Dr. Paul Conti: Therapy, Treating Trauma & Other Life Challenges | Huberman Lab Podcast #75

Dr. Paul Conti, a psychiatrist, provides a comprehensive discussion on trauma and the therapeutic process in this episode of the Huberman Lab Podcast. He highlights that not all perceived traumatic experiences are necessarily traumatic and that many individuals may be unaware of their own trauma. The podcast also covers topics such as selecting a therapist, approaching therapy, and evaluating its effectiveness. It delves into self-therapies and drug therapies, including antidepressants and psychedelics. Dr. Conti's book, "Trauma: The Invisible Epidemic, How trauma works and how we can heal from it," offers further insights into trauma and its healing methods. By the end of the episode, listeners will gain a deeper understanding of trauma and its impact.

Dr. Paul Conti, Trauma & Recovery

Key points discussed by Dr. Paul Conti include:

Not all experiences perceived as traumatic are necessarily traumatic.
Many individuals may have trauma without realizing it.
Choosing a therapist and approaching therapy are important considerations.
Evaluating the effectiveness of therapy is crucial.
Self-therapies and drug therapies, such as antidepressants and psychedelics, are explored.
Dr. Conti's book, "Trauma: The Invisible Epidemic, How trauma works and how we can heal from it," provides further insights into trauma and its healing methods.

Defining Trauma

Trauma is defined as an experience that overwhelms our coping skills and leaves us fundamentally changed. It alters the way our brains function and manifests in various aspects of our lives. Trauma can be identified through observable changes in behavior and brain activity. Processing trauma involves exploring changes within oneself and addressing feelings of guilt and shame. It can lead to a sense of loss of options and opportunities. It is important to confront and communicate about trauma with others. The video discusses trauma from psychoanalytic, psychological, and neuroscience perspectives.

Guilt & Shame, Origins of Negative Emotions

Guilt and shame are negative emotions that may have been adaptive in the past but can be maladaptive in our current society. These emotions are part of the emotion system in our brains and are related to survival. Trauma can change our brains and lead to increased vigilance and defensive behavior. Vicarious experiences, such as consuming distressing news, can also have a similar effect on the brain. Guilt and shame can lead to internal torment and drive individuals to seek relief through drugs or medication, which can result in addiction and other risks. The prevalence of this phenomenon highlights the impact of guilt and shame in our modern society.

Repeating Trauma, the Repetition Compulsion

The repetition compulsion is a concept in psychology that refers to the tendency for individuals to repeat traumatic experiences or emotional states. This compulsion arises from a desire to solve the trauma, but it can be counterproductive and prevent true healing. The dominance of the limbic system over logic in our brains contributes to this compulsion, as the emotional part of the brain seeks relief from suffering and does not comprehend the concept of time. Individuals who have experienced repeated trauma often find themselves in similar abusive relationships, as the brain seeks to resolve the unresolved trauma. Therapy aims to help individuals face and process the original traumatic experience, breaking the cycle of repetition.

How to Deal with Trauma & Negative Emotions/Arousal

Summary: Dealing with trauma and negative emotions/arousal involves exploring and acknowledging the trauma, which can be done with a professional or by talking to another person or writing it down. People often avoid looking at their trauma, but when they start talking about it or putting words to it, things start to change. The fear of being judged or rejected when sharing trauma is common, but the surprise and relief when others respond with understanding and acceptance can be transformative.

Key points:

Confronting trauma is important, rather than avoiding it.
Short-term strategies like thought redirection can be helpful, but directly facing and addressing the trauma is recommended.
Exploring and acknowledging trauma can be done through talking to a professional or another person, or writing it down.
People often blame themselves and feel guilt and shame after experiencing trauma, but gaining compassion and realizing their innocence can help release associated energy and challenge those feelings.
Crying is a beneficial coping mechanism that allows for grieving and helps direct negative emotions appropriately.
Expressing emotions through talking can significantly improve well-being.

Processing Trauma, Do You Always Need a Therapist?

The most profound aspect of the topic is the question of whether therapy is always necessary for processing trauma.

Individuals tend to default to guilt, shame, and hiding when confronted with trauma.
There is a repetition compulsion to place oneself back into similar or worse traumas in an attempt to resolve them.
Seeking out disturbing media or engaging in repetitive abusive relationships can be ways of trying to resolve past traumas.
The fork in the road is either repeating the trauma or getting to the root incident that started it all.
The question is raised as to whether this process needs to be done in the presence of a therapist or if there is benefit in engaging in personal reflection and emotional release.
Reactivating emotions and repetition compulsion can occur when trying to deal with trauma.
Introspection and developing an observing ego can be helpful in processing trauma.
Using music as a coping mechanism for trauma is mentioned as an example.
Self-reflection and introspection are important in understanding the origins of negative thoughts and beliefs.
Language, such as speaking or writing, can help in shifting perspectives and accessing the observing ego.
Talking to trusted individuals or writing can be beneficial without requiring significant resources.
Therapy can uncover deep-rooted issues and explore associated emotions like guilt and shame.
Memories themselves do not have inherent meaning, but are colored by the emotions attached to them.
Trauma can change the way we perceive and interpret memories, leading to negative self-talk and internal states.
Alternative strategies can be used to address trauma, but in cases where symptoms are significant, professional help may be needed.
Taking a trauma history is important to reveal the root cause of mental health and substance-related issues.
Addressing and processing trauma can lead to meaningful changes in individuals' lives.
Attempting to change without addressing trauma is likely to be ineffective.

Internal Self-talk, Punishing Narratives & Negative Fantasies

The most profound aspect of the topic of internal self-talk, punishing narratives, and negative fantasies is the exploration of why individuals engage in negative self-talk and create narratives about terrible outcomes or harm.

Internal self-talk can involve punishment, avoidance, and control.
Negative self-talk and negative fantasies serve as a way for the brain to try to make us do better by hurting us more.
Distraction, such as anger or fantasy, can be used to avoid feeling negative emotions.
These coping mechanisms are maladaptive and a result of trauma and brain changes.
These thoughts and behaviors may provide temporary relief but do not actually improve the situation.
It is compared to taking opioids, where it may make us feel better in the moment but ultimately makes things worse.
A different perspective and knowledge are needed to break free from this cycle.

Short-Term Coping Mechanisms vs. Long-Term Change

Short-term coping mechanisms, such as food, drugs, sex, alcohol, and negative thoughts, provide temporary relief but hinder long-term growth. These mechanisms can become addictive and prevent individuals from making lasting changes. The speaker emphasizes the importance of finding skilled clinicians for therapy, but also suggests self-generated strategies like journaling as a zero-cost tool for personal growth.

Tools: Processing Trauma on Your Own, Journaling

Journaling is a valuable tool for processing trauma and other life challenges, allowing for distance and integration of compassion and logic. It helps gain insights and revelations about ourselves and our experiences. Seeking an outside perspective and finding the right therapist are also crucial in processing trauma.

Key points:

Journaling involves bringing curiosity to our thoughts and emotions, questioning why we think a certain way and when it started.
It can be done at night or carried throughout the day for unpredictable moments.
Putting words to our experiences and reading them back allows for distance and integration of compassion and logic.
Trauma can manifest in various ways such as depression, panic attacks, addiction, and maladaptive choices.
Having a de novo perspective, whether through journaling or therapy, is important in processing trauma.
Finding the right therapist is crucial in this process.

Sublimination of Traumatic Experiences

The sublimation of traumatic experiences involves redirecting negative emotions and feelings into productive activities. However, this approach may not be the best solution as it does not address the negative aspects of trauma and limits one's perspective to only what can be seen through the lens of trauma. It is important to address trauma in order to optimize functionality and overall well-being. Finding a good therapist is crucial in this process.

Importance of addressing and processing traumatic experiences
Bringing curiosity and introspection to view experiences from a new perspective
Funneling negative emotions into functionality in the world
Reluctance or fear of giving up coping mechanisms
Role of trauma in shaping thoughts and behaviors
Potential benefits of working through traumatic experiences
Holding onto negative experiences as a source of motivation and arousal
Sourcing from a different fuel that feels better and allows for greater effectiveness
Process of transferring negative energy into something adaptive or positive
Sublimation becoming self-justifying if believed necessary for success or productivity
Limitations of sublimation in addressing the negative aspects of trauma
Importance of finding a good therapist in addressing trauma.

Tool: Finding a Good Therapist

Finding a good therapist is crucial, and the most important factor is the rapport between the therapist and the client. This rapport is built on trust, attention, and a sense of being in it together. Therapeutic modalities may vary, but the key is to find someone who is truly invested in helping the client and making them better. Eye contact and the therapist's approach are also important considerations.

Key points:

The rapport between the therapist and the client is crucial in therapy.
Trust, attention, and a sense of being in it together are important aspects of building rapport.
Therapeutic modalities may vary, but finding someone who is truly invested in helping the client is key.
Eye contact and the therapist's approach are important considerations.
Look beyond specific modalities and focus on the therapist's ability to adapt to individual needs.
Good therapists have a diverse range of approaches and prioritize building rapport.
Try out a few therapists and rely on word-of-mouth recommendations to increase the chances of finding the right fit.
Seek a therapist who is willing to address difficult and traumatic topics.
Therapy is not always pleasant, but it is important to have a therapist who is committed to helping and exploring the inner workings of the individual.

Optimizing the Therapy Process, Frequency, Intensity

The best way to show up to therapy varies from person to person, and it is important to do whatever allows them to be fully present during the session.
The post-therapy process should also be individualized, with some people benefiting from taking a walk or sitting quietly to process the information.
Tailoring the therapy approach to each person is crucial, considering individual differences.
Taking notes during therapy can help organize thoughts for some individuals, while others may need time to reflect on it later.
There is no set answer for how often therapy should be conducted, as it varies from person to person.
Meeting less than once a week can make it difficult to retain progress and may require more time to catch up in subsequent sessions.
Weekly sessions of at least one hour are necessary for significant progress in therapy.
More intensive work, such as 30 clinical hours in a week, can be equivalent to a year's worth of therapy and allows for active processing and dynamic engagement.
Increasing the intensity of therapy is particularly helpful when dealing with distressing situations or triggering prior trauma.
The decision of how much therapy a person should be doing is usually based on their level of distress or the impact of their issues on their life.
Seeking therapy can also be for gaining self-understanding and improving overall well-being.

Tool: Self-Awareness of Therapy Needs, Mismatch of Needs

In therapy, individuals must take ownership of their needs and evaluate if therapy is meeting them. If therapy is not helpful, individuals should communicate with their therapist to discuss potential changes. Self-awareness is crucial in determining if therapy is not beneficial and if more help is needed. External factors like insurance systems can pose challenges, but the solution lies in self-observation and taking responsibility for seeking necessary changes in therapy.

Individuals should evaluate if therapy is meeting their needs
Communication with the therapist is important if therapy is not helpful
Self-awareness is crucial in determining if therapy is beneficial
External factors like insurance systems can pose challenges
Self-observation and taking responsibility are key in seeking necessary changes in therapy

Self-talk & Journaling, Talking to Trusted Individuals

Self-talk and journaling can be helpful in therapy, but it is important to approach it in a way that is suitable for each individual. It is not necessary to immediately confront trauma or delve into every detail of it. Instead, acknowledging the impact of the trauma and reflecting on its effects can be beneficial. It is recommended to communicate with a trusted person, such as a clergy member, if there is no one in one's personal life to talk to. However, attempting an intensive self-guided therapy without support can be risky, especially for individuals experiencing suicidal thoughts or feelings of not wanting to be alive.

Key points:

Self-talk and journaling can be beneficial in therapy, but it should be approached in a way that suits the individual.
It is not necessary to immediately confront trauma or delve into every detail of it.
Acknowledging the impact of trauma and reflecting on its effects can be helpful.
If there is no one in one's personal life to talk to, it is recommended to communicate with a trusted person, such as a clergy member.
Attempting intensive self-guided therapy without support can be risky, especially for individuals experiencing suicidal thoughts or feelings of not wanting to be alive.
Warning signs that indicate the need for professional help include severe levels of distress, unhealthy thoughts, and a recognition that one is not in a healthy state.
Seeking external resources and talking to trusted individuals is important.

Prescription Drugs & Treating Trauma, Antidepressants, Treating Core Issues

Prescription drugs are often overused in the United States due to the healthcare system, but they can be beneficial when used appropriately. Here are the key points:

There are no direct tests to measure neurotransmitter levels in the brain, and peripheral blood tests are not informative.
Unraveling the underlying causes of depression is necessary for long-term improvement.
Certain diagnoses like bipolar disorder, OCD, and ADD may benefit from medication in addition to therapy.
Medications can help individuals engage more effectively in therapy by increasing distress tolerance.
The categorization of medications and the influence of the pharmaceutical insurance-driven medical system can limit their effectiveness.
The modern medical system's limited time for therapy and overreliance on medication is a concern.
The high usage of medication in the US compared to other countries may be influenced by cultural factors.
The healthcare system prioritizes short-term relief over addressing the underlying problems.
Investing more resources in treating the root causes of mental health issues would lead to better outcomes.
Prescribing multiple medications to treat different symptoms can result in side effects and complications.
Understanding the individual's specific needs and addressing core issues is important.
Antidepressants have significant benefits when used appropriately, despite the negative perception.

Short-term vs. Long-Term Use of Prescription Drugs, Antidepressants

Short-term use of prescription drugs, such as antidepressants, can be effective in certain situations. However, they should not be seen as a permanent solution or a substitute for human interaction and therapy. Relying solely on medication without addressing the underlying issues can lead to a cycle of adding more medications without resolving the problem. Society needs to prioritize investing in human-to-human contact and providing healthcare professionals with the resources and support they need to effectively help individuals.

Short-term use of prescription drugs, like antidepressants, can be helpful in treating severe depression and improving distress tolerance.
Medications should be viewed as tools rather than a solution for depression.
Long-term use may be necessary in some cases, but it is important to address the underlying issues.
Relying solely on medication without therapy can lead to a cycle of adding more medications without resolving the problem.
Society should prioritize investing in human-to-human contact and supporting healthcare professionals.

Attention Deficient Hyperactivity Disorder (ADHD) & Prescription Drugs

ADHD and prescription drugs, such as Ritalin, Adderall, Modafinil, Armodafinil, and Vyvanse, are commonly used to help individuals with focus and attention issues. These drugs increase dopaminergic transmission in the brain and act as stimulants. However, medication may not be the appropriate solution for everyone with attention issues, as attention deficit can stem from various factors. It is important to accurately diagnose ADHD before prescribing medication to avoid inappropriate use of stimulants. The healthcare system's reliance on medication for mental health conditions can lead to overdiagnosis and overmedication, with patients ending up on multiple medications, some of which may be counterproductive.

Negative Effects of ADHD Prescription Drugs

The negative effects of ADHD prescription drugs, such as Adderall or Ritalin, can include sleep issues, addiction, judgment impairment, heightened anxiety, impulsivity in decision-making, and in rare cases, psychosis. Short-term benefits of increased alertness and longer study sessions may be overshadowed by the long-term risks and potential negative consequences of misuse or addiction.

Key points:

Sleep issues, addiction, judgment impairment, heightened anxiety, impulsivity, and psychosis are negative effects of ADHD prescription drugs.
Misuse or addiction to these drugs can lead to long-term risks and negative consequences.
ADHD prescription drugs can change the brain, leading to impulsivity and decreased trust.
It is important to recognize the negative effects and understand the risks associated with using these drugs for purposes such as studying or working more.

Alcohol, Cannabis – Positive & Negative Effects

Alcohol and cannabis have different effects on the brain. Alcohol can lead to habituation, while cannabis narrows attentional perspective. Cannabis can be helpful for relaxation and sleep, but at higher levels of distress, it can narrow cognition to negative thoughts. It is not a treatment for depression, anxiety, or trauma. Alcohol and cannabis should be used thoughtfully and carefully. Cannabis may be safer than alcohol, but it is not uniformly safe.

Psychedelics: Psylocibin & LSD, Therapeutic Uses, Trauma Recovery

Psychedelics, such as psilocybin and LSD, have gained significant interest as therapeutic tools. They primarily affect the serotonin system and can alter perceptions of space and time. While currently illegal in most places, ongoing clinical trials are exploring their potential benefits. The conversation around psychedelics is now more acceptable in academic settings, but it is important to approach the topic within the context of legal and clinical settings.

Key points:

Psilocybin and LSD have shown therapeutic potential and positive impacts when used in the right way by professionals.
The legalization of psilocybin in Oregon is influenced by new data aligning with previous research.
Psychedelics can reduce communication in the outer parts of the brain, which are often glorified by humans.
They have the potential to alleviate distress by taking individuals out of the cortex, which is responsible for repetitive and anxious thinking.
Psychedelics may offer relief from trauma and anxiety by transcending survival-focused mechanisms.
They can deepen the therapeutic process and help individuals gain clarity and compassion for themselves.
Psychedelics catalyze the effects of good therapy by placing individuals in the part of the brain that can truly understand and process trauma.
The study of psychedelics is correcting the misconception of focusing solely on the outer parts of the brain, like the cortex.

Sentience, Language, Animals

Sentience is a crucial aspect in understanding animal experiences
Language is often overvalued while sentience is undervalued
Animal suffering is dismissed due to the lack of recognition of their sentience
Recognizing and valuing sentience in both humans and animals is essential

Psychedelic Hallucinations, Trauma Recovery

Psychedelic hallucinations, such as those induced by LSD and psilocybin, have therapeutic benefits beyond just hallucinations. They facilitate accessing different feeling states, establishing connections, and fostering self-empathy. Researchers are exploring non-hallucinogenic variants for therapy, raising questions about the value of hallucinations. Substance abuse involves experiences influenced by substances.

Psychedelic hallucinations can lead to profound experiences that challenge false beliefs and alleviate guilt and shame. They are powerful tools for personal growth and trauma recovery. When used responsibly, psychedelic medicines can be effective anti-trauma mechanisms. They also provide insight into the brain and challenge the notion of human superiority.

MDMA (Therapeutic Uses)

MDMA, also known as ecstasy, has shown therapeutic potential in clinical trials, creating a unique state of heightened introspection and inner exploration. It floods certain parts of the brain with positive neurotransmitters, allowing individuals to approach and contemplate trauma without fear or self-blame. The therapy can lead to a sense of well-being and potential healing.

Clinical Aspects of MDMA

The clinical aspects of MDMA involve potential hazards and risks, as well as the importance of clinician guidance. Key points include:

MDMA induces a high dopaminergic and serotonergic state, making individuals highly suggestible and prone to fixation.
Clinician guidance is crucial in navigating these experiences and ensuring valuable insights from therapy.
Future clinical MDMA use should consider evolving practices for sequential progress and meaningful outcomes.
Respect and clinical guidance are necessary to mitigate risks and ensure safe and productive experiences.

The topic also discusses the potential benefits of MDMA therapy and the importance of understanding its negative effects. The growing momentum of MDMA therapy and its future implications are also mentioned.

Language, Processing Trauma, Social Media, Societal Divisions

Language plays a crucial role in discussing trauma, depression, and PTSD, but it is important to avoid controlling it too much. Specificity in defining terms like trauma is necessary to maintain their meaning. Over-controlling language can hinder expression and prevent open discussions about these topics. Social media exacerbates societal divisions and promotes hatefulness, contributing to vulnerability and acts of violence. The decline of civility in political discourse and acceptance of aggressive language is concerning. Setting standards for those in power can prevent perpetuation of vulnerability and trauma. Addressing societal divisions and white supremacy through language and social media is crucial, regardless of political affiliation.

Defining “Taking Care of Oneself”

Defining "Taking Care of Oneself"

Taking care of oneself is an ongoing process that promotes well-being.
It involves finding a balance and paying attention to small things while working hard.
Self-care encompasses basic needs such as sleep, nutrition, natural light exposure, positive social interactions, and living in conducive circumstances.
Neglecting self-care can have negative consequences, even if one appears to be functioning well.
Recognizing and addressing the underlying reasons for neglecting self-care is crucial for overall well-being.
Focusing on the basics of self-care, such as diet, exercise, sleep, relationships, and leisure activities, is important.
Sunlight plays an undervalued role in maintaining well-being.
Dr. Paul Conti's book is praised as the definitive guide on trauma and encourages readers to explore it.