June 6, 2022 • 2hr 22min

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

Huberman Lab

In this episode, Dr. Andrew Huberman interviews Dr. Paul Conti, a psychiatrist and expert in treating trauma and psychiatric illnesses. Dr. Conti earned his MD at Stanford and did his residency at Harvard Medical School. He now runs the Pacific Premiere Group, a clinical practice helping people heal from trauma and other life challenges. The discussion covers the nature of trauma, its effects on the brain and body, and approaches to treatment. They explore therapy, psychiatric medications, and emerging treatments like psychedelics. Dr. Conti provides insights from his clinical experience on how to effectively address trauma and improve mental health.

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Key Takeaways

Trauma is defined as an experience that overwhelms our coping skills and changes how our brains function going forward. It's not just any negative experience, but something that significantly impacts us.
Guilt and shame often accompany trauma, leading people to bury or avoid dealing with it. This is maladaptive, as confronting trauma directly is necessary for healing.
The "repetition compulsion" causes people to unconsciously recreate traumatic situations in an attempt to resolve past trauma. This is driven by the emotional brain, not logic.
Effective trauma treatment involves bringing the trauma to the surface and processing it, rather than trying to suppress or avoid it. This can be done through therapy, journaling, or talking to trusted others.
Finding a therapist with good rapport is crucial. The therapeutic relationship is more important than any specific modality or technique.
Psychiatric medications can be helpful tools when used appropriately, but are often overprescribed as quick fixes without addressing root causes. Short-term use to facilitate therapy can be beneficial.
Psychedelic medicines like psilocybin and MDMA show promise for trauma treatment when used in controlled clinical settings with proper guidance. They can help access deeper emotional states.
Basic self-care practices like proper sleep, diet, exercise, and social connection are crucial foundations for mental health and trauma recovery. These basics are often overlooked.

Introduction

In this episode, Dr. Andrew Huberman interviews Dr. Paul Conti, a psychiatrist and expert in treating trauma and psychiatric illnesses. Dr. Conti earned his MD at Stanford and did his residency at Harvard Medical School. He now runs the Pacific Premiere Group, a clinical practice helping people heal from trauma and other life challenges.

The discussion covers the nature of trauma, its effects on the brain and body, and approaches to treatment. They explore therapy, psychiatric medications, and emerging treatments like psychedelics. Dr. Conti provides insights from his clinical experience on how to effectively address trauma and improve mental health.

Topics Discussed

Defining Trauma (7:00)

Dr. Conti defines trauma as an experience that overwhelms our coping skills and changes how our brains function going forward. It's not just any negative experience, but something that significantly impacts us. Trauma can be identified through changes in mood, anxiety, behavior, sleep, and physical health.

Trauma leaves us "different" as we move forward in life
Changes can be seen in brain function, like increased hypervigilance
Not every negative experience rises to the level of trauma

Guilt, Shame, and Trauma (14:05)

Dr. Conti explains that guilt and shame often accompany trauma, leading people to bury or avoid dealing with it. This is maladaptive, as confronting trauma directly is necessary for healing.

Guilt and shame are powerful deterrents evolutionarily, but can be harmful in processing trauma
People tend to avoid looking at how trauma has changed them due to these feelings
Communicating about trauma is crucial for healing, despite the discomfort

The Repetition Compulsion (21:38)

Dr. Conti discusses the "repetition compulsion" - the tendency for people to unconsciously recreate traumatic situations in an attempt to resolve past trauma. This is driven by the emotional brain, not logic.

The limbic system (emotional brain) doesn't understand time, so it tries to "fix" past trauma in the present
People often repeat the same traumatic relationship patterns multiple times
Recognizing this pattern is key to breaking the cycle

Dealing with Trauma and Negative Emotions (28:23)

The discussion covers how to effectively deal with trauma and the negative emotions it generates. Dr. Conti emphasizes the importance of confronting trauma directly rather than trying to change the past or control the future.

Short-term coping strategies like thought redirection can help manage acute distress
Long-term healing requires looking directly at the trauma and processing it
Writing, talking to trusted others, or therapy can help explore trauma

Processing Trauma Without a Therapist (37:17)

Dr. Conti discusses ways to process trauma for those who may not have access to professional therapy. He emphasizes the importance of bringing new perspectives to traumatic experiences.

Journaling can help gain new insights into traumatic experiences
Talking to trusted friends, family, or clergy can provide outside perspectives
The goal is to bring "de novo" (new) perspectives to something that has been stuck

Internal Self-Talk and Negative Narratives (45:30)

The conversation explores how trauma can lead to negative internal self-talk and punishing narratives. Dr. Conti explains how to recognize and address these patterns.

Trauma can lead to automatic negative thoughts about oneself
Recognizing these patterns is the first step to changing them
Observing our thoughts with curiosity rather than judgment is key

Finding a Good Therapist (1:02:34)

Dr. Conti provides guidance on how to find an effective therapist and what to look for in the therapeutic relationship.

Rapport is the most important factor in effective therapy
A good therapist should be adaptable and use various approaches as needed
It's okay to "interview" potential therapists to find the right fit

Optimizing the Therapy Process (1:07:20)

The discussion covers how to get the most out of therapy, including frequency and intensity of sessions.

Once a week for an hour is generally the minimum for effective ongoing therapy
More intensive work (like multiple sessions per week) can lead to faster progress
Patients should take ownership of their therapy and communicate if their needs aren't being met

Prescription Drugs and Treating Trauma (1:19:00)

Dr. Conti discusses the role of psychiatric medications in treating trauma and other mental health issues. He emphasizes that while medications can be helpful tools, they are often overprescribed without addressing root causes.

Medications can help increase distress tolerance and facilitate therapy
Short-term use of medications to aid in processing trauma can be beneficial
The goal should be treating underlying issues, not just suppressing symptoms

ADHD and Prescription Stimulants (1:32:18)

The conversation turns to ADHD and the use of prescription stimulants. Dr. Conti discusses both the benefits and potential risks of these medications.

ADHD medications can be very effective when properly diagnosed
Overprescription is a concern, as many factors can affect attention besides ADHD
Long-term use of stimulants when not needed can have negative effects on physical function and judgment

Alcohol, Cannabis, and Their Effects (1:40:37)

Dr. Conti shares his thoughts on alcohol and cannabis use, discussing both potential benefits and risks.

Alcohol is rarely a good coping mechanism for trauma or stress
Cannabis can sometimes help with sleep or relaxation, but isn't a treatment for trauma
Both substances should be used cautiously and respectfully, as they can change brain function

Psychedelics: Therapeutic Uses and Trauma Recovery (1:44:53)

The discussion explores the potential therapeutic uses of psychedelics like psilocybin and LSD for trauma recovery and other mental health issues.

Psychedelics show promise in helping people access deeper emotional states
They may help quiet overactive parts of the brain that maintain trauma responses
Clinical use in controlled settings with proper guidance is key for safety and efficacy

MDMA: Therapeutic Potential (2:00:01)

Dr. Huberman shares his experience participating in a clinical trial using MDMA, and Dr. Conti discusses its potential therapeutic mechanisms.

MDMA can create a more permissive state to approach traumatic memories
It may help reduce fear and increase openness to new perspectives
Clinical guidance is crucial to direct the experience towards therapeutic goals

Language, Processing Trauma, and Social Divisions (2:07:28)

The conversation explores the role of language in processing trauma and how it can contribute to social divisions.

Precise language is important when discussing trauma to avoid diluting its meaning
Social media and political discourse can sometimes perpetuate trauma through harmful language
Finding a balance between free expression and respectful communication is crucial

Defining "Taking Care of Oneself" (2:15:09)

The discussion concludes with an exploration of what it truly means to take care of oneself, emphasizing the importance of basic self-care practices.

Basic self-care (sleep, diet, exercise, social connection) is foundational for mental health
These basics are often overlooked in favor of more complex interventions
Consistently addressing these fundamentals is crucial for overall well-being and trauma recovery

Conclusion

This wide-ranging discussion between Dr. Huberman and Dr. Conti provides valuable insights into the nature of trauma, its effects on the brain and body, and approaches to treatment. Key takeaways include the importance of confronting trauma directly, the potential of both traditional and emerging therapies, and the foundational role of basic self-care practices in mental health and trauma recovery.

Dr. Conti's expertise shines through in his nuanced explanations of complex topics, offering hope and practical guidance for those dealing with trauma or other mental health challenges. The conversation underscores the importance of a holistic approach to mental health that addresses root causes rather than just suppressing symptoms.

Listeners are encouraged to explore Dr. Conti's book, "Trauma: The Invisible Epidemic," for a deeper dive into these topics and additional tools for healing and growth.