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[Music] I [Music] [Music] oh [Music] practice wishing for the object of your meta that these things happen to them so you'll repeat this thought may this person be happy may this person be free and may this person be at peace [Music] m [Music] [Music] oh [Music] so what we want to do is cultivate the compa cultivate a capacity for kindness So Close Your Eyes take a few moments to breathe in and breathe out [Music] [Music] h [Music] [Applause] [Music] w [Music] but I would say on a on a deeper level it's more like when when

we say work on yourself that involves all kinds of like things about moving your life forward and they struggle with motivation in these things it's because when I don't think I'm worth it I'm not worth fixing [Music] [Music] I [Music] [Music] [Music] oh [Music] when you develop empathy and compassion for other people there's going to be room for someone else in the relationship and then this in turn is going to reduce the feeling of being an object now two people can connect and now it's not about getting your needs met in Starvation it's about two

human beings forming a relationship [Music] [Music] [Music] [Music] oh [Music] alrighty chat let's get started sorry for being a little bit late today um we are doing a deep dive into cptsd and uh I found some really interesting research over the last 24 hours that took me a little bit of time to incorporate um so it took a little bit longer and I was just prepping everything so that once we get started I won't be stumbling around trying to find stuff so today we are speaking of stumbling around today we are stumbling around no um

so today we are going to be doing a deep dive into cptsd um just to remind that although I'm a psychiatrist nothing we discussed on stream today is intended to be taken as medical advice everything is for educational and entertainment purposes only um if yall have a concern or question please go see a licensed professional this is especially important as we're talking about today because oh my God quiet you um this is very important today because today we are going to be talking about clinical stuff right so this is not a substitute for clinical treatment

the goal of what we try to do here on stream is to educate people and if yall resonate with some of the stuff that we're talking about I highly recommend that you go see a clinical professional um we're going to talk a little bit about evidence-based treatment for cptsd at the end of the Deep dive and yeah so uh today we're doing a deep dive into cptsd and then the other thing that we're going to do today actually just as an FYI so we're going to start with this so I know that often times people

will want us to do things at HG so I want to show youall something so uh oh hold on fail there works okay so you'll notice that someone made a post about a year ago when is Dr K going to make a comprehensive or even short video on cptsd or does he have one that I already missed so and then can Dr K make a video on cptsd these are both from one year ago these are just the two posts that we found that were about a year old but people have been asking this for

a while so the first thing that I want to say is that when y'all ask for stuff like this we pay attention it just takes a while to do right so like between someone posting this and actually like building it um sometimes we have faster turnaround times but many times like it takes a while so we're paying attention to everyone's requests I saw a post a couple days ago that I responded to uh from someone sort of saying like hey HG feels like a boy club is it and yeah we get that it feels that

way sometimes but we have a lot of great content coming out for women there's certain challenges to that so I know sometimes like on the internet we're getting used to instant gratification in some kind of response but we do pay attention to the stuff and we add this stuff to the list which is very large and then we get around to it when we can so since this thing got posted in addition to this deep dive which we're going to do today we also built a whole trauma module so this uh is about it basically

takes about as long to build a module as it does to write a book um the scripting for the module is about 50 to 80,000 words a non-fiction book so the book that I wrote is somewhere around 80,000 words so like we built a a guide um I'll show you all just real quick so like the other cool thing is that guides are getting more complicated so like the cool thing about a guide is that we can add a lot of other stuff right so we're trying to build like graphics and stuff like that um

that help emphasize like the understanding of the principles that play right so we teach a lot of science and sometimes a picture is worth a thousand words and thankfully we have a whole team here at HG that helps us make pictures um so this these are the trauma guide Graphics that we're building uh so I know this sounds like really this seems like kind of overwhelming but I guarantee you that when I talk about the neuroscience and explain the Neuroscience like this is going to help people actually understand right so we teach a lot of

in-depth Neuroscience in the guide um so this these are this is the temporo parietal Junction so we're going to talk about this like just so you all know something cool if you electrically stimulate the temporo parial junction you can trigger an out-of- Body Experience super cool um don't go trying that at home kids so uh you know just as we're we're teaching some of these like so here's the challenge is like Neuroscience can help us a lot right so in the same way that we can understand things like how muscles build and like taking creatine

and and exercising and we want to do some number of reps like there's a bunch of exercise physiology which has been demystified and made available to human beings the challenge is that we have a ton of Neuroscience that has not been demystified and made available instead what we try to do is like translate things into layman's terms and then try to make it somewhat accessible through like Publications like hbr and stuff like that right where we'll have some pop Neuroscience where they'll say like hey this one trick will transform your life like we do that

stuff too so especially in the guide we try to really like teach all this stuff because I think that when I when I work with my patients I actually teach them all of these things or not I mean not everything but as much as I can about how their physiology works because that'll help you a lot especially with trauma um so there's a bunch of different stuff that we've got going on you know we're building things for y'all uh and super excited about it the guide I think comes out soon and so what we're going

to do today is actually watch one video of the guide after the Deep dive so we're going to do a deep dive into cptsd then we're going to show you all a video from the guide just to illustrate something because it's explained in there and I think it's a it's a cool video um and then we're going to get to Q&A okay let's see if anyone has questions before we begin I'm going to just check in with chat um okay will will you ever talk yeah we've talked about schizophrenia before um but we'll we'll talk

about it again for sure uh I had a we're actually working on something where we may um get into schizophrenia soon actually okay um yeah so as as mods are telling y'all the guide video that we're going to showing be showing y'all today is not the Final Cut um it's still in like post so we're just going to be sharing it with y'all today this will be by the way this stream is going to be available okay so it you know like I think it just stays on our our various channels um okay okay so

we're all traumatized so that's a great way to start so today we're going to be talking about complex PTS D and the reason that I think this is really important to talk about is because it's my belief that features of PTSD are present in large percentages of the population without being a full-blown diagnosis now let me explain what the hell that means so if we look at the epidemiology the rates the the prevalence of PTSD is about 1.5% so 1.5% of human beings on the planet have post-traumatic stress disorder about half a percent or about

a third of those people have something called complex PTSD and we'll get to what that is so the interesting thing is if you look at what separates PTSD and cptsd if you remove the PTSD component what is left over I think is actually quite common in our society today that's why despite the fact that only one out of 20000 people has a diagnosis of cptsd it is my firm belief that understanding that component will be very helpful to a lot of the people in our community and in the world so for me for example when

I work with people who have other diagnoses like major depressive disorder or addictions especially what I found is that the more that I learned about cptsd the more effective of a clinician I became at treating these people so that's why we're kind of diving it into it today and as I think a a large portion of our community and people today resonate with some of the features of P cptsd so let's start with a little bit of History so the first thing is like what are these diagnoses and where do they come from so a

couple maybe about 80 years ago soldiers came back from War and what doctors noticed was that these soldiers like weren't all there so they seem to have like this brain fog they have difficulty concentrating they're like having like emotional problems they drink more they can't incorporate back into society so the first round of doctors said oh this is something called shell shock and so what they thought happened is that even though this person doesn't have an actual physical injury the concussive blast of an explosion must have hit their brain in some way and caused damage

so okay the original form of PTSD was born and we called it shell shocked it's because a bomb went off off like very close close to you you didn't actually get hurt and then but there was some kind of vibration or concussive blast that affected your brain that's the injury it's not like shrapnel or anything like that so no bleeding but an internal injury so then what happened is as we started to like work with veterans more and more and more we started to realize that this is happening to a lot of people that like

weren't in the concussive blast zone so they like saw one of their friends die or something like that they were only on the field of battle for like a day and they just like retreated but still they saw someone die and then these people had the symptoms of shell shock so shell shock started with like concussive blast and then we noticed that people have these symptoms but haven't experienced concussive blasts this is where PTSD was born so PTSD is usually an adaptation or a maladaptation of the body to an acute specific traumatic event in in

its original form PTSD was primarily found in soldiers so seeing a friend die or something like that results in PTSD then what happened is once we had this construct once we had these like diagnostic criteria and stuff clinicians made a really interesting observation we see this kind of PTSD or shell shock whatever phenomenon in people who have never been in combat and they're like what on Earth they have all the same symptoms but they've never been in combat then we expanded PTSD to being non combat related things things like sexual trauma or physical abuse or

even things like bullying and stuff like that so the the the web of PT or the scope of pts group PTSD group we'll talk about what it is in a second then what happened is a group of researchers noticed that some people with PTSD have more a different flavor to it and have different kinds of symptoms and they noticed something really important that if the trauma is chronic if it is consistent over time that results in a different clinical picture and this is where complex PTSD was born so if we look at regular PTSD here's

the way that I understand it okay so first of all it has three core features so one is reexperiencing the second is avoidance and the third is I'm blanking I can't believe I'm blanking on this um so there's lots of diagnostic criteria but they get lumped into three things reexperiencing avoidance hypervigilance maybe hold on I will figure this out give me a second chat the joys of AATA memory okay oh hyper yeah so hyper hyper vigilance hyperarousal is the word that they use okay so basically PTSD has three core clusters of of symptoms hypervigilance or

hyperarousal um reexperiencing in avoidance so let's understand what PTSD is so we start off off with a human being who is relatively well formed and healthy and then some kind of traumatic event happens to them and then their physiology their brain their being adapts to try to survive that thing the problem is the way that we adapt to survive that one instance creates maladaptations or problems going forward so let's use a very simple example so let's say that I end up in a car crash right so I'm a relatively healthy person I'm in my mid

20s and I get into a car accident so once I get into a car accident there is a hyperactivation of my nervous system my autonomic nervous system so I have adrenaline pumping through my body I have cortisol getting flushed into my body and then my brain is being hyperactive I'm hyperventilating I get taken to the hospital and then I end up I end up being okay now the problem is that our brain has evolved to adapt so a human being can adapt to circumstances and what the brain does is says hey we almost died there

let's be extra extra extra careful and make sure that never happens again so this is where what we see in PTSD is first of all people will have then other things happen we'll get into this in more detail but other things happen that will kind of numb out our brain and so then what happens is all of these experiences get dissociated they live dorm they're dormant in our subconscious and then they will arise again so people will have flashbacks they will have nightmares this is these are both diagnostic features but this is what we call

reexperiencing even though the event is over people a part of their mind gets stuck in that moment and that part the part of that part of their mind will arise and fall over time so the second thing that happens is people have avoidance right so now our brain our brain remember our bra brain is designed to help us and Keep Us Alive so for example if I almost drown in a lake I will anytime I see a body of water I will get scared and my brain will tell me Don't Go Near The Water Don't

Go Near The Water Don't Go Near The Water right and you'll understand this if you've played video games especially multiplayer video games where you play a video game once and then you have a really bad game because your teammates are feeding and then your brain is like never again never again never again and the thought of playing the game makes you hyperventilate in in nauseous which is why most people play multiplayer games for about 5 to 10 hours over the course of their lifetime because they get so traumatized that they never come back right same

thing you all should be familiar with that phenomenon so it'd be interesting I wonder if we could explore the mechanism through which people keep going back to video games that are consistently traumatic as a way to desensitize people with PTSD and actually get them to re-engage in life that's really interesting I never thought about that for but I actually wonder why we don't why are video games so traumatic but we keep going back that's really interesting anyway conversation for a different day so in PTSD you have a solo event you have reexperiencing of it you

have avoidance of whatever it is so people will avoid getting into a car again and the third thing that you have is hyperarousal so what happens in our brain in our in our phys physiology is that we wire differently so I don't know if this kind of makes sense but like you know if I get attacked by something my brain will be more sensitive to detecting it in the future and I will be more um I will be like my response to that stimulus will be a lot more robust so let's say I get attacked

by a dog on the street the next time I see a dog first of all my brain will be able to pick out dogs out of a field of people if I'm walking down the street and there's like a 100 people in the park across the street my brain will notice if there's a single dog and it'll raise that to my awareness and then the moment that I see a dog my my physiology will activate it will go back to like being attacked so I'll see a rush of adrenaline and cortisol so these are the

features of PTSD basically I I'm a normal person I have a traumatic event and then these three things activate now then what happened is people noticed that like okay so this is a fundamentally different picture from when we have complex PTSD which is consistent trauma over time so what happens when you have let's say a teenager living at home who has an emotionally and physically abusive parent so this is the kind of thing where like you know it's not a single event this is the kind of thing where it's not like uh you know our

our body and and brain are are just adapting over the course of one day this is a chronic form of abuse or trauma that results in a far larger scale change to our sense of self even so what we see is um in in complex PTSD we have a cluster of three symptoms which are referred to as a disorganized self okay so this involves first of all emotional disre ation a loss of your sense of identity and a difficulty with relationships now you can see features of these things in regular PTSD let's actually start drawing

so now we we'll talk about itery disturbances in self-organization okay so let's take a look chat all right so here is a person okay and if they have one traumatic event but they are relatively well formed so what this means is they have relatively normal life this results or can result in PTS SD and this has reexperiencing um avoid oh avoidance and hyperarousal and we'll we'll get into all these okay now let's say that the C trauma is chronic so then what happens is that this person is not usually well formed so it changes their

sense of self and this is what we call disturbances in self organization so if you kind of look at this this so those the way I understand it if you have PTSD PTSD is happening to you this is an adaptation but you are sort of separate from the traumatic event when the trauma is is more constant and when it happens earlier so we'll get to this in a second in a little bit more detail it changes who you are it changes so it's not something that happens to you the trauma becomes a part of you

so this is what disturbances and self-organization mean so what this means is that there's emotional disregulation there is uh disturbances in a the sense of identity and there are difficulties in relationships okay so let's take a quick look at uh something else so I think this so predictors of complex PTSD the role of trauma characteristics dissoc dissociation and comorbid psychopathology so findings largely confirm earlier research suggesting that cptsd is a associated with traumatic events that start earlier in life and are perpetrated by acquaintances okay so if we look at cptsd how is this different what

this means is that remember we're well formed in PTSD so we have like you know like a random like if I get mugged by a random person I can get PTSD but I have no relationship with that person what leads to cptsd is first of all it happens earlier so our sense of self is not well-crafted and furthermore it often times relates to having someone that is close to us in life so our sense of self really gets messed up when our parents are abusive and that results in this symptom cluster okay now let's take

a second to look at the original paper on cptsd and by the way if you guys want to read about trauma the two references I would recommend is this one so uh Judith Herman um was the one who coined the term and this is an an excellent paper excellent excellent excellent paper Okay so uh we're going to just talk about we're just quickly look at this the current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events right so she's saying basically PTSD is talking about it relates to people have

single events or like you know circumscribed so they're they're you can draw a circle around this formulation fails to capture the protein seil of prolonged repeated trauma so now Dr Herman is saying this is a different thing if the trauma happens all the time in contrast to a single traumatic event prolonged repeated trauma can occur only where the victim is in a state of captivity under the control of the perpetrator the psychological impact of subordination to coercive control has many common features uh whether it occurs within the public sphere of politics or within the private

sphere of sexual and domestic relations so what what Dr Herman basically noticed is that we have a group of people who are put in situations where they no longer have control over their life and this has a different kind of of effect on the psyche right so like if I get into a car accident that doesn't fundamentally change like what I'm capable of doing tomorrow so Dr Herman was looking a lot at at people like uh prisoners of War where these people had was not this isn't just a single you know military conflict on a

single day this is someone who day after day is abused abused abused abused abused and it changes the way that they function So today we're going to be talking about that since then things have evolved a lot by the way the other reference on trauma that I would highly recommend we're just going to flash to real quick um is this so the body keeps the score is a great book on trauma but I think you all can get a lot of this summarized in bestl Vander KK's awesome paper from dialogues and clinical Neuroscience so this

talks a lot about stuff this talks a lot about stuff Dr K 2024 okay so now what we're going to do is dig into what happens in trauma so when we built this trauma guide what we basically have so we did a trauma work Workshop a couple months ago maybe about a year ago now and the trauma Workshop was like incredibly successful so like basically there were 200 spots it sold out in 24 hours and then we increased it to 250 spots and so a lot of people were super confused like hey like are you

going to do this again why aren't you doing again we realized that the demand was so high and there's no way that we can get to everyone that we actually decided to just build a guide instead said so we took the trauma Workshop which was about 8 or 9 hours and we expanded it to like 15 16 hours of stuff I think maybe that's last I don't know what the actual video size is but we built this guide and the guide also has meditations and exercises and stuff like that so today what we're going to

go through is some of the core features that we explained in the guide obviously there're in more detail there and we're going to focus on the features of complex PTSD so let's try to understand what happens in trauma okay now so we're going to start with the body so the first thing that happens when we get traumatized is we get hyperarousal okay so our nervous system changes our nervous system changes to be jittery so what does this mean this means I'm walking along and I see a oh God I can't draw a dog okay I

see a dog and normally like when I see a dog I don't have a robust physiologic response but once I have PTSD what starts to happen is even benign stimuli will trigger a very strong sympathetic nervous system response so we have this part of our nervous system called the autonomic nervous system or ANS and the autonomic nervous system is divided into the sympathetic nervous system and the parasympathetic nervous system okay so the sympathetic nervous system governs fight or flight the parasympathetic nervous system governs rest and digest and the simplest way to understand that is when

I was in college I used to talk to my friends we used to have this phrase called being owned and it's like I just ate this gigantic sandwich I am now owned I can't do anything I am gg gg and there are other times before you eat a gigantic sandwich where you feel active you feel energetic you feel you know you feel like optimistic about the future whatever so our body has periods of activity and then it has periods of rest and digest so I I don't know if you guys like H you know after

you have a meal what happens is our parasympathetic nervous system activates so when the parasympathetic nervous system activates and it's triggered by things like food in your stomach and then our body sends so our stomach sends signals to our brain that's like hey we've got a bunch of food coming in we we need to divert blood flow from our skeletal muscles like our arms and our legs and our brain to our digestive system our liver needs blood our GI system needs blood our stomach needs blood intestines need blood um you know our gallbladder needs blood

this is where we need all of our blood flow so we'll feel sleepy we'll feel like sitting around we'll digest things and then there are other times where like when I'm walking down the street and I get attacked by a you know like a a Thief so if someone's trying to mug me then my Paras my sympathetic nervous system will activate I'll get a surge of adrenaline and cortisol and then I will fight or I will run away now if we look at diseases like anxiety disorders or panic attacks what we see is that in

these disorders we have a hyperactivation of the sympathetic nervous system in our society today we have a very high stress State and the reason for that is that generally speaking the sympathetic nervous system was something that was supposed to turn on and off right so this evolved in like deer so if you think about a deer like a deer doesn't worry about paying mortgage at the end of the month they don't worry about GPA they don't worry about being alone for the rest of their life the deer has like is basically chilling and then responds

to its environment if it sees like a wolf it runs away and then it kind of Cs down so in most animals if we look at a 30-day period they may have an activation of sympathetic nervous system system here or here oh I see a deer that I'm sexually attracted to so I get a spike of it what happens in human beings is we get prolonged activation because if I have a test in two weeks I don't stress about that in two weeks I start stressing today and I stay stressed so hyperarousal is basically the

same thing it is a a elevated triggering of our sympathetic nervous system so it's not chronic it just means that so here here's the way that I would put it so here's a normal human being and let's say that I need a danger signal that is this high so if my danger signal hits this point actually let's do this way so let's say here's our stress response I'm going to redo this chat because this is done wrongly and here's our danger so let's say danger level one danger level 10 danger level 10 is like there's

a tornado flying towards me level one is I don't know there's like a someone rings the doorbell let's say so normally what happens is we need like a danger level of seven so as we go over here as we get a danger level of seven then we see an increase in the stress response so this is like for a normal human being when you have PTSD what we tend to find is that a danger level of four is sufficient to trigger a stress response so our threshold to trigger the sympathetic nervous system goes way down

it is easy for us to get triggered right and we use this term so much in in common language nowadays like this triggers me this triggers me this triggers me right it's it's and the things that we say trigger us I mean all kinds of stuff can trigger us but usually what people are referring to is that a very small dose of exposure will lead to a robust or disproportionate response so this is the first feature this by the way is very physiologic so has nothing to do do with your mind or your feelings or

stuff I that's not true but it has a lot to do with that but this is like at the level of biology okay so the second thing that we see um in let me think about how think about this so this is hyperarousal okay now hyperarousal will result in things like avoidance we'll kind of get to those in a little bit but now what we're going to talk about is the second level that we're going to focus on is emotions so the other thing that we see in in PTSD is that in complex PTSD is

that people have a tendency to dissociate so we've explained this concept before but it's really important to understand so our brain has two hemispheres the right Hemisphere and the left hemisphere the right hemisphere governs a lot of our emotions and the left hemisphere governs a lot of our analytical capability now this is an oversimplification because we also know that the dorsal dorso parietal area in the amydala in the limic system there we have emotional structures on both sides of our brain so like there's like other ways that this is not really that accurate but it

sort of is so what Vander kulk he's a he's a great trauma researcher I think this was vander's research what he noticed is that he basically dug into how people dissociate so what happens in trauma is that a very low threshold of exposure is necessary for a hyperactive physiologic response so if we kind of go back to our diagram I wonder if this is a good way to explain it so like I don't know if this makes sense but like so we can go from here to here and then we can kind of top out

but if we look at trauma what happens in dissociation is we can't we can't keep going up right this is like this is the max this is the top you can't get any more stress than that this is maximal activation of the sympathetic nerve system you can't just keep going up so what Vander Kul basically noticed is that somewhere around here I'm just sort sort of approximating okay this triggers dissociation so the stress level is so high that are are are it's kind of like you know I can I can put wattage through a light

bulb I can increase the number of the amount of of Watts that go through a light bulb and the light bulb will get brighter and brighter and brighter until it burns out so this is what happens in dissociation dissociation is usually triggered by a hyperactivation of the sympathetic nervous system it's like you go all the way around the world you're heading east and then suddenly you head up end up like west of where you started which is like really weird so this is what happens in dissociation is that the the signals are so overwhelming the

emotions are overwhelming the physiology is overwhelming that it triggers this process of dis dissociation now what happens in dissociation a couple of different things happen but the key thing that we're going to focus on is decreased activity across the Corpus colossum so our right hemisphere is where we experience emotions our left hemisphere is where we experience analysis so as you all know when I get emotional my analysis starts getting messed up and so our brain is like I can't handle these emotions I can't handle this is too much activity too much activity too much activity

and there's even um some studies let me see if I can find this I don't think I have this prepped but let me see if I can find it yes okay so what happens this is super cool dude so cool but weird okay the mechanism underlying this process is understood as being analogous to kindling which involves the emergence of generalized seizures in in response to repeated Sub sub threshold electrophysiological stimulation in PTSD similar to the kindling of seizures the progressive augmentation and amplification of symptoms occurs over time possibly as the result of neural circuitry associated

with emotional memory response becoming increasingly reactive and also expanding into neighboring neural circuits so I know that that probably doesn't make a whole lot of sense to youall but let's explain what's going on so basically what happens in PTSD is we almost get something like seizures right it's not really a seizure but what happens is that there's an activity so if you think about what a seizure is a seizure is when you have normally we have controlled electrical activity so neuron turns on second neuron turns on first neuron turns off second neuron turns off this

is how it works right so it's like I'm sending a signal and it's goes from here to there and then we're done so in a seizure what happens is we have unreg ated electrical activity across the brain so everyone is just activating each other and activating each other and activating each other so what people have noticed in PTSD is there is a similar thing going on where we have this feeding and unregulated upswing of whatever Badness is going on so we have panic attacks we have reexperiencing we have flashbacks we feel overwhelmed we feel triggered

and then much like a seizure so after you after you have a seizure people have this thing called a postal state where they're not quite comos they're like sort of semiconscious because their brain just shuts off and so the same thing happens in in PTSD okay or in trauma is that you have this overactivation and then the brain is like enough is enough and then we dissociate we just completely unplug now what happens in dissociation is that we have decreased activity across the Corpus colossum so the emotional center of our brain which is going absolutely

Haywire the emotional hemisphere which is going absolutely Haywire the left side of our brain is like enough is enough we can't handle this cut off all contact with the right side of the brain then we dissociate so what this what this feels like is you can watch terrible things happening dispassionately to yourself the logical part of your brain is like this is happening now I'm getting now this person is hurting me now they're hurting me more now they're hurting me more this is painful period there's no emotional connection to this experience okay so once we

dissociate once this this process happens and and this is where I think Vander Co coined this term and apologies to the researchers who coined it if I'm misattributing this we call this process hemispheric lateralization now this creates all kinds of problems because once we disconnect from our emotions we have all kinds of challenges okay so if we look at what what is the role of emotion so emotions do a couple of things emotions give us information they give us motivation right so let me give you yall an example of how they give us information so

if I walk into a room and everyone is laughing and then they suddenly go quiet and look at me I feel weird right I feel uncomfortable so like what really happened like my logical brain doesn't know but my emotional brain is like giving me information when someone calls and cancels on you for the third time and you feel angry your brain is telling you something okay second thing is emotions give us motivation so what we find is that when when people struggle with trauma and this is the video that we're going to show you all

today um let me go back to this so right so like the paralysis of initiative of chronic trauma combines with the apathy and helplessness of depression so what Dr Herman noticed was that when when people have been traumatized they become like listless like these veterans come back from their P camps and they don't feel like doing anything they just kind of sit around they kind of exist they have no Drive they have no passion and if we look at like where does drive and passion come from it comes from our emotions right well like I'm

not going to stand for this anymore I want to go achieve something I want to be the best I want to do better I want to be free I want to relax these are all emotional things the whole problem that a lot of people see in our generation we're talking like Millennials gen Z gen Alpha is that we're told that we should do a certain thing so our logical brain is like should study for this test instead of playing a video game but my emotional brain is not motivated to do it I'm motivated to do

something else so emotions are a big part of motivation and when we disconnect from our em emotions we lose information and then we also lose motivation but there's more at play it turns out that when we lose our emotions okay we also lose our sense of identity now the question is why so let's understand what your identity is so identity is formed through stringing together emotional events so if I ask someone who thinks that they are a loser and I say what makes you a loser let's say there's someone who's been who's 25 years old

so they've been on this Earth for like 8,000 days okay yeah so like way more than 10,000 days so let's say someone has been on this Earth for 10,000 days and if I ask them what makes you a loser they are not going to look at their average experience on a day-to-day basis that's not what makes them a loser 8,000 out of the 10,000 Days my day was relatively normal and like nothing good happened nothing bad happened I was just straight chilling what makes them a loser is the emotional moments in their life that moment

that I asked this girl out to a dance and she laughed in my face and then told the whole school about it and then everyone made fun of me for the week before school ended and so seven days out of 10,000 becomes this person's identity the flip of it is also true in terms of positive things right so when someone says when I ask someone hey like how do you think about yourself then someone says I'm I'm a really strong person who's just trying to make do good in the world and then I asked them

like how did you develop that identity like what makes you say that tell me about your life and they will tell you emotional moments in their life once again it's not about the 10,000 days that they've been alive it's not like that they ate PB and J every single day like that's not a part of their identity what makes your identity is a string of emotional experiences this is why people who like survive cancer like they they it becomes a part of their identity like I am a cancer survivor because it's an emotionally grueling experience

right joining the military very um you know in my case right so like I failed out and like those were very uh powerful emotional experiences getting into med school like I remember the day that I I still remember the day before Thanksgiving I got a call from the dean of the medical school after three years of applying saying that hey I've been accepted and I wanted to call I've been accepted to med school and I wanted to call so that you you know weren't worried and you had like a Happy Thanksgiving and then I called

my dad and I called my grandmother and it was like very joyous and ful and things like that and my you know anyway it was a very powerful moment for me um we can go into more detail if youall want but my point is that if we look at what makes our sense of identity it is like strings of emotional experiences this breakup this marriage the birth of this child Landing this job you know surviving a shark attack like like these are the moments getting this award it's emotional experiences that create our sense of identity

so the moment that you start dissociating you lose your sense of identity then you're simply existing you're not living so what we see in complex PTSD is disturbances of self-organization and it starts with emotional disregulation so when your emotions are disregulated when you can't control them you can't really make sense of the world right so like there are times where your emotions get out of control and then you end up triggering dis iation so now it's like hyperactive emotion followed by dissociation there's no way to make sense of that it's just like you get it's

like someone is like it's there's a difference between like painting a painting and taking a bucket of paint throwing it on a canvas and then burning the canvas this is the best analogy that I can come up with in this moment of the difference between emotional disregulation and disorganization there's no order to it it's just emotions out of whack followed by unplugging the whole experience so when we have this process then we lose our sense of identity and this is what we see in in cptsd so there's if we look at uh diseases like or

diagnoses like borderline personality disorder or narcissistic personality disorder what we find in this these diagnoses is a disturbed sense of self so in someone with BPD they do not have a stable sense of self so what does this mean so what this means is that if someone if I'm walking down the street and someone insults me and says hey Dr K you're bad at games they opinion of me whatever it is or I'm great at games they're saying I'm the best human being on the planet and I'm so good at video games whatever their opinion

of me is their opinion exists out here and my opinion of me exists in here and as they say one thing and I say another thing these two things conflict so in if enough people say this to me then my sense of self will change so if you have like this entitled little prick of a kid how do they become entitled because too many times their parents or the people around them are telling them over and over they're getting signals from the outside world you can do whatever you want you can do whatever you want

you can do whatever you want so you internalize this and on the flip side if you get told the opposite if you have someone who has low self-esteem because they're told you're a piece of you're a piece of you're a piece of then that becomes internalized so you have a stable sense of self and then you have the outside world's opinion of you so what happens in in borderline personality disorder is that their stable sense of self disappears it's not stably high or stably low so remember that people like who have let's say a mood

disorder like major depressive disorder they may have a stably low sense of self but in BPD the sense of self is absent so what that sort of mean Not absent but it's it's not well formed so what that sort of means is if people are treating me well I feel great I am a good person if people are treating me well and if they're treating me poorly then I'm a shitty person this is an unstable sense of self and now if you sort of think a little bit about complex PTSD PTSD and BPD so this

is kind of where you know we're going to I'm going to try to explain this a little bit more clearly so we know that if you have BPD you have a unstable sense of self which by the way if youall haven't seen our video on on BPD apparently it's really good so like I was just like someone told me recently that has a ton of views and we've gotten really positive feedback about it so so watch it we've got PTSD over here with our arousal vigilance and avoidance and then we have cptsd which is these

Plus plus this DSO which is Disturbed self-organization so emotional disregulation left out an S there but GG Get Wrecked to noobs um emotional disregulation identity issues and relationship issues and we'll get to relationships in a bit so what we kind of see is that like BPD has these two but BPD doesn't have these so BPD so now like this is really important to understand C cptsd is this plus this BPD is just this without this and then maybe some additional stuff does that make sense so we know that trauma can cause this if it's one

time if it's chronic causes this and if it's chronic causes this but it depending on the nature of the trauma and the fre fre quency and your genetics and and stuff like that like it it kind of changes the manifestation so the reason I think this lecture is super important is because I am seeing this as its own independent set of cluster the cluster of symptoms grow in the population more and more problem are more and more people are having problems with this without necessarily this or this okay so what happens in in cpts is

we have a disordered sense of identity which then results in all kinds of problems okay so the first thing is in BPD you know what the way that people feel about me determines the way that I feel about myself so there's no persistent sense of self to fight against other people's opinions right if I'm confident in here people can bully me and I can fight back but in BPD they can't do that and in cptsd they can't do that because this is not well formed the reason it's not well formed is because we don't we're

so emotionally disregulated that we do not lay down a foundation of of who we are this all also creates all kinds of other problems so in cptsd and in BPD we see that there's a lot of impulsivity so why is there impulsivity so on the one hand there's paralysis of initiation so people have difficulty getting things started that's the video that we're going to watch at the end of the Deep dive today by the way okay so we're going to teach all this because so this is like half of our community struggles with this I

have trouble getting started and it's so cool that the research on trauma helps us understand why your brain has difficulty getting started so we have difficulty getting started and then we also have impulsivity very common in complex PTSD and the question is why so impulsive is the desire to do something for a little while right so it's like I'm impulsive so impulsive is not in action it is temporary action it is sudden action and so what what we see a lot is people have difficulty with follow through right I can't stay consistent why so if

you look at where consistency comes from consistency comes from two places the environment outside you if you have an environment that is structured then you will be consistent right so like let's say you're in prison and like I used to have patients who would tell me oh yeah I had such big problems with insomnia and I was like what worked for you and he was like going to prison I don't have insomnia anymore and I was like why not and he's like well I have no choice I have no cell phone I have to go

to sleep at the same time I've been here for 3 years for 365 days for 3 years in a row I've gone to sleep at the same time and I wake up at the same time like I have no choice but if we do not have a horribly structured life then our consistency comes from our sense of identity right why do you go to the gym every day because I want to be in shape I want to be healthy I enjoy it why do you play games every day I enjoy them why do you play

games every day I don't know I hate them so your sense of self is what gives you a Drive in a direction over time so I worked with a I've worked with a couple but I'm thinking about one Olympic Athlete many years ago and so like when I talked to this person you know like how did you I was s curious I was like this the first person I worked with who was an Olympic Athlete I was like how did you become an Olympic Athlete like tell me about that like what's that like and it's

like a very strong sense of self that drives you forward so that when there are setbacks when RNG happens that strong sense of self keeps you focused on the task at hand so what is impulsivity so impulsivity is a combination of emotional disregulation and a lack of sense of self so when my emotions arise over here and I don't have a grounding from in here I'll I'll jump over there and as the emotion disappears I stop doing it because I have no driving force from it here so another very common feature of cptsd is impulsivity

and paradoxically paralysis of initiation so why how can those two things go together well like because remember it's not the problem with paralysis of initiation is that you want to start something but you can't bring yourself to start it so if if you're someone who really struggles to get things started what you will find is that there's a correlation between getting things started and being impulsive because in both cases you're not in control in both cases in one case you can't drive over your emotions and in the other case your emotions are taking advantage of

you and they're making you impulsive and now you do this and now you do that so these are common features in cptsd and they have to do with a combination of lack of identity and emotional disregulation now we get to the third thing which is relationships so people who have cptsd have difficulty in their relationships now this is where we get to some really cool neuroscience so um I think it's here okay let's actually take a look at some science to kind of support these points okay so um what we find in people who have

cptsd is that they have poor emotional awareness so they're not aware when they're feeling emotions right this is a result of like this dissociative pathway or hemispheric lateralization so an as emotional awareness enables increased self-reflection and regulation of affective states it is often considered a Cornerstone of emotion regulation so let's understand this for a moment see you can't regulate an emotion unless you're aware of an emotion and as we dissociate and we're not we we numb ourselves to our emotions then we can't regulate them now this is very important to understand when you numb yourself

to an emotion it doesn't mean that the emotion is inactive it just means that you're not aware of its activity so what happens when someone dissociates is that they're they don't feel any emotion but that part of their brain doesn't completely shut off it is still active we're just not aware of it so people who struggle with cptsd will be less emotionally aware at some times and also paradoxically hyper emotionally aware at other times okay so we're not going to go into the neurobiology of emotional selfawareness I think that's a bit too detailed but let's

talk about this okay the neurocircuitry underlying emotional numbing in PTSD so increased emotional numbing symptoms predicted decreased brain activation within the dorsomedial prefrontal cortex during imagery of both positive and negative social scripts consistent with the role of dorsomedial prefrontal Cortex in higher order reflective and metacognitive aspects of of emotional functioning um so we'll explain what that means in a second I just want to read this too so uh the developmental the development of neural circuitry facilitating May therefore be disturbed in PC PTSD leading to the difficulties these individuals often have in reflecting on interpreting and

acting in accordance with emotion a patient suffering from PTSD related to prolonged childhood abuse summarized feelings of emotional numbing in the following statement it's like a blank I think about my kids and I feel nothing for them I'll be sitting there feeling confused and numb and I wonder what I'm supposed to be feeling it's like dead space and when that happens I have trouble using words finding my words and I can't talk so let's understand how you can have numbness and feel emotionally disregulated this is what we mean by disregulated disregulation doesn't just mean hyper

action it also hyperactivity it also means low levels of activity and high levels of activity at the same time and this is where the Neuroscience becomes important so as we look at the Neuroscience of cptsd versus PTSD we find that there's actually different places that emotions come from in the brain and it turns out that the cptsd affects different regions okay so now we're going to get into the Neuroscience so we have our amydala and then we have this dorsomedial prefrontal cortex now remember was we looked at this paper we saw that decreased activation within

the dorsal medial prefrontal cortex okay so this is like a different region so most of the time when we talk about emotions what most people especially pop neuroscientists like myself will talk about is the amydala this is the fear Center the survival center the anxiety center of the brain fear anxiety survival and what we find in people with with PTSD is that this is hyperactive so like think about how this is okay I want you to think about this this is so pardon my language so here we have presumably a man or woman I'm not

sure who is emotionally disregulated so has like panic attacks and stuff like that has hyperarousal and then when they look at their kids they feel confused and numb so like this is like this is not fair so we feel confused and numb to our positive emotions but we have a hyperactivity of our negative emotions like how is that fair panic and anxiety and fear we can feel normally or even at hyperactive levels because remember in PTSD we're we're aroused but love and things like that I can't feel so this is something very important to understand

the amydala is where we feel feel fear and anxiety in survival stuff but a lot of our positive emotions a lot of our other emotions come from other parts of the brain like the dorsal medial prefrontal cortex and so what we see in complex PTSD is specifically a deactivation of those parts of the brain we see a deactivation of the positive emotional circuits of the brain which are actually is actually the dorsal medial prefrontal cortex while we see a hyperactivation of the amydala which is our fear center now the reason I think this is important

is I see this in a lot of people who do not have cptsd I see a hyperactivation of our fear for the future the world is going to hell I'm screwed I'm going to be alone today is Friday so we have a bunch of posts on our subreddit about how everyone is hopeless and yet they have a hyperactivation of their negative emotions but a hypoactivation of their positive emotions how is this Fair it's not now we understand the neuroscientific mechanism right it's because not all emotions come from the same place and what we see in

P cptsd is hypoactivation of the dorsomedial part of the brain so this is where look positive emotion dorsal medial prefrontal cortex negative emotion was also kind of in the same place anyway it's kind of weird the amydala I think is usually over here but yeah it's also weird because this person's backwards anyway so we may experience negative emotion there it's complicated so now what we're going to do is talk a little bit uh okay so that's that's emotional disregulation okay um let now let's talk a little bit about self-awareness and identity okay so specifically during

traumatic memory recall increasing severity of trait Alexia we talk a lot about Alexia which is emotional color blindness was associated with reduced activity within the vent medial prefrontal cortex and interior insula okay we talked about kinling um so I think we already covered this okay now let's talk about identity right so remember we said that this disturbs our sense of identity individuals with PTSD often exhibit disturbances in self-referential processing uh Johnson at Al proposed that the ability to reflect upon on ones self requires a robust sense of self which has been described as a collection

of schemata regarding one's abilities traits and attitudes that guides our behaviors choices and social interactions so we kind of already explained this but does this make sense like the sense of self is a collection of ideas they use schemata because it's not quite an idea about your abilities your traits and your attitudes I like tacos I don't like hot dogs I'm good at this game I'm bad at studying I'm a I'm a dog person I'm a cat person I'm a I'm a night owl I'm a morning Lark like we have like this kind of stuff

and then also when we have these kinds of beliefs about oursel they affect our behaviors choices and social interactions right so if I'm if I am a gamer if I identify as a gamer I'm more likely to play more video games so now let's understand the mechanism through which people with CP TSD have difficulty doing this neuroimaging studies suggest that self-referential processing is partly mediated by via cortical midline structures we're going to focus on the anterior singulate okay and the temporal pulse temporal prial Junction and temporal pulse see if that no all right so this

is where basically what happens is the parts of our brain that that give us our sense of self which is the anterior singulate the default mode Network and our parietal temporo parietal regions of the brain these parts are impaired in cptsd so our sense of self does not function quite the same way now if you all remember at the very beginning I said if you electrically stimulate the temporoparietal junction this is the not the junction but those regions of the brain are impaired in cptsd if I electrically stimulate the Pro parietal Junction I will trigger

an outof Body Experience so what is an outof body experience that an outof body experience is an experience of my Consciousness existing outside of my body right so this is the part of the brain that governs like my experience of self and if it is impaired in some way my sense of identity will not form well if my sense of identity does not form well that'll result in problems in terms of behaviors the choices that I make Etc the last Dimension that we're going to talk about is relationships so in order to have a relationship

we must have a sense of identity because a relationship is something between me and you there's a chunk of you in there and there's a chunk of me in there but if my sense of identity is Disturbed my capacity to have a relationship with another human being is impaired practically what this looks like is something very similar to BPD where when you have cptsd and you try to have a relationship with someone else like you don't add a whole lot to the equation I'm not saying that you don't factually add value to the relationship what

I'm saying is that your personality does not enter and shape the relationship in the same way that someone who's well formed has a well formed sense of identity does you know you sometimes what this means is that you become a doormat you become a people pleaser you don't really have a whole lot of strong opinions you become a chameleon these are all three different variants of how cptsd shapes our relationships in BPD like sometimes like so I I've worked with some women who have BPD and the people that they date feel like they found the

perfect partner for the first couple of weeks because whatever their partner is into they're into and like I've had friends male friends who have who've probably dated women with BPD and I I've heard what the way that they describe them they'll say like oh my God this person is amazing she's into like anime and she's into this and she likes she hates wine and she loves beer she likes she loves matcha but she hates coffee she's like perfect she's like a female version of me and she's hot and so they'll say things like this and

the gender roles can be reversed too absolutely but what happens is when when we don't have a sense sense of self it becomes hard to have a relationship because we absorb the other person's things so in BPD it's more about absorption of the other person in cptsd it doesn't have to be that way we can see doormat we can see people pleaser because I don't have a sense of identity and once we have these doormat and people pleaser Tendencies we also open ourselves up for more toxicity in relationships because I don't advocate for myself right

because I you're better than I am I don't have a sense when you treat me like crap I do not have something in here that instinctively Rebels so if you have a well-formed sense of identity and someone treats you like crap you recognize that you deserve better and that idea that you deserve better where do that idea comes from it comes from a sense of self it when you just think about the mechanics of this okay think about the language that I'm using when I say I deserve better there is a stable conception of what

I this quantity of I deserves I don't deserve $10 million I don't deserve zero doar I deserve $100 that is based on your identity now in the case of narcissism that identity is too high so what that means is if anyone remember this root of narcissism is actually insecurity so if anyone gives you even 1% less than you deserve you become prickly like a porcupine you're like I deserve better and it's like bro like you got what you deserve this is crazy like I did everything that I could for you and the opposite is also

true where when you don't deserve any like when you deserve when you don't have a sense of self then how can you deserve if you have no eye no stable sense of self and what you deserve so this creates all kinds of problems in relationships and we see that in in cptsd right so the dis disturbances of self-organization result in emotional disregulation hyperactivity using something like a kindling mechanism especially in the negative emotional regions of the brain where you have this sub threshold electrical activity that then activates it's like you're just going about your day

and then suddenly you feel intensely sad and you're like what the right you don't actually think that way because it's normal for you but people outside of you look at you and they're like I don't understand why this person just gets so upset so randomly and they do what they can to help and if you know people in your life who do this right they just go into funks for like very intensely for a day and you're like what's wrong and they're like I don't know or nothing and then we if you're if you're like

a normal person right I don't mean that in a in a judgmental way I mean that if you have a brain that is not developed like this you look at this and you say tell me what's wrong and they say nothing's wrong and they're crying their eyes out and you're like what the because and and the thing is in their case it they're right nothing is wrong this is what's wild about trauma see when you look at someone like that and you think there must be something wrong why because in order for you to cry

that hard you need something that is so powerful that it overcomes your sense of self and makes you cry really hard in their case they have a seizure like activity in their amydala that just disregulated a different way the rules that the brain is playing by are different that's what's wrong with you there's nothing wrong with your personhood the way that your neurons are activating are closer to a seizure which is why you have the disrupted emotional regulation and you just feel things so intensely and it comes out of nowhere and it's so confusing and

it's so debilitating okay and then there's also dorso medial numbness which results in like not being able to like do things like feel spontaneous love for your kids and all that kind of stuff it's all super sad and super debilitating cptsd is a really bad diagnosis good news is that it can get very you can get way better right so this is not it's not um it's not your destiny so the cool thing and I guess we'll get into this now is that we actually know we have a sequence of things that you can do

that will sustainably get you better now there are a couple of good things about treatment the first thing to understand is that trauma is an adaptation which means that you weren't born this way this is your brain adapting to circumstances which means that if your brain adapted once it can adapt again right this is very different from something like having a genetic you know a two recessive that result in a genetic deficiency in the blueprint of what your body is capable of making there is a problem so until we get to Gene replacement therapy like

there's nothing that can be done about that right like the fundamental Machinery like there's no it's like we're building a computer but there's like no place for the CPU right and then like there's no way to get that computer to work the good news about trauma is even though it is so debilitating even though it it feels like it it screws over every dimension of your life the majority of it can get better because these are all adaptations they're not the core thing they're the stuff that you've layered on top so you can systematically go

about changing that okay so how do we change this the first thing that we have to do is rewire our physiology okay so we go through this in a more step-by-step process in the guide so a lot of people with trauma and Vander kulk is a big advocate of this so he runs this place called the center of trauma and they do a lot of yoga so what we tend to find is there are a couple of key principles the first is you have to be comfortable in your own body and mind body practices are

very good at doing this so we what we specifically want to do to be comfortable within our own body our body has these the sense of we actually have six senses okay the six sense the six sense is not being able to see dead people the sense is something called proprioception so proprioception is our sense of our body in space so if I like close my eyes and I lift my arm I can tell where my arm is that's technically not the same as touching something right this is like a sense of where my body

is and proprioception seems to be really good at helping us rewire our physiology so a lot of studies show that things like yoga and taii are very effective for condition that have hyperactivity of the central nervous system or sorry not Central autonomic nervous system panic attacks high blood pressure anxiety disorders postural orthostatic tartic syndrome Mind Body practices are really good at this we know that mindbody practices recruit things like the vagus nerve which is our our primary parasympathetic nerve in the body so when we meditate our vagus nerve turns on it slows down our heart

rate it slows down it decreases our blood pressure it activates our GI system it does all kinds of good stuff so practically what I describe is what we really want to do is something called autonomic stretch so the best way to so this is important to understand so remember that our nervous system our autonomic nervous system has sympathetic and parasympathetic okay actually go back to this this work okay great so I'm going to show you all this okay so let's take a look okay so our nervous system our autonomic nervous system has sympathetic nervous system

and parasympathetic nervous system okay so normally what happens is this one is active about 50% of the time and this one is active about 50% of the time and anywhere between 45 minutes and 2 hours is the oscillation between the two so the problem with stress is not the stress it's that it's chronic so when we have chronic strength stress we have 90% activation over here and we have 10% activation over here so it becomes difficult then what happens is our body gets stuck in this mode so anytime the body gets stuck it loses flexibility

I know it's kind of like a silly statement but so in in Physical Medicine right so Physical Medicine and Rehab sometimes we'll have something called a muscle contracture so muscle contracture is when you hold your your body in a certain way okay and when you wow that vein looks huge sorry distracted by it's a real pity I don't shoot heroin cuz that's one hell of a pain okay um so this is why I love streaming like you know when I'm when I'm like teaching at like medical schools like you can't do that all right this

is why I love teaching here all right so if I hold my body in a particular posture I will develop something called a contracture so a muscle can get locked into tightness okay so if I'm like sitting at my computer all day the trapezius will get very tight your scaling muscles will get very tight your anterior scalings will get super tight if you want to feel how tight your anterior scalings are by the way this is super cool exercise you can do what I want you to do is tuck your chin back and turn and

what you'll feel if you just tuck your chin back and then turn you'll feel like this super tight muscle over here so when our when our muscles are in a sustained contraction they lose flexibility so this happens in our nervous system as well they get locked into a sympath a hyperactivation of the sympathetic nervous system so what we want to do is increase our autonomic stretch and the beautiful thing about this is that when when you look at stress okay this is fascinating you can meditate to decrease stress or you can exercise to decre decrease

stress that's weird because when you exercise you're not relaxing you're actually doing the opposite you are activating the par the sympathetic nervous system so the cool thing about autonomic stretch is anytime we hyperactivate the sympathetic nervous system we automatically send a signal to our body that we are going to rest when we are done so if I'm at a chronic state of stress okay so let's say that this is let's say this is the midpoint and let's say this is sympathetic nervous system this is parasympathetic nervous system so most of us live over here but

if you are in a chronic stress state you live over here so how do we get things back over here one thing we can do is meditate meditate brings us here and then after we're done meditating maybe we'll go to there the other thing that we can actually do is exercise so exercising will actually bring us up here but when we get up here right so when you exercise a lot what do you feel like doing you feel like resting so if I run really really hard and my CO2 level spikes and my O2 level

starts to drop as I'm increasing muscular respiration I mean muscular respiration my body is like oh crap we've run out of oxygen now sit the down and rest so we feel exhausted after exercise we don't feel energetic which means that once we hit this point this triggers a signal in our body to go back down here and then when we end up we'll end up here now the cool thing is when you do both exercise and meditate you will get here faster and if you do this kind of thing it will actually improve your it'll

improve your autonomic arousal so it'll help with things like trauma it'll help with things like generalized anxiet disorder it'll help with things like panic attacks you can do both the key thing is actually oscillating see if I want to stretch a muscle stretching a muscle isn't just doing this stretching a muscle is doing this and then doing this and then doing this and then doing this this is what really increases flexibility okay it's not just going like this and keeping it there this in turn will lock the muscle into this configuration so we want to

alternate between the two so as we rewire that physiology our hyperarousal will come down second thing we need to do is reconnect with our emotions now this is where the cool thing is that we actually don't have to reconnect with our emotions to reconnect with our emotions okay give me a second um let me see if I can find this um um let's see if I can find I think it's over here hold on you guys can look with me ah there we go okay thank God I remember the word that they used okay um

[Music] and okay so conceptual emotional awareness refers to the the ability to reflect on interpret and make a decision about an embodied sensation or emotion okay um so there are a couple of different things that we can do to increase our self-awareness uh where is this yeah okay during this phase of treatment patients have to develop an awareness and language that helps them identify bodily Sensations and how different bodily Sensations relate to different emotional experiences for example for one person tension in the jaw in combination with a feeling of tightness in the throat May correlate

with sadness while in another individual sadness May correlate with tightness in the stomach and a feeling of heaviness in the chest by developing emotional awareness patients can learn to identify precursors blah blah blah blah blah blah blah okay so there's basically two or three things that we're going to do to reconnect with our emotions the first is just be aware of your bodily Sensations so remember and this is what's cool about the Neuroscience okay I'm going to try to explain this because this is huge but I don't know if I can explain it so if

we look at this paper okay what this paper tells us where's table one is that different parts of our brain are messed up by PTSD come on table one where are you at table one there we go okay so if we look at table one here are all the things that are affected so medial prefrontal cortex self referential you know um let's look at the anterior singulate integrates cognitive and emotional aspects of experience right we have all these different parts of the brain now the thing is these parts of the brain have these broad functions

right so the the thing to understand about the brain is we used to think that like a particular part of the brain does a particular thing but what I want youall to understand is that regions of the brain are like letters of the alphabet the way that they connect and combine with each other is actually what creates a particular phenomenon in our life so curiosity or love there isn't a love Center to the brain a love Center the love Cent the the way we experience love in the brain can just hypothesize based on this is

some medial prefrontal cortex some anterior singulate cortex some amygdala and some insula see when we combine self-referential this is me I am in love and there's an emotion emotional aspect there's emotional salience what that means is feeling this means this thing what is the significance of the emotion I have a sense of me I have this emotion I attach a significance to the emotion and then I also have some degree of fear because what if this person doesn't love me back and then I also have bodily self-awareness because when they're around I start to feel

changes in my body my body changes I ache for you I need your body that's what love is there isn't a part of the brain it is a concert of different parts of the brain interacting with each other okay literally like so like if you guys have been in love you know what I mean like your body aches for someone else like think about that from a neuroscientific perspective you can't ache for someone else unless the part of your body that senses your Sensations is aware of what you feel in here is active in some

way okay so now we have a problem which is that these parts of the brain are shut off in trauma simplification so the cool thing is that in order to reverse this process we do not have to fix it we just have to awaken the part of the brain see if we increase the activity of the brain if we like reawaken our dorsal medial cortex prefrontal cortex right this where positive emotions come from all we have to do is activate that in some way and once it's on it will start to feel other things we

see this in clinical trials and I see it in my clinical practice I'm somewhat extrapolating here so in clinical trials on yoga for trauma just think about this for a second what the is the mechanism it's not just autonomic nervous system what's happening is we are activating this part of the brain through this yogic practice I can't find the sentence in in this paper but even the paper sort of talks about all we have to do is just activate the part of the brain even just increasing your awareness of emotions and even awareness of your

body you don't have to increase awareness of emotions you just increase awareness of the body and you will have an increased awareness of emotion why because some part of an emotion is physical butter flies in the stomach tightness in the throat so you can kind of backend emotional awareness through bodily awareness then what you can do is by the way I don't know if yall noticed this but we've been teaching you all this crap for years and that wasn't because I read this paper it's because I sort of found this in my clinical experience that

especially for men accessing their emotions through their body is very good okay so increased autonomic flexibility number one increased awareness of the body number two third thing is articulate your emotions physically if you don't if you don't have awareness of them fourth thing we want to do what's the fourth thing oh yeah articulate our emotions actually attach language to them this we go into in a lot more detail we can't go into everything in all detail in in the guide but the cool thing is remember we have this problem of hemispheric lateralization which means negative

emotions are over here or emotions are over here and languages over here when we have decreased awareness I me decreased communication through decreased activity across the Corpus colossum right and left hemispheres aren't talking what do you feel I don't know frustrated stressed those aren't emotion I mean frustration isn't emotion there's no emotional Nuance so in order to literally articulate your emotion you have to increase the connectivity so as you as I ask you what do you feel what do you feel what do you feel as you struggle to answer what's going on is your neurons

from this side are reaching over and connecting with your neurons over here what do I feel it's like hard it's like you're reaching reaching trying to grab it trying to grab it trying to grab it and even if you fail to say the right thing even if you don't know what you you experience you don't know what you feel those neurons are reaching that's where the money is so I've seen this a lot where people feel like the therapy isn't working because they don't see progress in 3 weeks and if you're looking for the ability

to articulate in 3 weeks it's not going to happen but the therapy is working because your neurons are Reaching Across the Corpus kosum bridging that Chasm and eventually the they'll figure it out and if they figure it out then once they figure it out it's figured out you will level up your EQ you will level up your emotional awareness and that will be a neuronal connection that is formed this is why I have hope for people with trauma see everyone thinks it's all about these temporary States like I'm emotional no what we're doing is we're

laying neuronal highways and once the highway when the highway is 90% built there's no traffic but the moment it gets built you can get a ton of traffic across so what I tend to see when I work with people is that their progress is nothing nothing nothing boom nothing nothing nothing nothing boom nothing nothing nothing nothing nothing so this is what we want to do we want to utilize language so as we Pro discover our emotions then that allows us to do a couple of different things okay so we're going to go back to this

person who's numb oh God uh where is that quote looking for the one oh yeah okay here it is so remember this where we say it's a blank I think about my kids and I feel nothing for them I'll be sitting there feeling confused and numb and I wonder what's supposed to it's like a dead space right so this is dorsal medial prefrontal cortex is not active now when this person lives this life and they go to their child's birthday party and they feel nothing there's nothing they don't have a s like their identity is

lost does this make sense because like if you think about what does it mean to be a parent like I went to this birthday party for my kid I planned it I saw the Joy on their face I saw all their friends be super super happy they've been struggling to make friends at school but everyone had such a good time that now their social like status amongst their friends is now improved so that makes me happy now I feel like a good parent but I can't feel like a good parent unless I can connect with

the joy in my child so not only does this person feel emotionally enough their sense of identity is going to be compromised so that's where once we start feeling things we're going to do two things to rebuild our sense of identity the first is there's a lot of dormant negative emotion which our mind has dissociated from which still lingers there and the reason we dissociate from it is because it's overwhelming if we let it overwhelm us our sense of identity will get swept away so as we start connecting the two parts of our brain and

articulating stuff all of that emotional Energy starts getting vented and essentially the negative emotions that we store start leaving if you do this process in Psychotherapy even better because it'll go faster as these things start to leave then your negative sense of identity will disappear with it the second thing that will happen is you will start to be able to engage in positive experiences which will then recreate your identity so now when you climb to the top of the mountain you'll feel something and then you'll be like I did it right so in both cases

you did it but in one case you don't feel that you did it and in the other case you feel that you did it you need dorsal medial prefrontal activation to feel like you did it okay then what happens is once we awaken different parts of the brain where's [Music] scan I'm going to show you all a different paper hold on I can't find it what the okay I'll just explain it to yall without showing you all the paper okay I'll try to find it later oh okay so next thing is um what did I

want to say so the next thing is that if we look at the Neuroscience of emotions what we now know is that not all emotions are like the same Neuroscience so we have something called affective Neuroscience which is the emotions that relate to like the way that we feel about the way we feel about our not about ourselves the way that we feel let me start over so we now know that emotions can be divided into two camps affective Neuroscience are the emotions that are independent of society so for example if I'm hiking down a

mountain and a bear shows up like I can feel fear or Joy or whatever right like I can feel that like I don't need a human being but if we look at human emotions there's a pile of human emotions that require a social connection shame guilt Pride you cannot be proud without someone observing your pride you cannot be shamed without being observed you can't feel guilty without doing something bad for someone else so what we've actually discovered is that there a couple of different emotional centers in the brain and these primitive emotions that reptiles reptiles

can feel fear they can feel anger right but I don't know that reptiles can feel proud like I don't know if like a crocodile like has the social connection with other crocodiles to feel Pride when we get to primates and stuff they absolutely can so there is a social connection pile of emotions those emotions exist in a different part of the brain they get activated under different circumstances so once we start developing our identity these emotions will arise as well they will start getting fixed once these emotions get fixed so it's not just the sense

of identity so now I built a sense of identity and my social cognitive emotions have become active so once these two things get fixed now I can fix relationships because when the shame Within Me is haywire and not functioning correctly it becomes very hard to engage in a relationship my partner tells me I love you I think you're beautiful and I feel ashamed of myself so I say no I'm not so that becomes hard until that part of my brain gets kind of cleaned out and normalized then I can do things like accept compliments okay

so then the last thing to get fixed is relationships now in our community why is this important see in our community there's a lot of people especially because today's a Friday and Friday is relationships day who are saying I'm struggling to get into a relationship and outside of our community not just our commun everyone's struggling to get into a relationship right some people are you know having sex and stuff some people are friends with benefits very few people are happy with their relationships and people say how do I fix my relationship how do I fix

my relationship and what everyone says is work on yourself first and then people get frustrated by this answer now I hope yall understand the mechanism see this is where like when I see people like tweeting stuff I can't say all of this but if you want to understand how to fix your relationship or if anyone you know wants to understand how to fix them Rel their relationship they need to watch this video because we have to understand that the relationship is at the height of what a human being can fix it is at the top

of the pyramid you can't fix a relationship if you don't feel emotions you can't fix a relationship if your emotions are disregulated you can't fix a relationship if your dorsal medial prefrontal cortex cannot feel Joy and accomplishment you can't fix a relationship if your sense of identity turns you into either a chameleon or a doormat the relation the best way to make a healthy relationship is to be a healthy human being now this gets even further complicated because part of being a healthy human being can come through relationships absolutely but this is what we're talking

about right so this is where people say like how do I like get this person to do this get this person to do this get this person to do this and here I am I'm talking about how to fix your relationships and I've not given you one ioda of advice about what to do if someone doesn't text you back and I don't need to and you don't need it if the brain that has evolved for millions of years to allow you to engage in relationships I hate to break it to youall a thousand years ago

2,000 years ago there weren't all these guides from Dr K about how to get laate or how to go on a date or how to set boundaries none of that that crap existed and people got along what has changed this has changed the activity of this the function of this so if you fix this if you fix your sense of identity fix your emotional awareness because why do we end up in bad relationships because we're not aware of our emotions when someone doesn't text me back in 5 minutes I get angry like I can't regulate

that anger there's emotional disregulation there are perception problems we haven't touched on perception yet but we talk about it in the guide there's all kinds of problems and then we'll have a whole video on sex and relationship I mean sex and trauma too because that's really important okay so complex PTSD oh let me show youall one last thing I lost it chat oh boy hold on there's something I got I got to show youall okay this is like very important uh okay I I I can okay here here it is so let's talk about treatment

okay so um we talked a little bit teaching uh PTSD patients with impair impairments and emotional awareness to identify their affective feelings early on in treatment and make exposure Bas treatments more effective so we need to understand our emotions um yoga has also been suggested to be effective in treating PTSD partially by increasing one's interoceptive ability here's what I want to show youall okay okay further evidence for the latter stems from investigation by hagars who reported a differential outcome for PTSD patients with high versus low dissociative symptomatology okay so remember dissociation is hemispheric lateralization and

remember that exposure therapy is often times what we do so let's take a step back and I got to explain this I realized talk about this so one of the treatments for PTSD is exposure therapy so the reason that we do exposure therapy is if let's say that I'm a war veteran and when I hear a door slam my brain because I'm hyperaroused triggers like we're getting bombed exe that's the basic problem in PTSD is that we go to war and we hear a loud bang and then our brain is like I'm going to code

we're getting bomb. exe any time you hear a loud noise dive under the table so now as I return back to life I will hear loud noises all the time car muffers going off door slamming and now I'm triggering we're getting bomb. exe so we get this hyperarousal so one of the ways to fix that is to expose people two things that induce their traumatic hyperarousal response until they climatize to it so as I slam doors over and over and over again eventually like my brain will realize oh like we're getting bomb. exe is not

appropriate here we don't need to pull this up and so exposure therapy is effective okay but this is what's cool so whereas only 10% of PTSD patients with low dissociative criteria symptoms still met uh PTSD criteria after a trial of exposure therapy 69% of PTSD patients with high levels of dissociation continued to meet PTSD criteria at followup so I'll translate that for you all if y'all didn't catch that if I take someone with PTSD who does not dissociate and I give them exposure therapy only 10% of them still have PTSD so let's presume that 90%

of them get better if I take someone with a high amount of dissociation and a diagnosis of PTSD and I just give them exposure therapy 69% of them will still have PTS so we can conclude not entirely fair right CU this is science and you can't make conclusions like that that simple exposure therapy doesn't work for people who have high dissociative symptoms if you have complex PTSD you're going to be further in that direction so let's see what they discovered therefore it is crucial before commencing exposure-based treatments to assess the level of emotional over modulation

and provide interventions to reduce such symptomatic responses in trauma related stimuli okay so basically what this this talks about stare which is a trauma treatment program but basically what I'm trying to tell y'all is that see in Western medicine we think that there is a diagnosis and diagnosis has treatment if you've got bipolar disorder take this medication if you've got ADHD take this medication it'll fix it if you've got PTSD do exposure therapy it'll fix it and we're not wrong to think that because we do trials right and like only 10% of people who had

PTSD still have symptoms of it after exposure therapy if they're low on dissociation but what I found with complex PTSD especially is that the more complex your presentation of difficulty is we can call it a diagnosis or we can call it an illness the more that we have all of these building blocks and the key thing is to build one block on top of the other and then you can get back to 100% most of y'all I've seen it time and time and time again the reason that treatments don't work is because we don't we're

not comprehensive enough real trauma treatment see trauma doesn't just affect there's not one part of the brain that's Mis active your autonomic nervous system your brain different parts of your brain some parts are hyperactive some parts are hypo Pro active your sense of self your relationships your motivation your ability to your impulsivity your ability to control your impulses everything is affected by trauma this is why trauma is the great chameleon so many people I've worked with have a diagnosis of ADHD but they really have trauma so many people I work with have a diagnosis of

bipolar disorder but they have trauma so trauma can look like just about anything okay all right so what we're going to do now so don't give up first of all like things can get better and the only reason that we don't think they can get better so put yourself in the shoes of someone who did exposure therapy they go to a psychiatrist the psychiatrist is very well trained and very intelligent says oh you have a diagnosis of PTSD go to exposure therapy at the end of exposure therapy they're still have PTSD 69% because this onedimensional

treatment is not effective in a certain class of people it's very effective and this is the way that yall need to approach trauma if you're struggling with it it's not just one thing it is not fixing a problem it is rebuilding yourself from the ground up and you say Dr K that sounds like too much work it's not see what the only reason it feels like too much work is if you've done a lot of work and it has yielded no results then it feels like effort is useless anything feels like too much work if

you're doing it wrong is it a lot of work absolutely is it hard to do absolutely but my overwhelming experience as a clinician is that people are into it once you start making progress once you're able to go to your child's birthday party and be like wow I'm so glad they had such a good time and I feel like a good parent it's like you guys want that vein like that's like heroin in your veins right there you begin to live the life the way that your evolution is designed you for this is the way

we are supposed to live and it's like drinking water after running five miles it just feels so good it's just water people say oh my God I don't like the taste of water or they drink soda all day and then they but this is the key thing to understand water is whether water tastes good to you or not depends on what your body is doing whether treatment is hard or easy depends on what you're doing what you're getting out of it this is the biggest mistake that we make so don't give up hope absolutely go

see someone if this stuff resonates with you if you guys want to better understand these principles check out the guide we're going to watch a video in a second right this is not a place where I would recommend coaching this is not where coaching is that helpful I mean it can be for some of these things like paralysis of initiation and motivation and stuff like that but like this is where you all should see a therapist right a trauma informed specialist is ideal because they will understand more of these principles okay now let's see um

okay so we're g to get to questions in a second I love Leaf flow right so do I hey so do I all right um so like y'all don't seriously don't give up hope like it is crazy how much we know about trauma we've gotten so much better at this the last thing that I want to say is this Disturbed uh sense of self-organization outside of trauma see if you have DSO without the symptoms of PTSD you can't get a diagnosis of cptsd cptsd is hyperarousal hyper vigilance all the regular trauma Stuff Plus the Disturbed

sense of of self-organization disturbance of self organization so what I'm noticing in the world today is that this Disturbed self-organization appears to be independent of traumatic events I'm seeing a a society that is increasingly emotionally disregulated increasingly unable to tap into Joy increasingly easy to trigger a seizure of negative emotion increasingly confused about their identity in life and increasingly increased difficulty in relationships so now the question that I've really wondered is that if you see this DSO picture can you do these trauma based interventions you don't need exposure therapy but can we do all of

this other stuff calm down your nervous system increase your emotional awareness articulate emotions improve your sense of identity reconnect with your positive self deal with negative emotional disregulation deal with that amigdalar pseudo seizur if we fix all of these things can we improve those DSO symptoms even if you don't have cptsd and that's really what I believe right that's the running hypothesis cuz I got I got it's too it's too similar the clinical picture are so the overlap is so strong I I can't believe that the same regions of the brain are not active and

if the same regions of the brain are active we can do the same stuff and if it works for someone who has such a severe diagnosis of cptsd it should work for you and what are we talking about here we're talking about yoga we're talking about meditation we're talking about getting in touch with your emotions we're talking about articulating your emotions we're talking about developing a sense of self we're talking about forming narrative about your life and that's what we see in this community because we've been working on this crap for yall this is why

I'm so this is why I care so much about the trauma guide because the trauma guide is the guide for our community and hopefully it makes sense to youall now like where I'm coming from you don't need cptsd the right answer for cptsd is medical treatment but for all of us who have features of this who don't have a diagnosis we can still understand the basic neuroscience and address those things right so the guide is not a substitute for clinical treatment it is everything else and that's what we're going to show you all today so

if you struggle with initiation we're going to help y'all okay one second all right so I can't watch this I'm going to like literally step out of the room because I cannot I cannot handle myself chat this is just too much so I'm going to turn this on um I'm going to turn this on so we're going to watch an early cut and then we're going to do Q&A when I get back okay next up we're going to talk about the paralysis of initiation and a lot of people that I've worked with have struggled with

this this almost seems to be a societal phenomenon where people have trouble getting started we know theoretically that there are other people out there who have goals and they can wake up and they can sort of just do it and then they also tell us right like if you want to go to the gym what you need to do is just do it you just got to put yourself out there and just get started CU getting started is the hard part but there's a large subset of people who struggle with just getting started and as

I explored this concept to try to help the patients that I was working with I stumbled into the trauma literature the original paper on complex PTSD uses this term paralysis of initiation now complex PTSD is a little bit different from traditional PTSD and we're going to dive into that for just a second so in post-traumatic stress disorder you usually have one or a short term series of traumatic events that then traumatizes us and then we develop a disorder a psychiatric problem as a result of the intensity of that singular trauma on the other hand there's

a group of researchers who discovered something called complex PTSD which is when the traumatic influence is persistent over time so it's not a one-time thing it's an environment that you grow up in or once again going back to the prisoners of War these are prisoners who are in these camps for years and years and years and what these researchers discovered is that when a trauma is repeated that it messes up our ability to start our own actions it seems to tamper with our very autonomy and what they discovered in the prisoners was that these people

became incredibly listless because if you kind of think about it there's nothing there's no point in getting anything started in a prison camp there's nowhere to go there's there are no goals to accomplish it's all about survival and what these researchers discovered is when these people got released from the prison camp they still struggled to initiate things in their own lives so we're going to dive into that Concept in more detail because we've learned a lot about it since then the first cause of paralysis of initiation is a loss of autonomy and a lack of

reinforcement so let's start with kind of a traditional household let's say a healthy household so in this household you have children that kind of grow up and they want to do things they have desires so they go to their parents and they say hey I want to go to the zoo today and so the parents says okay fine like I'll take you to the zoo If the child has an Impulse to start something or do something that impulse gets reinforced another good example of this is let's say I'm like painting a picture I made something

at school and I come home and I show my parents I say hey look at this picture I painted of the family and my parents are very very impressed and surprised with it and what they do is they put it up on my fridge or they put up put it up on my wall at some point though if you look at a healthy normal household as a child starts to initiate things that initiation is supported and reinforced if we look at something like a controlling household or an abusive household the picture is very different because

in a controlling household what I want to do is completely irrelevant it is what my parents want me to do that becomes important so when I enter the fifth grade and I have a choice between learning this instrument or that instrument which instrument I want to learn is not as important as which instrument my parents want me to learn and so what we tend to see is that the the behavioral impulses anytime I try to start and do something those aren't necessarily reinforced and instead of autonomy I'm sort of taught compliance the same is true

but in a slightly different way when it comes to neglectful households so in the same situation if I come home with a a picture that I painted of my family and my parents are absent or there's a babysitter there or for whatever 100 reasons that could possibly be going on something about my desires don't get reinforced in a neglectful household because as a child growing up who is it that refor reinforces and supports your desires it's your parents and so even in the case of absent parents we see a Common Thread of when I want

to do something the world around me doesn't necessarily help me do it and in the worst case scenarios what we actually see is that if I develop some sense of autonomy I actually get punished for it if I start to demonstrate initiative which is one of the other things that we sort of see in in the trauma literature is that when we take initiative some people will get punished for it so I decided that I wanted to plan a birthday party this weekend with my friends and I tell my parents about it on Thursday but

then they get really angry with me for not discussing it with them not getting their permission they're incredibly controlling so all of my initiative kind of goes down the drain it's all about what other people want so this is the first cause of the paralysis of initiation is if we look at the normal child development or normal human development at some point our desires get reinforced our autonomy gets rewarded but if you grew up in an environment where your autonomy was not rewarded where your desires were not reinforced that is a lesson that your brain

will carry forward the second aspect of paralysis of initiation has to do with the loss of the future Dimension I know it sounds kind of weird and abstract but it's actually pretty simple so once again as a child let's look at the normal situation so at some point I start thinking about the future right if I have present and loving parents they'll ask me oh what do you want for Christmas this year let's write Santa letter we are going to do something today that be will be rewarded not just tomorrow but a week from now

two weeks from now three weeks from now similarly supportive parents will take a look at your schedule for the week and sort of even if you're in the second grade or third GR they will sort of remind you or help you understand that okay this week you have these two assignments to complete so we need to start thinking about tomorrow or even the end of the week today so with healthy parenting it's kind of bizarre but we have this part of our brain that looks into the future and plans and executes tasks this is the

frontal lobe of our brain that kind of plans things out and makes sure they get done in a normal household this is a part of our brain that gets supported by our parents but once again once we move to a controlling or a neglectful household that all goes out the window so the first thing is planning for my future when I have controlling parents is a waste of time because my parents have decided what my future will be in the worst case scenarios like so for example in my culture there are some traditional Indian parents

that will plan everything for their kids you're going to be a doctor you're going to be a lawyer I had that conversation with my own dad when I was 9 years old he said we took me and my brother aside I was nine my brother was 12 and he said said one of y'all is going to be a doctor and one of y'all is going to be a lawyer and then I ended up applying to med school and people asked me like why do you want to be a doctor and I said well this is

the conversation my dad had with me and my brother was older so he got to choose first and he went to law school so here I am and we all had a good laugh about it but I never really answered the question the point though is that with controlling parents who sort of determine your future for you they tell you what you need to accomplish they tell you when you need to accomplish it you're going to learn the cello you're going to learn the vi you're going to do a sport you're going to do this

you're going to do that or you're going to carry on in your Father's Footsteps and you're going to play football whatever the situation is your sense of the future gets negatively impacted you don't get to think about the future and plan for the future on your own and the same is true in neglectful households although once again slightly differently because in this case if you're a seven-year-old kid and your parents are absent there's no point in planning for a slumber party in the future and remember that as kids we don't really know how to plan

for the future ourselves we actually need adults to teach us how to really use our frontal loes they sort of train us to do all of these things in addition to like walking and talking and doing laundry and all of these tasks that parents teach us are also affected in a neglectful household so this is the second thing that happens is that when we sort of think about the future dimension in a healthy household thinking about the future Dimension is rewarded if if I make a Christmas list for Santa I actually get those presents if

I plan for a slumber party this weekend the slumber party actually happens but in the case of controlling abusive or neglectful households this planning for the future does not get reinforced sometimes it just becomes neglected so I don't get rewarded for thinking about the future but in the harshest cases I actually get punished so since I have all these plans of I want this for Christmas or I want my friends to come over this weekend but on when Friday rolls around my parent is has been drinking and they don't feel like having kids in the

house so they tell me to call all my friends and cancel at the last minute and then I'm left with disappointing all of my friends and so in the most drastic cases we actually get punished for thinking about the future and this is the problem in each of these scenarios is that over time in in the simplest case these parts of our brain are not reinforced we don't have behavioral reinforcement of Desire we don't have positive reinforcement for planning of the future and in the worst cases we actually get punished for doing these things because

if you kind of think about it let's say I have a desire and then since my parents are neglectful I make this Christmas list but then no presents show up on Christmas Day what is the lesson I learn as a child over time the lesson I'll learn is it's better not to have desires in the first place because then I won't be disappointed so it's it's better to just not want anything at all it's better to not try to do anything it's better to put forth no effort whatsoever because at the end of the day

I'm living my life reactively I have no sense of autonomy or control and if I try to exert control if I am stupid enough to want things then that will actually hurt and lead to disappointment and then you learn a very dangerous lesson which is wanting things and thinking about the future is painful and harmful and once you learn this lesson this leads to the paralysis of initi ation later in life now there's another challenge that we kind of run into that keeps people who grow up in these kinds of environments from really initiating things

and that is a Reliance on perfectionism so there's a group of people that I've worked with and this group by the way is becoming increasingly common because once again a lot of people grow up in scenarios like this where they can't get started until it's perfect so I'm not going to apply to college unless I know I can get into Harvard I'm not going to take this course unless I know I can get an A I'm not going to even learn any skill until I practice ahead of time even before I join the course so

if I'm learning how to dance I'm going to spend three months practicing at home so I don't embarrass myself when I join the class that is even for novices so there are a lot of people out there that are very hesitant to get started until things are perfect and let's explore a little bit about why this happens so this too can be tracked back to trauma so if we sort of think about controlling abusive or neglectful households these households create situations that are very stressful and dangerous for the child so in order to understand why

some people become very perfectionistic and why some people can afford to take risks we have to understand a very important Divergence that happens very early in life so let's start with the case of a healthy household so if you sort of think about it the world is objectively a dangerous place for kids so if I'm like let's say an 18-month-old kid one-year-old kid 2-year-old kid the world is a dangerous place I I can barely walk I tend to stumble a lot things like stairs can be incredibly dangerous but it's not just that it's also things

like when I get served food does the food burn me or not and this is where parents come in because parents who are very attentive will protect the child from the dangerous world and this is like kind of what we know if you're a parent you'll understand this that your children will try all kinds of things to hurt themselves because they don't really know that the world is a dangerous place and the better you take care of them the more Reckless they become because there are never negative consequences for things a parent who's always caught

when they jump off the bed will not learn the danger of gravity so these children become very secure in the world around them because it's a safe place because mom or dad is there to protect me from danger so these children become more confident they're able to embrace more risks they can try new things and they also enjoy exploring the world they're very very confident that someone is out there protecting them they're not really aware that there's a person out there protecting them they just know that as they stumble around someone's always catching them and

they don't get hurt on the flip side let's look at something like a neglectful household so in this case now the world becomes a dangerous place because there isn't a parent paying attention if I slip and fall no is even watching as I start climbing up the stairs and on my seventh stair since I'm like a 13-month-old kid I Stumble and fall and then I roll down the stairs and start crying in the worst case scenarios even when I start crying either the parent doesn't pay attention doesn't care or even will get mad at me

for crying and will tell me to be quiet so if we see households that are incredibly controlling which also can be sort of scary for a child because in a controlling household with very demanding parents we want our children to be perfect right don't spill don't play with this you made a mess this happened this happened this happened so very controlling parents will be very angry with their children for not being perfect abusive households also lead to a Reliance on perfectionism because usually what the child learns when it comes to abuse is there is a

magical formula to avoid the abuse If the child can be kind enough if the child can be sweet enough if the child can be cute enough or pretty enough Demir enough invisible enough sometimes these children can sort of figure out almost from a survival mechanism that if I have an abusive parent there are some days that the parent is not abusive and so then the child naturally tries to figure out what is the difference between the abusive day and the non-abusive day and this is when they start to develop this idea that if I'm a

perfect child then I will be safe and so perfectionism and safety go hand in hand so if you try to do something in the outside world and you not perfect remember that this stuff gets baked in to your upbringing in the same way that you were understanding how strong gravity is or what the sun feels like or how many fingers you have this stuff gets really baked in and perfectionism and safety become one and the same so this is another reason why people struggle with initiating tasks they can be very very afraid of doing something

wrong they can't afford to make mistakes and they need to be perfect before they get started and why is this it's because the world that they see does not allow them to make mistakes that if they make some kind of slip up and if they screw up in some kind of way the world is a fundamentally dangerous scary and punishing place and if we are wired in any one of these three ways if our desires and our autonomy has not been reinforced if our capacity to plan for the future has actually been squashed or neglected

or we grew up in an environment Enon where we had to be perfect before we get started all three of these can result in the paralysis of initiation all righty so all right hold on a second um yeah so that's that's a uh that's one of the videos from the trauma guide and like I said like we we've been working on this for a while and and when I was making the trauma guide y'all can hear me right am I muted okay no y'all can hear me um you know I I was thinking about like

us and like what are the things that we struggle with and it's not and there's Absolut like clinically significant stuff and I was also thinking about like you know if I could take all of my patients who have diagnoses of some kind of trauma or a history of trauma and I could like give them a workshop for not stuff that we do in the office like nothing about I mean there's stuff about medication and treatment and stuff like that too but like not that stuff but like all the other dimensions of their life like how

do you find a relationship when you have a history of trauma um how do you reconnect with yourself and these are the kinds of things that like you know are not specific to a person this is the common stuff that I would teach to my patients um which isn't technically like a part of their diagn I mean it's part of their diagnosis I guess but it's it's like I don't know how to describe it it's not you know it's not about this relationship that this person has it's about the principle of why is it hard

for this group of people to form relationships um okay yeah so let's do some Q&A so we've got time for we wanted to save some time for Q&A so we've got I know we've like run long and we're at like 2:30 and we started late but let's do Q&A for about 15 minutes uh can you answer super chat questions I I I don't know I don't know how to do that um okay so there's one question here uh since trauma is the great chameleon what is your opinion on when you disagree with your therapist about

your presentation belief in oneself is important for Recovery yet they are a professional um okay I'm going to ask if we have mods if y'all saw good questions if anyone was keeping trap can y'all let me know via uh you know some method of communication just let me know um okay so what if you disagree with your therapist this is a great question so how do you go about how do you if your therapist disagrees or if you disagree with your therapist about your diagnosis or the formulation like what do you do about that right

they're the one with the degree but you're the one who's living the life so this is where I'd say disagreement in therapy is like not something to be avoided the whole point of therapy is that we don't know what the right answer is when we get started and finding the right answer is a series of like re-calibrating after overshooting or moving in the wrong direction like that's what therapy is so your therapist doesn't magically know what's going on with you we have the first layer of information and then we make some conclusions and then we

have the second layer of information we we Whittle away some of the conclusions and then over time we want to kind of like pingpong our way like to what the right answer is that's been my experience as a psychiatrist so if you disagree with your therapist I think first of all that's totally fine secondly I would ask I would ask the therapists to explain why they believe what they believe so walk me through your reasoning and then what you want to offer is your own reasoning so let me understand why you have your opinion let

me now explain to you why I think that's good or not good or what my perspective is and chances are neither of you is going to be 100% right and then the question is what can your therapist take away from your explanation that moves you closer to the right answer and what can you take away from your therapist's answer that moves you closer to the right answer now a lot of therapists myself included find that having a patient understand what's truly going on is not going to happen fast so I often times find that when

I explain things to patients or when I offer a formulation at the very beginning they will sometimes very strongly disagree with something that I'm very confident in and usually over time we get there right because you have to remember that as a patient you have more information about your life but you're not as objective so that's where it's like and you know medical doctors therapists psychiatrists we get diagnoses like wrong all the time so I you know I there's all kinds of stuff that we get wrong so I I I think it's more about the

process than it is about like being right or wrong so there's try to really understand where they're coming from and I I try to take that to heart right really try to be open-minded and try to see if you can understand okay how even though I instinctively react to this being incorrect there's a possibility that if I change my thinking in some ways this could be correct so let me try to do that right so the last thing I'd kind of say is Steelman instead of straw man their argument I mean it shouldn't be an

argument but do your best to alter your assumptions to see if you can understand where they're coming from good question okay um now let's go to there we go okay questions um trauma guide I think comes out at the end of the month uh okay a cptsd and ADHD there seems to be a lot of overlap how do you tell the difference between the two if you have both I think you mentioned in another video something about how all kids with ADHD end up with some trauma if that's true how do we know comes from

ADHD versus what comes from cptsd it's a great question so if you've got ADHD and Trauma how do you know what's what so there are a couple of different things to keep in mind the first thing that we have to remember is that psychiatric diagnoses are not real things they are abstractions or human Concepts to try to understand reality so like when I say someone has major depressive disorder there's absolutely some kind of biological mechanism but human beings made up the idea of major depressive disorder what psychiatric diagnosis really is is a bunch of human

beings observe real things in other human beings and then we try to come up with a language that unifies what we see in individuals and that's really what a psychiatric diagnosis is so how can you tell the difference between what's ADHD and what's PTSD or cptsd so both of these can result in impairment in concentration or attention both of them can result in impulsivity both of them can result in emotional disregulation how can we tell the difference so a lot of what we know about ADHD is from a neurodiverse perspective we know that their brains

develop in a slightly different way so we know that people with ADHD have less their frontal loes have less control over their impulses in their emotions so people with ADHD are more likely to get emotionally disregulated and we can track that back to the connections in their brain so our frontal loes are the brakes and they can control and re in other parts of our brain but people with ADHD have breakes that seem to be weaker and there's some kind of genetic component to this some kind of the way that your brain is wired now

things get complicated because growing up in a neurotypical society as someone who is neurodiverse results in usually some level of trauma so if you look at comorbid ADHD and major depressive disorder what you find is 3% of people who have major depressive disorder will grow up to have ADHD but 70 % of people who have ADHD will grow up to have major depressive disorder this is in within a comorbid population so there is absolutely a positive impact of ADHD on depression and the reason for that is because when you're neurodiverse and people just tell you

to try harder but your brain can't do that you start to believe something is wrong with you you don't have as much self-esteem people don't since you cut in line you don't get invited to birthday Pary you have fewer friends because you can't wait your turn and all of these there's consequences of untreated ADHD that will end up traumatizing so at that point we've kind of got both now this also gets confusing because there are a lot of features of PTSD like emotional disregulation difficulty cont concentrating so how can you tell the difference so there

are a couple of different things to keep in mind the first is that it's not so important to really tease it out because many of the things that we will do to fix one we would do to fix the other anyway so simple example is meditation right so meditation is a useful treatment for PTSD cptsd borderline personality disorder and ADHD there are some specifics about the kind of meditation which you kind of need to understand but generally speaking the treatment is going to be the same dealing with shame whether it comes from ADHD or PTSD

is going to be the not the same but there's it's in the same ballpark let's put it that way so the treatments for the two will overlap quite a bit the third thing is emotional disregulation that needs to be improved in both right so this is where the first thing to keep in mind is it is not necessary to perfectly tease these two apart before we intervene and this is something that we learn in clinical medicine right so when you become a psychiatrist you learn this if you're not sure what the diagnosis is lean into

a treatment that treats both options so ssris does this person have a anxious depression or do they have an anxiety disorder with an adjustment disorder laid on top who knows in either case ssris will treat both so if we're going to start with something let's start with an SSRI so the treatments can overlap now there are a couple of places where the treatments don't overlap so for example things like stimulant medication and that's where it is important so we can do things like neuropsychological testing right we can offer formal testing to detect the deficits of

ADHD um we can also offer like you know diagnostic scales of trauma and things like that and so like we can we can tease things apart in some way but I I'd say that practically you know I've treated a lot of people where we're not sure like what is causing what and that's where like as a clinician what we do is okay like so if I think your diagnoses are ADHD and PTSD we can start somewh on stimulant medication and then we see right what part of this does this fix so if more of it

is trauma oriented we would not expect ADHD medication to be that effective at improving things so over time it's like it's like a process right and that's why we we really emphasize that you should work with a clinician the advantage of working with a clinician is that they will collect more information over time and you will refine your diagnosis and you absolutely could both great question okay next um okay I'm going to see a therapist for the first time soon do you have any advice it's hard for me to open up and talk about myself

or how I feel emotionally so here's my advice if you're going to a therapist for the first time so remember that the therapist has a job and their job is to do their job so you don't need to be great at opening up you don't have to talk about yourself emotionally it is their job to make you feel comfortable enough to where you open up whether you kind of want to or not second thing to keep in mind is that success in therapy is a skill so the first time that you go ice skating I

wouldn't expect you to know how to ice skate in the same way going to therapy is something that you will get better at overtime so there are some patients that I've worked with where like I like one of the things that I'll put in their formulation and something that I'll let them know is that I think you utilize therapy very well right so people will get better at it so my advice would be the most important part is showing up and then follow their lead and let them know what you're looking for let them know

what works for you and what doesn't work for you it's totally fine to even tell them hey I I have difficulty opening up and talking about my emotions that's totally fair game right so that's their job to help you get better at that okay um what tactic would you take to heal cptsd mixed with moral injury from a specific event I'm confused about what moral injury from a specific event is um what's the relationship between cptsd addiction and sense of worthlessness so let's talk about that so the first thing to understand about trauma and addiction

is that tra addiction is not a problem it is a solution so human beings get addicted to things for a couple of reasons so you can absolutely make a genetic argument where there's a very strong you know vulnerability and once you get a taste like the first drop of alcohol and you're hooked I've absolutely seen that but for a lot of people addictions are solutions before they become problems so addictions give pleasure and take away pain and the problem with cptsd is that remember we have emotional disregulation we have difficulty so there's two parts there's

two ways that people with with trauma have difficulty with their emotions the first is that their negative emotions in the more primitive parts of their brain this is places like the the these are the part parts of our brain that experience fear anxiety things like that those are very itchy they've got itchy trigger fingers so they can trigger very easily and very intensely F that's the first emotional deficit second emotional problem that people with trauma have is that their sense of self often times carries with it a lot of Shame and guilt and stuff like

that so this isn't like fear of the outside world this is a persistent emotional negative state that I carry with me that's actually a different part of the brain it relates more to the default mode Network these are emotions that are called social cognitive emotions so we have two types of emotions we have our primitive emotions like anger and fear that even reptiles experience and then we have a different part of our brain that has our social cognitive emotions Pride guilt shame you can't have those emotions without a social component I feel proud when people

look at me I feel ashamed when people look at me it requires socialization so the people with PTSD have difficulty with that as well the third thing that people with PTSD struggle with is feeling positive emotions these come from a completely different region of the brain the dorsal medial prefrontal cortex so this is stuff like excitement love curiosity people with trauma feel kind of like numbed out right so it's kind of like the real tragedy is you feel numbed out in terms of positivity but you're you've got a very itchy brain and it's easy to

activate some of these negative emotions so where does Addiction come in addiction fixes all three right so if we look at things like benzo aines these are treatments for anxiety and we developed benzo diazines by recognizing that alcohol alleviates people's anxiety so we developed a pill that basically activates the same receptor as alcohol kind of chills you out right so we know we can treat anxiety with certain psychoactive substances next thing that uh psychoactive substances do is they will numb us right so this is also through the Gaba receptor like alcohol but there are other

ways that they will sort of make us forget ourselves that critical self dialogue that is always running in our head goes away when we get high for example so they alleviate our negative emotions the Third thing that they help us do is feel positive emotions so it's easier to feel like we're having a good time we're vibing we're relaxing we're chilling we're partying things like MDMA or ecstasy can help us feel connected to other people right so if we really look at it the reason that trauma and drugs overlap so heavily is because drugs and

addictions fix the problems of trauma but only temporarily so we also see this with with things like people who have a history of trauma and have diagnoses of borderline personality disorder will engage with things like Pro promiscuous Behavior intense unstable relationships to help feel loved right because when I'm head over heels in love with someone I can feel better about myself so we see that if we look at the Neuroscience of emotional challenges with PTSD we see that addictions actually like fix all three of those so there's a very high overlap the problem is that

the fix from an addiction is temporary and over time will get objectively worse great question um okay how would you heal Trauma from having been in an incubator for a long time as a b baby I have no clue I mean that's really interesting there's a lot of like interesting data about you know per natal and and post birth like stuff and correlations with things like learning disabilities and stuff like that I've never I don't think I've ever seen a clinical case where like we thought that the trauma originated at the level of an incubator

but it's a very interesting question I'm not saying it can't have an impact um really interesting question I don't have an answer to that one uh okay is there a significant difference between someone who developed cptsd because of one of those three household Styles versus someone who developed cptsd from a combination um especially if all three situations are yeah so I think the answer is basically yes so here's the here's the thing to understand about trauma so we know about trauma is that trauma shapes you and we know that the way that it shapes you

causes problems later in life that's how we Define trauma so negative events shape us all the time but if it doesn't cause a negative impact we don't diagnose someone with like PTSD so there's research on things like post-traumatic growth where you can go through something traumatic and you can end up positive now this is where like this is why I think the treatment of trauma is fun right so like I find it clinically enjoyable I know it's kind of weird to say but like I find it intellectually engaging I find I have a lot of

compassion I find a lot of like growth and it gives me like positivity to see people overcome their trauma so I find the experience to be very like enjoyable gratifying um and what we know is that the way in which you're busted will shape the way you're busted right so like if you have a combination of different traumatic things that can result in like something new or something different or a combination of the above now I don't know that one is necessarily worse than the other but we absolutely see like nuances of each of these

manifestations and that's very common um and so then it's just an issue of like seeing which manifestation is common when so like learning to think about the future again like we want to do that and we want to learn how to like reward our autonomy like we can do all of the above it's not either or so what if I don't have the safety to want to calm down I wouldn't be as safe anymore if I were calm so that's a very common experience of people who have been traumatized so if you look at uh

research on trauma what we find is that the most important thing for healing trauma is safety so we don't talk about this much as clinicians when we lecture about trauma but basically we know that like physical safety and even to a certain degree emotional safety is very very important so the first step to treating any trauma is not emotions or anything like that is actually physical safety that's number one and the reason for that is very simple if you're not physically safe your hypothalamus will be pumping out something called CR CR is corticotropin releasing hormone

the CR will go to your your pituitary glands and will release act so your pituitary will pump out act which will cause your adrenal cortices to pump out cortisol as long as your you have cortisol and other kinds of sympathetic nervous system or stress hormones floating through your system you cannot rewire and you cannot heal like physiologically it is very difficult to do so if we look at the role of these stress hormones stress hormones aren't about picking up the pieces they're about surviving and getting through the day so what you find in people who

have an experience of trauma who don't feel safe and aren't safe is that is very hard to work on the trauma because their brain is is not in a neuroplastic state so let's understand this okay so our brain develops or becomes increasingly neuroplastic when we sleep so if we look at like memory consolidation we have short-term memory and we have long-term memory our short-term memory which is kind of like our Ram gets Rewritten into our long-term memory which is kind of like our hard drive when we sleep so we do this process of memory consolidation

this involves a lot of neuroplasticity because we're forming new memories now if we look at sleep stress hormones impede sleep so sleep is when we build a lot of tissues and grow a lot of neuron I mean we don't grow too many neurons but bdnf increases brain derived neurotrophic factor I think increases in sleep as well so our brain rewires when we sleep when we're stressed out we it runs against the sleeping signals so we have these Pro sleep states where we our brain does things like rewire heal and learn and then we have these

anti-sleep states which is like survive stay awake and survive and so we absolutely need safety as part of the healing process so I think the first step to Healing trauma is creating safety now that becomes a little bit tricky because sometimes because of our the nature of our hyperarousal and the way our nervous system is wired the lack of safety is not quite as external as we think it is I'm not saying it isn't I mean there people who are in abusive households where it's unsafe objectively but the the tricky thing about trauma is that

we carry that lack of safety within us so there's a balance between creating external safety and even when you create external safety it's not like internally you'll feel safe right away so there's a process of of letting yourself rewire to feeling safe as well great question we're going to take one more um when I was born I was left crying for two hours in an incubator before someone held me and took me to my mother I blame my constant anxiety for this so that level of specificity I don't really like have much comment on I

would feel feel very very surprised to learn that that singular event is responsible for a persistent adult condition would be very surprised so the the other thing that we know is that isolated events in childhood kids are quite resilient so like the the cool thing about kids is that even if they go through a traumatic experience it is very common for them to bounce back and that's because like kids are their brain is very neuroplastic even their body is quite changeable right so like kids have their neurons can still grow in ways that adults can't

they can create new neurons most of what happens is pruning but you know so like the their healing capacity is way bigger because they're like not in read only mode they're still in right mode so that like a lot of them can children can heal very easily um so I'd be surprised I'm not saying it's not possible that's something to work through with a clinician um interesting thank you for sharing um do we know if EMDR is effective for cptsd I personally think it is but there's a lot of controversy around EMDR and we don't

have many studies on what's effective for cptsd uh so my problem has been so good at masking my cptsd that they don't find the issue any tips as to opening up yeah I'd start with the body right that's why we kind of talked about that like so I don't know if this kind of makes sense but the way that we've outlined our approach to trauma and especially in the guide the reason it's built that way is because we have gotten these questions over and over and over and I have this problem I have this problem

I have this problem I have this problem what about this what about this what about this what about this what about this what about this what about this so what we did is took all those questions and say okay if we take all of these questions how can we understand trauma that accounts for all of these so why do we have a video about paralysis of initiation and impulsivity because we recognize that there's an overlap between the symptomatology of ADHD and Trauma we recognize that people with trauma have difficulties that feel like ADHD so that's

in there we recognize that people have difficulty opening up we recognize that people have difficulty feeling their emotions that's why we start with the body right and that's why relationships is at the very end so start with the body okay um how do I bring up cptsd up to my therapist I resonated with this topic a lot but I feel like it's not my place to initiate the conversation there it is right so like I can say it's absolutely your place to initiate the conversation that's your job that's why you're going right you're going for

your benefit not the therapist benefit if it helps you by all means bring it up that doesn't work though right so one of the manifestations of cptsd is you feel like it's not your place you feel like deferring to the other person you feel like following someone else's lead see when we don't have a well-formed sense of identity we don't feel like we deserve very much it's not my place when it's absolutely your place like that's the definition of your place the the reason the therapy is the one place where you get to go for

you and for no one else so whatever you want is fair game right I within reason it's like the the therapist can say no but it's very common so notice that notice that your desire to not even bring it up or your feeling that that's not my place to bring it up could be a manifestation of the very problem itself and just notice that and then try your best to bring it up right you can even share so one last technique that I'll give you all is if you're having so this is like Pro technique

and therapy okay so sometimes we feel embarrassed bringing something up because there's a lot of emotional energy here there's shame there's guilt there's like oh my God this kind of kinky thing kind of turns me on and like oh my God I have these kind of thoughts and so we have difficulty like tackling that emotion and being vulnerable so instead what I want youall to do is go one layer above it so what you can say to your therapist is there's something that I feel ashamed of that I don't feel comfortable bringing up with you

so you go meta right so you're not bringing up the thing you're saying this thing is hard for me and then even if that's too hard you can go one level above I want to bring something up with you I want to bring up that I'm scared to talk about something but even that's hard to talk about so what we want to do is move away from the emotion and put that out there right say like even one step removed you don't have to talk about the shameful thing there's something that I'm ashamed of that

I don't want to talk about you can just say that and then it's the therapist job to take over like that's what we're good at right that's what we're trained for we're trained to help you do that and even when we're like so is a there's a good technique in therapy called going mattera right so and and that's when when there's something like so if someone says like hey I'm like I'm here for therapy I want to focus on this but I don't want to talk about this and so what do we do in therapy

we don't say okay okay screw you we're going to talk about that anyway because you don't want to talk about it no what we do is help me understand why you don't want to talk about it totally fine we don't have to talk about it just can you give me a little bit of context cool and then you can bring it up later so then it's your therapist job to get there if you want to talk about it you can say hey I want to talk about this thing but I'm too embarrassed and I'm going

to shut down okay um how do I explain my cptsd to a family member that has expressed that she wants to help but doesn't really understand the gravity of my issues honestly like I'd send them this video right so one thing that's starting to happen is that people are starting to share some of our content like not for themselves but like they're like you know we we had video about autism and gender identity we had a video about relationships with BPD with people with borderline personality disorder we've had and so we're seeing a lot of

like sharing going on so you know a lot of people struggle to convey what we convey don't convey it just share and like I I don't know if yall get this I cannot remember the last time I know that like all content creators are like hey if you like the video like subscribe and share share I can't remember the last time I can't remember I mean I've done it before right so maybe on like like why men the male suicide or why therapy sucks for men there are a couple of videos that we've done lectures

we've done streams that we've done where I've asked yall to share things I don't ask yall to share things like you know sure it helps us but like that's not we're not here for us we're here for you and that's why I don't ask yall to like subscribe or share the only time I ask youall to do it is when I think it benefits you or someone else who may need help so this is one of the rare times where I would say the whole reason we do this and we store these is so that

y'all can share it with other people so like if you don't know like if like let's say you watch a video about BPD and you realize holy crap I could have BPD this is what it's like to be in my shoes I think you should absolutely share that with someone who you're in a relationship with and be like H this person kind of explains what my experience is like in a way that I can't quite explain it right or something about addiction or whatever like if you're if you're a gifted kid and your parents tell

you that you have all the potential in the world and if you just tried harder send them more gifted kids a special needs video right so we're here as a resource for your benefit that does not just mean you you're you're the only one that can has to watch us so if we explain a concept in a way that it would be useful for someone in your life to understand then you should share our videos but once again that's not so that we can increase our views by 0.001% that is because it benefits you that's

why you should share or if it benefits someone else make sense would you consider Spanish subtitles I think we're working on it um oh what a beautiful question so we're at time for the day but I'm going to leave yall with one last question that I love uh there's two questions man these are so so best meditation for trauma we're past time so I don't have time or energy to do meditation today for which I apologize but in the trauma guide we've got hold on a second let me tell y'all we have a whole new

stock of meditations oh here oh damn it I just realized that people are telling me um these are so good okay we're going to answer one quick one one question then we're going to try to speed run a couple more so first thing is um what was I talking about I don't even remember brain death is setting in um oh meditations so we have we have a bunch of meditations let me count uh so we have at I think about 10 meditations okay no one is an overview one two one two 3 4 5 6

7 8 9 10 there's 11 meditations in the trauma guide um so definitely check those out I think they're great they'll build on the existing meditations that we've taught you all and I just ran into Will trauma ever go away quick answer to that one possibly actually so we know that we know that like a lot of people will heal from trauma without any overt intervention so the cool thing is like if you look at the body like the body and brain like heal that's what we're designed to do so the short answer is it's

very possible that you don't need to do a damn thing and you'll just just it'll fix itself or your relationships will organically fix it I wouldn't adopt that strategy though um there's another question of how do we address the sources of trauma out in the world and who is responsible for doing so that's a lovely question I love it love it love it love it love it it's Way Beyond the scope of what we have time for today so I think this is a oh actually that's in the guide what am I saying so I

was going to say so we can absolutely talk about it but I think Karma talking about karma is a very good exploration of this topic so over on the membership side we had a couple of great Karma lectures we talk about Karma and the trauma guide because there is this whole idea of like you know everything we're talking about is fixing you but what about the outside world so I think that's a very important discussion but I I don't think it's a short answer I think it's like a if we're going to talk about it

let's talk about it um okay so can you recommend specific meditation techniques there's 10 about 10 of them in the guide um which by the way is why we built a guide right because like I don't know if this makes sense but there's no way we can get to even 1% of the questions that y'all ask or even share with y'all 1% of like the meditations that y'all can try and things like that that's why we build these stock resources that are way more in depth I I don't know if this kind of makes sense

but you know filming of the trauma guide is like the filming is a week of me showing up at a studio at like 8:00 and leaving at 5: and cameras are rolling for like 9 hours a day for like 5 to seven days and so it's it's like you know like in order to duplicate that I would have to stream for like 50 hours in a week so I just can't do that like my voice cannot handle it so that's why we build these resources because there's just no way we can get to everything but

it's very like and the reason we edit and everything is so that like it's very high yield um so how do you start to build your own sense of self I think it's first of all cleaning out negative emotions and then starting to bring together emotional experiences into a new narrative there's a whole video about narrative and identity and constructing a positive narrative is something that can be taught it is a skill and it is something that has been shown to improve uh outcomes and Trauma so like narrative is an important part absolutely so there's

just a way to do it um how to not be one of the 69% to resist trauma treatment great question so remember that those people are not resistant to trauma treatment they are resistant to a particular intervention for a particular diagnosis and we know the cause for that resistance is a high level of dissociation we have other things that improve dissociation so there's a certain model of of trauma treatment called stare and the whole model is based on first you do this then you do this then you do this then you do this and when

you do it that way that's like a comprehensive approach that checks most of the boxes and deals with this concept of resistant to trauma treatment is cptsd curable or do you have to deal with it for the rest of your life I personally believe that for I would say most people it is basically curable I know it's a bold statement I may be dumb I may be wrong but I personally believe that trauma for most people can be cured I do not believe that for schizophrenia so I think we know that some of our psychiatric

diagnoses are like Progressive and more biologically driven so schizophrenia is a really good example of that one where but like trauma is different I've seen people basically be in complete remission or cure from cptsd before um I'm 50 and never felt happy how long into treatment for PTSD will I be before I can start to feel the short answer is I don't know so the other thing about trauma treatment is that your mileage may vary so if we look at most treatments they tend to be effective somewhere around the 8we mark and you'll have some

gains up until about the 16 we Mark and then beyond that you can absolutely have gains but generally speaking it takes two to four months for treatments to start to be effective that being said feeling happy let me actually pull up a paper feeling happy is not necessarily one of the things that we look at in in trauma treatment right so we'll like measure some things but we don't necessarily look at happiness so like this is the kind of thing where you know the short answer is your mileage may vary the slightly longer answer which

is super cool is complex post-traumatic stress disorder is an independent diagnosis differences in hedonic and UD dionic well-being between p cptsd and PTSD I imagine that the answer to your question is somewhere in this paper so what this paper talks about is that there are two kinds of Happiness there is dopaminergic happiness and there is serotonergic happiness dopam energic happiness is what we call hedonic hon Hedonism hedonic well-being so this is like my ability to experience pleasure UD dionic happiness is a sense of contentment peace or internal happiness that is not tied to a particular

thing so if I like go on a roller coaster that will increase my hedonic happiness playing a video game will will increase my hedonic happiness watching pornography will increase my hedonic happiness because it gives me pleasure but especially with things like video games and pornography it can decrease my UD dionic happiness so this is my sense of like peace and joy in life unfortunately cptsd is associated with impairments in both and less of both so what we do know is that if you get treated for this stuff those both of those indices will improve and

what we also know is that in cptsd UD dionic unhappiness is more profound than hedonic unhappiness so if you have a history of trauma your ability to engage in pleasure is modulated or impaired but your ability to feel at peace and feel Joy in life is even more impaired so the pleasure circuitry is somewhat intact the sense of Peace circuitry is more screwed up so let's just kind of take a quick look at I think I remember that correctly um see these findings indicate that core symptoms of cptsd Might hinder individuals from living fulfilling lives

that's what UD dionic happiness is okay it's bizarre so if you guys are wondering so like putting together this deep dive first thing is for every hour that I spend telling y'all about something there's four hours of stuff that I leave out and this is like this is why I like doing such a deep dive because it's like cool because if youall ask a question it turns out there's literally at least one paper that talks about happiness and Trauma right so the there's good news and bad news here the short answer is how long will

it take you to feel happy I would say give it at least 6 months but there are also other caveats there right because whether you feel happy or not can be somewhat independent of your treatment so I had a patient who once came in and I treated them for major depressive disorder and after about two years they said I don't feel like I've gotten any better and I was like well what do you mean by that because your life is improved we've talked about all the things that have improved and he's like I still don't

I still feel depressed every day and after tunneling down into it that's when we realized this isn't depression this is unhappiness and the presence of depression is different from the presence the absence of unhappiness the these are two separate things the treatment of depression moves us towards neutral learning to be happy is its own separate path this is often times more along the spiritual line as opposed to the clinical line and in trauma that can be true as well and so if someone hasn't felt happy we absolutely know that things like the dorsal medial prefrontal

cortex are impaired in cptsd which prevents people or makes it difficult for them to feel positive emotions instead they feel numbness when they go to a birthday party for them when they go to their birthday party everyone is happy and celebrating and you're just like I don't feel anything like it's not bad but I don't feel Joy and that's where there is the so treating cptsd will help with you dionic wellbeing absolutely but part of that treatment is a little bit more spiritual and you can do that on your own right so you can do

you can learn to appreciate you can start practicing gratitude there are other ways to engage to increase your happiness that don't have to do so much with cptsd now I suspect some of these techniques will be difficult for people with cptsd because the parts of their brain that normally these techniques would activate May somehow be impaired so I I recently did a lecture on the Neuroscience of Enlightenment and that may be showing up on on one of our channels soon maybe maybe not I'm not sure but the short answer is your mileage may vary it

is a very good question there's a lot at play between trauma and happiness and fulfillment treatment will help but even if it doesn't help don't give up I guess that's what I mean to say that the treatment of an illness is not the same as creating happiness in your life and sometimes that is an independent process and on that note we're at time for the day way past time so it's been an absolute pleasure to be here today with y'all um let me think about I just want to show y'all a couple of things before

we close out so for those of y'all that are joining us late we do have a trauma guide that is going to be coming out soon that is available for pre-order um I know we discussed a lot of dense Neuroscience today so we're also improving things in that Dimension so here we have some of the trauma guide Graphics right so some of these complicated Neuroscience things that we teach y'all we absolutely want to teach y'all like we try to make it accessible but we're not dumbing it down and I think that the more that yall

understand the difference between dorsal medial prefrontal cortex emotions and amygdalar emotions the more in control of your life you'll be and in order to facilitate that understanding we have a lot of cool stuff coming down the pipeline the trauma guide is made with a lot of love so definitely check it out thank youall very much for coming here today um and then you know take care of yourselves like don't give up it's not over like the reason it's it's reasonable to want to give up because you can try really hard and things don't improve makes

a lot of sense I hear that but it doesn't mean just because things have not improved does not mean that things are impossible so take car all happy weekend