 Welcome back to the art of charm podcast. I'm AJ and I'm Johnny and we are stuck in here in quarantine We hope everyone listening is safe now. We're gonna change things up today I know a lot of us are struggling right now with uncertainty fear Frustration so instead of a toolbox to kick off this month. We brought in an expert a psychologist to help us Unpack what's going on with our mental struggles and how we can work together to overcome them We're excited to dig in with anything like this that is novel and new to all of us even this experience of sitting home for this period of time does have a Psychological effect and it needs to be Respected so that we can move on Beyond it and that's very important. That's why we've brought dr. Dom in today. That's right So we're going to be unpacking the science and psychology behind some of the negative feelings that are weighing on us and how we can Communicate better to overcome the fights we may be having or the struggles that we're seeing now This is the art of charm podcast to show where we bring you actual tips and strategies on how to Supercharge your social skills and turn that boring small talk into smart talk Surround yourself with an army of high status individuals and to grow your social capital and unlock that hidden Charisma to crush it in business love and life. If you like the show, don't forget to subscribe and tell your friends Are you a maximizer? Are you someone that always wants to become the best at what you do? Are you ready for an unfair advantage? Now there's a secret game being played around you and you might not even be aware of it Over 70% of jobs are found through your network and I learned this the hard way in graduate school your network Opens doors that you didn't even know exist and you know, you're awesome You know, you're smart and you know that you put in the work. Are you ready to start getting real results? We know you spent time getting in shape working out Maximizing your sleep and getting an education to bring you the best and to get you to your fullest Potential but have you put time into your communication skills being able to Articulate and communicate who you are and your values to the right people. This is what opens those doors Are you ready to become extraordinary? Head over to the art of charm comm slash accelerate to learn more. It's the art of charm comm slash accelerate now Let's get started Today we have dr. Dominic's fortelli with us now doctors for telly is a medical doctor. He's a board certified Physician in adult psychiatry by the American board of psychiatry and neurology as well as a child and adolescent psychiatrist He's also a news expert in the media speaking on mental health family and childhood psychology along with a number of other topics We're excited to have him here to talk about dealing with uncertainty Stress and the challenges we've all been confronting here in isolation Doctors for telly is so great to have you with us. Welcome to the show. Obviously. We want to hear a little bit about what's been going on in your life as you're saying a little bit earlier that you're actually in the hospital with COVID patients currently and No, I can't even imagine what the mental toll is on the patients and the family members right now in isolation This is unbelievable and look so I'm getting hit by all sides because So right now I'm in the northeast and northeast is just taken a hit and You know, I think every day we get an update from the hospital in the hospital today said we had 90 thousand cases The good news is is we're plateauing a little bit, but we're full so our hospitals full our ICU is full our ventilators are full We're totally jammed Now what I specifically do at the hospital is I'm a medical doc I went to I went to med school and I did family medicine and then I pursued psychiatry and psychiatry and child psychiatry So what I particularly do at the at the medical hospital is what's called consultation liaison Psychiatry and what that basically means is a lot of people don't know that but what that basically means It's like this bridge between medicine and psychiatry. So I'm in a medical hospital So the same way that the generalist or the hospitalist will say, you know what? I think we need a cardiologist on this case or I think we need a Pulmonologist on this case. They'll say, you know what? I think we need a psychiatrist on this case, right? So that's how I get consulted at the medical hospital for anybody that needs a psychiatric consultation And that could be for a million things guys and you know, people don't realize that either But when you're medically sick, if you have underlying medical problems, you know Your psychiatric medicines might need to be changed or like, you know tweaked in different ways And sometimes there are things that can cause, you know Medical problems because of psychiatric medicine. So so I get a lot of consults to get consulted when people need detox I get consulted when people are suicidal. I get consulted for what's called capacity evaluations Capacity evaluations you're seeing if somebody can make their own medical decisions, right? So I get consulted On all of that and what I'm noticing now and I wanted to give you guys that background So the run of the mill day for me was just about a little of all of that, right? A little capacity of al maybe a suicidal ideation, maybe an acute psychosis But since COVID hit The acuity of what I'm seeing right now my census I go into the hospital and it's all what's called Encephalopathy. Encephalopathy is a just a fancy word for delirium or confusion based on your medical illness So what's happening is these people are getting COVID and they're delirious I mean so you guys know what it's like if you've had a high fever and you're just like whoa, you know Weird dreams and you know things you're getting crazy. I don't know where I am When people get this infection in a lot of cases, they're getting delirious and they're getting so delirious That they need restraints and they need sedation and it's so challenging Because this damn virus is affecting our respiratory drive Well, guess what the only way I could sedate somebody is by reducing your respiratory drive and getting you to relax So it's a really really challenging predicament that I'm in right now Trying to help these patients relax and come down from that delirium and still treat them safely But wait, hold on this I gotta take this a step further So here I am at the hospital and I'm doing this and I'm seeing patients and now I'm flooded with all this encephalopathy We call it toxic metabolic encephalopathy delirium and Because the doctors and the hospitalists and the nurses know that I'm a psychiatrist They're pulling me aside left and right like I'm walking down the hall and they're going hey doc Dr. Sportelli listen, I just need to grab you for a minute and they just start crying and And that's okay. I'm there for them You know, I am there for them. That's that's totally fine But they you know, they see a mental health professional and they really just open up today just today I'm sitting at my desk They're the doctors area where we do our dictations and there's a hospitalist sitting next to me and a hospitalist is someone that covers the general medical floors, right and She said I just got back, you know, I was on Quarantine because I had COVID and it was horrible and every night I thought I was gonna die and every night that I couldn't breathe I thought I was gonna end up coming in and getting intubated and She said now my mom has it and I'm back to work and she started to cry She said I'm not sleeping and she said I need to talk to you because I think I have PTSD I think I have post-traumatic stress We'll get this There was an amazing study done in the Lancet right Lancet's a very very peer-reviewed High-impact journal. It was done last month It was done. I believe it was in March or maybe in early April, but it was a great study That study looked at previous epidemics pandemics Ebola SARS You know some other ones that really affected various parts of the world and they looked at the psychological toll of What happened after these quarantines and guess who got hit the hardest guys? It was the frontline healthcare workers and then when they looked at what it was and they looked at what you know What were these symptoms? What were they experiencing? Well, guess what? It was insomnia hyper vigilance hyper sympathetic tone means you're always just you know Ready to jump because you're what happens is is your Psychologically resetting your thermostat to be on high alert all the time So right right so frontline healthcare workers, you know physicians nurses are now I'm seeing exactly what this research paper showed happened in the past with quarantines and epidemics and pandemics and So basically at the hospital not only am I seeing that acuity of the patients themselves with these delirious processes But I'm seeing all of my colleagues Just completely overwhelmed and exhausted and it's hard. It's just incredibly challenging obviously this thing has become politicized and Now with okay, if you want to go to work This is where you are and if you want to stay home. This is where you are and the adults in the room or Know that this is a nuanced situation and we're all coming to terms I was just telling AJ this today that that even for myself. There's these many levels of getting used to what's going on and For for myself today I realized that there was a small part of me the child in me that for the few weeks Was thinking that this was gonna be over soon and we're gonna go back to normal and it's not gonna be a big deal But as the weeks have rolled on and the more information comes out that it's not really information the more we don't know That that little piece that I'm holding to is slipping through my fingers And today I had to realize that if I continue to hold on to this thinking that we're just going to go back to the way We were the more frustrated I'm going to get and rather than hold on to this to let go and start thinking and prepare myself for what the new normal moving forward is going to look like and For what and that's just Joe blow on the street Let alone how your actions of how you're going to move forward are going to Not only put our health care system of overwhelming its capacities But what you're bringing up now the the the mental health of our practitioners is at is at risk everybody Yeah Right and and you know you hear these things like in you know I'm reading stuff and I get these little blurbs on my on my feeds and stuff that say that You know the psychological pandemic or the psychological fallout from this is going to be the next pandemic, right? And and here's the truth. I mean in all honesty, I think there's some truth to that because You brought up some really really interesting points in psychiatry and psychology number one Number one is change when I see private patients in my practice for the most part People are dealing with some challenge based on change and that's a divorce. It's a move It's a loss of a job. It's you know what you know fill in the blank Whatever change you're experiencing see as as humans were creatures of habit, right? And that's safety for us Even if it's bad, right? So in a lot of cases that coping strategy is bad It'd be but if it's comfortable we stay in relationships that are bad We stay and you know, we keep taking drugs. We do a lot of bad things because it's what we're used to So we stick with things no matter what now when there's a sudden change a divorce or a move or whatever fill in the blank Like I said, we have a really difficult time with that and and I think over time unfortunately and again I listen last thing I want to do is get political or get sociological But I think I think resilience has decreased quite a bit in people that haven't experienced Significant adversity, right like prior generations have experienced some pretty tough stuff potentially, right? And this is pretty much our first. Yes, at least in my generation our first real Unprecedented significant adversity. I mean we had our recessions and things like that, but I mean this is this is unprecedented stuff. So This is a tsunami of change This isn't just the divorce or just the move or just the loss of a job this is a complete drastic life change so people don't know what to do with that and psychologically to process that it's almost impossible So what we try to do is we try to develop all these little coping strategies like fill in the blanks and in a lot of cases filling in the blanks is What's the next answer? That's why social media is nuts. That's why everybody's got an opinion. That's why there's conspiracy theories That's why right because it gives us it's a little strange solace. It gives us this little strange Control for a minute, right? It's okay. We have an antibody test or okay. We have this rope We constantly need that and I seriously think based on my private practice and my experience with psychology Psychotherapy and psychiatry that we do need to change perspectives in a greater scheme at this point And and I think that admitting that Admitting that getting out of the denial and I remember denial is a primitive ego protection strategy Right. We know that that's as old as Freud right denial a lot of people are still in denial like hey You know what in a month everything is gonna go back to normal We're gonna go back to work. Everything's gonna be fine. I Think that's trouble. I think that's asking for trouble because things have changed probably As we know it things are probably gonna be incredibly different and that perspective needs to needs to happen You know, we're no longer in a sprint. We're in a marathon and You know that that's that psychological adaptation that needs to happen I think this has a duration that we're still coming to terms with and With that duration a lot of our leaders are going to mathematical models that are fallible and We as humans crave certainty We want to know and when we hear these numbers thrown around in these various models unless you're a statistician And you work with numbers on a daily basis you take them as truth and you try to plan around them and with this shifting and The fact that everything else in our lifetime that we talked about the duration has been pretty clear Whether it was 9-11 whether it was the recession it happened the event happened and then it ended and then we went into the rebuilding It doesn't appear as much as we're hearing from our leaders that we've reached peak that We've truly even come out of the the other side of this and we can start thinking about recovery and this Uncertainty it's plaguing me personally. It's plaguing our clients our listeners not knowing what the future holds and Obviously, some of us even have kids that are now also facing uncertainty And I think it's twice as hard as a parent when your children are asking for certainty You can't give it to them and you can't even find it yourself So from a psychological standpoint, how do we handle this level of uncertainty? That's unprecedented in our lifetimes yeah, I think uncertainty is very very worth talking about in this because I think everything you're saying is spot-on and You know, it's interesting just kind of go off what you said, you know, most people really aren't educated in epidemiology and statistics and When you do study that stuff, you realize how hard it is to know anything for certain anything, right? Yeah, I remember the statistics courses that I took in graduate school and med school I mean, it's like the more, you know the less, you know, it's a very strange phenomenon, but You know uncertainty psychologically There have been studies and this makes sense if you think about it, right? But they're they're very fascinating studies There was a British study that showed that If you take a group of people and you put an electrode on their finger and you tell them I'm going to give you a shock All right, and then you measure their psychological response And then you take a separate cohort and you say there's a 50-50 chance that I'm gonna give you a shot Guess which one was worse 50-50 Yeah, right. It was so on a scale of anxiety and fear and discomfort and heart rate and sweating and all these things The people that didn't know they were gonna get the shock It was so much worse Psychologically, right? So that that's a perfect example of of how this is affecting our our lives our physiology our psychology Because don't forget, you know, when you are in a heightened state of awareness, which uncertainty Causes Right. Our brain does not like uncertainty. It's unsafe and as a species we need to know certain things to survive Right, we don't like to not know what's around that corner So if the caveman didn't know that, you know, a tiger was around the corner He was in big trouble So it's a survival mechanism for our brain to predict where we're going and what's around each corner So we don't like that and it puts us in a heightened state of awareness and it puts us in a fight-or-flight presentation in an ongoing manner and you know what that does physiologically it raises cortisol levels and it reduces immune response and It does all kinds of horrible things Physiologically and it actually makes us unhealthy, right? So uncertainty, right? It's it's bad. It's bad psychologically It's bad physiologically and I think that's what's happening now Now as parents and I have three kids, you know I have a six-year-old a ten-year-old and a 12-year-old and and I did board certification A child in adolescence psychiatry too. So a lot of the media work that I'm doing now is is really trying to help parents Because It's the big questions. What do we tell our kids? How do we approach our kids? Do we tell them too much? Do we tell them too little? Do we scare them? Do we not scare them and? That's a hard question because it's developmental, you know a five-year-old and their brain and their ability to comprehend is very different than a 17-year-old right So the way that we the way that we approach this is if you have children and you have a family The best thing that you can do for them right now is create a sense of safety and that sense of safety is structure and Again, remember like, you know, not knowing what's gonna happen next this uncertainty is a very frightening thing as we talked about So doing simple things to create structure, right? And that's that's a simply, you know, you may have heard this You may have just routine routine routine, right? Make sure you stay on a routine But there's a lot of psychological merit to that because what it does is it takes this enormous tsunami and It makes it in bite-sized chunks Right. So if you have a family and you set up a daily schedule now that we're in quarantine You say, okay, we're all gonna get up at 8 a.m. We're gonna have breakfast at 9 We're gonna do schoolwork from 10 to 11 We're gonna have some outside time from 12 to 1 and 1 to 2 we're gonna have some family time, right? What that does is it breaks things down in chunks and it makes our brain feel better And it allows us to control what we can control and Psychologically, that's huge. That's a really really big deal Because if you if you're looking into the horizon and you don't know all of a sudden what comes back is well What's next week gonna look like how's this summer gonna look? Are we gonna go back to school in the fall and like it and then you start the what-if thinking avalanche and Then you're you're in big trouble psychologically, right? And that's why that's why the recommendation When you hear this everybody rolls their eyes I tell them all the time like you know structure and schedule and circadian rhythms and sleep white wake cycles and like I know I know But there's psychological merit to that. We're making what we can't control controllable and little pieces Right and then when it comes to talking to kids, it's developmental based You know, there's no reason that you should tell your four or five-year-old that we're all gonna die from COVID You know, there's no reason you should do that you let them first you let them know they're safe and Children model their behaviors after parents You know guys, I can't even tell you how incredible like the studies I've seen and going through child and adolescent fellowship They say the apple doesn't fall far from the tree but a lot of that's genetic But a lot of it is also learned behavior All right, so your children are going to respond to their environment the way that you do So if you're running around with your hair on fire every time you read something on social media or the news Your kids are going to be very uncomfortable Right, so it's okay to be anxious and I actually tell parents Tell your child it's okay to be afraid You know being afraid is not the problem being afraid is actually very normal And you should be afraid if something is dangerous then be afraid But it's how we respond to that fear is how you want to teach your child Right, that's that's the lesson and part of that is the behavior your own behavior of how you're responding to your fear Are you running around with your hair on fire or Are you saying okay, look this is scary, but this is what we can control We can wash our hands. We can wear masks. We can stay in the house. We can food shop appropriately We can do our school work. We're taking care of each other. We have a roof over our head We have bedtime stories, right? So we're making it controllable and even though we're scared We're handling it and what better life lesson is there than that? and and look guys, you know, this is a horrible horrible circumstance, but If there is a silver lining to this nightmare It's the two words that I think are gratitude and resilience gratitude and resilience And and that to me as a child psychiatrist and adult psychiatrist You know, I hate to say it and I don't want to sound cynical, but I think we were we were lacking a little bit You know before this mess and I think that's why we were so unprepared in so many ways I definitely agree with that gratitude especially Not realizing how grateful we should have been for that normalcy that we now crave But at the same time creating that routine Especially with your loved one or with your family Where even if you went down that rabbit hole of social media you went down that I'm going to do this new model And I'm going to figure out the population and all this stuff that we are going on right now If you end your day and you start your day with that positive moment of this is what I'm grateful for I have another day on this earth. We have food in our refrigerator. We're safe That allows you to get through this tsunami as you call it of emotion that we're feeling and I know myself personally what has become the struggle is Discipline so I felt that when I had those routines and everything modeled out with my perfect day It was a lot easier for me to be disciplined and stick to those habits But since my routine has been upended And trying to create a new work from home environment That is new to me and my fiancee amy and getting our routines back to normal I found that once I actually got back in a rhythm and a routine that discipline came back as well It's a great point. It's it's an incredibly valid point and you know something else guys too. I think it's an important Thing to think about and this is off the cuff as we're talking conversationally I I also think And you know, listen you guys are talking to me. So you're gonna end up we're gonna end up in some existential discussion It's just gonna happen. I hate to say it because I'm a Yeah, that's how it usually goes if I'm in the room as well Yeah It's just gonna happen, you know, I somebody, you know, my eighth grade english teacher introduced me to like Thoreau and emerson and then the rest is history. I was just I was just off to the races but Most of our lives Have become a big distraction from what we really fear Or all the things that we're afraid to sort of face on a day-to-day basis, right? I've always said to my patients You know when you're you know when you're okay, sorry for the dog barking You know when you're okay and they say one of my okay doc and I say when you can sit by yourself And you're happy and you're calm and everything is good when you're on you when you're on a vacation And you can sit on a lounge chair And not worry about your brain going a million miles a minute Then you know you're okay because you're not distracted anymore. You're finally sitting down with yourself And I think in this fast-paced society that we are We are distracted from the moment we wake up to the moment we go to bed and we never truly face what's important And I bring this conversation home to my wife and to my friends and they're probably so sick of me saying this at this point They're like a dom is like a Debbie down or I don't even want to talk to him anymore But it's not that's what I'm trying to do part of my job as a psychiatrist in the consultation service Is capacity evaluations and end-of-life decision-making And you know in new jersey we have a death with dignity act and I assess those patients Um, I see terminal patients every day before kovat forget about kovat. This is before kovat, right? and All of the dozens and dozens probably hundreds at this point in my career the conversations that I've had with people that were terminal None of them and I'm telling you this none of them brought up their bank account None of them brought up the car they were driving None of them never you know the conversation is it's their family It's how they were a dad their kids You know, um How they how they were involved in their community is a big one You know things like that. Um, they're social connections You know, that's it. That's what they talked about And I would come home and I would I would just process this all the time and then I would look around and I and I would go Everybody's living in this strange kind of bubble of what they think is important And That's what this is doing. It's like we're getting like that cold bucket dumped over our head right now As a war as a war earth forget about just as an american society I think we're getting like a ice bucket in the face of Whoa What's important What is important right and I think it's I I hate that it took this Right. I really do um, and that's sad But man, that's what it's doing I have a a friend of mine and I have been talking and I was Using the analogy of the apple Apple cart and why not get over why dump the apple cart if I'm able to build a career and I'm able to do the things that I want and my My buddy aj is with me on this ride and we're building things and he's built his own little company But for us, that's a very small segment Of the of the public. There is a lot of other people who are Are not enjoying this ride And they want the the apple cart dumped over because they feel that they didn't have the opportunity those opportunities and Well, here we are at a place where guess what? Because I want everyone to have those opportunities and the apple cart has been forcibly dumped over by somebody else And now we have this opportunity to to rebuild it And start from scratch and make sure that there's more opportunities opened up for everybody And at the same time, I don't need to worry about where I'm traveling next week I don't need as you mentioned. I don't need to worry about the car. What I'm worried about is am I getting sun today? And do I have that opportunity? Do I have a nice meal? And am I going to be able to connect with my family later on this afternoon after I Gratefully finished some work that I have. Yeah, and that's that is and and I'm back to those things and I did get to get out into the sun for a bit this afternoon and it was the best Time that I had been in a sun In a very long time. I live in a studio apartment here on Hollywood Boulevard and so all of our amenities have been cut off during this and and I was I was in desperate need of laying out in that sun A few weeks ago when it was it was nice out I found a parking lot where I could lean against the light pole to be able to read for an hour And I was still being bothered By some unsavory characters who are making my time in that park a little bit uneasy So today was wonderful, but it's How amazing it is it to go back to what do I really need today to make me be happy? What's the bare minimum and how am I going to engage in those things? It's like we're forced to go back you guys remember from psychology 101 maslow's hierarchy of needs. Yes Yes, remember that triangle. It's like we're forced to go back to that and that's okay, man That's okay. And and again the two words of the day. I think a resilience and gratitude and And I think the resilience part Is realizing and I'm seeing this in my kids. That's the greatest thing to observe forget about me You know, I'm seeing this in my kids. I'm seeing I'm seeing a 12 year old who used to come home from school every day Throw his backpack on the floor and be like mom and dad. What are we doing today? Like I was a cruise director, you know It was hard. I'm a child psychiatrist, you know, and I'm going oh my god. What am I doing wrong here? I gotta go back to the textbooks But now it's it's And I used to tell patients this and parents this it's let your kids be bored Right, let them be bored. Absolutely. And they would be like, oh my god I gotta make me nuts. Let them make you nuts. Let them let them be bored because boredom fosters creativity independence and self-confidence And now they're sort of forced Now they're forced to but I'm witnessing this in my 12 year old and my 10 year old that that they can't Be entertained all the time. They can't have that we call it the hedonic treadmill, right? Like what's that next thing that we're going to get that's going to make us happy for a minute They're not getting that so they're starting to turn internally now And realize okay, what what truly makes me enjoy my day and my time So that's a really cool thing to see in my own kids We get this question a lot and certainly AJ and I have had our discussions about it here on this podcast I would love to hear and for our audience to hear rules that you might have set up That will help foster that creativity rather than just giving the kid an iPad to when he's bored Yeah, yeah, for sure. Now. I am a huge fan of the creative arts and I think So, you know, so it's kind of tricky, right? There's good and bad to the electronics They make our lives convenient, right? And you know, they call it the it's like a It's like a babysitter sometimes and we need some free time to just give me the iPad and just, you know, leave it on but But of course limiting screen time because as a child psychiatrist I've read ever, you know, not every study, but I've read the studies that show that children that spend time on social media And all this have higher rates of depression up higher rates of suicidality higher rates of self-injury higher rates of anxiety all of that stuff So limiting screen time because number one, I mean, that's a foundation limit that screen time They can use it, but it's going to be an hour or two per day And then it's then it's now it's about a discovery process Because maybe they've never been forced to actually figure out what they like Outside of this stuff that we've handed them on a silver platter. So that's a little bit of a challenge now It's like, okay, well, what do you really like? And that might be a little bit of a painful experience for a minute or two or a day or a week Is what what do you really enjoy, you know, and for me I was the kid that um Was kind of afraid of sports, you know, I was afraid to be the guy that dropped the ball and you know So team sports kind of spooked me as a kid. So I sort of reverted to music And uh, I play guitar so so that's sort of my go-to thing, you know And and I go and I strum and I learn learn something new and and that's my therapy But I think the word is therapy, right because if you're doing something that you find meaningful It's therapeutic So my 12 year old draws he plays guitar and he plays the drums, right? Right, and I and I support that and encourage that tremendously and I want every parent out there And it doesn't have to be music, you know, it it could be any form of self expression I don't care if it's dance if it's art if it's clay if it's drawing if it's music I don't care Whatever it is that they have this sense of self expression and meaning That's what you need to foster and that's not going to be an easy process in a lot of kids Not going to be an easy process. So there's going to be the withdrawal from the from the fortnight Right, they're going to have a little it's it's like crack, you know, they're coming off They're going to be all irritable and stuff for a couple of days But but that portum is going to foster the creativity and and then let them Guide them sort of bumper bull them And that's important as a parent too. You never ever want to guide them completely bumper bull them Let them bump into they don't let them fall in the gutter just kind of bumper bull them a little bit And and find that outlet and and every kid is going to be different for some it might be recreation and sports For some it might be music for some it might be, you know, other creative I just want to give you kudos on that idea though that pulling the ipad from your child Who's playing fortnight? I just had a friend who his teenage son With all this going on has been doing all night fortnight sessions with his friends And my my friend got alarmed and he pulled the ipad away and says i'm tired of this and he The kid freaked out and my my friend who's also a musician and we've been around some unsavory characters Playing music in our younger years And he's like my son acted like a crack addict and it flipped me out and I never seen anything like it And I was I was like well, I'm sorry john But what is going into that? That makes your kids like it so much is exactly the same Mechanisms and a crack addict is getting and he was he didn't know that he never saw the research He didn't because he thought it was it's a silly game. What is what's the big deal? But when he saw that reaction it triggered What he had seen and in real life How that works and but it is it is exactly the same yes You better believe it and listen to the same the same, you know psychometrics that are done for roulette wheels and you know Gamblers and all that stuff are the same people that are putting together What are the rewards reward patterns that we're going to give the kids for fortnight to get that skin So they can keep playing and and it's it's a dopamine hit just like Just like a lot of drugs, you know, you do a lot of cocaine and dopamine goes through the roof I'll tell you what, you know, you do good at get whatever you got to get in fortnight. I don't play it But you're getting a dopamine hit So there is a withdrawal and there's a lot of there's a ton of debate about this among the psychiatric and psychological community Like is gaming addictive and stuff and and i'm on the side that says absolutely positively 100% It shows the same characteristics of addiction as some of the physiologic addictions and even the non-physiologic addictions like gambling and You know sex and things like that So so you have to limit it right and they're going to go through withdrawal period And they're going to hate you for a minute and and the truth is you may not you probably don't want to do it cold turkey because Even if we use the addiction model, let's use the let's use the psychological addiction model. Wow, you know going cold turkey rarely works You know, so um, so you got to set limits and let them know ahead of time and you say look You know, we're just going to limit this now instead of being up all night of fortnight We're going to we're going to cut things off at 10 p.m. Or whatever it is But you're just going to have to just set limits and stick by those limits because There's something called an extinction bubble or extinction burst in psychology that as soon as you go back to your old ways You start from scratch. Yeah, right? So when it comes to kids and all that stuff Um, just just take it easy on them and especially now and and look guys There's a lot of discussion too in the psychological and psychiatric community too about You know, we're all going through a little bit of a rough time So it might not be the time to pull that rug out from under their feet right so Yeah, I was gonna say as as someone who plays fortnight I I want to play devil's advocate here because the other part of fortnight is the community aspect And the fact that you're interacting with your friends that you're now isolated from and outside of uncertainty I think the other real negative mental presence Psychological issue that we're struggling with right now is loneliness We are social creatures Our mental and physical health depends on feeling connected to one another And many of us are in isolation And I think you have a really unique perspective being on the front lines of the battle with kovat because The stories that i'm at least seeing in the media are around this isolation that you face If you test positive and you're hospitalized because you are completely isolated from your friends and family They can't come visit you and if we're trying to avoid Getting kovat. We're also isolating ourselves. So how do we deal with this loneliness epidemic that we're all facing kids as well Yeah, you know, and I do agree with you a j I think that I've actually been pleasantly surprised when I sit in the room Watching my son play fortnight how it is this community They're talking with like 10 people and they're all working together and they're doing so there is a lot of positivity there There's no question about it. I think the important point Is to not go all in with it to make sure that that's a part of your day Just as if you would have a gym class or a recess class or or a workout, right? That's part of your day, right? So it's like, okay two hours on fortnight and then then we do something else because you just want that well-rounded experience You don't want to rely on anything that'll that'll saying don't pull your eggs in one basket That shouldn't be your own only social outlet and that shouldn't be their only social outlet, right? But I do agree with you a lot of merit there for sure Isolation As a human species is just devastating and and we know that we've known that for a long time, you know We go crazy when we're isolated. We're not we are social creatures now some of us are introverted and things like that but And this and this this you know pandemic is is affecting a lot of people differently and and your personality structure does matter You know if you're an introvert and you're not a super social person It's probably a little easier, right? But that doesn't mean that we're not social creatures We are all social creatures now strange things happen when you isolate to the human mind actually there's been some really really interesting studies that You know, we're so we're so in tune with our external environment and our social interaction with people And our mind relies on that so much That when you remove that what starts to happen is your mind just starts to focus inward And the opposite happens is isolation tends to breed more isolation, which is a very strange phenomenon And you hear these stories, which is actually pretty strange right pretty wild stuff. Have you ever heard the stories of You know, like the guy that crosses the Atlantic in a one-person boat, you know And and he's you know at sea for like 30 days doing this When they get back or when they reach land they will be like listen I was out at sea and one night I spoke to god and and I had a conversation with a person sitting next to me or They actually have perceptual disturbance. That's how much isolation can affect us We will actually experience perceptual disturbance in in psychological studies shown with people in isolation You know that whole thing with with tom hanks and wilson. I mean that was actually that's valid. That's true We will actually start talking to inanimate objects. We will we will humanize things our pets whatever it may be Because we need that communication. We have to express ourselves and we need feedback of some kind, right? Otherwise We start to develop symptoms of what almost seems like a psychosis I admit people to the psychiatric unit that see things and hear things right But the guy that crossed the Atlantic took up 30 days. He was chatting away with You know his dead grandfather for a couple of days, right? But that just goes to show you how powerful the mind is and how much we rely on others to keep our bearings to sort of Keep our structure and foundation very present. Wow, right now now. Let's let's compound that Let's compound that with being sick when we're when we're most vulnerable Right. So so imagine I mean this is he it's it's hard to even talk about you know And this is what i'm seeing the doctors see and the nurses and the frontliners and and everybody that's at the hospital Is that because of the quarantine when someone's you know infected with cova, they're isolated They can't see their love with the people that mean the most to them They're north star They're the person that they need that that rock that they need to hold on to when they feel the most vulnerable They can't communicate with or it's very hard to communicate with Right. So think about that think about how unbelievably challenging that is Right just to add to that. So we are social creatures. We need people Now how to deal with it? Obviously we need to use what we have now We need to use exactly what we're doing now like zoom and and all of these, you know Electrical capabilities that we have now all these like, you know communication devices We have to use them and when I say make a schedule like before when I said make a routine make a schedule Part of that and there's a long list of that So circadian rhythms get up and go to sleep the same time make sure eating habits are on par Make sure you're doing your 30 minutes at least of cardiovascular exercise every day, right? Make sure on that schedule there is time for social interaction And that could be a telephone call. It could be a face time. It could be a zoom chat It has to be a daily priority because like I said isolation breeds isolation And also from a psychiatric perspective depression anxiety Dysthymia, they're like it's like a snowball effect Right, it gets worse and worse and worse and you got to stay on top of this stuff So it's more of like a mitigation strategy, right? It's like, okay How do we prevent it from getting worse and how do we prevent poor outcomes? Six months from now, you know or four months from now So part of that daily schedule guys is it has to be social interaction Now one of the challenges that I've had personally is my mood has swung And there are days where I'm positive about things and and I feel like we're going to come out of this Stronger and I can see the opportunity and then there are days where I spend too much time on Twitter Or I think about like Johnny said the the things that I miss the most and that normalcy that's been ripped out from under me and I get really down And I find that there's like this cycling of emotions going on with all of my friends as well and sometimes I'm on a low and my friends are on a high and it feels like we can't really communicate and It it creates this distance or vice versa Uh, how do we manage that when there's so much emotional uncertainty? Even with the people that we love and care about And I certainly don't want to be someone to knock them off of their high because I know how great it is to be positive and Opportunist and feeling opportunistic But at the same time in some of those lower moments. I also need to just hear that. Oh, it's going to be okay Sure I well, I just want to add to that as somebody who's worked with AJ for over the last 14 years and everything that we're going through We certainly have back and forth where I'm on the having the good day. He's having the bad day or vice versa But when we can sync up, we can get some stuff done You're right and you're absolutely right But you know what I think the most important part of that is sincerity and honesty with the way you're feeling, you know I I think what ends up happening is you're going to feel more isolated if You're part of that zoom conference and you feel horrible and everyone else is in a good mood You just kind of play along that's going to make you feel more isolated And you know, we know that psychologically too that that being honest and sincere is an important thing in those conversations And showing a little bit of vulnerability And and if your buddies are all laughing and joking and everybody's jovial and be like, ah, this is great I get to sit at home and you know put my feet up and and you're just like, oh my god You know the world is the world is going to end. What are you guys talking about? You know, I don't think you have to bring up that negative catastrophic thought but you could say, you know what guys? I'm just having a bad day. You know, it's just a bad day for me And then I think what Hopefully and what you probably get because we're all human here And I think we are for the greater good that that was a question of mine for a long time But I do think we are for the greater good. I think somebody's going to come out and say, hey man What's going on? What are you thinking because you know, and that's what therapy is therapy is The reason why people go to therapy here get this you're ready for this and this shocked me I'm in my psychiatric residency. I want to be a psychiatrist and I'm learning psychoanalysis and psychodynamics and all this stuff and my preceptor said You're never going to give advice And I was what what is that what I'm going to I'm a psychiatrist. What do you mean? I'm never going to give advice It's not about giving advice. It's not about telling people what to do. It's about allowing people to express themselves And you are you can process it and mirror it back And show that you understand it And then allow the person to provide to to come up with their own strategies based on that mirroring Because here's the thing when it's in here, it's usually a lot worse than when it comes out our minds tend to cat could you know Catastrophize things and make things much much worse And that's why we have things like cognitive behavioral therapy And that's why we know that cognitive behavioral therapy is so efficacious and that's why You know like psychoanalysis like the old Freudian stuff really don't do that anymore Because the doctor wouldn't say a word and just kind of sit there and write and take notes You know about your dreams and your sexual desires and you know come up with all kinds of weird stuff But cognitive behavioral therapy is just this right? It's it's kind of like what we're talking about and you guys probably know already But it's it's a thought that leads to an emotion, right? What ends up happening is though the thoughts are usually not right. They're not valid thoughts, right? So so if you're having a bad day, AJ Let's just say you're having a bad day If you can somehow identify the thoughts and this is not easy. This takes practice Identify the thought that you're having that's leading to that down emotion the thought probably has some piece of Non-reality, right? It's probably not valid So in a sense, you have to be your own defense attorney Your mind has to be your own defense attorney and say, you know, I'm feeling like crap today Because I I think I'm going to get covid and I think I'm going to end up on a respirator and die And my family's going to be all alone and my kids are going to grow up parentless and whatever whatever the thought is So let's stop right there and let's think about that thought And let's break it down And then when you truly break it down a little bit, you realize, okay No, I am catastrophizing a little bit. I'm overgeneralizing. I'm black and white thinking I'm doing all of these things that our minds like to do Which really isn't real Right, and then once you sort of process that then it can kind of uplift that mood a little bit All right, so that's what friends can do for you. They can kind of point out that well, wait a second You know that thought no, you know, I mean that's not real, you know And that's what a good therapist can do to sort of point things out for you right So when you do feel down getting back to that question when you do feel down and you're not on the same wavelength I think honesty is super important, you know And it doesn't have to be you don't have to divulge everything that you're feeling or thinking but just say yeah guys I'm just I'm not on I'm just not feeling having a bad one I know Johnny has been a little more fortunate because he's staying with animal, which is an inanimate object Uh that sometimes comes to life and Johnny's State of mind recently, but I'm In a situation where I'm in isolation with my fiance and It has created arguments that we never would have had before it has Put us on top of each other in ways that we're just discovering and we've been together for six and a half years so For those couples who are now finding themselves in arguments over utensils or what's for dinner and things that just Don't even really seem to have meaning in what's going on How do we deal with the the tension and the conflict that's now rising in our house? Yeah, I think that brings up a great point because You know, I'm sure that in China the divorce rates went through the roof after kovat and this is true. This is true and domestic violence has increased in the United States since quarantine And you know and I know this because I work in the psyche are so we're getting the calls, you know so all that is very true and valid and and When we are stuck with someone even if we love them it can be incredibly challenging now There are a few things to think about here first first off this makes sense again Then when we break it down that if you are faced with an anxious circumstance if you're faced with an existential crisis Facing your mortality you're facing your you are potentially facing your mortality here, right? You are going to take your life a little bit more serious now. I'm I'm I'm going a little deeper We're going to get back to the silly stuff like I can't stand when you chew your gum That look that that But but I think what's happening is the reason why you're seeing divorce rates go up and the reason why you're seeing People make these drastic life changes after quarantine is because we're forced to face things that we didn't have to face before It's oh my god. I am faced with my mortality again coming back full circle. What's important You know, is this relationship right for me? Is this person right for me? Is this did I make the appropriate decisions in the past and what was I basing those decisions on so So that it's kind of like the seriousness of the circumstance is real now So I think it's more people are more apt to act on that when you're faced with that ultimate You know, like I said existential crisis, right mortality. This is my life. It's like finally we're saying Whoa life is short. I better do something about this if I'm not happy Right, so we have that piece which is valid and very important to look at And then you have the piece of just human nature How repetitive actions and people get annoying. Okay, and that's okay. And that's normal too Number one the big blanket statement here that I want everyone to sort of process Is that even though this is long term stuff, right? This is long term. It's like I said, it's a marathon Not a sprint. I still want people in relationships married girlfriend boyfriend boyfriend boyfriend whatever it is and you're living together in tight quarters Remind yourself that that situation is temporary. All right, so the quarantine is not going to be forever Because when our minds generalize And catastrophize it's I'm going to be stuck with this person chewing gum like this forever And that makes you nuts and it makes you crazy and it makes you want to just run, right? So again putting things in perspective. This is temporary, right and and and just kind of reframing So you have to have that psychological reframing capability To just tell yourself that and I think parents are good at that parents are good at that Because when your toddler is screaming every five minutes at you for something You you take a deep breath. I know I do as a parent go It's a phase. This is not going to be forever. I'm not going to have a I'm not going to have a permanent five-year-old Right? Unless I purchased like a monkey as a pet. I am not going to have a permanent five-year-old, right? This is temporary and then what that does is it resets my brain And it allows me to look at the circumstance and help him and pick him up and he's crying or whatever They're fighting whatever's going on. It's not permanent So so even dealing with your loved ones at home when they're annoying you Just take a step back take a breath and remind yourself that that this truly is not is not permanent And what you're seeing is a magnifying glass On a circumstance absolutely positively, right? It's like throwing fuel on a little spark every now and then So that's super important. So remember big picture. Remember that it's that it's temporary and that circumstance is going to go away So to reframe that is super important But I think in daily structure and again, you guys are going to get sick of me saying this But structure of the of your day Try and think about this you need to strategize Okay, so if you're both working from home Think about each daily structure and try not to overlap too much Right, so try to make sure that maybe you can work from one room. They can work from another room Make sure you still have some space and even if you're stuck in a 1200 square foot apartment, I mean you could still have different work spaces You could still have different things So do your best to have personal space and in that structure that you guys set up that you should be setting up And I know it's a pain, but you should In that structure, you do have Date night You're not going out, but we're gonna get dressed up. We're gonna get dressed up and we're gonna cook dinner I'm gonna cook dinner tonight. You're gonna cook dinner tomorrow night Right, so you still have to have that romance You still have to have that date night thing going on even if you're stuck in the house You remember that it's temporary keep as much space and respect boundaries as much as you can and that should be on your on your daily protocol um and you know And and then when it starts to flare up a little bit just step back take a deep breath and step back It's all about perspective, right? So all of this has to be taken to account now. Look If you're getting that big existential smack in the face like this is not the person that I really want to be You don't have to make that decision right here and now if it's really that serious That's a decision that you can make in a month or two from now, but I certainly would wait right So amy, I know you're listening. You're only temporarily quarantined with a five-year-old This is just a phase. We will get through it I will make the bed Uh, I think the other the piece of this is the level of self-compassion That goes along with this that we need to be compassionate to ourselves for the bad days It's not expected for every day to be a good day and to be honest with our partner Our roommate our spouse that I'm just having a bad day and even this bad day is going to be temporary But I read some bad news or I thought about this too hard and it knocked me off my thing And being someone to be honest about that vulnerability I think is important and and it's a lesson that I've learned In this process, you know, we've been quarantined now together for almost six weeks And at first, you know, I want to just shoulder it all and be the tough guy and and and keep A level head and keep a smile on but it has got to me at times and being Compassionate to myself and saying, you know what? This is a bad day and it's just a bad day It doesn't have to be a bad week and then being Vulnerable enough to share that with Amy and say, you know what? I am having a bad day and I'm sorry for being disconnected I'm sorry for being a little sour right now, but this has got the best of me And knowing your partner Amy knows me really well. So it's like, well, let's go on a run Let's do something physical to get the endorphins moving shake things up a little bit And maybe we can get that sour mood or that negative feeling that you're having Out because we don't need to hold on to that. It doesn't help Yeah, absolutely agreed and and that goes back to the bigger picture of this whole thing with just anxiety, you know In general, I think I think that having a quote-unquote stoic Sort of attitude right now is kind of silly, you know I think it's it's okay to have that vulnerability Just as you're saying to admit that this is a scary time and that it's okay to have fear It's just about how you handle it right and tell you strategize and and how you sort of approach it. It's You know guys, it's like It's like saying look we're gonna we're about to climb Mount Everest, you know, you don't just show up You know you plan You plan your stuff and you get the right clothing and you and you get the guide and you get a map and you do things I mean, that's how we have to approach our lives in a day to day fashion from here on out for a little while You know and part of that is being honest with yourself And you know in psychiatry we call that insight and that's a huge huge huge therapeutic Catalyst, you know if that happens if we can if we can help someone gain insight into truly how they feel And able to express that comfortably You know, it's like it's amazing. It's an amazing place to be Now we love ending every episode with a challenge for the audience And I think right now with all the uncertainty we're facing Is there an exercise or a challenge that you could give us to help us strengthen our resiliency? An exercise or a challenge? Hmm. All right, you guys so listen In all honesty, and I'm probably the worst at this You know what? I'm gonna get where is it hold on It's over there. I'm not gonna grab it because I'm gonna pull out my earplugs, but So If people can do this I promise you your life will be better Oh, I like this Yeah, and it's not that hard, but it but it is because people don't do it. I don't know why I didn't do it I was I was terrible Okay, so every morning when you wake up Three questions that you ask yourself Okay What am I grateful for here? Hold on. I'm gonna I gotta get it. I'm gonna get it because I do it I do it. So let me get it. Hold on. Love it So you gotta prove to you guys that I'm doing it. Otherwise, it's just like an empty thing I gotta show you it right on so all right journal. Yeah now years ago years ago I was the I was the scientific dude that Needed empirical data. Otherwise. I want I don't want to hear it and I was like whatever, you know Show me statistics. Show me this. Show me that show me this If anything was like eastern philosophy and mindfulness and I was like Forget it. Show me pharmacists. Show me pharmacology. Show me a PET scan. Show me what's happening to the dopamine neuron Show me what's happening to serotonin. Well, let me tell you something The more I've learned about human physiology and neuro physiology The more I've realized how incredibly powerful the mind is with regard to perspective right Perspective it's crazy. That's everything. So long story short. I'm going to challenge everyone Okay, and I don't know how I don't care how corny you think this is it's going to make your life easier I want you to ask yourself three questions every morning and I want you to write it down. The first question is What are you grateful for at this very moment? All right, I just want you to think about it and I want you to write it down The second question is is what is going well? And the third question is what could be better simple Sounds simple very very challenging to get people to do do those three questions every single morning And give it time and think about it. I challenge you guys to do it All right, I love that. Thank you so much for joining us dr. Dominic. Oh, you're very welcome. Yes Where can our audience find out more about you? I'll just go you guys. I don't know. I don't know google me. I don't know So I have an instagram page. It's dr. Sportelli for dr. Sportelli, you know facebook I do a lot of media work on you know, I do a lot of news media the doctors California live bunch of stuff So you probably see me there but jump on my instagram page and give me a follow Dominic, this has been great And also Eric will be in touch with you with some social media assets and stuff as we get them prepared every here And you'll get all that kind of stuff So we'll get me back up with you and how you can help promote this episode. All right guys, you're very welcome Yeah, this was great. We'd love to have you back. Have a good one And today's shout out goes to collin. He wrote us this message. Hey, I just wanted to say thank you for the work You guys put in on your podcast. I've been listening to them almost every day and replaying them four times a day I have a greater understanding of myself and other people and you've started a positive change in my life Many thanks and I hope to keep in contact collin I have to say johnny and I pour a heart and soul as well as michael into the prep to bring you the best science and Actual content so that you can improve your social skills and your lives And it's so great to hear from our audience when they realize the impact that this is having and Someone like collin who replays it four times talk about incredible Well, I certainly know I listen to my favorite podcast over and over again to squeeze every bit of juice out of them So i'm just glad that people view us in that same manner That makes me feel good about all the work that we put into the show I have to say I really enjoyed the conversation with dr. Dom. I know myself personally I've been facing a lot of stress and uncertainty and at times that's even carried over into my relationship We know that isolation is taking its toll on us mentally But it's great to hear that there are steps that we can take to calm that uncertainty To look for gratitude to shape our days to be more impactful and to come out of this the other side stronger I agree wholeheartedly. It's and it's good to know that you're not alone And that we're all working through this together now We want to hear from you Let us know how you enjoyed the show or if you have any questions You can send them over at the articharm.com slash questions You can also email us questions at the articharm or find us on social media on facebook instagram or twitter at the articharm And johnny you've been doing something special every weekday morning. That's right aj I've been going live every morning at 8 30 am pacific on all of our social media channels talking about self-development Psychology and a lot of other topical items through the self development lens It has been a blast and I would love to see you guys there Also, could you do us in the entire articharm team a big favor? Could you go over to itunes and rate the show? It would really mean the world to us and if you enjoyed it share it with your friends and hit that subscribe button The articharm podcast is produced by michael herald and eric mcgummery and engineered by sam j and bradley denham I'm aj and i'm johnny. Have a great week