Dr. Paul Conti: Therapy, Treating Trauma & Other Life Challenges

Dr. Paul Conti on Trauma and Therapy

• Trauma: something that overwhelms our coping skills and leaves us different as we move forward 
  • Changes the way our brains function
  • Evident in mood, anxiety, behavior, sleep, and physical health
• Identifying trauma:
  • Can be difficult due to the reflex of guilt and shame around the trauma
  • Often leads to burying or avoiding the traumatic experience
• Importance of understanding trauma: 
  • Helps identify changes in brain function and behavior
  • Allows for healing and growth from difficult circumstances
• Therapy process:
  • Involves picking a therapist, evaluating the relationship, and determining if therapy is working
  • Self-​​therapies can be helpful for those without access to professional therapy
• Drug therapies:
  • Antidepressants, antipsychotics, alcohol, cannabis, ketamine, psychedelics (psilocybin, LSD), and clinical use of MDMA
  • Future of drug therapies in treating trauma and mental health disorders
    Trauma and Its Effects
• Trauma can lead to guilt, shame, and avoidance 
  • People avoid looking at the change in themselves, which is the opposite of what needs to be done
  • Communication and putting words to the experience is crucial for healing
• Trauma can be acute or chronic, and can result from various situations 
  • Can lead to changes in self-​​talk, thoughts about the world, and ability to navigate safely

Guilt and Shame

• Guilt and shame are aroused affects, meaning they are created in us without our choice 
  • Powerful emotions that can control behavior
• Evolutionarily adaptive for survival, but maladaptive in the modern world 
  • Traumatic experiences and negative emotions were important for survival and learning
  • In the modern world, these emotions can lead to negative outcomes and suffering

Trauma and Addiction

• Majority of addiction seen in clinical practice arises from trauma 
  • People try to soothe the pain inside with drugs or medications
  • Can quickly turn into addiction, danger, and risk

Repetition Compulsion

• Freudian concept where people repeat behaviors to continue trying to stuff away traumatic experiences 
  • Instead of acknowledging and distancing from the trauma, people feel shame and guilt and try to suppress it
  • This ongoing effort can lead to negative outcomes and suffering
    Repetition Compulsion and Trauma
• Repetition compulsion: people return to scenarios or emotional states resembling their trauma 
  • Attempt to solve or resolve their traumas
• The limbic system (emotion system) trumps logic 
  • Doesn’t care about time, focused on relieving suffering from trauma
• People try to recreate traumatic situations to “make things right” 
  • Belief that fixing the situation now will also fix the past
• Addressing the original trauma can help break the cycle of repetition compulsion 
  • Therapy can help bring the trauma to the surface and take away its power

Changing the Past and Dealing with Arousal

• Many behaviors and thoughts are attempts to change the past 
  • Can lead to maladaptive behaviors and thought patterns
• Dealing with arousal from trauma: 
  • Catharsis: telling the story and feeling the emotions
  • Packing it down: suppressing the emotions (not ideal)
  • Confronting the trauma: looking directly at the source of the emotions
• Dealing with trauma can be done with a professional, trusted friend, or through writing 
  • The goal is to explore the trauma and understand its impact on the present
  • Facing the trauma can lead to healing and breaking the cycle of repetition compulsion
    Discussing Trauma and Healing
• People often fear discussing their trauma, worried about others recoiling from them 
  • When someone listens without recoiling, it can be a relief and help the healing process
• Trauma can create a sense of shame and guilt, making it difficult to process and heal 
  • Discussing the trauma can help shift the perspective and bring compassion towards oneself
• Repetition compulsion: the tendency to repeat traumatic experiences in an attempt to resolve them 
  • This can be maladaptive and counterproductive to healing

Approaching Trauma and Healing

• Introspection and observing one’s thoughts and emotions can be helpful 
  • Writing or talking to a trusted friend, family member, or clergy can also be beneficial
• Understanding the origins of negative self-​​talk and emotions can help unravel the trauma
• Sometimes professional help is necessary to address significant symptoms and get to the root of the trauma 
  • If professional help is not available, other strategies can be employed to address trauma and promote healing
    Addressing Trauma and Negative Thoughts
• People often have unresolved trauma that leads to mental health issues and substance abuse 
  • Taking a trauma history can reveal the root cause of these issues
• Negative fantasies can serve three purposes: 
  • Punishment — guilt and shame from trauma lead to self-punishment
  • Avoidance — anger and negative thoughts can distract from more painful emotions
  • Control — imagining worst outcomes can give a sense of control and preparedness
• These negative thoughts can provide short-​​term relief but do not lead to long-​​term improvement

Self-​​Help Strategies for Trauma

• Journaling can be a helpful tool for processing trauma 
  • Provides distance and perspective on thoughts and emotions
  • Can help integrate compassion and logic
• The key is to approach oneself with curiosity and a desire to understand the root of negative thoughts
• Trusted friends or support groups can also provide an outside perspective

Finding a Good Therapist

• A skilled clinician can help navigate through trauma and provide guidance
• When seeking therapy, consider factors such as: 
  • Accessibility (remote therapy options)
  • Experience and expertise in trauma therapy
  • Personal rapport and trust with the therapist
    Trauma and Therapy
• Trauma often hides itself in various symptoms like depression, panic attacks, addiction, and maladaptive choices 
• Addressing trauma requires a new perspective and finding the right therapist

Importance of Rapport in Therapy

• Rapport is the key factor in finding a good therapist
• Trust, attention, and a genuine connection are essential for effective therapy
• Good therapists are not pigeonholed by a certain modality; they adapt to the patient’s needs

Finding the Right Therapist

• Word of mouth is important; recommendations from trusted individuals can be helpful
• Try a few therapists and have a session or two to see if rapport develops
• Approach therapy with the understanding that it may be difficult and challenging, but ultimately helpful
• Look for a therapist who is attentive, adaptable, and genuinely invested in your well-​​being
  Mechanics of Therapy
• Showing up to therapy 
  • Varies by person
  • Goal: be fully present during therapy
  • Some people meditate before, others just show up
• Post-​​therapy processing 
  • Also varies by person
  • Some people need to reflect immediately, others need to set it aside and come back later
• Frequency of therapy 
  • Depends on individual needs and circumstances
  • Minimum once a week for an hour if working on specific issues
  • More intensive work can be beneficial for some
• Intensive therapy (30 hours in a week) 
  • Usually for people in crisis or highly distressed
  • Can be very effective in a short period of time
• Taking ownership of therapy 
  • Important for clients to communicate their needs and feelings with their therapist
  • If therapy isn’t helping, consider changing approach or frequency
• Self-​​generated intensive therapy (journaling, walking, etc.) 
  • Could be helpful for some, but depends on the person
  • Important to communicate with a trusted person if possible
    Prescription Drugs in Mental Health Treatment
• Overutilization of medicines in the US due to healthcare system focused on throughput 
• Medicines often used as an endpoint rather than a tool to support therapy
• Diagnosis and level of severity are important factors in deciding medication use
• Medicines can help improve distress tolerance and reduce rumination, aiding in therapy
• Shortcomings in the healthcare system lead to overuse of medications and less focus on the root problems
• Short-​​term vs. long-​​term use of drugs: some medications can be helpful in the short term to increase distress tolerance while working through therapy

Challenges in the Healthcare System

• 15-​​minute visits with psychiatrists often not enough time to address root problems
• Focus on short-​​term symptom relief rather than long-​​term health
• Need for more investment in human aspects of mental health care
• Overuse of medications due to systemic reasons and categorization issues
• Multiple medications often prescribed to treat various symptoms, leading to side effects and complications

Potential Benefits of Medication in Therapy

• Can help ease symptoms and improve distress tolerance, allowing for more productive therapy sessions
• Can be used in conjunction with therapy for conditions like OCD and bipolar disorder
• Short-​​term use of medication can provide support while working through difficult issues in therapy
  Short-​​term Use of Medication
• Can be effective in certain situations 
• American medicine better at starting medications than taking them away
• Pharmaceutical industry’s strong presence influences this
• Medications should be seen as tools, not fixes or substitutes for human-​​to-​​human work

ADHD Medication

• Can be extremely effective for those with ADHD
• Increases dopaminergic transmission and adrenaline in the brain
• Stimulants generally well-​​tolerated by those with ADHD
• Attention deficit can come from many sources, not just ADHD (e.g., anxiety, depression, poor sleep, stress, trauma)
• Overdiagnosis of ADHD leads to inappropriate use of stimulants

Negative Effects of Stimulants

• Prioritizing short-​​term benefits over solving long-​​term problems
• Risks include judgment impairment, heightened anxiety, impulsivity, and, in rare cases, psychosis
• Stimulants can change the brain without the user realizing it, leading to negative consequences in decision-​​making and relationships
  Cannabis for Anxiety Management, Depression, and ADHD
• Alcohol is not a good coping mechanism 
• Cannabis can narrow attentional perspective 
  • Can help people be present and gate out intrusive thoughts
  • Can be helpful for sleep
• However, at higher levels of distress, cannabis can narrow focus on negative thoughts
• Cannabis is safer than alcohol, but not uniformly safe

Psychedelics for Therapeutic Potential

• Psilocybin and LSD are true psychedelics 
  • Powerful positive data from labs and academic centers
  • Used in professional hands and with proper guidance, can have immense positive impact
• Oregon moving towards legalization of psilocybin in 2023
• Psychedelics may reduce communication in outer parts of the cortex 
  • Outer cortex is focused on survival (language, vision, executive function)
  • Psychedelics may take us out of the cortex and into deeper parts of the brain
  • This may help us connect with our true humanness and reduce distress

Note: The discussion of psychedelics is within the context of legal clinical settings and ongoing research.
Psychedelics and Therapy

• Psychedelics can help people see traumatic events with clarity and compassion for themselves 
  • Release guilt and shame
  • Catalyze therapeutic process by accessing deep parts of the brain
• Hallucinations may have metaphorical or symbolic value 
  • Can lead to understanding of truth and personal growth
• MDMA (different from classic psychedelics) floods the brain with positive neurotransmitters 
  • Creates a greater permissiveness to approach and process trauma
  • Allows for thinking about trauma without fear, guilt, or shame

Sentience and Humanity

• Sentience is extremely important and often undervalued 
  • Psychedelics may help us understand and value sentience in humans and animals
• Overvaluing language and undervaluing sentience can lead to ignoring the suffering of animals

Personal Experience with MDMA

• Profound, beneficial, and different experiences in each session
• Increases dopaminergic and serotonergic transmission in the brain 
  • Creates a pursuit of inner landscape and self-exploration
• MDMA may be particularly beneficial for trauma therapy 
  • Allows for processing trauma without fear, guilt, or shame
    The Power and Importance of Language
• Language can be both helpful and harmful 
• Over control of language can be detrimental, but specificity is important
• Defining terms like trauma is crucial for clear communication 
  • Trauma: something that overwhelms our coping skills and changes us
• Social media can amplify harmful language and hate 
  • Can lead to increased vulnerability and fear
  • Civility and decorum in discourse have diminished
• Need for rational use of language and setting societal standards 
  • Rejecting those in power who use denigrating language
  • Avoiding divisions and promoting unity
  • Addressing issues like white supremacy and hate-​​motivated actions
    Taking Care of Oneself
• Taking care of oneself is a deep and powerful concept 
  • Important for everyone, regardless of trauma or mental health status
  • Involves addressing basic needs and self-​​care practices
• Basic self-​​care practices: 
  • Sleep
  • Diet
  • Exercise
  • Social interactions
  • Living circumstances
  • Leisure activities
  • Sunlight exposure
• Importance of addressing why we might ignore self-care 
  • Trauma-​​driven or automatic behaviors
  • Sense of power tied to not taking care of ourselves
  • Need to reevaluate and prioritize self-​​care for overall well-being

Dr. Paul Conti’s Work and Book

• Dr. Conti runs a robust clinical practice focused on trauma and mental health
• Author of “Trauma: The Invisible Epidemic — How Trauma Works and How We Can Heal From It” 
  • Definitive book on trauma
  • Offers insights and tools for healing from trauma
• Website: pacificpremiergroup​.com