put up walls so that people couldn't hurt me i reached a point in my early 20s where i did a lot of work to start to take down those walls and build relationships with people in my young adult group during that time i experienced a lot of hurt and the trust i put into people and leaders was broken often since that time i feel like i've unintentionally replaced my old walls with really thick skin where i'm still able to be very open about who i am and how i feel but without allowing myself to be truly vulnerable or feel any significant emotional connection with people including my wife what steps would you recommend to repair what i see as an inability to be intimate with people how do i have intimacy without triggering these defense mechanisms that i didn't consciously choose to have in the first place yeah i wonder how many people are going to resonate with this question it just sounds so human right the the pain of being hurt and then realizing how much it costs us when we feel alone within the within the confines of our defenses and then trying so hard to take a risk to to pull some of those walls down and then being hurt again it's just it's so human right and so to you who wrote this question i'm so sorry that it happened that when you you were bullied but that also when you tried to risk and trust people that you were hurt by them and i just have a lot of a gratitude for those defense mechanisms that they are there for a reason that they helped you that the pain of being hurt was likely so acute that the thought of being hurt again was too much and so our our brain body system our attachment patterns our behavior it steps in to stop us from being hurt and one of the things that we often forget about is that our social wounds are extremely impactful for our nervous system even for our cognitive functioning i think a lot of us think that being hit by someone being physically assaulted or hurt is a different level of pain but the fmri results show us that when we feel socially isolated wounded hurt ostracized that it impacts our brain just the same as when we are physically hurt and and we have to validate our body's way of responding to those hurts right in the same way that if we were hit or injured it would probably be hard for us to enter a space where we thought we would get hit or injured again so i thank the defense mechanisms before anything else and i think we need to honor the way that your system has responded to to all of that pain the things that i'm curious about in in here and maybe some listeners some other listeners will resonate with this but i heard you say or i heard you write that you took the walls down before so there is a part of you that knows how to do that that knows how to take these risks and let people in you did that with a group of people before so there is a part of you that knows how to do that and i'd be curious about if you reflect on how you did it before if any of those things apply now or if you need to do some different things and maybe the only difference is that is that you do some work around the pain and the fear that came up from what it felt like to be hurt the first time and the second time but if the opening up process is just the same another thought that i had was around the difference between transparency and vulnerability and how there is some ease for some people with sharing openly about their life but not about anything that has any kind of emotional risk to it or any kind of um yeah some vulnerability some nakedness so i think it's an interesting thing that you're able to notice the difference between sharing about facts about your life or whatever it is that you feel like you can let people into readily and then the things that are vulnerable so here are some things that i think can help around building intimacy when we have a hard time doing that building intimacy with ourself first can sometimes feel like the safest way to do that like in therapy right we can practice letting someone else in and have them help us practice paying attention to what that's like doing so might automatically bring up some of those defenses and then you'll be in a place where you can work on them where you know you're not going to get dropped if you say it feels too scary to let you in but building intimacy with yourself might mean that that you're honest with yourself so learning to notice and pay attention to your cues in your body not that you have to share them with anybody else but practicing tuning in in a way that's just for you for example notice and cues that might say oh i feel unsafe or oh this is what i want but i'm afraid to let someone know and learning to those learning to respond to and notice those cues with kindness and compassion and then adding in some soothing around the parts when you feel activated or wounded or afraid a lot of us have resources that we use so well with other people so if another person that we know is afraid of taking a risk we know exactly what we would say right i think about the people in my life who i love if they're in fear i would say i'm with you and i'm so sorry and what can we do and it's gonna be okay and i'll be with you and let's plan and can you take a breath and what do you know for sure and what is is the fear about a past wound or is it about a real present danger and can we figure out the difference and can we do do this thing side by side so you don't feel alone in it and if all of the things that we would normally say to other people when they're in fear some of those things work when we say them to ourselves i think we can be aware of defenses when they come up noticing them that feeling that you have whatever that feeling is that says don't let anyone in or the shutting down that happens noticing those defenses and regulating and soothing and then deciding if you need those defenses in that moment sometimes there is an element of considering the evidence is this environment like the one that hurt me and if it's not it might be interesting for us to dip our toe into a little bit of vulnerability when people are trying to change patterns with defenses i think it can be easy to think about doing all or nothing right like i just launch in i just share everything or i let you all the way into my pain and often that can lead us to feeling shame or like a vulnerability hangover as i sometimes call it but we might start by just dipping our toe in or taking a tiny little step towards paying attention to our emotions or paying attention to the social environment and we might notice sensations when we do that that remind us of when we felt unsafe and then we can remember that the first time we felt unsafe was in this case when you were bullied and you might be able to pause for a moment and then talk to your younger self and reassure them and validate that part of you that still feels stuck in that bullying and saying i'm so sorry that you were bullied it was so scary and it's over now but it really hurts you but it makes sense that you're still afraid and after soothing yourself and talking to yourself when your body settles down you can look around and say are those bullies here if not then maybe the fear is from the past and the pain in the past and not really from the present working on healing and trauma in the first place the bullying but then also the betrayal from later in your life working on that might help your body know that those things are actually over and then your nervous system won't be as stuck in the defensive mode automatically i mean the defenses might be there but it might be easier to remind yourself i don't need them anymore because your nervous system is actually at rest and it can make it easier to notice than when the defenses come up it's understood in one of the kinds of therapy that i practice that defenses are a way of keeping emotions underneath like fear or sadness or anger and that the emotion feels unbearable and likely reminds us of some of the aloneness we felt when we were young and had all of that fear and sadness but there was no one there to help us through it or protect us so the defenses aren't actually the problem they're actually the temporary solution to the problem which can be i don't know how to feel my pain and i don't know how to be with it and work with it in a way that helps me release the hurt and connect me to others emotions are social in nature they show up in our face and on our face and on our bodies so that we can signal to our tribe what's going on and maybe even signal to ourselves what's safe what's unsafe what we like so naturally learning to notice what's under the defenses feelings wise and staying with that might allow us to have something to take to people around us allowing them to have a point of entry into our lives and a way of helping us that leaves us feeling connected to each other so the situations in our lives that we go through remind us of the past and bring up these feelings and when we know how to work with them and spot our defenses and redirect ourselves back into the tenderness and presence with the emotions underneath then we can really begin to experiment with moving forward and see that the defenses were there but we might not need them anymore [Music] um yeah coping with the fallout from bullying has been the journey of my whole life from early childhood to present and the ebb and flow of learning new strategies growing and dealing with the fallout of that growth and learning to grow again it is very much the pattern of my entire life and so i just wanted to congratulate you for being aware of the ways that you have to protect yourself because of the way that bullying affected you that insight is powerful and the fact that you can ask how do you have intimacy without triggering defense mechanisms that you didn't choose in the first place tells me that you're already on the path to doing so yeah and so i just hope that you can take a moment wherever you are right now whether you're the person that wrote this question or you're a person for whom this question resonated i just wish you could take a moment right now and celebrate your strength and your resilience and the fact that even though people were so unkind and so cruel to you you're still a person who cares who tries to make choices that benefit you and benefit others who cares about having intimacy and who cares about healing and growth i just want you to know that right now from this little studio in los angeles california i am proud of you for doing so and i'm confident that you will find the growth and the healing that you seek and by the way everyone else don't bully people okay i see adults bully all the time it's not okay yeah that one hits close to homie [Music] i'm not even sorry for all the trigger warnings uh we're gonna do a question about abortion right now so if if you need to hit pause this is your opportunity here's the question abortion is a topic that is not talked about very much it seems outside of politics i'm just going to pause right there and say yes absolutely i agree as someone who got a medical abortion and has kept it from her evangelical family members and many friends i've been looking for healing resources it can be a horribly traumatizing experience especially for those who've who feel they have no other choice it is often difficult to actually get an abortion and it is unfortunately very common to be uninformed in the process for example not knowing what might come out of their own body what pain they will experience for how long or how long the body might confuse a tampon with giving birth the resources i have found are for repenting or healing from a regretted abortion but i just want to know how to begin to heal and that others are struggling from the trauma of getting an abortion that was perceived to be absolutely necessary like mine every person's story of getting an abortion is unique and complicated in so many ways and i feel even after therapy that the pain of getting an abortion is not getting easier it is not understood or acknowledged in the world hillary what advice would you give to the healing process and do you know of any books or resources that would speak to the reality of healing from a wanted abortion thank you both for all that you do i'm so sorry that the trauma happened to you and that you weren't informed in a way that could have helped you feel better prepared and i just feel the ache knowing that you haven't been able to go to family and friends in the way i imagine that you long to the thing about trauma is that it's not defined by an event it's actually based on how our system responds to what an event was like for us one event can happen to one person and it can seem totally normal and the same event can happen to someone else and it can feel like drama so while it might seem counterintuitive at first i actually think it might be helpful to think about this in a way that's less about the abortion and more about how our bodies respond when events that are negative and have an unexpected component to some degree leave us feeling confused overwhelmed and powerless sometimes if we look for the ways that we are like other people it helps us have a sense of belonging so you might find that in accessing resources about trauma that makes sense of what you've been through it actually helps you feel like you're part of a community of people that's experienced something that left them with trauma regardless of what the event was anytime like i said that we find ourselves a part of our community can help us feel us alone and help us believe the healing that we can have that it's possible more so than if we think we're the first or only person i think that it's complicated to experience a kind of trauma that is disenfranchised a kind of trauma that is silenced or dismissed that's also happening in a socio-political context where you're having to fight for something at the same time so this this is the very unique kind of experience but the way that your body is responding is very normal based on what you've been through and there might be some things about trauma that help you feel like what your body is doing is actually part of a survival response in a way that can help you feel validated in yourself regardless of what caused the trauma our bodies store trauma way more than our thoughts do we can form sensory memories that are implicit and they don't actually have a cognitive story attached to them but as a felt bodily memory they're connected to the trauma so as i've mentioned in one of the earlier questions this could be smell in the air a song a time of day a position of our body a sensation in or outside of the body and all of those sensory elements are stored as an integral part of the trauma memory and whenever our trauma memories get activated our nervous system does too so when a similar sensation occurs our body remembers that trauma and responds sometimes as if it's happening again so when you're thinking about the healing process it can be helpful to access some kinds of therapies that help that brain body system learn that the trauma is over right when we're doing trauma therapy it's actually a lot different than doing regular talk therapy so some of the kinds of therapies that i might recommend or somatic experiencing sensory motor psychotherapy emdr lifespan integration and in some cases actually working with trauma-informed pelvic floor physiotherapists to help your implicit memory change now when you feel yourself remembering the trauma either thinking about it or feeling like it's happening again it can be vital to use both compassionate self-talk saying something like it happened and it's over and i made it through or it was really scary so scary that i remember it sometimes when i don't even want to and i didn't do anything wrong but it was so scary and then trying to ground ourselves in the present moment using her breath feeling her feet on the floor orienting so looking around to make sure our brain really gets the memo that we're here and not there but there is this social piece that i hear you mentioning and so the the last thing i'll say is about the social context that women have been having abortions longer than we care to admit culturally and although there is less stigma now than there's been within the last century or so it's still something that people do not understand and often comes with shame even if it's a wanted abortion and leaves women feeling alone to deal with challenges feeling under-informed so you are not the only one who has had this experience and i can tell you that because i've worked with people in therapy who have been struggling with this experience of having had a wanted abortion but then feeling the trauma of it but because of what's going on socially it's hard for women to talk about it so if you're finding it hard to find resources it might be that there aren't actually any that are easy to get access to and it might mean that we need more resources or need to find ways to make them more public and i think your question might be hitting on something really important socially sometimes we can also find a sense of healing and knowing that other people won't suffer the way we did and for some people i'm not necessarily saying you have to do this or this is for you but for any of the people who are listening sometimes there's a call that comes along with healing or trauma about creating resources or shifting social discourse and saying i don't want any people to have the sense of aloneness that i do so writing letters of complaint to service providers or creating resources that are public on the internet to let people know what's important what they need to know and to help other people feel less alone or maybe even to prevent in some cases the thing from happening again but women need to be better informed about what's happening during a procedure and unfortunately it's a common thing within any reproductive health practice for the health care practices to be taken away from women themselves and into the hands of the care providers so there's a there's a systemic thing that's happening in healthcare for women's bodies and unfortunately you're not the only one who struggled with this but i am so sorry that the context has made you feel alone and has left you without the kind of resources that you deserve when you're trying to heal so my my advice would actually be find some resources about trauma read some books about trauma and trauma and the body and there are loads that you can find online on amazon and in libraries and and my hope is that even though the content is not necessarily specific to abortion that you would find yourself in those stories and realize that you and your body have been doing exactly what they needed to do to keep you safe during and after a really awful event i'm so glad you were here for that question hillary i i just think it's so important um that in every conversation involving abortion that women's perspectives are centered um so i'm i'm not only thankful that you were here but willing and qualified to answer so adeptly and i also want to zoom in on that first sentence that you you also spoke to so well abortion is a topic that is not talked about very much it seems outside of politics people who identify as pro-life and people who identify as pro-choice have abortions every day real flesh and blood people for many reasons sometimes those abortions are elective sometimes those abortions are medically necessary but they happen and sometimes people who are pro-life have abortions that are traumatic and sometimes people who are pro-choice have abortions that are traumatic and i hope that everyone who hurt hears that question and everyone who hears hillary's answer can reflect both now and in the future on the reality of the experiences that real people have every day with abortion that aren't theoretical aren't hypothetical and are not in that moment political or theological in nature but a basic matter of life and well-being i think too often we allow our politics to diminish or eliminate our realization that every one of us is a human person and every one of us is worthy of dignity and at least in america abortion is such a divisive topic that we are too ready and too eager to villainize people who are primarily victimized [Music] okay on to perhaps an easier question uh can you please talk about your theoretical orientation as a clinical counselor and why these theories slash techniques resonate most strongly with you thank you for being on the front lines of demystifying the therapeutic process more than anything the heart of my approach is that i value and cherish people and that i find it extremely meaningful to be with people who are hurting in a way that helps them heal and see their own goodness and so i actually tend to look for theories and approaches that allow me to bring that that into my work instead of trying to fit myself into a theory i've been looking for a theory that allows me to be me with people i think that um and we know actually that some of the therapeutic factors that heal are the relationship itself over and above theoretical framework and orientation i mean there are some situations where we know that a certain kind of theory is contra content we know that a certain kind of theory is contraindicated for a certain presenting issue but by and large it's the felt sense of being seen and known that heals and i'm able to do that best when i can be fully me in a room so i draw heavily from theories that have empirical evidence and try and use an approach that suits the person in the room i tend to flex to meet with people where they're at and do things with them that i know i can back up with reliable and valid research findings that being said um i try and tend to keep up with the literature so when there's a consensus in the academic community that's building like for example emotional dysregulation as a primary source of psychopathology and that emotional regulation is learned best when we connect with an attuned and regulated other i'm gonna do that i'm gonna adapt my theory to see where the field is going and where we have the most evidence for therapists who are listening or social workers psychologists theorists here is some more of the formal language the feminist somatically oriented and trauma-informed relational psychodynamic psychotherapy that's a mouthful i'll kind of break that down here relational and psychodynamic means that i'm attachment-based and that understanding the system um that and means understanding that the system that we see is not always obvious to our conscious mind and and there are things that are at play while we act and think and connect that we're not always aware of so looking at the dynamic nature of the self and the the dialogue or the dialectic between conscious and unconscious processes that are stored in our nervous system neurobiological and somatic trauma informed means um again that some of the things that are at play that we don't often bring into the picture are the body and how the body stores memory and is the place where life happens not just in thinking or conscious thinking the trauma piece means that i'm sensitive to how the brain changes when we're in experiences once or regularly that cause us to adapt to survive but can make it challenging to function in the world if trauma or if an old experience is over but our body doesn't know it's over and this means integrating the body into treatment and the empirical findings about memory processes and emotion emotions are really big part of what i do in light of what is now this overwhelming empirical evidence about the role of emotion both in psychopathology and attachment and attunement i understand that learning to pay attention to emotion and how to respond to it in ways that are healthy for us and appropriate based on our context is actually what helps us not only heal but helps us move past dysfunction or pathology into growth and thriving and we don't often learn growing up that these emotions that we experience are in the body and that they're good i also bring in a positive psych perspective um i don't believe that the best we can do in therapy is just reduce symptoms i think that in therapy we can also help people connect with their sense of identity and find and stay with joy to learn and deepen their experience of connection with themselves and others in the world and then kind of on a more meta level my feminist approach means that i'm looking at systems of power and social dynamics as they relate to our functioning psychopathology well-being and healing so a person might come in with a presentation of psychopathology but what is the context within which they're in that has allowed that psychopathology to flourish or is actually caused it in the first place what's going on contextually that also stops us from being able to heal like a good example this would be sexual assault and some of the problems around messaging around sexual assault and victim blaming things like rape myths need to be considered when we're looking at how people heal or not and one of the best ways that i've seen all of these things integrated into with each other is through practice something called aedp exper accelerated experiential dynamics psychotherapy a practice and theory that i draw very heavily on in my work i also use other approaches but i use this when there is evidence that would be effective for helping a person with a particular presenting concern like emdr mindfulness self-compassion somatic work gestalt or other process experiential interventions but really anything that can help us have an experience of healing connection with the other that feels oriented around it oriented around growth and the goodness of the person those are the things that i'm going to choose to use in therapy that was that was theory heavy as an answer it was wonderful oh gosh it made me elated not only to hear you say it but to have known you long enough to understand all of it even though uh for me it took an intense amount of concentration to keep up um so i just want to say to the listeners right now if you're like i love hillary i'm so confused by all of that uh pay close attention to that uh for the therapists and social workers disclaimer at the beginning yeah oh my gosh was that the deep end of the pool it really is but so impressive and i just so appreciate your care for people as expressed by your intention in research and rigor to not only understand those schools of therapies but others and to have arrived at that role that that that place out of a desire to best help people you know find healing and find growth [Music] it's why i appreciate therapy as a discipline so much and why i think it's so essential thank you hillary you're welcome it reminded me this question reminded me a little bit of something that we do as part of a phd in in any kind of clinical training program but it's called a clinical comprehensive exam and basically you have to identify your theory and then defend it rigorously using all of the empirical evidence that we have in the field of psychotherapy to a committee of a committee of people who are experts [Music] using tapes as well to prove that you are doing actually what you say you're doing and it's a really important rigorous process that has helped me grow so much to realize what do i believe about change what do i believe about people do i really think we're good and if i think people are good how does that show up in the clinical work that i do and can i back that up with my actual practice so the process of answering this question um brought joy to me because it's something that i've thought a lot about and have spent years working on and the there is an evolution that happens in the process of being a therapist where the things that we think about change and people and ourselves are different when we start the journeys when we end and so i imagine if you ask me this question in five years or ten years depending on what the current empirical evidence is my answer might be different so i think we have to be adaptive and and to do the best care that we can for people flex to where the research is um and what people need hmm yeah [Music] last one and it's a doozy hi mike and hillary even before your podcast about climate change i've been worried about the climate crisis as you said panic is good to spur action but it can be paralyzing i also have a profound sadness for the people and the natural world that will suffer i have a wife and two kids and i know that my mental well-being can influence the whole family are there any resources that can help me and others on how to specifically deal with the anxiety and sadness of climate change thanks erin aaron and anybody else who identifies with this the sensitivity to climate issues is so important oh man two i think too many of us are living lives unconcerned with the impact of our actions um the care that i hear is underneath the paralysis that care is so so so good so i want to clarify that panic specifically is not helpful but fear and fear and panic are different but fear comes with a sense of urgency or like a kind of awareness to what's happening around us even quite literally our eyes open wider because of what our nervous system does when we're having a fear response so it can spur us into action if we channel it appropriately that care about something is connected to the fear and the fear can move us to action what i'm curious about is if you can connect with the care if any of us can connect with the care that's creating the sadness and the suffering and what it would be like for us if we saw that the sadness was actually pointing us to our value system so the sadness was not a means in and of itself or the end in and of itself but rather the the flag to us as reflective beings that what we matter or what matters to us is being compromised i'm wondering as well about the community piece so when we have these particularly strong values and we feel alone in them it's really important for us to find community that shares our values when we're with people or around people who do do not see the things that matter to us we can often feel more alone more paralyzed more despondent and sometimes it can polarize our response so we actually become more full of despair because we look around us and think oh my gosh no one cares i'm hopeless so i'm wondering if there are clubs communities non-profits volunteer organizations anyone that you could join with and lobby with a group of people you could say i am a part of them they resonate with my value system and look at the things that we're doing so that when that powerlessness comes up you can remind yourself of your action and see oh look the fear did move me to something believe it or not i've actually worked with people in therapy before who've come in for similar concerns that you wrote about i tell you that one because you're not alone and two because uh if you're finding the sadness as eclipsing your ability to connect with care as a motivating force and you feel hopeless it can actually be good to talk about it with someone in a political setting right when we have these impulses of emotion that move us towards action if they get frustrated that it can leave us feeling even more stuck and depressed so finding a way to connect with the emotion and move it through you and connect with the care and the values underneath can be helpful and it's okay to ask someone to help you do that learning emotional regulation can be really helpful sadness is not bad not when something that is precious and valuable is in jeopardy sadness is not ever bad and neither is fear but learning how to respond to our sadness or fear in ways that help us stay in the present and connect to our values and people around us that takes practice and skill lastly when we feel hopeless it's really important for us to find opportunities to prove our competence and efficacy and to look for where that's already happening we can focus on how much there is to do and see this huge chasm of things that are undone that need to be done and can feel how dire that is and that feels less overwhelming this is just a little bit of a cognitive trick but when we see how much we've already done and how we're giving what we can sometimes it means accepting the inevitable or accepting our powerlessness but knowing also that we are doing what we can and we can only do what we can i love what i heard the mystic matthew wright say recently when he was giving a talk he said we either wake up together hand in hand or not at all so i want to remind you that you're not meant to do the work alone and it's not all on your shoulders and yet as someone who cares about the earth you have a very important role as a voice in this lifetime to nudge your colleagues to nudge your friends and family even the people listening to this episode i imagine that it's activating them to get to think a little bit more about their actions and the earth but your job might be to do what you can and to move the needle just a little bit to more attunement towards our care for the earth but hear what i'm saying that that the care that is there is so good and if we can redirect our attention towards that care that sometimes it can help us understand who we are what matters to us and what our calling is in life it's so well said um as i reflect on it i you know it's so similar the dealing with the anxiety from climate change and just learning to deal with anxiety in general yeah the kind of strategies we learn to be more whole people also help us deal with environmental stressors in this case literal environmental stressors yeah like a changing climate and then that notion of reflecting on what we've done you know uh every time i get a meal and it doesn't have very much or any meat in it i feel good about myself i know that i'm not only doing something that's good for my body nutritionally but i'm also causing much less carbon to be released into the air when we make small choices like you know if you're an amazon addict like so many people are there's an option now to have an amazon day where your packages arrive on a single day of the week instead of as they're available in as few packages as possible that's a small thing you can do that materially impacts the amount of carbon emissions your actions produce and focusing not only on what needs to be done but what you are doing as hillary's so effectively elucidated does create relief i don't live with a constant gnawing fear and anxiety about the climate even though the climate is dire or at least the impacts of a changing climate are dire because i know that i'm doing what i can today and i'm going to try to do more tomorrow and that's what i can do and i can't take ownership for things that i can't do and i a single person cannot halt or reverse human driven climate change but i can do everything i can do and i can try to encourage others to do the same and leaving that box of paralysis is not only good for our own thoughts and our own feelings and our own quality of life but actually good for the entire web of ecosystems that are spread across the surface and the oceans of this truly wonderful planet [Music] hillary mike thank you um that's just fun thank you for having me it has been obvious yeah i wonder if there are um places online you'd like to refer people listening to where they can keep track of your work or any upcoming projects that you'd like people to be aware of yeah yeah um so i'm i'm pretty active on social media instagram and twitter my instagram handles hillary lyanna mcbride and on twitter i'm hilary l mcbride you can find my website for some some more information about me some speaking stuff i've done in the past or bookmespeak hillary l mcbride.com i've got two books out one's an edited text about embodiment and eating disorders one's a book for the the lay community so not academic which means you don't have to suffer through the jargon but that's called mother's daughters and body image and i've got a book that i'm working on now about embodiment and healing our relationships with our bodies that extends beyond women and femmes to all of us as humans um yeah and then you can hear me on the liturgists podcast and a podcast that i've done through cbc called other people's problems which is a podcast all about therapy we actually put mics in my therapy sessions with clients who were of course consenting and knew about what was going on and you hear what therapy looks and sounds like um yeah so i think that's i think that's that i usually update speaking engagements that i have on my website or post about them on social media so you can keep track of me there too well everyone thank you for listening thank you for listening to this series of episodes with hillary mcbride and as always i look forward to talking with you next week thanks everybody