The Depression Cure in Action with Dr. Stephen Ilardi (Part Two)

Theresa Hubbard [00:00:00]:
Well, you said that the TLC addresses the modern depression epidemic at its source. The fact that human beings are not designed for the poorly nourished, sedentary, indoor sleep deprived, socially isolated, frenzied pace of 21st century life. Is there anything that you would add to that sentence today versus 16 years ago?

Dr. Stephen Ilardi [00:00:26]:
Oh, that's good. I like that question a lot. Yeah. So I mean, I guess, you know, in a broader sort of framing, that question is, could be interpreted as like, well, did you need a second edition of the book? So the first edition came out 16 years ago. What has changed? And to unpack that question. I love the question John Packet. I think the first part A for me is has the science changed on anything I recommended in the first edition? Was there something that we thought 16 years ago that was helpful, that now with better studies. This happens all the time in science, by the way, is like, oh, well, maybe high dose Omega-3 fats are not as antidepressant as we thought.

Dr. Stephen Ilardi [00:01:20]:
Turns out they are. Thankfully, it turns out everything that was part of the core set of recommendations 16 years ago has stood the test of time pretty well.

Walker Bird [00:01:35]:
My inner knowing empowering you to find your compass for the journey. We are dedicated to supporting you to rediscover and trust your natural ability to navigate life. Each day by sharing insight and experience through the lens of two professional communicators and their guests. We intend to prompt internal inquiry that supports all those willing to explore a unique path.

Dr. Stephen Ilardi [00:02:03]:
But there's some refinement and there are some new things that we've learned that I would say expand upon in different ways the principles that were laid out initially. So I wanted to make sure in the second edition to share with readers my take as a clinical researcher, as somebody who stays on top of this fast changing literature, where are we right now? And then what's actionable and what's reasonable among the things that are actionable? Because there's a pragmatic consideration here as well. When people are depressed, by definition, they don't have as much energy as they have. People are depressed by definition, they don't have as much mental bandwidth typically as they would have at their healthier baseline. And so any treatment program for depression has to be very thoughtful and intentional about like, well, what is achievable without being overwhelming or unrealistic or, you know, and so that's a really interesting sort of fine line or dialectic, you know, if I can use Marsha Linehan's work, between on the one hand, wanting to be, you know, to throw in the Kitchen sink, like, oh, well, here are all the possible things you could ever possibly try because, you know, depression is somewhat. God, I help me out here. I cannot get out of the. These fancy scientific word.

Dr. Stephen Ilardi [00:03:45]:
I'm going to just drop it and then you can give me a better one. Heterogeneous depression is a fancy way of saying there are a lot of different subtypes of depression. There are a lot of. Is there a better word for that? It's highly variable, I guess.

Theresa Hubbard [00:04:00]:
Yeah. I think people think depression is one thing. And I was like, oh, I think it's hundreds of things.

Dr. Stephen Ilardi [00:04:05]:
Yeah, yeah. It's not. Oh, I'm going to drop another fancy word. It's not monolithic. Right. It's not just like. And oh, and because of that there's no one size fits all. That's a huge point.

Dr. Stephen Ilardi [00:04:17]:
Right. There's no size fits all treatment.

Theresa Hubbard [00:04:22]:
Right.

Dr. Stephen Ilardi [00:04:23]:
And so my, the treatment approach that I call it mine, I probably should say ours because I had a lot of talented grad students that helped.

Theresa Hubbard [00:04:32]:
Sure.

Dr. Stephen Ilardi [00:04:32]:
Fine tuning the protocol. The program we developed, it's called Therapeutic Lifestyle Change or TLC. The book that describes this is called Depression Cure, which we can come back to because I hate the title, but it is what it is. So they know I hate it. But it's, it's a hope Walker back to a point you made earlier. I mean, it's a very hopeful title. Right? Yeah. And you know, so I think it serves its purpose that way.

Dr. Stephen Ilardi [00:05:12]:
That program, Therapeutic Lifestyle Change, is built around six core principles of modifiable lifestyle strategies. Modifiable habits that are part of our lifestyle that are not that hard to modify, but they can't all be done at once. So we have to kind of pick and choose. Like, all right, well, what's some low hanging fruit that just about anybody can do? On the other hand, probably nobody is going to respond equally to all six of them because depression is highly variable because there's no one size fits all approach. What I have discovered. So we've probably treated a couple hundred patients with therapeutic lifestyle change. Folks who come in with clinical depression and at the end of the program, I've always asked them systematically of the different lifestyle changes you've made, which did you personally feel were helpful or what were the most essential for you? Based knowing your own body, knowing your own mind and your response and it's all over the place.

Theresa Hubbard [00:06:37]:
Yeah.

Dr. Stephen Ilardi [00:06:38]:
I mean every single strategy that we include in the program was nominated by several patients. Like that was a thing. And every single strategy was also nominated as Yeah, I don't know if that really did anything. And that's fine, right? I mean, that's probably as it should be. Part of the beauty of having a lifestyle based approach, which by the way is an increasing emphasis in all of medicine. If you see a cardiologist, if they're a good cardiologist at the cutting edge, they're going to talk to you a lot about your lifestyle and your habits and your diet and your movement and your sleep and your stress management and all those things. They all matter a lot. But part of the beauty of a lifestyle medicine based approach to depression is it's like offering a smorgasbord.

Dr. Stephen Ilardi [00:07:35]:
And you know, if you, if you go through a line at a cafeteria, you know, smorgasbord, it's like you may sample lots of different dishes. You're not going to love all of them, you know, but hopefully a couple of them are. Oh, that's the thing, you know. And so I think that's a really important principle in all of treatment. But especially when we get into the realm of lifestyle based interventions, like we don't want to overwhelm, we want to take one thing at a time, build one habit at a time, understanding that your mileage may vary, you know, you may know people for whom this was a life changer and for you it might be less so, but there will be something that will be. And if you get all the way to the end of the program, you know, and you put everything in place. I've never known a patient to do that who didn't experience some really significant clinical improvement. But there are some conditions that could keep them from getting into full recovery.

Theresa Hubbard [00:08:43]:
Sure.

Dr. Stephen Ilardi [00:08:44]:
Then we need to, you know, problem solve and troubleshoot and think like, all right, well, you know, what else could be going on? Are there some other clinical strategies for depression or do we need to. Well, at that point we definitely need to get like a full medical workup because there are a lot of medical conditions like sleep apnea or hypothyroidism or, you know, million things that if they're undiagnosed, like we're never going to be able to get somebody all the way into full recovery.

Theresa Hubbard [00:09:09]:
Right.

Dr. Stephen Ilardi [00:09:09]:
Until we get to the bottom of that. Likewise, there are some psychiatric comorbidities or co occurring conditions like post traumatic stress disorder. If it's, you know, active and the person's, you know, their sleep is being disrupted every night because they're waking up with traumatic nightmares. And you know, it's going to be very hard to get them into full remission until we then address that. So notice that this is a very. It's the opposite of most things that are promoted on social media. Most things that go viral which are like, oh, here's this one weird trick that will cure your, you know. No, there's no one life hack.

Walker Bird [00:09:50]:
Yeah.

Dr. Stephen Ilardi [00:09:51]:
One life hack that's going to cure everybody's depression. And yet if we're willing to stay at it with intellectual humility and open curiosity and treat it almost a little bit like a detective, you know, regimen, like we're medical detectives, but I understand he was like a medical forensic detective, you know, to have that sort of mentality of like, ah, you know, there are going to be some cases that are really hard, really tricky.

Theresa Hubbard [00:10:24]:
Yeah, absolutely. Yeah. I talk about it as we're experimenting. That's what I talk to clients about. Like we're practice. We're experimenting and practicing. Like this is what it is.

Dr. Stephen Ilardi [00:10:36]:
Yeah, always. Yeah. And, and I don't know, I mean, I, I find that maybe it's just a principle of human nature that we don't like. Uncertainty makes us, I mean, in fact, this is a really robust finding. He makes us anxious. Uncertainty makes us anxious.

Theresa Hubbard [00:11:00]:
Yeah.

Dr. Stephen Ilardi [00:11:01]:
People with generalized anxiety disorder cannot tolerate uncertainty at all. I mean, that's like, you can take that to the bank practically. So, I mean, all of us would rather be certain than uncertain. And so I don't. In the first session with people, I don't know how you deal with this, Teresa, but I don't introduce all that complexity at the outset. Here's a bunch of evidence based strategies that really, really strong research support. And if they happen to be one of the unlucky folks, that's not going to get them all the way there, then, you know, we start introducing more nuance and more, you know, more, more of that. It's like, okay, no, we're good.

Dr. Stephen Ilardi [00:11:51]:
We still got this. But now we'll. We're going to need to, we're going to need to pull out all the stops.

Theresa Hubbard [00:11:59]:
Yeah.

Dr. Stephen Ilardi [00:12:00]:
Even have a chapter in my book at the end that's just all about troubleshooting.

Theresa Hubbard [00:12:06]:
Nice.

Dr. Stephen Ilardi [00:12:07]:
But I save it for the end, you know? Yeah, right. I'm like, all right, if you've done all this and I, I recommend up front, like many people find, not everyone, but many people find that putting these strategies into place will really go a lot better with the assistance of a trained professional. Sometimes it's going to be absolutely essential. It can be an adjuvant, it can be, you know, something to enrich an ongoing therapy or, you know, maybe just find a therapist who's willing to coach, coach you through and support you through these changes. Because when we're depressed, we need a lot of coaching often and support and encouragement. And, and so if they get through it and they get to chapter 11, not the bankruptcy, but they get to chapter 11 of the book and they're still, you know, feeling like I solve a lot of prominent symptoms. Then it's like, all right, well let's look at all the other possible things that could be going on and you know, many other things to try and, you know, so now going back, if I can circle back, I think I can, to the last question I think that was on the table, which is like, why write the second edition? You know, what's changed scientifically in the last 16 years? Yeah, most of the things from the first edition have held up really nicely, but we've learned a thing or two. So what have we learned? Well, the gut brain, gut brain microb axis we've learned is massively important, that we have trillions of microbes that live in our bodies, most of them in the gut.

Dr. Stephen Ilardi [00:13:53]:
And they really, they're very good at hacking into our brains and messing with our brains, for better or for worse. Some of them are very friendly and symbiotic. They want us to thrive so they can thrive. And you know, they want us to be social so they can spread their progeny to our friends and family members. They want us hanging out with others. You know, it's a win win. You know, that's what symbiotic species are all about, right? It's like, oh, it's a win win. It's a collaborative.

Dr. Stephen Ilardi [00:14:22]:
We give them a nice home. They, you know, they extract nutrients from our food, they enhance our immune function and then they hack in the brain through like five different pathways that we know of so far. A big one is the so called vagus nerve, which probably listeners know about. That's highway connecting the gut to the brain. Direct broadband connection from the gut to the brain that they can hack into and give us more of a feeling of relaxation and turn down our stress response, basically. So the friendly microbes are great at that, but we have a lot of bad actor microbes that we've picked up along the way. So that's all new science. We didn't know any of that or it wasn't mainstream at all.

Dr. Stephen Ilardi [00:15:10]:
So absolutely had to address that, had to address mindfulness, which I did address in passing a page or two in the first edition. But you know, I just said, look, the originators of mindfulness based cognitive therapy for depression said that when people are depressed it's very hard for them to do mindfulness training. And so they only train people in this protocol once they're recovered. Meant to be a, a relapse prevention, so a protective strategy. And in the interim we now have learned no, in fact, if you're clever about it, you can learn mindfulness while you're depressed.

Theresa Hubbard [00:16:00]:
Right.

Dr. Stephen Ilardi [00:16:01]:
And so I really wanted to make sure to acknowledge that. And then so in the chapter on how to stop ruminating, how to stop brooding on negative thoughts, which is a very toxic process in depression, I wanted to expand someone, well, you know, mindfulness is a phenomenal anti-rumination. So I wanted to really bring that out in the chapter on fish oil and omega 3 fats. And you know what to do with that and why it's important. Well, because they're anti inflammatory and we have, most Americans have way too much inflammation using their brains. It's a sort of overdrive of a type of our immune response that's way too active. And so the immune system is kind of sort of attacking our body now instead of microbes. And in the first edition I said the best evidence suggests there are two omega 3 fats that are antidepressant.

Dr. Stephen Ilardi [00:17:08]:
And I don't want to get too deep in the weeds, but one's called EPA, one's called DHA. And if we have a piece of wild ocean caught salmon, it'll have both in abundance. And the best research said, well, when you get an antidepressant response with fish oil, it usually has EPA and DHA, usually in about a two to one ratio. And we know that the dose, the antidepressant dose of EPA, which we already knew was the more potent dose is about 1001-2000 milligrams a day, which if you have a pretty refined fish oil capsule that might be two or three capsules could be up to five or six depending. And they were usually like in a two to one ratio, two to one EPA to DHA. So I, I recommended in, in the first edition, like get that two to one or close anywhere around that. And now we've since learned like for depression at least the ball game is EPA and the DHA really just doesn't seem worrying about.

Theresa Hubbard [00:18:20]:
Yeah.

Dr. Stephen Ilardi [00:18:21]:
And so I wanted to be sure to talk about that. And then another cool discovery is when you eat a piece of fish or like wild venison or any Wild game has Omega 3 EPA, it's in a form that's known as triglyceride form. And we all probably have heard of triglycerides as a type of fat or lipid. And we think of triglycerides as a bad thing because we don't want to have too much that can be linked to heart disease risk. But that's the way all fats get shuttled around in the body. EPA is a fatty acid, free fatty acid. If it's just unlinked to this shuttle of triglyceride or some other shuttle, it gets immediately turned rancid, basically in our blood. The technical term is it's oxidized.

Theresa Hubbard [00:19:21]:
Okay.

Dr. Stephen Ilardi [00:19:22]:
Which not only neutralizes it from being helpful to us as an antidepressant, anti inflammatory molecule, but it actually now is potentially a little bit toxic. Fascinating. And okay, now get this. The cheapest way to make a concentrated fish oil capsule with a lot of EPA is to strip it away from the triglyceride form. Technically there's a little molecule called glycerol that's like a backbone that has three little docking stations. And we like use a solvent, chemical salt, hopefully non toxic chemical solvent. And now we've just got the free fatty acid, the EPA. And we're doing this under nitrogen so it doesn't go rancid.

Dr. Stephen Ilardi [00:20:09]:
Right. So it's all, you know, hermetically sealed off under nitrogen. What they used to do when I wrote the first edition of the book is now bring in an alcohol ethyl and that would be the backbone. So it would be. Technically it's called an ethyl ester, which is a fancy way of saying you got this alcohol docking station that has five compartments instead of three. So it can carry five EPA molecules around the body. Okay, well that's great, except the problem is your cells can't use it. They don't know what to do with the ethyl.

Dr. Stephen Ilardi [00:20:51]:
And a lot of it really needs to get processed in the liver. Some of it can be processed in other cells in the body, but basically it's way less bioavailable. And a lot of it leaves the gut in free fatty acid form where it's going to be turned, it's going to be oxidized or turned, rancid or unavailable. Bad news, right? So what we've learned is we want to get the fish oil in triglyceride form, which is the same form that we'd get in our piece of salmon steak. And now there are lots of different fish oil supplements that deliver it in triglyceride form and they Will say triglyceride form.

Theresa Hubbard [00:21:34]:
Oh, okay.

Dr. Stephen Ilardi [00:21:35]:
And so I really wanted to get that information then there are probably 10 other kind of fine tuning things like that that are actually pretty important.

Theresa Hubbard [00:21:46]:
Okay.

Dr. Stephen Ilardi [00:21:48]:
That I wanted to be sure to talk about. You know, I needed to talk about social media, which was a thing back in, I mean it was around in 2009, but smartphones had just kind of started to have widespread acceptance. So I didn't really spend a lot of time on smartphone addiction early on. Needed to talk about that social media talk, toxic screen addiction, you know, so many different things that, I mean, we think back to 2009. In some ways it feels like it was a different world.

Theresa Hubbard [00:22:20]:
Yes.

Walker Bird [00:22:22]:
It's funny to think about that because it doesn't seem that long ago to me.

Theresa Hubbard [00:22:26]:
Correct.

Dr. Stephen Ilardi [00:22:27]:
It really doesn't. But I don't know. There's a time capsule TV show that we kind of like called Big Bang Theory and we hadn't seen it for 12 years, 14 years. And it's on a streamer that we have. So I was like, you know what? It's been. That series dropped in 2006, I believe, 2007. So 18 years ago. I was like, let's, let's go back and watch season one, which we thoroughly enjoyed.

Dr. Stephen Ilardi [00:23:00]:
But it was just like the world has changed so much. It was crazy how much things had changed. But it was really helpful for me to just see it vividly. It's like I remember watching these episodes and these were a bunch of tech geeks who were like ahead of the curve. These were super early adopters. And it still seems so primitive.

Theresa Hubbard [00:23:23]:
Yeah.

Dr. Stephen Ilardi [00:23:24]:
And life seems so much more innocent and charming. People were so much more living irl, you know, as a kid would say in real life, irl.

Walker Bird [00:23:37]:
Well, thanks. I'm like, what?

Dr. Stephen Ilardi [00:23:40]:
Talking to somebody. I live my life among Gen Z, you know. Yeah, sure. As a survival strategy, I really learn Gen Z. I try to be bilingual there, you know. That's great. Relentlessly they mock me, I mean lovingly. But they're just like, yeah, you're not cool enough to use irl.

Walker Bird [00:24:02]:
Steve, do you see those factors as, I mean, is that what you see as this continued increase in depression and you said, especially in our younger population. Is this what we're talking about? That, that social media, smartphone, you know, the rise of all that and now AI on top of the rest?

Dr. Stephen Ilardi [00:24:22]:
Yeah. And that that's a newer threat or a newer, you know, largely a threat. But, but I, I think it, I don't want to come across as a Luddite. I mean I use AI. I use AI every day for the record, I want to be honest about that. I, I think it has like so many great technologies. It has incredible promise and credible peril. Yes.

Dr. Stephen Ilardi [00:24:47]:
Depending on how it's used to your question. Yeah, Gen Z has by far the highest rate of mental illness we've ever seen. Young cohort. But I mean it's not even close. Second and I mean it's absolutely staggering out of clinical anxiety in various manifestations ranging from panic disorder to social anxiety disorder to generalized anxiety disorder to adjacent disorders like post traumatic stress disorder, ocd. I mean we see specific phobias, we see a lot clinical depression for sure. Various addictions, various eating disorders which seem to be on the rise again after again thing in prevalence for a while. But yeah, I think it's, I think it's three things.

Dr. Stephen Ilardi [00:25:43]:
One, I think just in general their lives are far more sedentary, indoor, socially isolated. I mean in terms of face to face interaction and we have really good data on this. I mean they, they spend, high school seniors spend half the amount of time each week based on general surveys as seniors did a generation ago, half as much and you know, it's, it's tragic. So, so their lifestyle is degrading in terms of kinds of things that could improve mental health. Now when I teach our used to be called abnormal psychology class, probably a lot of listeners took it as abnormal psych. Now we call it psychological disorders which is a little more descriptive. But when I teach that class students invariably walk into the class thinking oh these are all chemical imbalances. And they, and by the way, you know, probably a third of them have been on medications since they were right or earlier like and, or more and they're like well you know, I have a chemical imbalance so I just need to get on the right chemical cocktail.

Dr. Stephen Ilardi [00:27:05]:
And again I try to make it very clear I'm not anti medication but we just need to be realistic about what these meds do and don't do. The meds which are not as effective as we need them to be. Right, right. And so I have to kind of gently bring them along into this sort of reorientation to the idea that you know, first of all chemical imbalance is a wildly over simplistic way of framing things because it's not like oh your brain doesn't have enough serotonin and you take this effects or, and all of a sudden you're gonna, it's like no, nothing, doesn't work anything like that, nothing works. But you know, do these medications affect the signal strength of the circuits in the brain that use serotonin? Yes, sometimes. Can that be useful for some of these symptoms? Yes, sometimes. Does that mean, you know, that's the main driver of your anxiety or depression? No, absolutely not. Sometimes.

Dr. Stephen Ilardi [00:28:10]:
But most of the time, it turns out with clinical depression, those are distal effects of more proximal, more central processes like the brain's runaway stress response that will not shut off and the brain's illness response to chronic inflammation that says, oh, we are sick right now. So if I have the flu and I've got my brain goes into illness mode because of inflammation, inflammatory hormones across the brain, Do I have a chemical imbalance that helps you? Right. But not really. I mean, I'm having an illness response and brain circuits are saying, shut down and withdraw so you don't infect the people that you care about and so that you can have time, give your body time to recover. And the person who's clinically depressed, their brain's telling them to the exact same thing often because not not every case, but in at least half of cases, because the brain says, oh, we're in sickness mode. We need to shut down and withdraw. And I have to, you know, when I'm talking to patients, I have to say, I have to validate. Yeah, that is what your brain is telling you.

Dr. Stephen Ilardi [00:29:28]:
So, yes, you really, really do have a strong feeling that you're going to be infecting the people around you with your negativity, your sadness, your, you know, whatever. And you really do feel like crawling into a hole and pulling the shades. And, you know, but that's a false signal because that's your brain's sickness response that you should have when you have Covid that you should have when you have the flu, but you don't have those things and your brain is right now. So let you back out into the world of other people and activities that we're designed to be engaged with. And, you know, so I'm trying to re socialize students, and it takes me about a month usually, you know, and think about the needle that I'm trying to thread here, which I think is like anything, any concept that's worthwhile. It's not all or nothing. And one of the very first lessons I teach them is we have to resist the lure of all or nothing black and white dichotomous thinking, which gives us great emotional comfort, make our world very black and white and very simple comforting if we're not very bright. It makes life easier, you know, they're all bright, you know, so I don't have to worry about that.

Dr. Stephen Ilardi [00:30:59]:
But, but I mean, truly, the, the, the more intellectual bandwidth we have, the more capacity we have for very easily seeing the shades of gray. But in many cases, that doesn't matter because it's so emotionally appealing to think in black and white terms. So some of the smartest people I know are really stupid when it comes to just seeing the world in very polarized black and white terms because of the emotional comfort that gives them. Right. And students are. They're kind of like, oh, actually that's pretty cool. That actually, yeah, I see that they could see it more easily in the people around themselves.

Walker Bird [00:31:43]:
As they are.

Dr. Stephen Ilardi [00:31:48]:
But, you know, so we keep coming back to that. It's like we don't, you know, we don't want to be thinking about anything in black and white terms or almost anything. And so it's like, all right. Does depression involve problems with brain function?

Theresa Hubbard [00:32:05]:
Yes.

Dr. Stephen Ilardi [00:32:08]:
Is that all that's going on? No, not by a long shot. Because depression also involves the sort of negative thinking. We're talking about rumination. And these things interact because the more we ruminate, the more it ramps up the brain's stress response and the more it amplifies our negative emotions, which ramps up our feeling of emotional pain, which ramps up inflammation, which pushes us into shutdown mode. So it's like, okay, these things are all interconnected. And it turns out that you can affirm that depression entails some neurochemical imbalances, and that doesn't tell us anything about the most effective way of treating it.

Walker Bird [00:32:57]:
Tell us more about that.

Dr. Stephen Ilardi [00:32:58]:
Well, okay, and these are maybe some deep waters, but I think it's worth going again. Ah. Most people, intuitively, in most cultures, most times and places, most people have intuitively been what we would call mind body dualists. Meaning intuitively, it feels to all of us on the inside like, there's our body. And yes, we have a brain, it's in our body. But then we have a mind, the real us that possesses our body and inhabits our body and controls our body, but is not in any meaningful way co resonant with the body. I mean, in a full neuroscientific sense, neuroscience says the mind is what the brain does. Neuroscience says the mind and brain are flip sides of a single unitary underlying reality.

Dr. Stephen Ilardi [00:34:01]:
They're different levels of experience and analysis, but that the mind emerges from or is, you know, basically the software, ish software, running on the platform of our neural architecture. And our. Our thoughts are the Internal, subjective experience of a brain, the thought running our mind. And so, you know, if we are willing to let go of radical mind body dualism, the idea that nothing that affect, nothing that's happening in our brain truly affects our mind, or if it does, the way a lot of people who bought into the chemical imbalance framing heavily promoted by our drug companies, I just have to put out there, heavily promoted by our drug companies, they love the idea of chemical imbalance. Why? Because when patients hear, oh, you have a chemical imbalance, and they're like, okay, well, I'm still a mind body dualist, but I can accept that my brain is part of my body. And if there's a chemical imbalance in my brain, that can affect me. And there are off the shelf analogies like, oh, when I'm drunk or tipsy, that's something that I ingested. It affects my brain and it affects my subjective experience, my mind, my emotion, my perceptions.

Dr. Stephen Ilardi [00:35:22]:
So I get the idea that something could affect my brain and that could affect my mind, but it's. It's this one off sort of edge case. It's not central to who I am. And so patients often get really excited about the chemical imbalance frame because they're like, oh, well, it's like diabetes, you know, I just don't have enough insulin. So if I have a chemical imbalance, oh, I have anxiety, I have depression, I just don't have enough serious serotonin. I'll take this pill, It'll give me serotonin. It doesn't. But take this pill, get the serotonin that my brain needs.

Dr. Stephen Ilardi [00:35:58]:
Just like an insulin pill would help a diabetic, this is going to help my anxiety. No harm, no foul. And. But if we are neuroscientifically informed, we're like, oh, the mind and brain are flip sides of the same reality. The mind is what the brain, brain does. Then anything. Oh, this is good. Okay, I'm gonna.

Dr. Stephen Ilardi [00:36:18]:
I wish I had a drum roll. I don't know if you can add it.

Theresa Hubbard [00:36:22]:
We will add one. We'll figure that out.

Dr. Stephen Ilardi [00:36:25]:
Anything. Anything that changes my thoughts is changing my brain.

Walker Bird [00:36:33]:
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Walker Bird [00:37:13]:
Thank you.

Dr. Stephen Ilardi [00:37:16]:
Yeah.

Theresa Hubbard [00:37:16]:
Okay.

Walker Bird [00:37:17]:
I thought that was pretty good.

Theresa Hubbard [00:37:18]:
Okay, sounds good.

Dr. Stephen Ilardi [00:37:19]:
Okay, check, check. Like, literally our brain is changing during this conversation. We're growing new synaptic connections, right? And lots of other changes as well. I mean, changes even, but. Oh. And then any, anything that changes. The brain has the potential to change our emotions and our, and our feelings. So everything we do with our bodies, you know, our level of physical activity, it turns out physical exercise is profoundly neurotrophic, profoundly neuroactive, changes our brain, signaling our brain chemistry in ways that are broader than any currently marketed psychiatric medication.

Theresa Hubbard [00:38:12]:
Wow.

Dr. Stephen Ilardi [00:38:15]:
Our diet, I mean, and it makes, it should feel obvious to most of us. We think about it, it's like, well, our brain is made out of the stuff we eat ultimately, right? Every molecule in our brain pretty much came from our diet at one point. So obviously what the nutrients we get or don't get in our diet is going to affect our brain function, our sleep. What happens when we sleep? Well, we detox the brain. We get, you know, and we recharge it. So we replenish all the wrong. It's like a pit stop, you know, for. I know there was a movie, F1, I haven't seen it yet, but out in IMAX, you know, Formula One racing cars, like, they come in, stop, and it's like, oh, we got to refuel, we got to change the tires, we gotta like, you know, like our brain is like this high performance Formula one car.

Theresa Hubbard [00:39:05]:
Yeah.

Dr. Stephen Ilardi [00:39:05]:
And you know, we go in for this seven, eight hour pit stop at night and if we don't get it, like, we cannot expect that Formula one, you know, that highly precision to high performance machine to keep operating at that same level. So what I tell my students, same thing I tell my patients, is, look, there are literally hundreds of ways that we can affect so called brain chemistry or brain function. And most of them have nothing to do with medication. And that's profound. I mean, even as simple as this, we have specialized photoreceptors, light receptors, the back of the eye in the retina of the eye. And they have a broadband connection to the body in the midbrain. It's called the sscn, Superchiasmic nucleus in the hypothalamus of the brain. It's our body clock and it has downstream projections to the Circuits that regulate our sleep and the circuits that regulate our activity level and our arousal level and our energy level.

Dr. Stephen Ilardi [00:40:11]:
So just by getting natural sunlight, which turns out depending on the day to be 100, 500 times brighter than indoor artificial lighting, by getting natural sunlight, we're not only resetting our body clock so we get more reliable, better sleep, but we're also getting a dopamine based stimulant effect as if we were taking a mild stimulant. And a lot of people with attention deficit problems find if they exercise outdoors in the morning because exercise has a lot of similar dopamine based effects, then they get a double whammy and it's like a mild stimulant dose for their productivity and their focus. Four to six hours, maybe it's not going to give them the same sort of boost as like a high dose of Adderall, but it's, you know, it's going to be noticeable.

Theresa Hubbard [00:41:11]:
Yeah. Yeah.

Dr. Stephen Ilardi [00:41:13]:
So I don't know. Walker, did I get. Get to your question?

Walker Bird [00:41:15]:
You did, thank you.

Dr. Stephen Ilardi [00:41:16]:
Yeah. Any, any follow up, Counselor?

Walker Bird [00:41:20]:
No, I actually, I do have another follow up if you've got a hot one. The, the brain's illness response that you mentioned. Yeah, I have autoimmune issues myself and so I'm working with a functional medicine doctor and doing a lot of different things right now that I'm going through. But the brain's illness response was something that really clicked with me when you said that. And it struck me as you were talking that it sounds like the illness response is the culmination of a multitude of factors. Like you move down that road and then the illness response kicks in. At first when you said it, I thought, oh, it's just one of many brain responses, responses that come along. And that may be true as well.

Dr. Stephen Ilardi [00:42:05]:
Well, yeah, no, it's a great. Oh, I'm sorry, did you.

Walker Bird [00:42:08]:
That's really an observation. But I guess the question is, is through the, the six steps of, or six options, however you want to say it, of the TLC protocol.

Dr. Stephen Ilardi [00:42:20]:
There are.

Walker Bird [00:42:20]:
I'm assuming, ways to address that illness response because it struck me I could be in a loop of illness response and maybe many of our viewers are as well. And so, you know, I'm wondering how your protocol fits in with, hey, how do we get that thing to turn off and keep it off as often as possible.

Dr. Stephen Ilardi [00:42:39]:
Right, Absolutely. Yeah. So a lot of that illness response, it turns out, and you may have heard this before, but when we have a viral infection, especially a lot of the symptoms that feel so crappy are not the virus or even the damage that the virus is doing in the short term. It's our body's immune system ramping up to try to get the virus under control. And so there are all these hormones, inflammatory hormones that are released to coordinate all kinds of functions. Some are tissue repair, so like if we sprain an ankle, it's going to swell up and be all inflamed. Right. Some are antimicrobial, so, you know, killing invaders, including viruses.

Dr. Stephen Ilardi [00:43:36]:
But some of it is actually overshoot where it's just like it's way too much. Right. And that's what we think of as autoimmune illness where it's so much that the immune system system is so ramped up and on edge that it's just like, well, we're just going to attack anything in the neighborhood, you know, even if it's our own tissues. Oh, yes. And when people have high levels of inflammatory hormones, they're, they're, I mean, technical term is cytokines, which are used by the immune system. Many of them cross into the brain and some of them originate in the brain. We now know that wasn't known for a long time. The brain has sort of its own native immune cells and its own lymphatic system.

Dr. Stephen Ilardi [00:44:23]:
And that, that's a pretty recent discovery actually. But, but they can cross the blood brain barrier. So if they're circulating out in our body, those inflammatory hormones can go into the brain and they're picked up by circuits that mediate our illness response. And some of them actually are modulated by circuits that use serotonin. So there is a connection. I mean, most of the serotonin in the body is found in our gut, not in our brain. But 10% is in the brain. There is a connection.

Dr. Stephen Ilardi [00:45:04]:
Sometimes people with chronic illness take an SSRI or snritenergic drug and they'll experience some uplift in their sense of, well, being, some tamping down of that sickness response. But it, you know, your question was a really sophisticated one. It's like, well, is that the ultimate downstream effect of these other processes that we talked about? Like maybe sleep gets messed up because we're not getting enough, you know, sunlight exposure in our body clock. That happens to a lot of us in the winter, by the way. You know, when the days are cold and short and we, you know, go to work in the dark and get home in the dark. And so we don't get that reset body clock drifts or the runaway stress response. So we have all these Stress hormones like cortisol, Right? Well, cortisol is a steroid. Steroids should be anti inflammatory.

Dr. Stephen Ilardi [00:46:04]:
And it turns out, yeah, in the short term, cortisol is anti inflammatory. Fantastic. So stress response should be helpful if we have a lot of inflammation. In the short term, maybe in the long term. No, the opposite. In the long term, if somebody is stressed out a lot, they have a lot of cortisol, the receptors for cortisol disappear. And so now, I mean we have cortisol every day, all of us, you know, we have a little bit and we get a surge in the morning that helps us wake up quickly and you know, prepare for the day. If we're a night owl, we get a second big surge in the late afternoon, early evening gives us the energy to not fall asleep, you know, five o' clock or six or whatever.

Dr. Stephen Ilardi [00:46:51]:
But if we have cortisol at elevated levels for months and months, our cortisol receptors disappear and that's hugely inflammatory. So we've desensitized to our own cortisol. So in the net downstream effect, as you predicted, is inflammation. And that can be related of course to autoimmune illness. And that is a subset of all depression, it turns out. Just so I don't overly confuse or confuse any more than I already have, listeners or viewers only. About half of all depressed patients, clinically depressed patients, have really high levels of inflammation. Inflammation.

Dr. Stephen Ilardi [00:47:41]:
And that half are going to be preferentially response responsive to anti inflammatory lifestyle factors or other anti inflammatory interventions. You know. So what are those in our protocol? Well, we've talked about omega 3 fats and EPA, the most anti inflammatory. The most. That's basically the molecular version of Omega 3, that's like a drug. And a thousand milligrams of EPA is anti inflammatory, is basically like a research based antidepressant dose. But some people need 2000, some people need 2000 because they have a lot of inflammation or they just don't absorb it well or I mean there are a lot of reasons why, why they might need more. And by the way, I didn't give the disclaimer.

Dr. Stephen Ilardi [00:48:35]:
I'm not giving medical advice, I'm for everybody. Talk to your healthcare provider. This is educational, not, you know, please.

Walker Bird [00:48:43]:
Don'T say doctor alert your 100% biased opinion.

Theresa Hubbard [00:48:46]:
All right?

Dr. Stephen Ilardi [00:48:48]:
Right.

Walker Bird [00:48:50]:
No, we understand.

Dr. Stephen Ilardi [00:48:52]:
So I would say the Omega 3 is the most obviously anti inflammatory and it's the lowest hanging fruit right in our program. And interestingly enough, if you look at the antidepressant effect of our current antidepressant drugs. The gold standard is you do a randomized trial where patients are randomly assigned to get either placebo, sugar, pill, medically inert. You know, it's not even sugar pit, blank gels and capsule, or the drug, you know, the ssri, the sri. It's not a very big effect. Now placebo is a reasonably large effect because people, you know, when they take a placebo, if they think it's a real drug, which they usually do, if they're in one of these double blind trials, Everybody, not everybody, 75, 80% of patients assume they're getting the real drug. So they're taking this, the blank gel cap, they think it's a real drug. And that addresses their hopelessness, that addresses their helplessness.

Dr. Stephen Ilardi [00:49:55]:
Like, oh, I take pills and they make me feel better. You know, that's a pretty big effect. So if you take a placebo, it's way better than doing nothing. On average, you do nothing. Depression over three months, you do nothing. Time will heal most depressions, but three months is not long enough for time depressions. It's a very small average improvement. Take a placebo and you think it's a drug.

Dr. Stephen Ilardi [00:50:24]:
You know, you might get like a 30% reduction in symptom severity over typical treatment windows. Two or three months. So if you take the antidepressant, you might get like another 10, 15% percent boost. But the delta, the difference between on average. Now again, individual results can and do vary, but the average patient, we have a depression severity rating scale that we use in clinical research called the Hamilton Rating Scale for depression. And it goes all the way up to 55 points. That's, you know, if somebody just maxes out every single possible symptom. 10 typical patient who's clinically depressed in a treatment trial is going to be like around 20.

Dr. Stephen Ilardi [00:51:13]:
Hamilton score of 20. If somebody's 20, they're clinically depressed, it might be a little higher. They could go up to 30, maybe 35. At the end of treatment, the placebo group might go from 20 to 12 or 20 to 13. The antidepressant group might go from 20 to 11. Know like a point or is on average it's two point difference, right? Two points. That's not much. No, that's not much at all.

Dr. Stephen Ilardi [00:51:45]:
So we put that in the standardized units called effect size and the, the standardized unit is 0.3. Those who are taking stats, that's 0.3 10 of a standard EVA between the average of both groups with high dose EPA. Now, big caveat, big disclaimer. There are over 500 randomized antidepressant trials. I've just given average for those 500. Right, right. In a type of analysis called a meta analysis. When you do the meta, we throw everything together and you adjust for how big was the sample, yada yada.

Dr. Stephen Ilardi [00:52:26]:
If you do the same thing for high dose EPA for depression placebo control, it's usually more in the realm of like 0.5 or even higher if they use really quality. So it's at least as high. How about that? At least as high. And of all the lifestyle based changes that we ask people to make, this is the easiest because it's like 10 seconds a day once you have right exercise. And I'm talking like brisk walking to get heart rate up, you know, into the aerobic range. So like you're breathing kind of heavy, you might be perspiring a bit. It's challenging to carry on a conversation. More challenging wouldn't be able to sing with good breath control.

Dr. Stephen Ilardi [00:53:20]:
If you're walking to the point of aerobic, just brisk, it's like you mean it like you're late for a plane or something. 30 minutes in the aerobic range three times a week. So think like 5 to 10 minutes of warmup to get your heart rate up that high. So say like we'll say 35, 40 minutes three times a week. Now we're talking about an effect size, size that is probably more like 0.6 or 0.8, so higher. Remember antidepressant 0.3. So you know, and why? Well one reason is it addresses more things. It's anti inflammatory and it turns down our stress circuits and it helps with our brain's energy utilization.

Dr. Stephen Ilardi [00:54:17]:
It will actually help us grow new mitochondria in the brain cells. It'll help with the deepest, most restorative phase of sleep which we call slow wave sleep or delta wave. It's a deep, if you have a, like a smartwatch or something that tracks your sleep, it'll be when it says deep sleep. So you know, there are a lot of things that we can lean into that are just simple modifiable lifestyle habits that can really help now with an autoimmune illness that's taken it to a whole different level. And you know, I know more than I ever wanted to know about this because my daughter illness and she was, well that we know of since she was 14, she's now 28. And you know, it's been a really challenging journey and one where you know, and she's a clinician, she's all about lifestyle medicine and you Know, she's really leaned into it and you look at her and you just think, just like I look at you, you know, and think, oh, well, she's thriving, she's healthy, she's, you know, and she is. But like, it wouldn't be the sort of thing like, oh, just do Dr. Ilardi's TLC program and it's going to cure your lupus, it's going to cure your mixed connective tissue disorder or your, you know, because, no, you know, there are a lot bigger guns, you know, and again, I'm not anti medication.

Dr. Stephen Ilardi [00:55:57]:
I'm not, you know, I'm anti suffering, I'm anti illness. I'm like, yeah, I love that.

Walker Bird [00:56:04]:
Thank you.

Dr. Stephen Ilardi [00:56:06]:
Whatever. We could possibly use that. Though I will say that I think 21st century American medicine is way too dismissive of the power of lifestyle based in the vet and too eager reach for a prescription pad. And to be too reliant on that and not to, not to give us as patients the credit, just, you know, the respect to, you know, shoot straight with us about, like, what are the limitations of it? You know, what are the downside risks? What are the side effects? What else? What else you got? What else is there? Right? And I think a lot of times patients are just never told.

Theresa Hubbard [00:56:52]:
Yeah. There are two things that I had written down, And I know, Dr. Ilardi, that we are set to end in four minutes.

Dr. Stephen Ilardi [00:57:00]:
Can you believe it? No. But yes, I think we've got our.

Walker Bird [00:57:06]:
Conversations with our guests, so this has been great.

Dr. Stephen Ilardi [00:57:09]:
Anyway.

Theresa Hubbard [00:57:09]:
I know.

Walker Bird [00:57:10]:
Get to it.

Theresa Hubbard [00:57:10]:
I know, I know. We didn't get through hardly any of the questions we had. What recommendation do you have for people whose healthcare providers. Maybe they aren't saying don't do the steps in the depression cure book, but they're not. Oh, maybe they're more dismissive or uninformed. What do you imagine would be helpful for someone to say to their doctor?

Dr. Stephen Ilardi [00:57:47]:
Yeah, I think, well, the biggest thing that I've run into again and again, I'll give you two things, actually, but the biggest is people who fail to take seriously the fact that depression usually profoundly lowers our ability to initiate things. So when we're depressed, we very often know what to do or what could be helpful, or we have an intention to do something that seems like it could be helpful, but we don't have those. The circuits of the brain in the left prefrontal cortex that are going to give us that. That spark of initiative to act. It just doesn't happen. And so the person will sit and they'll be with their phone or they're on the couch or, you know, doing whatever. And they're like, oh, I heard that Dr. Lardi guy talk about, like, oh, brisk walk outside, like that.

Dr. Stephen Ilardi [00:58:45]:
You know, I could do that. I could get out in nature. I could, you know, but they just can't make it happen. So with our patients, we went into the program. In fact, I had colleagues tell me, like, oh, yeah, great idea. But, like, these are all the things you can't do when you're depressed, so it's not going to work. Work. I said, well, no, these are things you can't initiate easily when you're depressed, but if you have somebody to partner with you, right? And, you know, and provide that spark of initiative and that encouragement and that, you know, that little impetus and.

Dr. Stephen Ilardi [00:59:25]:
And now that could even be a smartphone app willing to, you know, use their app that way. Like, oh, I just got the notification. Like, yeah, okay, I can get up and put my tennis shoes on, whatever. So I think it's really important for providers to understand you cannot just hand your patient a list of like, oh, start doing these six things on your. Every one of our patients, for example, we connected with a personal trainer, and these were volunteers, by the way, because we didn't have a big federal grant for this. We were flying, lean and mean. We had no money. These were students in health, sports and exercise science who wanted to do a practicum where they were meeting with clinically depressed patients and being there, what do we call them, Exercise consultant, which had the beauty of shortening down to ex cons.

Dr. Stephen Ilardi [01:00:25]:
We didn't call them that to their face, but, but. So we had the ex cons come in and, and they would meet with, with the patients, the exercise consultant, trainers, and, and, and look at their calendars and, and schedule three blocks of time, 45 minutes each for the following week and say, we're, we're committed, we're locked in, we're going to do this. And then give them that little reminder that we love to get from, like, you know, you're going to get your teeth cleaned tomorrow. Oh, just reminder that, you know, you're scheduled to get your teeth cleaned or I hope you get these. I need them sometime. And, you know, and so they get that little prompt and with the patient's permission, they would get it again, like, right before, like, you know, they're on board. And there's that accountability and there's that encouragement. And so I just think that's absolutely essential.

Dr. Stephen Ilardi [01:01:20]:
And for folks listening to this or watching this who are struggling with depression or they have a loved one who's struggling. It's like I really want to validate like yeah, it's hard when you're depressed. I mean honestly, let's be real. It's hard even when you're feeling great to pick up a new habit. Habit formation is effortful.

Theresa Hubbard [01:01:45]:
Yes. Dr. Stephen Ilardi [01:01:46]:
You know, and sometimes more than others. Like picking up a habit of taking fish oil every day, not that hard. Picking up a habit of getting outside and getting some bright light or using a therapeutic light box Winter when, you know, not that hard but like, you know, once you build it in, you get the little prompt. It's like ah, it's pretty passive. It's not that difficult. Exercise harder. Reconnecting with people that we've been pulling away from harder. It takes a lot of coaching and encouragement.

Dr. Stephen Ilardi [01:02:19]:
Anti-ruminative strategies that varies a lot for people, you know. So we talk about breaking the rumination habit that rumination, the fancy word for just dwelling on our negative thoughts, you know, which requires noticing them and then making a noticing that we're ruminating, that we're just sitting wall and going over and over and over like oh my God, I can't believe the thing I said or they did or you know, whatever. And when people are depressed they spend hours often a day doing that and even when they're like watching TV or scrolling on, you know, scrolling on social media or watching TikTok watching, you know, watching TikTok, they're ruminating and to learn how to notice what's happening and then yeah, something more engaging for some people that comes more easily for some people that's a real challenge and that requires some coaching. And so all right, well let's just work on one habit at a time and you know, make that begin to feel. Once something becomes a habit then we don't have to use any willpower, right. We just little finite amount of willpower that we can spend on one or two things maybe a day. So we power on the habit of the week. Like you know, oh, I'm going to be taking my fish oil.

Dr. Stephen Ilardi [01:03:45]:
Oh, I'm going to be, you know, meeting with Biff, my personal trainer, you know, we're going to go for a brisk walk, whatever. And then once it's a habit I don't have to use willpower anymore. Like when I first started flossing daily, I don't know why I'm on dental. So when I first started flossing every day it's like really, it's like, two minutes, it's too long. It's such a hassle. And. But once you've done it, like 20 times, it's like your brain is like, oh, yeah, that's the thing we do, you know, and you even get a little burst of reward. It's like, we do, yeah.

Dr. Stephen Ilardi [01:04:28]:
Doing the habit.

Theresa Hubbard [01:04:30]:
Doing the habit. Yeah. There is an app. I don't remember how long ago I came across it, but it. And it is on Android and Apple, and it's called Mind Bell.

Dr. Stephen Ilardi [01:04:42]:
Ooh, I like that.

Theresa Hubbard [01:04:43]:
Yeah. And what I like about it is that it's not like an alarm that you have to turn off, and it's not intrusive. And you can set it to start going off a certain time of day and ending a certain time of day, and then you can set it to go off approximately every 30 minutes or every 60 minutes. And what I. When I'm using that with clients, what I say is, you know, we're trying to get this higher in your consciousness. We're trying to get your brain to see that you really feel like this is important to you. And so you're not going to hear the chime go off every time it goes off. Your brain will dismiss it sometimes.

Theresa Hubbard [01:05:29]:
But the times that you do, let's say for the first week when you hear it, maybe you just take a breath. And then maybe the next week you decide to go outside and walk. And so for me, letting your body know that you really are putting in effort. But it's just a nice, unintrusive, gentle reminder.

Dr. Stephen Ilardi [01:06:00]:
Yeah. And we can.

Theresa Hubbard [01:06:02]:
Yeah.

Dr. Stephen Ilardi [01:06:03]:
Helpful for rumination.

Theresa Hubbard [01:06:04]:
Yeah, absolutely.

Dr. Stephen Ilardi [01:06:06]:
When people have a habit of ruminating.

Theresa Hubbard [01:06:08]:
Right.

Dr. Stephen Ilardi [01:06:10]:
The first step is learning to notice when it's happening.

Theresa Hubbard [01:06:13]:
Absolutely.

Dr. Stephen Ilardi [01:06:13]:
A little reminder, like, that would be perfect.

Theresa Hubbard [01:06:16]:
So great.

Dr. Stephen Ilardi [01:06:17]:
Like, hey, am I room? It's like, oh, hey, I wasn't ruminating. I was actually locked in, you know.

Theresa Hubbard [01:06:22]:
Right.

Dr. Stephen Ilardi [01:06:23]:
Because the opposite of rumination is like, we're focused. We're, you know, we're engaged. We're doing something that, you know. And we know this even from. Again, from. If I can invoke one, one last brain circuit, there's a brain circuit you may have heard of called the. The Default Mode Network.

Theresa Hubbard [01:06:42]:
Oh, yeah, absolutely. I do neurofrog. So, okay, so we talk about the Default Mode Network.

Dr. Stephen Ilardi [01:06:48]:
So, you know, the DMN Default Mode Network, you know, gets active when we are in our head, you know, when we're reflecting, when we're processing. And we need some of that, but we don't nearly as much as Most of us get. And when people are depressed, they're in default mode network all the time.

Theresa Hubbard [01:07:07]:
Right.

Dr. Stephen Ilardi [01:07:07]:
When we toggle out of it, there's a piece of the parietal cortex called the precuneus, which is like a toggle switch. Or actually, it's more like a slider. How much are you going to be in default mode versus what's the opposite? Like, you're just all in. You're engaged. UNIA says no default mode network. Calm down. Just, you know. No, we're.

Dr. Stephen Ilardi [01:07:31]:
Because we're all in. We're in flow now. We're just like, fully in this flow state. We're all in. We've had this conversation now for, like, two hours. We've all commented. Like, it's gone by really fast. Like, you know, that's like a hallmark of, like, oh, we've been in this flow state.

Dr. Stephen Ilardi [01:07:48]:
Right? Yeah. And I haven't been aware of any rumination in the last two hours.

Theresa Hubbard [01:07:55]:
Right.

Dr. Stephen Ilardi [01:07:57]:
You know, so. So once patients learn, like, what rumination is and how to notice it, and it's like, they need to make that decision. Like, okay, you know, this is toxic. It can be seductive. Like, you know.

Theresa Hubbard [01:08:14]:
Yeah.

Dr. Stephen Ilardi [01:08:14]:
Like, oh, wait, I don't want to let go of this. I might still figure out why he left me here. You know why? It's like, right? It's like, oh, I'm just going to keep just chewing away at it. And it's like, all right, set a timer. I try to be more polite, you know, when I'm. I know we're sort of time, but, you know, if we will set a timer and give ourselves like, 10 minutes and just say, all right, so self, knock yourself out. Write down all the thoughts of, you know, and then walk away. So, like, ruminate to your heart's content for 10 minutes and then just set it aside and there's something beautiful about getting it on paper.

Dr. Stephen Ilardi [01:08:53]:
And then. Right. We can walk away. And then it's like, well, okay, now what do I need? I need something engaging. What's that? The world of people and activities that we're designed for. You know, I need to be interacting or I need to be doing something engaging. I mean, it might be I'm out, like, you know, picking weeds in a garden or something. But, I mean, I.

Dr. Stephen Ilardi [01:09:16]:
Now I could ruminate while I do that great podcast like yours while I'm doing that. Right. But now my mind's engaged and I'm not ruminating. And so, Yeah, I don't know if that answers your. Your original question, Teresa. But I, I do think that we want to validate for patients. Like, habit formation is not easy for any of us. It's harder depression, but it's not impossible.

Dr. Stephen Ilardi [01:09:42]:
Probably going to need some coaching and some improvement. And what I tell my graduate students, and I'll be really curious to get your perspective on them. This is like a closing thought. I think that being a good therapist is often more comparable to being a good coach than it is to being some Svengali, some wise mystic coming down from the mountaintop, but being into the depths of your soul and having all great spidey senses. And you know, I'm not saying, you know, God bless the people who could do that, but, but I mean, I think a lot of times if you look at what's a good coach, you know, there's somebody that's like, okay, well, I'm not, I'm not running, I'm not out on the field. Those are my players, you know, But I got to be able to draw up the play and I got to bear them to run the play and I got to inspire them and give them the confidence that this play is going to work, but you're going to be the one who's going to run it and you can do it. And I hear with you, you know.

Theresa Hubbard [01:10:49]:
Yeah.

Dr. Stephen Ilardi [01:10:49]:
And I think in our training we, you know, I was lucky. I did get a little bit of training in that, but I didn't have that orientation at all until I started really leaning into lifestyle based interventions. And then it's like my patients need my coaching more than they often need my insight. And. Yeah. So. So I think if, if listeners to this who are thinking about putting these things into practice, take that to heart. It's like, okay, well, you're probably going to need to find a good coach as habit formation is challenging.

Theresa Hubbard [01:11:27]:
Yeah.

Dr. Stephen Ilardi [01:11:27]:
And even under the best of circumstances.

Theresa Hubbard [01:11:29]:
Yeah.

Dr. Stephen Ilardi [01:11:30]:
So, you know, it's okay if you can't do this on your own. It doesn't mean you can't do it. It just means you need appropriate help.

Theresa Hubbard [01:11:37]:
Yeah, yeah, yeah. When I think about my role, absolutely. I see myself as a coach, not a mental health coach, but a coach, a teacher. I often am reflecting back to clients like when they're like, thank you so much. And I said, you made every choice. I was just here, you know, loving you and supporting you and you sharing with you the things that I've tried in my life, you know, all that. Whether this, it's self work or training. I'm just trying to be curious with you about what is really helpful to you or not?

Dr. Stephen Ilardi [01:12:23]:
Yeah.

Theresa Hubbard [01:12:23]:
So, yeah, let's just keep experimenting. And so, you know, for me, you know, being curious and present and just knowing this is the rest of my life, learning so that I can just keep sharing with people is really what I feel like my role is. And. Sure. You're like. When people are like, what are you thinking? And I'm like, do you really want to know? I'm like, just be really clear that you want to know what I'm thinking. Sure. I'm more than happy, you know, to share with you what, you know, what it is that I'm observing.

Dr. Stephen Ilardi [01:13:05]:
Oh, you do the. The. The therapist jiu jitsu. I'm really curious what prompted you to ask that right now.

Theresa Hubbard [01:13:14]:
Tell me more.

Dr. Stephen Ilardi [01:13:16]:
Right back on you. Right, right.

Theresa Hubbard [01:13:18]:
Tell me more. But I am. It's about empowerment. I. I know how much more effective we feel and what life is like when we feel capable and competent in living our own life.

Dr. Stephen Ilardi [01:13:35]:
Absolutely. Yeah. Yeah. That's great.

Theresa Hubbard [01:13:38]:
Yeah.

Dr. Stephen Ilardi [01:13:39]:
I'm so sorry, I gotta run, but way past time.

Walker Bird [01:13:42]:
Thank you so much, Dr. Ilardi, to meet you.

Theresa Hubbard [01:13:44]:
We would love to do this again because I would love to ask you more questions.

Dr. Stephen Ilardi [01:13:51]:
Well, sometimes, if you're up for it, I don't know if you have any interest, but I really want to talk about AI and psychotherapy.

Theresa Hubbard [01:14:00]:
Absolutely, absolutely.

Dr. Stephen Ilardi [01:14:02]:
Yeah. Because it's. It's. I'm not even gonna say it's coming for us. It's already here.

Theresa Hubbard [01:14:06]:
It's here. It's part. Again, part of what I'm writing about, so. Absolutely. Okay, well, we. I will email you, we will find another date and we'll have another conversation.

Dr. Stephen Ilardi [01:14:17]:
Okay, Sounds great. All right, thank you.

Walker Bird [01:14:19]:
Take care.

Dr. Stephen Ilardi [01:14:19]:
Thank you. Bye.

Theresa Hubbard [01:14:22]:
Thank you for joining us today. We are excited to explore life with you. We encourage curiosity, self growth, and we strive to be more compassionate every day.