 Hey, Psych2Goers. In our first video, we chatted with Dr. Mike about the physical and mental health relationship, who to reach out to for support, and how you can maintain or improve your mental well-being. Stay until the end to learn practical tips on managing your body and mind. Thoughts on any resources that might be useful for just the general public to read on about mental wellness? For sure. So I have sort of like, I would say two books that I recommend quite often to my patients as one is an introduction to cognitive behavioral therapy. It's called Feeling Good. There's actually an updated version called Feeling Great by David Burns, great author, great book, has workbook within a book. So you're kind of like not passively reading, you're actively reading and then filling stuff out and learning about yourself in the process. I've read it. I've got tremendous benefit from it. I was actually introduced to it by our behavioral specialist in my residency program, who kind of helped teach us, who helped take care of us when we were struggling as residents. That book did wonders for me and there's some preliminary research showing that bibliotherapy just reading that book alone for mild symptoms goes a really long way to helping alleviate them. So that's one that I often use as an introduction for cognitive behavioral therapy. And then when it comes to how your physical health is impacted by your mental health, there's an author by the name of Dr. Sarno, the late Dr. Sarno. One is called A Divided Mind. And oftentimes if I feel a patient is coming in with a physical manifestation of a mental health situation, common example of this would be low back pain or some other musculoskeletal complaint where I'm like, look, we've ruled everything out. Atomically, you're okay. There is no nerve impingement. The muscles are intact. There's no major spasms. You have good range of motion, but you are having pain. It's not all in your head, but it's happening as a result of what's going on in your head. And that's part of life. That's like what our bodies do naturally. It really stems from the science of pain perception because I think something everyone can relate to is if you're having an ache, no matter what it is, stomach ache, elbow ache, back ache, and you go to a party and you're having fun with friends, I guarantee you you're feeling that ache less. Like you're on adrenaline. You're having a good time. You're feeling it less. But if you were to receive some bad news, I guarantee you that ache becomes intensified. And it's not, again, just all in your head. You're making it up. It's true. The pain is true. Your body's perceiving it differently. But that's because of what's going on in your mind, in your mental health state. And that's what the book The Divided Mind really dives into as to why our minds do this. Dr. Sarno postulates some interesting theories as to why our bodies do this. Something he talks about is repressed childhood trauma emotions, how they potentially, if they're being repressed and untapped, that our bodies are actually creating some of these physical manifestations to prevent us from thinking about that. And I think there's definitely something there. I don't think it's fully fleshed out yet, but to me it's interesting. It's an interesting field of research. It's an interesting part of reading because I've had patients who've come in with these manifestations physically that nothing medically I can give them a diagnosis on. The MRI is normal. The imaging is normal. The function of it is normal. But there's pain. And then we dive into the mental health side of things and all of a sudden the pain is gone. I've actually had an interesting interaction with a patient. I mentioned elbow pain several times because she came in after three visits with other doctors. Elbow was bothering her. MRI was normal. X-rays normal. Functionally looks okay. Had some physical therapy. No improved. I bring up this topic. She was very reluctant to talk about her emotions. But then we said, you know what? I want to try it because the elbow is bothering me. I asked her to give me a call back to give me an update in a couple of weeks to see how she's doing. No call. So I was kind of upset. I said, you know what? Maybe I should call and just make sure everything's okay. And when I called her, she said, you know, I'm kind of upset with you, doctor. Why are you upset? What's going on? And she says, because my elbow pain's gone. And I'm like, well, why are you upset if your elbow pain's gone? Because she says, you know, now it makes me feel like it was all in my head. And we have to have that conversation about it's not all in your head. This is part of how your body perceives pain. If there's some kind of trauma there, your body will act differently. It will perceive pain differently. Your experiences in the world will be subjectively different. And that's normal. Again, it's so important to talk about because it's how the body copes, part of its natural mechanisms. And I wish we put that out there more because I feel like we would have a lot less sham medicine of miracle cures. We'd have a lot less imaging that is unnecessary. And we have a lot less surgeries and procedures that patients don't need, but then end up suffering from because of the side effects of these procedures. If you're feeling good, you're releasing endorphins. Those are natural pain relievers. It's almost like our own opioid system within our own bodies. So like the fact that we feel less pain when things are good goes to show that there's something happening mentally that's affecting this. A really simple question I ask patients is, you know, does your back hurt or does your head hurt only on weekdays? And if they say, yes, what happens on weekends? On weekends, I'm off. I'm not stressed from work. I'm having a good time. I'm with my family. I'm happy. Well, why is that if you have a broken bone, if you have pressure on your nerve, if you have a tumor, God forbid, why would it take weekends off? Like medically, it doesn't make sense. So we have to start looking elsewhere and figuring out why it's happening with that pattern. And that goes back to that cascading pathway and figuring out the diagnosis in the beginning. And that's why the mental and physical health relationship is so cool. But at the same time, there's a lot of stigma around it. So patients aren't always open to having that conversation. Some have experienced true traumas that they're not comfortable sharing, especially meeting me for the first time if I'm not their primary doctor. That makes things even more tricky. That's my field of learning where I'm trying to figure out how to get patients excited, motivated and looking deeper into themselves to become more introspective. Right. Mental health and physical health as we just described as we just chatted, it's just so, it's almost inseparable, I would say. Sometimes it's unfortunate that it's quite difficult for people to reach out. And I think one of the difficulties is that there are so many different types of healthcare providers. For example, social workers, like hiatris, psychologists, you name it, that it's hard to know who reach out to first. Primary care. That's why. If you have primary care, they'll help you guide this. The system is complicated. You're so right on this. Even for me, when I have something wrong and I need specialty care, I'm confused. I'm like, who do I go see? I need to start digging into my Rolodex, or maybe even using our references that we use for medical conditions to see who is the optimal person to refer to this patient? Is it ear, nose, and throat? Is it maxofacial surgeon? Who is the best person to take care of this? Because sometimes things are very subspecializing. You don't know who to see. So the fact is, if you have a good primary care doc who cares, who understands the system, they'll be able to guide you if you need a social worker or counselor. And sometimes a counselor may not be enough for the severity of the case that a patient has. Maybe a patient needs an inpatient stay. Maybe after their inpatient stay, they may need an intense outpatient program where they're going every single day to this program. And I've had patients benefit greatly from doing these intensive outpatient programs as well as inpatient programs. But unless you're aware that they're available, you may not take advantage. And the only way you can really know outside of doing a lot of serious digging and research is to have a good primary care doctor and be plumbed in. So after someone reaches out to their primary care provider, presumably it would take some time to actually meet them. So in the meantime, do you have any recommendations on what someone can do to either maintain wellness or to just feel better for the time being? It's so hyper-dependent. It's hard to give generalized advice here. I just think like everyone could benefit from cognitive behavioral therapy. I think even if you're not having a quote-unquote diagnosis, you could still benefit from cognitive behavioral therapy. Because we're all so prone to disorder of thoughts where, you know, I didn't get an A, so I'm a failure. My partner was looking at their phone a little longer than usual. They're cheating on me. Like these thoughts pop into all of our minds. They can really derail how we feel. If you feel a certain way, whether you're feeling down, angry, sad, if someone tells you to snap out of it, they're kind of being rude because you can't really control your feelings. But you do have some control over your thoughts. So if we can attack some of those disorder thoughts through cognitive behavioral therapy, even from the knowledge of cognitive behavioral therapy, it can go a long way. So for everyone, I recommend doing at least the initial reading of feeling good or feeling great general gist and understanding of what's going on. And something that kind of a hack or a tip that I like using is some of these simple, almost gimmicky things, but they actually have evidence behind them that you can do. One is like the letter of gratitude. Basically in the field of positive psychology, it's been found that if you write a letter of gratitude to someone who you're grateful to, whether it's a family member, friend doesn't really matter, you write it out, but you don't send it. You call, you meet the person, and you read it to them in person. And oftentimes it's an incredibly emotional experience, obviously depending on who you choose, how you choose to read it. And the benefit in terms of decreasing anxiety and depressive symptoms, just by reading that one letter to one person and writing it, there's weeks of relief or at least a slight decrease in symptoms. That's been validated in scientific research. The second one that's probably more well known is the three positive things. At the end of the day, jotting down on your phone, on a piece of paper, three good things that happen to you. There's slight different variations. You could do three good things with one sentence as to why you think they happened. There's three good things that you can write how you earned those three good things. Like for example, if I say, oh, Bear, my dog behaved well today. And my reason could be because I took a lot of time to train Bear. And that is useful for someone who may be having problems with self-confidence so we can add those little boosters in addition to the three good things. That also has been validated for decreasing depressive and anxiety features if you do it for a period of two weeks. And yet again, multiple weeks after you even discontinued doing it of relief of your symptoms. And again, it's not a cure-all, it's just something you can do that is just a healthy exercise for your brain. Almost how I can tell a patient, you know, oh, walking is healthy for you or movement is healthy for you. This is a form of brain exercise that's good for you because our brains are so attuned to being anxious and nervous in order to survive. And now that our worlds have become safer, we need to sort of retune them back to enjoy this and be happy and be optimistic. And something interesting that my behavioral specialist in my office said to me the other day is therapists call optimism a form of functional delusion, which is funny because optimism is a good thing, right? But yet it's a delusion. And the reason why it's a delusion is because validated scientific research separated folks into two categories. Those who were optimists and those who were more pessimists and they gave them scenarios, short-term, medium-term and long-term, and they tried to have them predict how the outcomes would happen in the world. And every single time the pessimists were more accurate in their predictions. The optimists were less accurate. So they were almost delusional in how they thought the future would go. But the optimists were healthier. They had a happier life during that time. They met more of their goals and they achieved more. So it's like maybe if you're pessimistic you might be more accurate, but then you're missing out on some of the positivity that is life. And that's where that balance comes into play that you can't always be optimistic and fully happy all the time. But you can also be pessimistic because it's going to take a toll on your body and mind so much so that you won't have the longevity and the joy that you would if you were somewhere in between. Any other personality trait typically associated with people leading happier, healthier lives apart from the things that people think of like optimism? Yes, this is really interesting. So we talked about gratitude, right? That's an important thing in order to have a healthy mindset. And there's some recent research that I've looked into about how there's something even more powerful than gratitude in terms of keeping happiness levels up and fighting off feelings of depression or hopelessness, especially during a time like the pandemic. And that's looking forward to the future, like not predicting the future, but being excited about the future. And it's something that I personally experienced and then when I was exploring it with my own psychologist that I've seen for myself throughout the pandemic, I realized that this is actually a new form of research. And I'll give you my personal example. My coping mechanism that has worked very well for me, doesn't work for everybody, was looking forward to the future. So if I had one month in an ICU that I was working and I was working seven days a week, six days a week, whatever it was, people say, how do you function? Aren't you sad? I wasn't because I knew after that month I was going to go play basketball. I was going to be with my friends and I would look forward to that. Or if I had a long hospital shift, I wouldn't be sad because I would say afterwards I'm going to go watch a movie or Netflix, whatever, or hang out there. So it would always be like thinking about the future to not feel sad about the present. And that was my coping mechanism. The pandemic took that away because the pandemic, there was no certainty. There was less social communication. There was less ability to go play basketball, especially in the beginning when we didn't know what was going on. And because of that, my coping mechanism was essentially taken away from me and I started suffering. That's why I needed to get help and I realized that. I started working with this therapist and she told me about some research that was being done testing whether gratitude or looking forward towards the future like I was doing as my coping mechanism was more powerful. They started doing this with war veterans. They started to see that war veterans who look towards the future actually had healthier levels of satisfaction in life and less feelings of hopelessness in comparison to those who use gratitude as their strategy. So that also is another area where, okay, if gratitude isn't working for you, the three good things isn't working for you. Try looking forward to the future and that may not always be possible with the circumstances, especially in the middle of a pandemic, but maybe there are small wins that you can have there. For example, in order for me to have something to look forward in the future, I bought a piano and I started, I want to learn how to play the piano or I bought a new game and a video game. And I was like, you know what? I want to play this video game. When I would be working a long shift, I would say, at least I can come home and play my video game. So it's about creating things and finding unique ways to look forward to the future. And again, there's no one way to do that. It's so individualized. That's why it's good to work with someone who is objective, like a mental health specialist or a primary care doctor, because they can not feel the emotions you're feeling, not be misguided by your emotional reasoning and actually just give you some objective data points or objective advice that you can use to help yourself. What do you think about looking forward to the future is particularly helpful? Do you think it comes along with aspect of hope or more like excitement or just another method of social support if you get a deal with people, if we really break it down? There's multiple variables there. You have the excitement that comes with the future, right? That things will be cool, things will be better because you don't know how it's going to be. And when you don't know how things will play out, but you're excited, there's like, it's almost like a form of optimism that you're excited about it. Next is the social connection that if you're excited to see your friends, not feeling as lonely as you might be in that moment. And then the final one that comes to my mind is distraction. If you're having pain and I start talking to you and distracting you, you might not feel that pain as much. So if your brain, oh man, I'm working this long shift and I'm tired and you keep saying that to yourself, you're going to feel worse. But if instead you're distracting yourself by getting excited about the future, you're changing your hormonal profile so you're working on that neuroendocrine system by like starting thinking about positive things. So you're getting excited about that. You're not feeling and thinking about the moment now, maybe tough to get through. And I think that sort of distraction probably, even though it's the less sexy one of all of them, is probably the one that's most effective. Yeah, I can confirm. I did research on the effects of distraction on pain perception and we found similar things. Oh really? Tell me about that. So essentially we gave people rewards to either focus on a distraction task or to not reward them as much. And then we would have them rate subjectively. They're pain perception when we would give them kind of like a hot kind of stimulus. Yeah. And of course they would rate the trials where they were rewarded more to focus on a distraction task as less painful that we shout out to. That almost reminds me of the ice water test, right? Yeah. You have people put their hand in ice water and you say supportive things to them, as opposed to like grill them or like heckle them. They'll spend way less time in the water. So like imagine like essentially, if you're in a tough day job, that's like your hand being in the water and you thinking of how bad it is, is you heckling yourself. As opposed to thinking about the future, is you basically saying supportive things to yourself. And I think that's where like you get a lot of the benefit. Right. For sure. I think we established very clearly to the audience as well that mental health and physical health are just inseparable. They're so closely related to, never hesitate hopefully to seek out for help to your GP first if needed. And so I'd like to just finish off by asking whether you have any pieces of advice for the Psych2Go community or the community at large. Psych2Go is I think an important point is if you do end up seeking help, there's a couple of things that can go wrong when it comes to mental health being tied to physical health. One is that your doctor or whoever you're seeing the provider might not take into account your mental health. And that's a failure on the medical system. And there's a second way it could fail, which can happen but is rare, which is where they blame a lot of the physical symptoms on the mental health side of things without fully doing an investigation of the physical health. Because it's very easy to have a patient who is battling with severe anxiety to come into a medical office because I've seen this happen and say, doctor, I'm having back pain and I'm really worried about it. Something's not right. My back is killing me. And for the doctor to write that off as a symptom of severe anxiety as opposed to investigating it thoroughly. What a good doctor does is take into consideration both factors, make sure that your doctors are doing both. They're ruling out physical manifestations, meaning they're doing a thorough history. They're doing a thorough physical exam. They're doing lab work or imaging as appropriate because if a patient comes and they're feeling down out of nowhere, nothing changes in their life, I should be ordering a thyroid test to see if there's something going on with their thyroid. I should be checking if they have an issue with anemia, like physical manifestations of that. And once those are ruled out, we can address the mental health stuff and then say that we suspect that it's due to that. We could also address the mental health stuff simultaneously, but you can't solely blame mental health until you rule out the physical health because unfortunately, we only have one physical body. And if you start ruling out chest pain as just, oh, it's just anxiety, that's the quickest way to have a patient have a serious heart attack and lose their life. We really need to be attuned that it's mind body, not body, not mind, and not get overly focused on one or the other. Thank you so much for your wonderful insight, for your time, and for sharing your thoughts to me and to the Psych2Go community. Yeah, thanks Monica. If anybody wants to watch, I have a few videos on mental health and trauma that expand upon all the stuff that we talk about on my channel. So go ahead and check that out. And as always, stay happy and healthy.