Dr. Paul Conti on Therapy, Trauma Treatment & Life Challenges 

Paul Conti, M.D. (website) is a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and Harvard, where he was appointed chief resident. Dr. Conti was named one of Oregon’s Top Psychiatrists in 2008, his first full year of practice in Oregon. He is a general psychiatrist, treating all aspects of both mental illness and the impact of life stressors. He is CEO of Pacific Premier Group in Portland, Oregon.

Andrew Huberman and Paul Conti take a deep dive into trauma: what it is, its effects on the mind and body, and treatment approaches for trauma. They also explore how to choose a therapist, getting the most out of therapy, self-directed therapy, psychedelics, and much more.

Host: Andrew Huberman (@hubermanlab) Books: Trauma: The Invisible Epidemic by Paul Conti, MD

Trauma: something that overwhelms our coping skills and leaves us different moving forward We can have memories of something negative, but trauma rises to the level of changing the function of our brains – changes in mood states, sleep, behavior, etc.

There is a level of guilt and shame that come with trauma and often lead people to avoid exploration about the changes that take place (the opposite of what we need to do) Our reflexive response to trauma is an attempt to change the past

The limbic system is the emotional system in our brain Trauma can come from acute or chronic things, or even vicarious events (e.g., seeing someone’s suffering)

“As a person who’s treated addiction very intensively over many years, I feel sure that the majority of addiction I see and treat arises from trauma.” – Dr. Paul Conti By bringing trauma to the surface, we remove its power

Brain markers of trauma: punishment, avoidance, control The trauma inside of us often leads to a desire to punish ourselves – the brain tries to make us better by hurting us more a

Distraction and anger feel more gratifying and let us avoid the actual matter at hand Our desire to control stems from an urge to see the future and try to dictate it based on our past

The confusion of trauma: part of the brain wants to punish us, part of the brain wants to avoid it, and another part of the brain wants to make it better

People will traumatize and re-traumatize themselves over and over – think of people who repeatedly get into abusive relationships Repetition compulsion: we all have an innate desire to solve our traumas so repeatedly put ourselves in some version of that event

The brain tries to make sense of the trauma by recreating the situation and trying to “make it right” this time to relieve the suffering Substance abuse and drugs mask the emotional state and allow detachment and avoidance

“When logic and emotion come head to head, emotion wins all the time. It’s powerful enough it will always win.” – Dr. Paul Conti

Sometimes we fuel from trauma: taking something negative and turning it into something beneficial – e.g., dad was an alcoholic, and you wanted a better life so studied extra hours Sublimation: transforming the negativity into something positive or adaptive

Sublimation limits our perspective of what we can see and do through the lens of trauma The problem is, that we can become attached to the trauma and avoid working through it because we’re dependent on it

“I have not seen one person who has addressed the trauma but become less functional.” – Dr. Paul Conti

Trauma creates internal arousal – often guilt or shame We need to confront the trauma without repeating compulsion

“We so often try and change the trauma of the past in order to control our future. What that really adds up to is the trauma of the past dominates our present. But it doesn’t have to be that way.” – Dr. Paul Conti

The answer is to explore the trauma and look directly at it – we’re so afraid of looking at the trauma, we’ll look anywhere but right at it

We need to put words to the trauma and remove the shame – over time, this will allow you to see things from the outside with a new perspective Crying is one of the best coping mechanisms we have

Putting words to the trauma will evoke a shift from anger and frustration to processing and compassion

We need introspection through words: if we’re always thinking about things in the same way we have in the past, we stand the risk of retraumatizing ourselves – we need to have new thoughts and not just bounce around in our own minds

Our brains need something from the outside to really move past trauma Self-exploration can be tricky because it’s easier to mask and can take you to a worse place

Short-term soothing (none of which are a good idea): food, drugs, sex, negative thoughts – all of which take place at the expense of long-term change Bring new eyes to the problem: ask, “Why am I thinking like this?” “When did it start?”

Journaling may work for some people but avoid the compulsion to feel like you need to write about everything or feel guilty when you don’t journal Reread journal entries with compassion

If you don’t have access to therapy , find a trusted source or confidant to share; even start with small bits over time

Core feature of a good therapist: rapport! It’s not helpful to try to fit yourself into the box of your therapist – you want to be yourself Good therapists should shift to what you need without being dogmatic about modality

Try a few sessions with a therapist to see if rapport is good; if it’s not the right person, find someone else The right therapist doesn’t mean it’s always pleasurable or enjoyable, it can be a tough journey at times

Preparing for therapy: do whatever helps you get into a state to be fully present – maybe it’s a walk, giving yourself time to get there and park without rushing, etc.

After your session: some people do best taking a walk and reflecting on the session, some write down their “ah-ha” moments Do what works for you: the key is to be present during a therapy session, then consolidate and retain the information

Dose: this is individual but generally, it’s hard to get anywhere with less than once per week

Turn up the intensity if there’s something you really need to process (i.e., crisis point) – some practices will condense 30 hours a week with different therapists throughout the time

Take ownership of your therapy and journey – if your needs aren’t meant, change something whether it’s the therapist or modality

Psychiatrists only have talk to diagnose and treat Medicine is just one piece of the puzzle

Approach to prescribing medicine: (1) ask whether the diagnosis responds well to a drug; (2) what is the severity of the condition; (3) is there a medicine to help the patient engage in therapy more completely

Antipsychotics can improve distress tolerance, don’t get fixated on the phone In the U.S. we take 5x more medicine than European countries – our insurance system makes it difficult to really get to the root during 15-minute sessions weeks apart

Our healthcare system is focused on short-term soothing at the expense of long-term benefit Medications get overused in large part for systemic reasons instead of really getting at the core and exploring what’s going on

Remember, medications have side effects as well – it’s worth exploring alternative routes depending on the condition

Short-term use of medication: it is possible to have a brief stint with antidepressants, antianxiety, or antipsychotics for more temporary regulation of mood and distress tolerance

ADD & ADHD medication can be extremely effective – but all attention deficit is not attention deficit disorder; inability to focus can come from poor sleep, anxiety, poor diet, stress, trauma, etc.

People who truly have ADD/ADHD tolerate the stimulants well versus people who use the medications but do not Our system makes physicians quick to make diagnoses when there’s an opportunity to throw medication at it

Cannabis narrows our attentional perspective and has been helpful for some levels of distress but there is a risk it can make you focus on the traumatic event Cannabis is safer than alcohol but not uniformly safe

Psilocybin & LSD have gained momentum for therapeutic use We get lost in the outer parts of our brain cortex which is focused on survival

When we can explore deeper in the brain, we can bring truth to the surface and see events with more clarity instead of using the lens of survival Psychedelics provide an opportunity to explore how our brains are really functioning and which parts of the brain matter in experiences

We don’t fully understand hallucinations, but it could allow you to access deeper things you otherwise dissociate from Used clinically, psychedelics are powerful tools for trauma and will be beneficial in exploring deeper regions in the brain instead of just the surface

MDMA increases dopaminergic and serotonergic transmissions which put the brain in a unique state MDMA studies are showing strong benefits for healing from trauma because it’s almost granting you permission for introspection without the chatter of guilt, shame, or fear

Trying to overly control language is not good but being specific in your words is – define your words Social media can be used to harm people from a distance and throw anger at others

Important factors in self-care: sleep, sunlight, positive interactions with others, proper nutrition, living in secure and comfortable settings It’s easy to overlook self-care because many of us can get by with very little – but where will it leave you in 5, 10, or 20 years?