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Welcome to I'm Not Dead Yet with Judy and Travis, a podcast about living an extraordinary life with extraordinary circumstances.
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Welcome to the I'm Not Dead Yet Podcast.
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I'm your co-host, Travis Robinson.
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I was diagnosed with Parkinson's disease at age 35 in 2014.
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And I'm Judy Yaras, your other co-host.
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My husband Sandy had Parkinson's disease for 18 years, and I was his care partner.
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Today's episode will be finding out.
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Probably so.
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Well, Travis, I think this is a great topic, and we are really fortunate today to have a wonderful guest with us, Dr.
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Dov Gold.
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And I'm going to give you a little background on him.
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So Dr.
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Gold earned his doctoral degree in clinical psychology from William James College and completed a specialized concentration in neuropsychology.
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He completed his pre-doctoral residency at the Warren Alpert Medical School of Brown University's neuropsychology program, followed by a postdoctoral fellowship in neuropsychology at Cedar Sinai Medical Center in Los Angeles.
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Dr.
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Gold's training has included various settings, including school-based mental health programs, outpatient clinics, the veterans' health care system, academic medical centers, and psychiatric hospital programs.
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Dr.
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Gold works with adults across the lifespan with specialties in geriatric neuropsychology, psychiatric neuropsychology, neurodevelopment neuropsychology, medical neuropsychology, and rehabilitation psychology.
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I can't believe I did that all.
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Very good.
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Who knows to me?
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Blending a developmental framework and expertise in neuropsychology.
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Dr.
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Gold strives to understand the larger whole of his patients and partner with them to identify areas for meaningful growth.
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And I also just want to say he's a really interesting person.
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I've had the pleasure of hearing him speak in person.
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And I'm very excited about this.
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It's an amazing topic for us to cover because we always hear about stress.
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And obviously, with PD, you assume if you have PD, there's going to be stress.
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But I think that it applies to just about everyone.
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But there's two things I'd like to do first.
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One, if you will explain just briefly the role of a neuropsychologist, because a lot of people don't understand the distinction.
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And then we want to hear a little overview of stress, define what it is, why do we have it?
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I hear about good stress, bad stress.
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Maybe you can give us a little background on that.
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Yeah, absolutely.
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And thank you for having me and the warm introduction and getting through all of that.
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So a, you know, a neuropsychologist in most cases, and I say most only because there's these couple of exceptions, and I don't want to exclude anybody, is a person who has a degree in psychology, a PsyD or a PhD, and they have additional training in the brain and behavior and how different sort of injuries to the brain or processes affect cognitive functioning and affect our day-to-day life.
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The training for that, according to the prevailing doctor in the Houston Conference guidelines in neuropsychology, which are currently in the process of being updated, involves a two-year post-doctoral fellowship in clinical neuropsychology.
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So that's the technical definition.
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If you're a patient, if you're a family member, and that clinical jargon means nothing to you, what we essentially do is we bring patients into our offices.
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In my case, sometimes I'll meet patients at their homes and we do testing.
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We do testing of their cognitive functioning, of their psychological functioning.
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We use standardized questionnaires, we use paper and pencil tests.
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We also use spoken word tests.
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As you can imagine, paper and pencil tests sometimes might get confounded when we're talking about Parkinson's disease.
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It's not really a fair measure of certain abilities if we know that there is a tremor or there is motor rigidity that would impact that score.
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So we kind of bring all of that to the fore to develop a battery to test these people based on the referral question.
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That's probably where a lot of practice differs.
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Some referral questions are very specific.
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For example, in the world of Parkinson's disease, is this person a good candidate for deep brain stimulation?
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There's certain domains you're going to want to cover in that battery.
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On the flip side, same disease process Parkinson's, I just want to get a cognitive baseline.
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Okay, my battery is going to look a little bit different.
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So the battery tends to differ among different utilizers based on referral questions.
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And the secret sauce, if you will, of neuropsychology, apart from just all of our training and our knowledge of the brain and behavior, is our normative data sets.
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We take your scores on testing and we compare them to the closest approximation of you, the most appropriate approximation of you that we have.
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So we are talking about, at minimum, probably a correction for age, because we know that cognitive functioning is not stable throughout the lifespan.
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It's quite dynamic, and different aspects of cognitive functioning will change at different points in people's lives.
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And so we want to have a good age cohort to compare you against.
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But what's really great is when we can actually start accounting for other demographic variables, like people's educational achievement, people's gender, sometimes even racial identity, ethnic identity, because a lot of those factors have really meaningful implications for how we understand and make sense of our data.
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And so that's where the psychologist, if you will, comes in.
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What do I know about this person?
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What's going to help me select the best normative data set that's going to give me the most accurate read on this person's cognitive functioning?
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We put all that together.
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We answer the referral questions as best we can, but also recommendations.
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One of my supervisors, if she is listening to this podcast, and she will certainly get the link for it, would be remiss if I didn't, if I didn't honor her through hammering our recommendations.
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What can we do with what we now know?
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Right?
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How can we improve our life?
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How can we improve our emotional functioning?
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How can we compensate in a world where we're talking about cognitive deficits for a lot of what I do with the older adult population?
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We're talking about last phases of life.
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And I don't say that in a scary way.
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I say that in a really optimistic way, where we can prepare and we can plan and we can squeeze every little drop out of it that we can and enjoy and optimize quality.
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And in my case and in my practice, me and in my practice partners and founders and colleagues, we really like therapy.
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I started this by saying neuropsychologists, most of them are psychologists by training first.
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I really like therapy.
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That same supervisor I just referenced once told me neuropsychology will stimulate your mind, therapy will stimulate your soul.
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That's good.
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I like that.
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I know, right?
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That's why it stuck with me, you know, eight years later.
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I really believe that.
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I've worked coast to coast at a lot of different places.
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And some of my favorites and where I have some of my fondest memories are the institutions or practices where I have been able to do the neuropsych with someone, generate this incredible fingerprint of them, but then actually work with them on it, see them for the follow-ups afterwards and actually put that into practice.
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And that's something that we really pride ourselves in in our practice.
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And different people have different skill sets, but that is something that we really try to emphasize because it's one thing for me to give you a report, say goodbye, and send you out the door next.
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Right.
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That for me at least, that's that's not how I prefer to practice.
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Right.
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I mean, that's where the whole person comes in.
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And I think that's amazing.
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That's wonderful that you do that.
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Okay, I love that definition.
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It was it was very clear for me.
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And I'm sure for our listeners who have never heard the term neuropsychologist, it's gonna give them a nice idea of why, especially with Parkinson's, why you should have a neuropsychologist on your medical team that is going to be doing treatment.
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Great.
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Okay, so now let's go to the big question of what is stress?
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I think a better question or a shorter question would be what isn't stress?
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Yeah, you're right.
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What isn't stress?
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There we go.
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You know, I stress, I was I was really thinking about the definition in preparation for this conversation.
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And what I found myself thinking about is stress in the most broad definition is anything that takes our homeostasis out of balance.
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Right?
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Our body prides itself and thrives at keeping things at balance.
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It really likes to keep things at balance.
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When things go out of balance, things start to go a little bit wonky.
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And so stress broadly is anything that sways that balance.
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And it could, you could define stress in a number of ways.
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You could describe it as the psychosocial stress, which I know we're gonna talk a lot about.
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You could also define it as just physical stress, right?
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For those of us who are exercising, that is a form of stress, is a desired form of stress, but it is eliciting a stress response.
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The body is responding to the pressure that you are putting on it.
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In fact, there is recruitment of the stress response, even when we're waking up in the morning.
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That requires the mobilization of a lot of the same chemicals that we talk about in the stress response.
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So to me, the broadest and I think most encompassing definition would be anything that exerts pressure on the homeostatic system that then elicits a response from that same system, good or bad.
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Good or bad.
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That makes sense.
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I understand that.
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This it's part of that.
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What is it, flight or fight?
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Uh-huh.
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Fight or flight.
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And in fight or flight.
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In the trauma world, in the PTSD world, there's fight, flight, or freeze.
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That's kind of been it's kind of been addended.
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I've I've seen that come up a bit as well.
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Oh, I've never heard that with freeze.
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That's interesting.
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Yeah, I mean, you could perhaps liken it to a static but internalized flight.
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That is to say, right, freeze in in the sense of a traumatic experience or a traumatic event.
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Sometimes people will describe feeling frozen by the fear.
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And there are tendencies that people will kind of quote unquote leave their bodies, right?
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You hear that, or you hear people say that they were looking down on themselves.
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So that makes sense to honor that experience and the very real potential for dissociation among trauma, but it may also just be an internalized quote unquote flight response, right?
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This is so overwhelming, I must detach from what's happening.
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That's interesting.
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Get away from the situation, regardless of how.
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That's right.
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You can't physically run away, mentally.
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Mentally, you turn off.
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I never thought of it that way, but that's a really good way to look at it.
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You know, and it's interesting when you say freeze in the Parkinson's world, obviously, it has a whole different meaning.
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But I'm thinking about that word, and maybe there is something to that freezing that happens with Parkinson's as well, that is like a disconnect, it turns off.
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And we have to go back.
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We're gonna explore that a little bit down the road.
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I have to really think about that.
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I've got to spend some time working on that.
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So, you know, we look at the world today and it is everywhere.
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I try so hard not to.
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I do too.
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I do too.
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My house does not have news on at any time.
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But, you know, the world is so stressful.
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COVID was so stressful.
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We came out of COVID feeling, oh, we can take a breath now.
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Everything's gonna go back to being pretty and sweet and nice.
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But we're in turmoil at all times.
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And that brings and it creates different sensations for people.
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And the question I think Travis and I had kind of talked about this at different times is what is the difference between, let's say, stress and anxiety?
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Are they the same?
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Are they different?
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Does anxiety bring stress, which I think it does?
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And does stress bring anxiety, which it does?
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But what what how does that work?
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What's that relationship like?
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Which one's chicken, which wants egg?
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Right, exactly, Travis.
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That's such a good way of putting it, Travis.
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It's a razor's edge distinction, but there is one.
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There is one, okay.
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Stress is the recruitment of resources metabolically in the body to meet a situation, a stressor.
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Whereas anxiety is best captured by worry about a future event.
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We are worried about something that perhaps is not right in front of us, but it's a far-off worry.
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But to your point, does stress cause anxiety?
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Does anxiety cause stress?
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I think it's very easy to see how anxiety causes stress.
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If you get enough worry going, you can elicit the stress response.
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Right.
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Does stress cause anxiety?
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I think certainly at the indirect level, because they play on a similar pathway in the brain.
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They touch on a lot of the same nodes in the brain.
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And in a chronic activation of the stress response, the ability to turn that mechanism on or off can actually be impacted.
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Where the on button is a little bit more sensitive, and the off button, it's almost like sticky, like you can't hit the off button as quickly.
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So I would argue there's a bi-directionality where if you're under chronic stress, you're probably more vulnerable to anxiety.
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And if you're chronically anxious, you are probably more vulnerable to stress.
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But I think that piece of the future-oriented worry is how I would separate stress from anxiety.
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And it's it's funny with this because the anxiety that people experience with PD oftentimes, it's, you know, I'll hear people say this in support groups, and you've heard this a million times too, Travis, where people are going, I don't know why I was fixated on this one thing, on something so ridiculous.
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Was my care partner gonna eat lunch?
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You know, this was an example that came up this week.
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Like, what difference did it make if he was gonna eat lunch or not?
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But this person woke up in the middle of the night stressing about this and having anxiety over it.
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What could he do to support his care partner, carever eating lunch?
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And it's such an odd thing that seems so unimportant.
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Yet for him, it kept him up half the night.
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Wow.
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Yeah.
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And I found that very telling, you know, in terms of where he is in his interaction with the people that are close to him.
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Yeah, and how and where where Parkinson's is playing with those dynamics, right?
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Right.
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It it certainly exerts its influence.
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Because he's someone that is supposed to be taking care of him.
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And yet now he wants to get into that role of being the caretaker a little bit.
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And I I thought that was an interesting dynamic.
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Did you hear that, Travis?
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I think we were in the same group for that one.
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Yeah.
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Yes.
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It was kind of interesting.
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You know, when we look at stress, anxiety, we look at Parkinson's, there's this third big syndrome or symptom that comes along and it's depression.
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And I'm really curious how depression ties in with stress and anxiety.
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Like, is it a trifecta of the three of them together, or is can it be really separate?
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Can you have depression without stress and anxiety?
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To the latter, yes.
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I've met patients who really are purely depressed.
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They don't strike much elevations in the way of anxiety, but part of it is they're too depressed to be anxious.
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Oh, okay.
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Anxiety is an activation.
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Your arousal curve, if you will, is pushing upward, whereas in depression, it may be pushing downward.
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The two are very, very comorbid.
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I sometimes describe them to patients as cousins because they tend to run together a lot.
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I don't think there is necessarily one thing that will guarantee someone's going to respond in a depressed way versus respond in an anxious way.
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Some of it is temperament, some of it is your experience, your own just unique psychology.
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You know, the person who responds to stress in a, well, what can I do way, right?
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That kind of frantic problem-solved way.
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That person may lean more into the anxious axis of their emotional response.
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The person who receives a stressor and just feels absolutely overwhelmed and can't really move because they feel almost like they're wearing a lead jacket now.
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That person might lean into the depressive axis more so.
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It is, I think, rarer to just get one, but I think this is where this is where the diagnostic system comes in when we're talking about normal depression, normal anxiety versus clinical disordered anxiety and depression.
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Oh, okay.
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So the distinction there, clearly.
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Okay.
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Right, right.
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When we're talking about anxiety disorders or depressive disorders, you know, we have criteria.
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We know what they both look like.
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Still a lot of comorbidity.
00:18:58.640 --> 00:19:05.599
But when we're talking about a non-disordered individual, by that I just mean someone who does not have either of those syndromes.
00:19:05.920 --> 00:19:10.240
I've never met anyone that is never that, yeah, a little bit, maybe.
00:19:10.559 --> 00:19:14.079
I, you know, I I hope this joke, this joke doesn't get me in trouble.
00:19:14.079 --> 00:19:19.680
Uh, if you don't have any depression, any stress or anxiety, you must not be paying attention.
00:19:21.599 --> 00:19:24.799
That's my feel too.
00:19:24.799 --> 00:19:27.119
Yeah, that's probably true.
00:19:27.119 --> 00:19:35.519
All right, I'm gonna throw another word in here because this is another symptom with PD that I feel is sort of in this world.
00:19:35.519 --> 00:19:40.160
It's maybe on the same hemisphere, and that is apathy.
00:19:40.160 --> 00:19:46.880
So with apathy, where does that fit into the picture?
00:19:46.880 --> 00:19:53.519
You know, you were saying someone feels frozen, they just can't move, they can't do anything.
00:19:53.519 --> 00:19:57.359
I always think, oh, that's the apathy that's coming into place.
00:19:57.359 --> 00:20:03.200
But is it really the apathy or is It really is a part of the depression?
00:20:04.559 --> 00:20:10.799
So every psychologist or neuropsychologist listening to this will laugh at me saying it depends.
00:20:10.799 --> 00:20:30.160
Um the answer depends on the internal experience of the person because there's a lot of cross-contamination between the behaviors you would see in apathy and the behaviors you might see in depression.
00:20:30.160 --> 00:20:34.960
But really, what is distinct between them is the person's emotional experience.
00:20:34.960 --> 00:20:38.720
In apathy, there is almost an inertia, right?
00:20:38.720 --> 00:20:46.720
If we think about physics for a moment, it takes more energy to take an object at rest and put it in motion than it does to keep an object in motion.
00:20:46.720 --> 00:20:48.720
It's an initiation issue.
00:20:48.720 --> 00:20:51.599
Um apathy is very much that.
00:20:51.599 --> 00:21:03.680
It is a problem with the initiation or selection or activation of a behavior, but in the absence of the emotional or affective component of it.
00:21:03.680 --> 00:21:25.039
Whereas in depression, you might have that inertia, but it coincides with this low mood, these depressogenic cognitions or beliefs, perhaps thoughts of death, suicidality, changes in appetite, changes in motor functioning, restlessness or agitation or even slowing.
00:21:25.039 --> 00:21:30.160
Whereas in apathy, it really is more of this disinterest.
00:21:30.160 --> 00:21:34.480
Nothing's really rousing the person, but they're not necessarily depressed.
00:21:34.480 --> 00:21:36.160
They're not necessarily sad.
00:21:36.160 --> 00:21:38.240
They're not necessarily anxious.
00:21:38.240 --> 00:21:43.279
There is really just this kind of show fucks given.
00:21:43.440 --> 00:21:44.000
Yeah.
00:21:44.000 --> 00:21:46.000
There we go, Travis.
00:21:46.000 --> 00:21:46.720
Thank you.
00:21:46.960 --> 00:21:47.359
Yes.
00:21:47.599 --> 00:21:50.079
That is uh I like your virgin better, Travis.
00:21:50.079 --> 00:21:51.680
We'll get that into the next iteration.
00:21:52.000 --> 00:21:53.519
This is a non-clinical.
00:21:53.519 --> 00:21:54.880
I love that.
00:21:55.039 --> 00:21:58.000
We should get that into the next iteration of the diagnostic criteria.
00:21:58.319 --> 00:21:59.599
We should definitely go in there.
00:21:59.599 --> 00:22:02.559
Travis will have a few good ones on this.
00:22:02.559 --> 00:22:09.279
But I do think it's something that again, we hear this in support groups.
00:22:09.279 --> 00:22:12.799
We hear people talking about it very openly.
00:22:12.799 --> 00:22:16.319
And they know what they need to do.
00:22:16.319 --> 00:22:23.119
They know what is best for them in terms of their mental well-being.
00:22:23.119 --> 00:22:27.279
But then that apathy sneaks in.
00:22:27.279 --> 00:22:31.200
And I'm always wondering, is this person, is it just apathy?
00:22:31.200 --> 00:22:33.920
Is are they really deeply depressed?
00:22:33.920 --> 00:22:35.440
What's causing that?
00:22:35.440 --> 00:22:40.640
And I think with that person, I never think of anxiety as much with apathy.
00:22:40.640 --> 00:22:45.920
I feel like there's more depression with the apathy than anxiety with that.
00:22:46.559 --> 00:22:49.920
The the overlap with depression is far greater.
00:22:49.920 --> 00:22:51.519
In fact, I don't know.
00:22:51.519 --> 00:23:06.319
Again, if if you hold on to my simplification of anxiety being a sort of activation or your arousal curve is creeping up, that is antithetical to the apathetic response where it's kind of just flat.
00:23:06.319 --> 00:23:10.000
Nothing's moving it up, nothing's moving it down.
00:23:10.000 --> 00:23:18.720
Um, and again, that's where the person's internal experience, their internal emotional experience becomes so critical in distinguishing it.
00:23:18.720 --> 00:23:32.319
And I will say, apathy, whether it be Parkinson's, brain injury, Alzheimer's, frontal temporal dementia, any other neurodegenerative disease or brain injury, apathy is really hard.
00:23:32.319 --> 00:23:38.319
Apathy is so hard to manage, to treat, to get our arms around.
00:23:38.319 --> 00:23:47.200
The research around treatment for it pharmacologically is just not giving a lot in the way of intervention sometimes.
00:23:47.200 --> 00:23:53.279
There is some modest benefit with certain agents, but it is very tricky.
00:23:53.279 --> 00:24:00.319
I think for care partners and family members, it's quite distressing because they'll do everything, right?
00:24:00.319 --> 00:24:06.480
They'll do anything and everything if mom or dad or brother or sister would just come along with us.
00:24:06.480 --> 00:24:09.440
Any loved one, if they would just come along with us, right?
00:24:09.440 --> 00:24:11.440
But they don't they don't want to do anything.
00:24:11.440 --> 00:24:14.160
They're telling us they don't want to do anything, they don't feel interested.
00:24:14.160 --> 00:24:16.799
I feel bad pushing and I just don't know what to do.
00:24:16.799 --> 00:24:18.160
And it feels like they've given up.
00:24:18.160 --> 00:24:25.119
And then you, as the care partner, are throwing up your hands because you know, I I can't try harder than this patient's trying.
00:24:25.119 --> 00:24:38.559
And I think sometimes neuropsychologists can almost give permission structure for care partners to just exhale, like this is part of it.
00:24:38.559 --> 00:24:44.799
It's not insurmountable, but you can't let their apathy feed your own.
00:24:45.200 --> 00:24:45.519
Right.
00:24:45.519 --> 00:24:59.440
Because what happens, I think, for the care partner is the care partner starts to go into depression over their lack of ability to be able to help the person that they love.
00:24:59.440 --> 00:25:01.200
And that could be a friend.
00:25:01.200 --> 00:25:04.000
It's it's not, we have care partners that are friends.
00:25:04.000 --> 00:25:07.200
They may not even be partners that live in the same household.
00:25:07.200 --> 00:25:10.400
And it's it's very challenging when you hear that.
00:25:10.400 --> 00:25:14.799
I've heard people with PD say, oh, I think I'm just a lazy person.
00:25:14.799 --> 00:25:16.079
I've I've been lazy.
00:25:16.079 --> 00:25:19.039
And I keep going, like, yeah, I don't think it's lazy.
00:25:19.039 --> 00:25:20.400
I think you have apathy.
00:25:20.400 --> 00:25:24.079
You know, like that's that that's something you can't avoid.
00:25:24.079 --> 00:25:26.799
So, okay, so we have these things.
00:25:26.799 --> 00:25:31.200
We have anxiety, we have depression, we have stress.
00:25:31.200 --> 00:25:35.759
Obviously, we have stress, anxiety, depression, we have apathy.
00:25:35.759 --> 00:25:40.319
So now, you know, what is the coping philosophy?
00:25:40.319 --> 00:25:41.839
Like, what do we do with this?
00:25:41.839 --> 00:25:44.799
Do we just, is there a pill for every little thing?
00:25:44.799 --> 00:25:53.759
You know, I you we live in Los Angeles, and probably I think this is true all over the world, maybe not so much all over the world, but all over the US.
00:25:53.759 --> 00:25:58.079
You hear people taking their antidepressants, their happy pills.
00:25:58.079 --> 00:26:03.519
And certainly in PD, you know, we say to people, are you on an antidepressant?
00:26:03.519 --> 00:26:07.680
You know, I've heard people in groups say, have you tried an antidepressant?
00:26:07.680 --> 00:26:14.400
So what is the general idea of how to help someone that is going through all of this?
00:26:14.400 --> 00:26:18.559
Is it strictly pharmacological or are there other things?
00:26:18.559 --> 00:26:20.400
What does that approach look like?
00:26:20.799 --> 00:26:27.200
Well, since you did bring a neuropsychologist on the podcast, you're definitely not going to hear me say it's strictly pharmacological.
00:26:28.160 --> 00:26:28.640
Great.
00:26:28.640 --> 00:26:29.279
Good.
00:26:29.279 --> 00:26:29.839
Good.
00:26:29.839 --> 00:26:30.480
Okay, good.
00:26:30.799 --> 00:26:34.400
But if you have a psychiatrist on in a few weeks, maybe they'd have a, they'd take a different take.
00:26:34.880 --> 00:26:38.319
Oh, and let's let's touch on that because I want people to understand that.
00:26:38.319 --> 00:26:40.240
This is really good that you said that.
00:26:40.240 --> 00:26:43.519
Because a lot of people say, Oh, I have to see a psychiatrist.
00:26:43.519 --> 00:26:47.759
And I said, Well, do you understand the difference between that today?
00:26:47.759 --> 00:26:52.720
It's my understanding that psychiatrists are more pharmacical based.
00:26:52.720 --> 00:26:54.079
Does that make sense?
00:26:54.079 --> 00:26:56.160
Am I saying that correct or is that incorrect?
00:26:56.160 --> 00:26:56.720
Okay.
00:26:56.720 --> 00:27:05.920
So that they are more to figure out medications for you, where the neuropsychologist is looking more at the therapeutic side of it.
00:27:05.920 --> 00:27:06.559
Right.
00:27:06.640 --> 00:27:06.799
Yes.
00:27:06.799 --> 00:27:17.119
There's, with the exception of a few, a few states that are looking at prescribing privileges for some for some mental health professionals, California not being one of those.
00:27:17.119 --> 00:27:17.440
Right.
00:27:17.440 --> 00:27:18.960
That distinction holds true.
00:27:18.960 --> 00:27:23.119
And it it kind of follows the tracks of their of their education and training.
00:27:23.119 --> 00:27:23.359
Right.
00:27:23.359 --> 00:27:26.400
If you're a psychiatrist, you went to med school, right?
00:27:26.400 --> 00:27:31.279
You studied medicine, that's what your degree is, and then you specialized in psychopharmacology.
00:27:31.279 --> 00:27:42.240
And you may have had some experience around therapy and provision of therapy around that, but that is not what you spent years and years and years and years doing.
00:27:42.240 --> 00:27:46.640
Whereas, granted, some people are MD PhDs and they do.
00:27:46.640 --> 00:27:48.799
And in that case, you're a double threat.
00:27:48.799 --> 00:27:50.160
God bless you.
00:27:50.160 --> 00:27:54.880
Um, and you have you have a stomach for school far greater than mine.
00:27:54.880 --> 00:27:55.440
Right.
00:27:55.440 --> 00:27:59.599
Whereas whereas the psychologist, you're doing years of work.
00:27:59.599 --> 00:28:02.799
Whether if you're a PhD, you're doing a lot of research in practicum.
00:28:02.799 --> 00:28:14.319
If you're a Psy D, which I am, instead of spending the majority of my time in research, every single year of my graduate school training was practicum, right?
00:28:14.319 --> 00:28:15.519
I was in a different setting.
00:28:15.519 --> 00:28:17.200
I was working with a different population.
00:28:17.200 --> 00:28:21.920
It was the clinical laboratory instead of the research laboratory.
00:28:22.240 --> 00:28:22.559
Right.
00:28:22.559 --> 00:28:31.599
That's what I loved about reading your bio was you you really span from children to geriatric treatment, which I thought was great.
00:28:32.079 --> 00:28:39.200
Full credit to my program for their structure where your first year, you have to be with a kid or adult, and your second year is going to be the other.
00:28:39.200 --> 00:28:42.799
And then all the years after that, you can you can apply wherever you'd like.
00:28:42.799 --> 00:28:50.400
But they really force us to have the lifespan, at least in the beginning, so we can figure out what we like and also importantly, what we don't like.
00:28:50.400 --> 00:28:54.960
But every year, that was where the specialization was.
00:28:54.960 --> 00:29:14.400
We took a lot of the same courses, but I spent a lot of time relative to, say, a PhD cohort, paralleling me a lot more time in the clinical trenches, if you will, applying these therapeutic techniques, refining my therapeutic craft and all the way through, even into fellowship, especially.
00:29:14.400 --> 00:29:19.680
So can psychiatrists provide therapy and provide good therapy?
00:29:19.680 --> 00:29:21.279
I'm sure, absolutely.
00:29:21.279 --> 00:29:25.279
It's just a matter of where our relative specializations are.
00:29:25.279 --> 00:29:28.319
Whereas that is all of what I studied.
00:29:28.319 --> 00:29:34.079
That is all of what my focus was on in concert with the neuropsychology and neuropsychological assessment.
00:29:34.079 --> 00:29:43.680
So it's just a matter of what it is, you know, what it is that the person needs, truthfully, in the best case scenario, you'd have both working hand in glove.
00:29:43.839 --> 00:29:53.440
And I that's what I was thinking, that for your team, as we're building this medical team, you have a neuropsychologist, you have a psychiatrist.
00:29:53.440 --> 00:29:54.000
Yeah.
00:29:54.000 --> 00:30:05.279
In the same way that you have a movement disorder specialist, and you might have a urologist, a gastroenterologist, or a neurogastroenterologist?
00:30:05.279 --> 00:30:13.200
We have all these specialties that we're kind of bringing to the table now to build your team of doctors to support you with your PD.
00:30:13.440 --> 00:30:13.920
Yes, absolutely.
00:30:14.240 --> 00:30:19.839
So, what are some of the best practices then that you look at when you see people that are going through this?
00:30:19.839 --> 00:30:25.200
Is it do they do months, years, weeks, weeks, months, years?
00:30:25.200 --> 00:30:26.640
I mean, what does it look like?
00:30:27.119 --> 00:30:28.000
Here it comes again.
00:30:28.000 --> 00:30:29.039
Depends.
00:30:30.000 --> 00:30:30.240
Okay.
00:30:30.640 --> 00:30:36.799
And I say that because there are certain conditions that lend themselves better to one or the other.
00:30:36.799 --> 00:30:45.279
On base, if I take all conditions all being equal and just kind of mesh them together and give you an aggregate, the answer is going to be probably both.
00:30:45.279 --> 00:30:54.640
The best outcomes are gonna yield from a combination of psychopharmacology and a combination of psychotherapy.
00:30:54.640 --> 00:31:02.640
The duration and the target of the psychotherapy, which I'll that's we're all focusing on, that's going to depend on the person.
00:31:02.640 --> 00:31:10.240
Because there are people that I have seen who have Parkinson's, and we are just talking about a very targeted issue, right?
00:31:10.240 --> 00:31:11.599
They want to come and see me.
00:31:11.599 --> 00:31:15.279
It's a really targeted stressor, and we're working through it.
00:31:15.279 --> 00:31:20.799
And we're coming up with strategies with what I know about this person, what works for them.
00:31:20.799 --> 00:31:28.240
Their stress management plan might differ from the patient who's coming in the door right after them, even if they have the exact same problem.
00:31:28.240 --> 00:31:35.920
Because it depends on certainly what's available to you, what you like, what you've tried and haven't tried.
00:31:35.920 --> 00:31:39.680
And even as we're talking about Parkinson's physicality.
00:31:39.680 --> 00:31:48.319
Because it would be really messed up of me to tell a patient with ambulatory limitations, oh, you just need to run three miles a day.
00:31:48.319 --> 00:31:49.359
You'll feel great, right?
00:31:49.359 --> 00:31:50.559
I can't just give.
00:31:52.880 --> 00:31:53.440
Yeah, yeah.
00:31:53.440 --> 00:31:53.920
Yeah.
00:31:53.920 --> 00:31:55.599
It's not something you can do.
00:31:55.599 --> 00:32:05.200
And I think, you know, for me, I really have a lot of friends in the YOPD group in this young onset population.
00:32:05.200 --> 00:32:17.920
And for me, I see that their challenges are really different than someone who is, let's say, 75 plus, or even 70 plus.
00:32:17.920 --> 00:32:43.519
They are at the peak of their careers, or they may have young children or children going off to college, or, you know, they how the things that they are facing creates a different stress level than for someone perhaps that is older, that has had their time in working and living out a lot of their dreams of their life.
00:32:43.519 --> 00:32:49.920
So how does that play in with all of this, the therapy?
00:32:49.920 --> 00:33:01.119
What are some of the things we can say, or can we, or do we not say something specific to someone who is a a young onset Parkinson's patient?
00:33:01.519 --> 00:33:01.759
Yeah.
00:33:01.759 --> 00:33:06.559
And I I mean, Travis, I don't know if you if you have a take on this, just given, you know.
00:33:07.200 --> 00:33:08.559
He's gonna add, but trust me.
00:33:10.160 --> 00:33:10.480
Fair enough.
00:33:10.799 --> 00:33:12.160
He has it, he has an ad.
00:33:12.880 --> 00:33:22.240
I it's it is so, I mean, symptomatically, but also I think psychologically different than your older onset group.
00:33:22.240 --> 00:33:35.519
Um because if you imagine your 30s and 40s and just the developmental milestones, the life milestones that are happening in those 30s and 40 years, a lot of them require a lot of physicality, right?
00:33:35.519 --> 00:33:41.359
If we are talking about someone really rising through the ranks of their career, right?
00:33:41.359 --> 00:33:44.000
That's a kind of 30, 40-year-old, I think.
00:33:44.000 --> 00:33:44.559
Right.
00:33:44.559 --> 00:33:45.599
Well, we would hope.
00:33:45.599 --> 00:33:46.799
We'll see what the economy looks like.
00:33:47.680 --> 00:33:51.119
You never know, not today, but that's the change.
00:33:51.680 --> 00:33:51.839
Right.
00:33:51.839 --> 00:33:55.119
That's the model we all we all uh aspire to.
00:33:55.119 --> 00:33:56.720
That's a lot of energy.
00:33:56.720 --> 00:33:58.960
It takes a lot of energy to put in those allies.
00:33:58.960 --> 00:34:00.160
It takes a lot of energy.
00:34:00.160 --> 00:34:06.559
And and if we're talking about Parkinson's disease, energy is not at the peer level in many cases.
00:34:06.559 --> 00:34:14.480
We might feel more tired, we might not have the energy, the stamina, or or if we're talking about even just recreation, right?
00:34:14.480 --> 00:34:16.480
If we, you know, we live in California.
00:34:16.480 --> 00:34:19.039
Everyone in California seems to love hiking.
00:34:19.039 --> 00:34:24.559
And if you don't believe me, go take a look at just the parking lot outside Runion Canyon on a Saturday morning, right?
00:34:24.559 --> 00:34:25.599
Saturday morning.
00:34:25.599 --> 00:34:26.320
It's right.
00:34:26.320 --> 00:34:26.800
It's crazy.
00:34:26.800 --> 00:34:28.159
Um it's right.
00:34:28.159 --> 00:34:40.239
But okay, you, you and your early, your early young adult onset Parkinson's disease, you've got a group of friends, 16 of them arranged to go do a 10-mile hike uphill.
00:34:40.239 --> 00:34:43.760
Okay, like if you have the ability to go do that, go do that.
00:34:43.760 --> 00:34:50.079
But at the same time, that does present on its face a very obvious challenge.
00:34:50.079 --> 00:34:56.800
Um, and I would say to my patient in that particular situation, what is the most important thing for you to get out of this?
00:34:56.800 --> 00:35:00.559
Do you do you want so badly to participate with them?
00:35:00.559 --> 00:35:02.400
Okay, let's let's figure this out.
00:35:02.400 --> 00:35:04.079
Let's figure out a mid-ground, right?
00:35:04.079 --> 00:35:05.519
It doesn't have to be all or nothing.
00:35:05.519 --> 00:35:13.840
Maybe you just do the first five miles and then you, you know, tell them you'll meet them for drinks or for brunch after, go to Mel's Diner or something, right?
00:35:13.840 --> 00:35:19.360
Um But maybe they say, you know, that's just physically, that's not where I am.
00:35:19.360 --> 00:35:26.719
I can't really do more than the mile and say, okay, so maybe we have to talk about being our own best self-advocate.
00:35:26.719 --> 00:35:30.320
Maybe we have to talk about being the squeaky wheel.
00:35:30.320 --> 00:35:34.400
And what are you, what are you afraid of with being that squeaky wheel?
00:35:34.400 --> 00:35:36.159
Are you, you know, are you afraid of the pushback?
00:35:36.159 --> 00:35:38.880
Are you afraid of being the wet, the wet blanket?
00:35:38.880 --> 00:35:42.880
I think we all sometimes assume the worst of ourselves.
00:35:42.880 --> 00:35:45.199
We are our harshest critics.
00:35:45.199 --> 00:35:54.159
Um and I think sometimes that lends itself to us being quiet when we when we feel like there's a need that is not being met.
00:35:54.480 --> 00:35:54.719
Right.
00:35:54.719 --> 00:36:00.239
And you you pick the perfect thing too, because Travis is a mountaineer.
00:36:00.239 --> 00:36:15.360
I don't know if you know this about him, but you may not know this, but he is a true mountaineer and has climbed, I I forget how many mountains, but well over 10,000, 13,000 feet.
00:36:15.360 --> 00:36:30.960
And is hung from the side that my my most pronounced visual that I always have is Travis in a cot hanging off the side of a mountain when they could not complete the the climb for the day, which gives me anxiety.
00:36:30.960 --> 00:36:31.440
Okay.
00:36:31.440 --> 00:36:34.239
That's as his friend, it gives me anxiety.
00:36:34.239 --> 00:36:44.719
But Travis, for you as a young onset person, we all know your motto for the most part, that you have a fuck this motto.
00:36:44.719 --> 00:36:55.280
But in reality, there have been times that you've had to change direction or change change plans, pivot a little bit.
00:36:55.280 --> 00:36:56.639
Am I right?
00:36:57.840 --> 00:36:58.480
Yes.
00:36:58.480 --> 00:37:11.360
And what often makes that decision for me is who else is involved?
00:37:11.360 --> 00:37:38.079
You know, yes, I do not live my life in a vacuum and everything that I do or don't do the facts other people in my life.
00:37:38.079 --> 00:37:52.639
So I try to be cognizant of the facts of my action.
00:37:55.199 --> 00:38:00.719
That's why he never tells me when he's going on a planet, because he knows I'm gonna worry all weekend.
00:38:02.000 --> 00:38:02.559
Right.
00:38:02.559 --> 00:38:04.400
Exactly.
00:38:04.719 --> 00:38:14.079
You know, but I mean with that though, even our absence in among from our from our social groups, that has an effect.
00:38:14.079 --> 00:38:14.639
Right?
00:38:14.639 --> 00:38:21.360
People, people who who just withdraw from the world, I think do so on the assumption that no one notices.
00:38:21.360 --> 00:38:24.239
But the reality is Oh, that's interesting.
00:38:24.400 --> 00:38:25.360
That's a very interesting point.
00:38:25.440 --> 00:38:29.920
I never Yeah, just like, oh, it's better off for me to just fade into the background.
00:38:29.920 --> 00:38:32.400
But I don't think that is true.
00:38:32.400 --> 00:38:45.440
And I think for the the person who does not have Parkinson's who is missing you, they don't necessarily know how to break in there because right, we don't wanna, we're all so self-conscious.
00:38:45.440 --> 00:38:53.360
Oh, I don't wanna, I don't want to overstep and and say something and upset them, you know, maybe they don't want me to mention the disease, right?
00:38:53.360 --> 00:39:00.079
And and everyone kind of just shuts down because we don't want to talk about the the uncomfortable thing.
00:39:00.079 --> 00:39:14.079
But the reality is if your friends are doing an activity that is physically not accommodating to where you are, and you just decide to disappear from that social group.
00:39:14.079 --> 00:39:23.679
Well, for one thing, you're just promoting your own loneliness and you're you're inviting the depression that is so easily already, so easily arriving in some of these cases.
00:39:23.679 --> 00:39:25.039
Yeah, it's on your shoulder.
00:39:25.039 --> 00:39:25.840
It's on your shoulder.
00:39:25.840 --> 00:39:27.599
You're just bringing it on faster.
00:39:27.599 --> 00:39:42.800
But imagine, imagine that same that same person who's withdrawing getting a phone call or getting a text message from someone of that group saying, you know, hey, like we've done a lot of hiking this month, and I haven't seen you at any of them.
00:39:42.800 --> 00:39:45.840
And what can we do to spend time with you?
00:39:45.840 --> 00:39:48.159
What you know, what what do you want to do?
00:39:48.159 --> 00:39:50.639
How do you want to spend time with us?
00:39:50.639 --> 00:40:05.199
I think most people would react really positively to receiving to receiving a message that is that empathetic and Consider it, even if it requires addressing the elephant in the room of Parkinson's.
00:40:05.519 --> 00:40:06.079
Yes.
00:40:06.079 --> 00:40:07.760
What do you think, Travis?
00:40:07.760 --> 00:40:09.519
Would that work for you?
00:40:11.440 --> 00:40:13.039
Absolutely.
00:40:13.039 --> 00:40:29.360
Yes, that consideration of my situation would be worth a lot.
00:40:30.559 --> 00:40:32.559
I think that's such a great point.
00:40:32.559 --> 00:40:41.760
And I hope for people that are care partners or friends of care partners that are listening, this is a great takeaway from today.
00:40:41.760 --> 00:40:45.679
And that's Travis's medication alarm.
00:40:45.679 --> 00:40:47.599
That's okay, folks.
00:40:47.599 --> 00:41:02.079
I think it's wonderful that we can touch on this to let people know that it's okay, it's uncomfortable to talk about it and it may make you feel uneasy.
00:41:02.079 --> 00:41:08.320
But sometimes it's just good to say to the person with Parkinson's, what would you like to do?
00:41:08.320 --> 00:41:10.400
What are you able to do?
00:41:10.400 --> 00:41:12.239
And I'll do it with you.
00:41:12.239 --> 00:41:13.440
I'm your friend.
00:41:13.440 --> 00:41:16.159
And I know Travis has those friends.
00:41:16.159 --> 00:41:28.639
And I know that he has climbing friends that have adapted to his style and needs in his climbs at different points as his as his PD has progressed.
00:41:28.639 --> 00:41:29.760
Am I right, Travis?
00:41:29.760 --> 00:41:30.719
I've met a few of them.
00:41:31.599 --> 00:41:32.239
Right.
00:41:32.719 --> 00:41:33.119
Yeah.00:41:33.119 --> 00:41:35.760
And this is, I think, very admirable of them.00:41:35.760 --> 00:41:37.920
I mean, they want to be with him.00:41:37.920 --> 00:41:42.320
They're not looking at the experience just for themselves.00:41:42.320 --> 00:41:53.440
And maybe that's the clarification that that can help people understand that you're not just a fly on the wall looking in.00:41:53.440 --> 00:41:56.400
You're part of that whole process, right?00:41:56.400 --> 00:41:58.000
You're part of the group.00:41:58.000 --> 00:41:59.679
It's it's community.00:41:59.679 --> 00:42:00.639
It's community.00:42:00.719 --> 00:42:01.679
It's community, right?00:42:01.679 --> 00:42:09.039
Like that's, I think fundamentally that's that's something we all we all look for and we all sometimes struggle to find.00:42:09.039 --> 00:42:13.840
I mean, especially I feel like in LA, it can be really like a lot of people.00:42:13.840 --> 00:42:16.239
I mean, I'm I'm not a native, I'm a transplant.00:42:16.239 --> 00:42:25.280
Um so for me, I mean, I establish my community through my through my profession, through my professional relationships, through family relationships, right?00:42:25.280 --> 00:42:26.320
That's that's mine.00:42:26.320 --> 00:42:38.159
But you know, for someone who just moved here and doesn't have the sort of the the community, the the professional community as an outlet, it can be really hard to make friends in LA.00:42:38.159 --> 00:42:41.440
Yes, and it can be build that community, and that's a stress.00:42:41.440 --> 00:42:42.400
That's a stress itself.00:42:43.119 --> 00:42:45.519
That is a stress right there, yeah, absolutely.00:42:45.519 --> 00:42:58.239
And I think even if you've had community, but you have pulled away from them, I think getting back to it can be really, really hard to do.00:42:59.119 --> 00:43:13.599
Particularly if you pulled away before you had PDR before your symptoms were very pronounced.00:43:13.840 --> 00:43:15.360
Oh, that's a good point, Travis.00:43:16.800 --> 00:43:22.559
Introducing yourself to folks.00:43:22.559 --> 00:43:33.440
It's like I'm the fucked up cripple down the street.00:43:34.000 --> 00:43:34.639
Right.00:43:34.639 --> 00:43:36.480
How are you?00:43:36.480 --> 00:43:37.679
Right.00:43:37.679 --> 00:43:46.800
Obviously, that's not the introduction most people would use, but it's but I think but that's what's in your head, right?00:43:46.800 --> 00:43:47.679
Right.00:43:47.679 --> 00:43:55.840
So that's the introduction that sits in your head, but it's not what comes out of your mouth, obviously, you know.00:43:55.840 --> 00:44:08.960
But I I think being able to even just take that first little step to contact someone, that is the hardest part that I see for people.00:44:08.960 --> 00:44:14.800
And I hate it when I hear that people are isolated, that they don't have a support system around them.00:44:14.800 --> 00:44:17.119
It's it breaks my heart.00:44:17.920 --> 00:44:19.599
Because such a difference.00:44:19.840 --> 00:44:21.519
It makes such a difference.00:44:21.519 --> 00:44:28.320
And you know, that's what COVID took away from so many, and people couldn't wait to get back together.00:44:28.320 --> 00:44:33.679
Now people are sort of back together, but it's in a different way.00:44:33.679 --> 00:44:50.159
I think people, and I see a younger, and a younger generation now that likes to, they work from home, they stay home, they don't go places, everything's delivered to them, their clothes are delivered, their shoes are delivered, their food is delivered, they don't step out.00:44:50.159 --> 00:44:53.440
And so what's happening now with society?00:44:53.440 --> 00:44:55.440
How are we managing this?00:44:55.440 --> 00:44:58.719
That everyone is so isolated.00:44:58.719 --> 00:45:00.719
So that's a whole other story.00:45:01.039 --> 00:45:07.519
No, it is, but I mean, I I remember some of my first social encounters after the lockdowns.00:45:07.519 --> 00:45:11.280
And right again, like I have a degree in psychology, for God's sakes.00:45:11.280 --> 00:45:13.039
I felt so out of place.00:45:13.039 --> 00:45:17.039
It's like, it's like I had forgotten some of my just like basic.00:45:17.039 --> 00:45:26.239
And I think, I think many people who knew me before the lockdowns kind of would describe me as a pretty extroverted, extroverted, outgoing conversational guy.00:45:26.239 --> 00:45:28.159
And I certainly have a lot of that.00:45:28.159 --> 00:45:35.679
But my my consumption of out-of-the-home activity dropped precipitously.00:45:35.679 --> 00:45:40.320
And it, I wouldn't, I don't even think it's near that baseline at this point.00:45:40.320 --> 00:45:48.559
And you know, some of that might be just increases in professional obligations, sure, maybe, but I certainly still feel it, right?00:45:48.559 --> 00:45:53.360
I think we all we were all so excited to be done with the pandemic.00:45:53.360 --> 00:46:14.000
And what what I think we missed was, you know, the COVID pandemic, now endemic, may have may have sort of may have sort of fallen in the rear view, but we traded it for a different type of pandemic, a sort of social isolation, a sort of loneliness pandemic, which I know the the surgeon general last year.00:46:14.000 --> 00:46:14.639
Yes.00:46:14.639 --> 00:46:18.719
Oh yeah, last year he yeah, yeah, raised the alarm bells about it.00:46:18.719 --> 00:46:22.239
Um and that I think is still is still going on.00:46:22.239 --> 00:46:47.679
And I think when you have when you have a disease like Parkinson's, or really any of the non, shall we say, the non-invisible diseases, um I feel like there is a inadvertently a subtext to that we have to sort of hide it or that we sort of, you know, we we can't make other people uncomfortable with with our symptoms.00:46:47.679 --> 00:46:52.320
And I'm gonna I'm gonna borrow from Travis's dictionary.00:46:52.320 --> 00:46:53.440
That's bullshit.00:46:53.440 --> 00:46:58.559
That is just absurd to me.00:46:58.559 --> 00:47:07.039
I think that when you when you feel like you need to hide your symptoms, you have just given the disease more than it took.00:47:07.039 --> 00:47:07.519
Right?00:47:07.519 --> 00:47:08.559
The disease will take.00:47:08.559 --> 00:47:09.199
It will.00:47:09.199 --> 00:47:09.599
Right.00:47:09.599 --> 00:47:12.400
You don't need to cede ground to it prematurely.00:47:12.400 --> 00:47:19.920
And if you do, you might invite, apart from depression, disease progression through stagnation, through right, right, right.00:47:20.239 --> 00:47:24.159
Travis, you you wanna I know you want to comment on this too.00:47:24.719 --> 00:47:27.199
Yes, absolutely.00:47:27.199 --> 00:47:31.920
And it is awkward.00:47:31.920 --> 00:48:04.480
I myself have found sharing my disease symptoms with folks that I don't know as well uncomfortable because they see it and I can see their awkwardness.00:48:06.320 --> 00:48:08.719
Like they don't know what to say to you, right?00:48:09.039 --> 00:48:09.679
Right.00:48:10.559 --> 00:48:11.199
Yeah.00:48:11.599 --> 00:48:12.239
Yeah.00:48:12.239 --> 00:48:22.159
But but in a way, the fact that you are still willing to share what's going on with you, I think is is pretty positive.00:48:22.159 --> 00:48:25.840
And we know that there's many people that don't share that.00:48:25.840 --> 00:48:45.519
And and in the young onset population, the fear of losing a job, you know, because you share that information or wanting to go on a date, you know, and you can't date if you're if you have Parkinson's, but there are people that definitely date with Parkinsons and have relationships.00:48:45.519 --> 00:48:53.280
So yeah, it's I mean, I I've watched you, Travis, over the years, and I I have always felt you are pretty open.00:48:53.280 --> 00:48:55.199
I've I've even traveled with you, you know.00:48:55.199 --> 00:49:02.320
We went we went to Barcelona for a conference together, and and I watched you in different settings the way you present yourself.00:49:02.320 --> 00:49:08.239
And you've always been very open to let people know what's going on with you.00:49:08.239 --> 00:49:14.159
But we both know people that do not do that and are trying to keep it a secret.00:49:14.480 --> 00:49:22.559
And I'm saying, even for me, it's uncomfortable and awkward.00:49:22.559 --> 00:49:31.679
So for other folks, it must be magnified.00:49:32.639 --> 00:49:33.280
Yes.00:49:33.280 --> 00:49:43.199
Are there tools that people can use to help them get to a place where they can feel more comfortable sharing?00:49:43.199 --> 00:49:46.880
Is there a recommendation you would have for something like that?00:49:47.599 --> 00:49:59.360
Yeah, you know, and I think this comes up a lot with a lot of my patients, again, whether it be Parkinson's or stroke or injury, or even just physical injury or spinal cord injury.00:49:59.360 --> 00:50:07.280
I think it's the at the talk therapy level, I like to understand what's the root of this fear, right?00:50:07.280 --> 00:50:16.400
And and it's sort of a a sort of Socratic dialogue of so you are worried about people seeing your symptoms.00:50:16.400 --> 00:50:20.880
Because if people see your symptoms, then fill in the blank for me.00:50:20.880 --> 00:50:23.599
And if that happens, then fill in the bright.00:50:23.599 --> 00:50:24.639
And we just drill down.00:50:24.639 --> 00:50:28.800
We drill down to what you're really what the real fear is.00:50:28.960 --> 00:50:29.199
Okay.00:50:29.440 --> 00:50:29.920
Right, right.00:50:29.920 --> 00:50:33.199
And for some people, it might be as simple as, oh, it's embarrassing.00:50:33.199 --> 00:50:34.320
Okay, well, now we know.00:50:34.320 --> 00:50:40.159
And we can we can develop some really targeted therapies around that embarrassment, right?00:50:40.159 --> 00:50:46.800
That may be more of a an exposure paradigm where you kind of run at the fear instead of running away from the fear.00:50:46.800 --> 00:50:50.480
Because when we run away from the fear, it feels really good in the short term.00:50:50.480 --> 00:50:51.679
Avoidance feels great.00:50:51.679 --> 00:50:53.599
Oh, who doesn't love avoidance?00:50:53.599 --> 00:50:58.239
But it just increases the likelihood that you're going to avoid later.00:50:58.239 --> 00:51:00.639
And it just makes the fear bigger and bigger and bigger.00:51:00.639 --> 00:51:08.800
And so, exposure therapy, the main thrust of it is run at the fear in a really conscious and deliberate way.00:51:08.800 --> 00:51:13.440
Expose yourself to the thing you're scared of because one of two things will happen.00:51:13.440 --> 00:51:19.280
The thing you're scared of won't happen, and you'll realize that your brain will learn not to be scared of this thing.00:51:19.280 --> 00:51:27.119
Or the thing you're scared of will happen and you'll survive it, and you'll realize it wasn't necessarily as life or death as you thought it might be.00:51:27.440 --> 00:51:30.400
As you imagined, right, as you imagined it to be.00:51:30.400 --> 00:51:39.119
That's really fascinating to me because I'm thinking when you said that, I thought, oh, like people that are afraid of flying, they just don't take airplanes.00:51:39.119 --> 00:51:43.840
They take trains, they take buses, they take cars, but they will not get on an airplane.00:51:43.840 --> 00:51:48.239
But people have done work with exposure therapy, right?00:51:48.239 --> 00:51:50.639
To get over fear of flying.00:51:51.039 --> 00:52:05.119
Yes, it is for so many different anxiety disorders, whether it be social anxiety, panic disorder, a specific phobia, obsessive-compulsive disorder, which, you know, technically it's a different category, exposure, exposure, exposure.00:52:05.119 --> 00:52:06.320
Exposure, right.00:52:06.320 --> 00:52:14.320
Um, and then separate, and sometimes as an adjunct to that, basic, just basic stress management.00:52:14.320 --> 00:52:16.079
And it takes so many different forms.00:52:16.079 --> 00:52:17.920
It's so And what does that look like?00:52:18.320 --> 00:52:20.639
Class of ideas, basic stress management.00:52:21.039 --> 00:52:24.960
You know, I think mindfulness has taken off in America, and that's wonderful, right?00:52:24.960 --> 00:52:30.000
It's this the Western the Western world has finally caught up to what the Eastern world has been saying for generations.00:52:30.239 --> 00:52:32.079
Breathe for centuries.00:52:32.079 --> 00:52:32.719
Yeah.00:52:33.280 --> 00:52:38.880
Um, the, you know, and and mindfulness, it doesn't just have to be breathing.00:52:38.880 --> 00:52:43.039
Um, I think sometimes people get in their heads like, oh, I'm a bad meditator, I'm a bad breather.00:52:43.039 --> 00:52:44.239
And I'm like, what the hell do you mean?00:52:44.239 --> 00:52:45.519
Like, what are you talking about?00:52:45.519 --> 00:52:46.800
No one, you're breathing.00:52:46.800 --> 00:52:47.360
You're doing it.00:52:47.360 --> 00:52:48.079
You're breathing.00:52:48.079 --> 00:52:48.960
Right.00:52:48.960 --> 00:52:55.280
And uh and a different mentor of mine once told me it's about losing your mind and coming to your senses, which I just I love that.00:52:55.519 --> 00:52:56.000
Oh, I like that.00:52:56.000 --> 00:52:57.039
I know, I know.00:52:57.039 --> 00:52:58.719
I'm writing that one down.00:52:58.719 --> 00:52:59.840
That is so good.00:53:00.719 --> 00:53:13.360
So it's such a great way of describing it where you are, you are coming to your own thought process, non-judgmentally, attempting to connect with just what you're doing right now, right?00:53:13.360 --> 00:53:20.000
And so as I'm sitting here, if I were to sort of turn my mindfulness mind on, I like to do it in a sensory way.00:53:20.000 --> 00:53:33.599
So I'm coming to, I'm feeling bringing my attention to my body, I'm bringing my attention to the feeling of different fabrics on what I'm wearing, I'm bringing my attention to the vibration of my voice in my chest as we're talking, right?00:53:33.599 --> 00:53:36.079
But while I'm doing that, guess what I'm not doing?00:53:36.079 --> 00:53:38.400
I'm not worried about what I'm doing after this podcast.00:53:38.400 --> 00:53:40.480
I'm not thinking about my agenda.00:53:40.480 --> 00:53:41.679
I'm I'm sent to the water.00:53:41.840 --> 00:53:42.960
You're staying in the moment.00:53:43.199 --> 00:53:43.440
Right.00:53:43.440 --> 00:53:49.280
And you could do mindfulness walks, you could do dishes mindfully, you can bake mindfully.00:53:49.280 --> 00:53:53.280
I mean, it's so it's so broadly applicable.00:53:53.280 --> 00:53:57.199
And all you need is your breath and a little bit of time and practice.00:53:57.199 --> 00:53:59.679
You have to flex that muscle just like anything else.00:53:59.679 --> 00:54:08.000
So that's, I think most people have some exposure to that just by living in our culture nowadays, at least.00:54:08.000 --> 00:54:21.119
You know, there's also progressive muscle relaxation, which is basically going through the different muscle groups, pairing it with breathing to actually force the physiological relaxation response.00:54:21.119 --> 00:54:26.079
Because when we talk about the stress response, most of it's automatic, involuntary.00:54:26.079 --> 00:54:32.079
There are only two sections of it that we have any voluntary opportunity to control.00:54:32.079 --> 00:54:34.480
And that is our breathing, and that is our muscles.00:54:34.480 --> 00:54:35.360
That's it.00:54:35.360 --> 00:54:38.480
The rest of it is just gonna go one way or another.00:54:38.480 --> 00:54:40.000
And there, those are the doors.00:54:40.000 --> 00:54:41.199
You don't have those, that's it.00:54:41.199 --> 00:54:42.559
Um doors.00:54:42.639 --> 00:54:43.440
There isn't a third.00:54:43.760 --> 00:54:44.000
Right.00:54:44.000 --> 00:54:49.920
That's that is how that's how our openings to regulate the stress response when it is happening.00:54:49.920 --> 00:54:56.800
And as we train ourselves to do this when we're not stressed, we train ourselves in these skills when we're not stressed.00:54:56.800 --> 00:55:01.840
It's amazing how they just deploy themselves when we are stressed, right?00:55:01.840 --> 00:55:13.679
If you want to be able to lift a car from an accident, you need to have been going to the gym for months, probably years, to build the muscle to rise to the occasion.00:55:13.679 --> 00:55:17.280
And if you've never done any of these things, yeah, no kidding.00:55:17.280 --> 00:55:19.599
Mindfulness is not gonna help you in your panic.00:55:19.599 --> 00:55:22.159
But you shouldn't do it the first time there.00:55:22.159 --> 00:55:26.960
It might help, but it's not gonna, it might not give you the give that you're looking for.00:55:26.960 --> 00:55:44.960
But if you've been practicing it and cultivating it, it's much more likely that that pathway, that groove in your mind will turn on in response to the stressful stimuli, or it'll be more quickly accessible to you in the frantic, what do I do?00:55:44.960 --> 00:55:47.360
Maybe the first step is breathe, right?00:55:47.360 --> 00:55:49.199
Separate from our first reaction.00:55:49.199 --> 00:55:51.199
What's our second reaction?00:55:51.199 --> 00:55:52.800
What's our third reaction?00:55:52.800 --> 00:55:57.760
And then allow ourselves to problem solve more effectively.00:55:57.760 --> 00:56:04.719
Those are, I think, really practical and and easily applicable, and you don't need anything to do them.00:56:04.719 --> 00:56:15.039
And then beyond that, it's I think a stress-resilient lifestyle such that we can, you know, and these get these get to the simple things.00:56:15.039 --> 00:56:17.679
These are, are we just taking care of ourselves?00:56:17.679 --> 00:56:21.840
Are we throughout the day when we're not stressed, are we tending to ourselves?00:56:21.840 --> 00:56:29.760
I will tell you right now, my stress response goes from a dimmer switch to a light switch, depending on how much sleep I got.00:56:29.760 --> 00:56:33.119
If I get less than four hours, I am punchy.00:56:34.079 --> 00:56:37.519
I'm just I think everyone is punchy with less than four hours.00:56:37.760 --> 00:56:40.239
Yeah, but you know, but sometimes that's what life demands.00:56:40.239 --> 00:56:58.079
But I'm really, I'm I'm almost militant about trying to get closer to seven or eight hours because it just makes such a big difference for how I'm dealing with the dodgeballs that life and my life or my clients' lives or any just is throwing at me day to day.00:56:58.079 --> 00:57:05.679
So it's both what you can do in the moment, but also how can we cultivate resiliency before we even get there?00:57:06.000 --> 00:57:13.360
I love that because I think resiliency is you have to be, if you have Parkinson's, you have to be resilient.00:57:13.360 --> 00:57:14.400
You have to be.00:57:14.400 --> 00:57:29.760
It for I think it forces you to be resilient unless you are going to just stay in your home in a big chair and watch TV all day long and sleep and eat and do everything from that chair and never leave your home.00:57:29.760 --> 00:57:32.159
Because to be, am I right, Travis?00:57:32.159 --> 00:57:34.800
Like you have to be, you're resilient for sure.00:57:35.119 --> 00:57:40.719
Yes, you have to be, or you will die.00:57:41.840 --> 00:57:42.320
Yes.00:57:42.320 --> 00:57:47.039
Yeah, I think that's that's the the key to it all.00:57:47.039 --> 00:57:48.880
This has been like fantastic.00:57:48.880 --> 00:57:56.719
I mean, I feel like I could go forever talking to you for another hour or so, but I I don't want to take you down here with the time.00:57:56.719 --> 00:58:09.039
Travis, do you have any other points or anything that you wanted to talk with Dov about or share anything of your your experiences, what you do when you feel that stress?00:58:09.920 --> 00:58:16.719
No, I feel like we capsured it pretty well.00:58:16.719 --> 00:58:44.639
I think that I own personal tricks all in what you were saying about mindfulness or exposure therapy.00:58:44.639 --> 00:58:55.280
I'm very much a "run at the fear" sort of person.00:58:55.280 --> 00:59:06.800
So that is a lot of what I do.00:59:09.039 --> 00:59:11.360
And maybe it's good to analyze.00:59:11.360 --> 00:59:15.199
You know, Travis is definitely running towards it.00:59:15.199 --> 00:59:21.360
I tend to I might slowly move a little bit.00:59:21.360 --> 00:59:22.079
That's okay.00:59:22.639 --> 00:59:23.360
That's okay.00:59:24.719 --> 00:59:30.000
But I I don't like heights, so I I love to hike, but not up too high where I have to look over an edge.00:59:30.000 --> 00:59:33.679
I like flat roads.00:59:33.920 --> 00:59:34.239
Yeah.00:59:36.480 --> 00:59:48.480
But but I, you know, I think the takeaway for me too is with all of this, is you need to take some time and reflect about who you are.00:59:48.480 --> 00:59:59.199
You know, every time you said it depends, well, it really depends on who you are and maybe being honest with yourself about who you are.00:59:59.199 --> 01:00:09.840
And I I've known people that have really changed their lives having Parkinson's doing exactly the opposite of what they did all of their life.01:00:09.840 --> 01:00:24.079
People that were very type A, pushing, pushing, never spent a moment doing meditation, and now they're exercising and doing meditation and they're socializing and they're meeting with people that they never thought they would ever meet with before.01:00:24.079 --> 01:00:27.599
And they have really radically changed their life.01:00:27.599 --> 01:00:37.519
So for me, I think this idea of understanding and taking a moment to reflect on who you are can really be good.01:00:38.400 --> 01:00:46.320
And it's worthwhile that we take time to know ourselves.01:00:46.320 --> 01:00:53.840
As the Greeks told us at Delphi.01:00:53.840 --> 01:00:58.000
Know thyself.01:01:00.960 --> 01:01:01.840
You're right, Travis.01:01:02.159 --> 01:01:03.599
Ancient wisdom, yet again.01:01:03.599 --> 01:01:04.880
Ancient wisdom.01:01:05.119 --> 01:01:14.960
But you know, also I think for a lot of people, it's okay to not feel like you have to know yourself, know thyself on your own.01:01:14.960 --> 01:01:28.719
I mean, this is why I think it's important we have neuropsychologists that we can help guide us to see who we are and help us discover who am I now?01:01:28.719 --> 01:01:38.239
Okay, so I've got Parkinson's, and maybe I'm not exactly the same person, but who can I be while I have my Parkinson's?01:01:38.239 --> 01:01:47.679
And how can I still feel that joy and love and success in my life, even though I have Parkinson's disease that I didn't ask for?01:01:47.920 --> 01:01:48.239
Absolutely.01:01:48.480 --> 01:01:50.079
And it really sucks, you know.01:01:50.400 --> 01:02:06.079
No, I think there's there's a real question of identity that comes up, I think at various points, but I think in the face of disease, most disease, especially chronic disease, now who am I in response to this, right?01:02:06.079 --> 01:02:08.559
I don't like what this disease is making me.01:02:08.559 --> 01:02:13.039
And let's, okay, can we can we excavate some of that?01:02:13.039 --> 01:02:17.119
Can we understand what it is, what it is that the disease is taking?01:02:17.119 --> 01:02:23.679
And can we work around to give you back what you feel you've lost or some semblance?01:02:23.679 --> 01:02:26.000
And is that semblance, is that sufficient?01:02:26.000 --> 01:02:27.519
And some people will say no, right?01:02:27.519 --> 01:02:29.199
Some people have this all or nothing.01:02:29.199 --> 01:02:31.360
If I can't do it my way, I don't want to do it.01:02:31.360 --> 01:02:31.920
Right.01:02:31.920 --> 01:02:32.639
Fine.01:02:32.639 --> 01:02:34.559
That's not my job to push you beyond that.01:02:34.559 --> 01:02:39.920
I might ask some insightful questions about if you know how that strategy is working out for you.01:02:40.239 --> 01:02:41.360
Oh, yeah, how's it working for you?01:02:41.840 --> 01:02:43.679
You're sitting in my office, how's that working out?01:02:43.679 --> 01:02:49.039
But yeah, okay, what well, have we have we explored all the options?01:02:49.039 --> 01:02:51.679
Have we explored things you haven't yet thought of?01:02:51.679 --> 01:02:53.519
Because it it can be quite simple.01:02:53.519 --> 01:03:03.760
And, you know, one other thought on just cultivating um resilience and really protecting ourselves, especially in the the world we live in today.01:03:03.760 --> 01:03:19.840
I with some of my my clients who are really struggling with stress and who are really struggling with the anxiety that this disease creates, sometimes the question I ask them is before the session ends, what what have you done for you today or this week?01:03:19.840 --> 01:03:24.159
What have you done, patient, to take care of yourself this week?01:03:24.159 --> 01:03:27.119
And sometimes I get wonderful answers.01:03:27.119 --> 01:03:33.440
And sometimes I get a deer in the headlights moment, and I'm like, now I know what your homework is this week, right?01:03:34.000 --> 01:03:35.519
Whatever that's so good.01:03:35.519 --> 01:03:37.039
That's such a great question.01:03:37.199 --> 01:03:37.519
Yeah.01:03:38.239 --> 01:03:40.320
We ask that all the time in the sport groups.01:03:40.320 --> 01:03:41.280
We talk about that.01:03:41.280 --> 01:04:06.559
You know, Joe, I I want you to come back another time when you have another hour to uh hang with us because I would love to talk about loss in relation to Parkinson's, not necessarily loss with death, but this other this other idea of loss, and and that's a whole other thing we could talk about.01:04:06.559 --> 01:04:08.960
This has been very enlightening for me.01:04:08.960 --> 01:04:10.079
I learned a lot.01:04:10.079 --> 01:04:12.639
Travis, did you learn anything?01:04:13.119 --> 01:04:13.760
Yes.01:04:14.559 --> 01:04:14.960
Good.01:04:14.960 --> 01:04:16.480
I'm glad to hear that.01:04:16.480 --> 01:04:17.679
I know you did.01:04:17.679 --> 01:04:26.159
And and I, you know, I I love talking with Travis because I always wait for his great pearls of wisdom, know thyself, right?01:04:26.159 --> 01:04:28.159
And where it came from, right?01:04:28.159 --> 01:04:33.360
You know, most people have know the saying, but they don't know where it really stems from.01:04:33.360 --> 01:04:34.559
I think origin.01:04:35.039 --> 01:04:37.440
Yeah, I've I've used that saying, but no, I didn't know.01:04:37.440 --> 01:04:38.800
I didn't know it's Greek origin.01:04:38.800 --> 01:04:39.360
So thank you.01:04:39.679 --> 01:04:41.280
Greek origin, Socrates.01:04:41.280 --> 01:04:43.519
Okay, now we know who to give the credit to.01:04:43.760 --> 01:04:45.280
Yeah, no, excellent, excellent.01:04:45.280 --> 01:04:47.760
And I I would love to I would love to uh thank you.01:04:47.760 --> 01:04:49.440
It's it's a wonderful conversation.01:04:49.440 --> 01:04:54.079
They're all wonderful conversations, and yeah, uh, for better or worse, uh, I can talk forever.01:04:54.880 --> 01:04:55.760
Well, that's good.01:04:55.760 --> 01:04:57.760
We thank you so much, Dov.01:04:57.760 --> 01:05:06.800
This has been wonderful, and uh it's just been a great experience to have you on and to be able to share this time with us.01:05:06.800 --> 01:05:07.360
Thank you.01:05:07.360 --> 01:05:08.400
We really appreciate it.01:05:08.719 --> 01:05:08.880
Thanks.01:05:10.559 --> 01:05:12.400
All right.01:05:13.840 --> 01:05:15.920
Is that a wrap, Travis?01:05:16.239 --> 01:05:18.159
That's a wrap.
