00:00:00 Hi I'm Rhonda Kelly with all clear Foundation thank you for joining us for this session I'm really excited to speak with Dr Ron schwinkler and Dr Eric French of Mind Spa Denver about the use of psychedelics in therapy for trauma and stress related injury and other breakthrough therapies that can really shift the way responders are experiencing their career in their lives so I'll let the doctors introduce themselves would you please tell us a little bit about your background and what brought you to this work
00:00:43 I've been in the Mental Health Community you'll be 27 years next month so I've got a master's in counseling a master's in Clinical Psychology and a doctorate in Clinical Psychology I started out working with with kids and families and I just kind of fell into that you know it just came really natural it wasn't really the plan but I started out and then working with those families and you know I just realized that you know trauma any it seems like any family I worked with
00:01:15 any any adolescent I worked with trauma was just a part of the narrative at some level and so it just made sense through my education to keep on specializing in in trauma over the last I think maybe 10 years it's been my sole sole specialization so through my doctorate that's that's pretty much everything every class I took kind of focused on what can I what new aspect of trauma can I can I learn about and work on um current you know after I graduated then I started focusing a lot on personal
00:01:53 injury work so a lot of car crash stuff and that was probably the closest I've ever come to single event trauma usually that's kind of like a joke because like who who has one trauma right in this in this life and so that but I actually saw people that just had one trauma and that's refreshing it's really cool to be able to help people get back on the road literally but then through that experience in my private practice I was been working with veterans First Responders um and then you know childhood trauma uh
00:02:23 victims and you know just anything anything that I can do to help those people and it just kind of evolved into meeting these two and uh it's just kind of taken off it was Synergy right right from the get-go fisted oh great yeah and I'm Dr Eric French you know me we've met before um so I'm I'm one of the co-founders and Med director here at uh at Mind Spa and like Dr schweikler this was Psychiatry was not even the plan that was not my intention as I was going through medical school and and I was pediatric neurology
00:03:02 with sub-specialization in neurodevelopmental disorders all the way and shift paths uh you know near the end and which was very frightening but found engaging with my patients on a deeper level and not having to stare at Diagnostics and lab work and computer but to really connect with a human being was a lot closer to the ideal of practicing medicine and healing than I had initially envisioned so um you know connecting with these guys with Sam Peterson he's our director of Business Development and Dr Ron
00:03:39 schweigler has really meant everything because we have been able to dream forward our ideal of how healing takes place and as opposed to just working for somebody else who is dictating what what this care looks like so um it's been really exciting and and I I do focus a lot on trauma myself because I have my own drama history um you know so I've battled with depression and Trauma as well as ADHD for a long time and I know how important it is to connect with patients and be more than just you know them be more than
00:04:15 something I read about in a book right so in you know approaching my own history I've been able to bridge a lot of gaps that way and it's just been exciting work and you know being a veteran myself Sam and I are both veterans Sam's a combat veteran we feel that it is essential to be reaching the the veteran active duty first responder Community because you know the the work is intense you know as you said you know stress injuries trauma this stuff is is very important work and a lot of times it's the difference
00:04:48 between high performance and low performance and the people who are engaged in these career paths are looking for high performance um so it's you know we've we've been super lucky to kind of examine the outpatient Mental Health Care model and uh and challenge every aspect of it possible fantastic well and I love I noticed from the beginning that was one of the parallels between our organizations is that we really do focus on performance doing well on the job but also doing well in life and not suffering needlessly and I think in the
00:05:20 military cultures the responder culture the healthcare worker culture there's been this glorification of martyrdom and putting others first the expectation that you should just be able to perform and to endure everything that that quote from Rachel Naomi REM and I like that I love is something about being expected to walk through trauma and suffering without being impacted is like being expected to walk through water without getting wet yeah and I I see yeah so many similarities between the veteran
00:05:50 and Military population and responders in regards to personality body motivators impacts yeah yeah I think it's you know we we'd like the idea of looking at Trauma from a performance point of view I mean um professional sports do it all the time right and baseball it's called The Yips right where there's we have a flow State we're taking care of business we're doing our jobs and then something happens and it interrupts the outcome that that we're used to getting what's that thing that interrupts it
00:06:22 it's a you know it's a life event it's an adverse experience it's a trauma and that could be a small T trauma all caps trauma Big T trauma right I mean it's there's lots of layers of trauma but we want to get people back into their performance right we want to in a sense going off that quote to to help people learn how to suffer well so we can get the wisdom that comes from trauma that we normally wouldn't be able to get anywhere else like we can read a lot of different stories and we can feel impacted by them but until we go through
00:06:57 it you know and and feel our way through it and transcend it then we get at a type of wisdom that is reserved for those that have suffered I love that concept of Suffer Well heard that before well what have you seen what we've noticed over the past couple years is that there's been a significant increase in the openness of responders to admit that they're suffering well or poorly and to reach out and ask for help to realize it's not shameful to see some destigmatization particularly around the mental and emotional suffering
00:07:32 and that there's been this anecdotally reported significant increase in responders using substances whether it's Ayahuasca or mushrooms or others in recreational settings or in ritualistic settings microdosing I've been hearing a lot about what are your thoughts on that especially versus using them in a therapeutic setting yeah I mean the it's interesting the the remark about there being a little bit more of a generalized acceptance across the board you know I will say yes and no to that simply because you know and Sam
00:08:07 will tell you this you know as a combat vet that if you verbalize that you need help for mental health that can literally jeopardize your security clearance and so and I think that people do fear that it will impact um their day-to-day job and this thing that they love and are committed to um but certainly we we do see more of a drive towards an acceptance as more Specialized Care is provided right like being able to reach um this demographic in particular where they are at is so essential to having that sort of conduit
00:08:40 to a more healthy career right um but to speak to microdosing of various substances psychedelics things like ketamine psilocybin MDMA the literature has been there for a long time right it you know when these things were falling out of the labs and into people's labs for recreation you know in general you know the whole concept of doing further research was was sort of dropped like a hot potato but we've had good data on this for a long long time and the fact that we're circling back around to that again with good effect is
00:09:15 is really exciting but it's it is a very um nuanced and specific way of approaching that needs to be done right like the recreational approach just it lacks so much in the way of understanding these substances and how to prepare a patient for them the coaching around it the way to optimize that treatment to you know get that that connection to the why is really really important and I think one of the reasons it is a little bit more appealing to the first responder and Veteran demographic is for good reason a lot of people don't
00:09:55 want to be on a daily medication you know there's there is a lot for want in the way that they are prescribed currently in the limitations that they have and I think the concept of doing something like this and having some deep intensive work associated with that is a lot more attractive than being on a daily medication for most people well I think among this population in particular there's this thought that well if I'm going to suffer I want to get something out whether it's growth or Insight which I guess is gross yeah but
00:10:24 the preparation I know you're both very big on making sure there is appropriate preparation of appropriate follow-up to to Therapies yeah I think you know what setup can be everything you know and that can be a personal meaning I mean that's really what I think people are looking for symptom reduction and a shift in meaning you know um I think a shift in meaning causes great symptom reduction and the symptom reduction in and of itself does not necessarily cause a shift in meaning we want to be able to relate differently to
00:11:00 these memories memories you know and how do we know we're relating differently intensity decreases we're not experiencing them as much right not for as long right so intensity duration and frequency are changing and we're allowing that meaning to trickle through in whatever way that is you know um which is very personalized but you know we we spend a lot of time with psycho education helping people prepare like we want to stalk meaning we want to to get after it and not just be a passive you know experience of you
00:11:37 know I hope this works for me um no and that's so important right because there are a lot of places that will do this work um and you know I'm grateful that they exist but I think there is an implication or a sort of an implied idea of you know let the medication do the heavy lifting you know and in my opinion feeling better is nice right but transformative is so much better and there's an opportunity with a lot of these these substances that we can apply and that's why I feel like it's so important to have this deep
00:12:14 understanding behind it that we can really bring that treatment out for every drop that it's worth instead of just saying you know sit down feel better like there's there's ways that we can connect to this in a different uh approach that takes our patients a lot further down the road in ways that that do create meaningful change right well and I like I'm sorry but I like what you had said well both of you have said it that a lot of the traditional medications the prescription courses are more about numbing or reducing the
00:12:43 symptoms without creating healing or transformation I love that term and I think that the way you provide the set in the setting is really having an impact on the outcome for your patients do you have any thoughts about that or can share why you why you do things the way you do them I think that speaks to the the concept that that we've coined uh in regards to experiential Psychiatry which has to do with layered interventions to approach the sophistication that the patient has experienced in regards to trauma right like trauma
00:13:23 doesn't happen on one in one context right like we take that thing across several contexts and we experience it on many sensory input levels right and so our idea is to to invoke um different interventions traditional Psychiatry traditional counseling um with sensory inputs that are allowing our layers the the you know we could say it we want our resources and how we approach the intervention to be layered so we can speak to the multi-contextual experience of trauma that they are experiencing I love that well and we've
00:14:04 spoken before I know some of the shortcomings I've heard from a lot of responders with therapies like EMDR some people it seems to work very well for others say I could never get to a safe place when I was being resourced at the beginning I just couldn't calm down I couldn't relax I couldn't go back into whatever I was exploring because I didn't feel safe I think that's one of the things you guys have done incredibly well is create that external and internal sense of safety yeah absolutely well we really want to invoke the
00:14:32 biological experience of safety which is very different than the cognitive experience of safety right so that's a big part we want parasympathetic activation as much as possible through a variety of interventions so that they then can feel that experience somatically which allows them to approach the trauma of memory um in in a more secure way but you know I mean there's a really big difference between trauma interventions like EMDR and being and specializing in trauma Theory and I think that's where a lot of
00:15:08 practitioners kind of struggle a little bit you know taking a certification course does not mean a person is schooled in trauma Theory um you know that's a different effort right and so um I think that's why I think a lot of people struggle with those interventions because the person's doing everything right they're doing everything that they were taught except they don't understand the context of the theory which allows that person to you know either you know worst case scenario AB react or you know
00:15:39 on a lesser level just not get anything out of it and then they have a tainted view of therapy because it didn't work exactly when we see that so often when responders or military go to a counselor that they weren't able to establish a rapport with they come back what they tell people if they talk is I tried counseling and it didn't work for me it wasn't that I connected with a counselor that wasn't a good fit for me yeah yeah just generalized rejection yeah and that makes a lot of sense I mean who wants to
00:16:06 keep thinking about something bad right and if we want to transcend trauma we got to keep fighting for it right like when we go to the gym we don't just work out once and go that didn't work exactly we don't go on a diet and try a salad once and go well that didn't work like we gotta we gotta work at it and that's it's hard doing that when biologically we're wired to avoid the bad thing right like we could approach salads over and over again I can't but a lot of people can um but it's really you know we're wired
00:16:37 to just Retreat from that adverse experience and yeah I mean it's hard when someone has that adverse experience about therapy in and of itself I think that some of that um is is on the responsibility of the provider to have a conversation uh very clear conversation with a patient who is pursuing some help that you know essentially it is not the tools that you're using to get better right it is the behavioral activation that you are engaging in or not engaging in once you are feeling better great to do things
00:17:10 differently in your life that is either going to fortify the distance from the symptoms that you've created or you know undermine its its structure entirely and I think that you know this is shame on us as provide us for not doing a better job explaining to patients what these interventions do right I tell my patients all the time talk therapy medications even ketamine infusion transcranial magnetic stimulation they're all tools so those are power tools right but ultimately they are tools that are meant to create that
00:17:39 distance from the patient and the heaviness of the symptoms that are concerning them right but then once that space is created and it's a little easier to activate and do things differently examine your life like okay cool my way wasn't working right how do I avoid this from falling back on me again like that's the work that is so important right so these are just Vehicles there are spotters right I tell my patients if you're if you're in the gym and you're on the bench and you're putting up your Max and you're having a
00:18:06 hard time and you're shaking and it's coming down I just got to crush you right like the spotter these interventions will help you re-rack the weight right but your spotter doesn't make you strong your workout makes you strong right so we really have to stage and explain the process to our patients in a way that's that's meaningful for them to connect with that like oh I got some work to do right and to make that a good thing you know and then that creates a balance to the why right because then we get a lot
00:18:38 more what right there's some space in there the interventions are allowing some space to win history or the moment bumps into them and then they can they can get into behaviors and do things a little different you know one of the things that we say here is confidence comes as a consequence and so we we want to to do things different we have to engage in behaviors different and and that builds our confidence and we start reclaiming ourselves after trauma when we can do things like that it's great can you talk a little bit
00:19:13 more about behavioral activation what that looks like what it really means and how much time we got I love it as much as you want I love it yeah I mean there's you know there's a a kind of an ongoing debate in Psychotherapy does does reason heal or behavior heal right and I think I'm I'm would classify myself as a functional behaviorist and so we really want to get into especially our emphasis with performance we want to get into um you know the the right behaviors that allow a person to like I said reclaim
00:19:53 their confidence um and and that has to be a almost a mindful a purposeful not almost it has to be a Mindful and a purposeful Endeavor we have to go out of our way especially using these moments after interventions to really consider what can I do differently right feelings are going to come and go feelings are fickle right I mean they they really are you know there's just this impermanent nature to to the feelings we want to help people commit to the values and the behaviors that they want to optimize
00:20:29 their performance which then brings more meaning to to their life right because they start experiencing a self-mastery right but we have to develop that behavioral activation plan um and and help people go back to it often a lot of times that behavioral activation is what can I do different but also what are the values that are driving that behavior right how do I increase mindfulness to understand the context then so I can pick the the values and behavior that's good for that context all right so yeah this is the
00:21:01 combination of those things I think too that you know as as we're discussing some of the the application of psychedelics and a form of therapy there is a distinct advantage on the other side of these treatments where there's more psychological flexibility that's created right okay so part of what these things accomplish is they significantly increase the brain's ability to talk with itself and with an increase in things like brain Drive neurotrophic Factor supporting new neural networks you know we try to get our patients and
00:21:35 once again this is part of that the importance of the the work around this let's capitalize right you've just had this treatment you've got some flexibility let's talk about how things can be done differently you just had an experience that showed you that life can look a little bit different than you've been experiencing right how do we capture this and get you doing things differently and I think that that that psychological flexibility is one of the most advantageous outcomes of these forms of treatment
00:22:03 yeah in that psychological flexibility does that offer a different perspective then so it pulls somebody out of the brets that they've fallen into yeah I I like using the the term of being really being able to turn over the Rubik's Cube and kind of play with it right so there's this when we are using our own thought process to try to logic our way through stress we keep thinking the same path right and it's just it's traversing that forward and backward day in and day out multiple times a day but when you
00:22:32 have the ability to really turn in the Rubik's Cube over into sort of you know examine what is happening from alternative perspectives you can have a new relationship with that event right and disconnect from the physiologic jarring of a trauma and allow it to become an advisor that strengthens you that really reminds me of the quote I think it's Einstein that we can't solve our problems with the same thinking we used to create them that's right so true that's the problem with history right I mean rely on it so heavily I mean it's
00:23:02 it's such a fundamental part of our lives but there's sometimes there's answers back there but you know we really have to focus more on what's the new thing I can do great the old thing is the whole thing got me here right um but there's also a fear of focusing on that new thing right because we don't know what's going to happen next at least the history we know what's going to happen next right even if it's bad it provides some safety because it's predictable and predictability allows us to feel safe you know
00:23:31 but it's treacherous you know and that's you know this is you know we we talk about the Mind using using five descriptors mine is brilliant beautiful treacherous silly and stupid and it's you know our history can activate a lot of different parts of that the current context activates all of that and our mind can do all those things in in two seconds how do we get that presence to witness it to witness our history to capitalize on the intervention so we can try something different wow you know so we
00:24:06 can practice more of that Brilliance and beauty while being able to witness and catch the treachery silly and stupidness wow I love that no well he had mentioned that there is a significant amount of research out there can you speak a little bit to the efficacy for various conditions whether it's depression anxiety substance misuse trauma and what I'm hearing more and more from responders is just debilitating grief I can't take another loss yeah how does how does ketamine engage with those in therapy are there other therapies that
00:24:39 your breakthrough therapies that you think are more efficacious does it tend yeah I think it depends on a lot of things I mean if if we've done nothing so far we've talked about how important it is to set the stage do the groundwork control the setting and use this as opposed to just experience this right like so you know the ketamine research is going to tell you that it helps roughly 80 percent of patients with significant depressive symptoms but I have seen it utilized and applied in a lot of
00:25:10 different ways successfully right so it's not just for depression it's not just for suicidal thinking if we are doing the right kind of groundwork around this it can be used to significantly help with substance use disorders to help with grieving a loss reconciliation of anything that's that's terrible in somebody's life you know it just really depends on the work that you do around it right this is a tool so we we watch these things applied in so many different settings in a way that is just missing the boat completely you know so
00:25:45 I think it is the importance of really using these things in a way and it's is Meaningful for the patient and creating a difference in the way that they view their circumstances is in the construct is in the way that we put all of this together well and you've talked a lot about setting the patient up correctly you also Ron I know talk a lot about the follow-up the not only the behavioral activation but can you can you speak a little bit more about what that looks like in a therapeutic setting yeah I
00:26:15 mean it's it's the continued effort that we need to encourage people to engage with right I mean change is maybe we could say our our biological and god-given right right like we're we are the animal on the planet that does change and it's the hardest thing that we you know have to accomplish and you know it um takes it takes that Aftercare it takes that follow-up a calling you know sometimes randomly reaching out to just saying hey how are you doing with that what are you doing about the intervention that you know you can feel
00:26:55 good about that that follow-up but we really you know just then saying it's like water dripping on a rock right like Drip by drip you can't tell what's happening to that rock but over time the rock changes Drip by drip and so we want to keep that that effort you know cooking in contact you know and we're mammals so like contact is really good the right contact is really good okay but not all hugs are good so we you know we it's like be a good mammal I mean that's one of our one of our things and it's you know we we can
00:27:29 role model that as practitioners um sometimes we get held accountable for because maybe we didn't do it and then we can correct ourselves and say you know we could practice being a good man we'll say I'm sorry like you know I'll do better you know and we want those corrective experiences but really we want to encourage people to to take that bull by the horn and get it done yeah try new things yeah there's other aspects of the Aftercare that we like to connect with you know our patients and the people supporting them through this
00:27:58 so that they know how to support their loved one who's going through this treatment right like and to not get in the car after treatment and have an argument or like try to you know solve some very challenging problems right but to kind of Foster and hold that space for their loved one who has just gone through this treatment to really capitalize on its effects in in that moment and and you know as we're working on this behavioral activation and teaching them ways to carry forward what they've just experienced we want the
00:28:30 people supporting them to understand how to help them with that right you know that brings them deeper into this person's care and process as well which is you know always not a benefit I'm sure it helps them feel not threatened by the change yeah that's a big deal right so there's this there's a psychodynamic ideal or concept it's called positive affect intolerance and it's the significant part of of trauma it could be a significant part of having neurotic parents in general let alone some traumatic parents but you
00:28:59 know we really are so good at adapting and we really get scared of feeling good right because feeling good means my guard is down that means a random event can happen that means I get hurt again can be disappointed disappointed right caught off guard literally heard right so we we want to we don't want to we develop an intolerance to positive affect and and on on to your point right the the moments after treatment it just like let's allow ourselves to feel okay and like notice nothing bad is happening
00:29:35 right right and then let's let's allow ourselves to feel get a little more used to that and then do some new things and then reinforce those good things with partners and and you know whoever else wants to get involved and it's like we have to retrain the nervous system that like being okay is actually okay right that's interesting that's interesting several years ago we did a workshop on stress injury and we borrowed the stress injury Continuum so green yellow orange red and ask the group of responders what
00:30:07 does green look like for a cup and immediately cop stood up and he said yellow is green you you can't go to green you're you're going to be victimized you're you're going to be vulnerable and just How Deeply ingrained that messaging is is I have to be on guard all the time because the world's a dangerous place makes so much sense doesn't it yeah you know how effective is the use of ketamine and resetting the nervous system I you know it's very good for that I think that when you have an opportunity
00:30:36 to gain some deeper perspective on the circumstances that you are dealing with you know that we we are able to reset we come back at things with a different um you know a different narrative right if we're doing the work that we're supposed to be doing how we're talking to ourselves about our our circumstances and experiences should be shifting as well um and so I've I've heard a lot of people who engage in um you know maintenance Academy maybe they come in quarterly for a one-off treatment that
00:31:05 they feel like they they that word reset is used very commonly that like they feel like it just gets them back in contact with you know this state that they found so beneficial and you know sort of control all deletes it in a sense I like that you know well and that brings up another Point I've heard a lot of responders kind of mulling around pursuing ketamine assisted therapy one of the first concerns I hear is am I going to become addicted another is is this going to have a negative impact and
00:31:34 you mentioned that in my career am I going to lose my security clearance am I going to lose my job is this illegal this is a controlled substance what do you have to say around all of those fears and is addiction a risk in this setting it's not okay and the reason why is because a we are micro dosing right we're not using these large recreational doses um you know B it's a very controlled setting see this is not our only means of combating these symptoms right we are not relying on ketamine infusion as a
00:32:06 form of monotherapy for a patient right this is a piece of their overall work right and doing this work over a short period of time ideally within a two-week span you know there's very little chance of experiencing that addiction takes place when you're utilizing a control substance substance day after day and now your body has has a you know accustomed itself to seeing that and is waiting for it right and so doing it on over a short span of time and having you know like doing this only three days out
00:32:39 of the week your your body does not have the opportunity to form that sort of dependent relationship with it and this is why we don't do ketamine every other day permanently on patients right like nobody wants to even flirt with that you know we we want to engage this power tool and build something out of it and then back off and do the work you know great oh and I love how you described it earlier that it makes this it creates the space for the work to happen and yeah so what would you say and have you
00:33:13 or have you experienced clients who push back with I'm afraid that I'm going to lose my clearance I'm afraid I'm going to lose my job is this legal have you experienced that concern from patients and how do you address it yeah how do you address with your patients full-on you have you have to address it right they have to do a lot of research into their their context um they have to be an active participant and really understanding the protocol you know are they are they getting polygraphed what you know what's a fine
00:33:47 print the policy and procedures yeah I mean it just really depends and I think there's we have to be cautious and courageous in regards to you know new interventions or more you know intervention especially with the Adventist psychedelic intervention in general and how it it's trending in a direction right there's going to be people have to be wise you know they got to be smart about about their job the context and and what they're doing and the policyholders need to get on board right with adjusting to these new
00:34:24 interventions and really looking at the data um and and not engaging in witch hunts so readily yeah you know I mean there are witch hunts are alive and well you know and so you know we it takes cautious cautiousness and courage on all the different parts not just the responder not just the the warrior you know but on the policy holders to take a good look at this okay yeah I think that's an important aspect is that you know understanding what your Department's policy is on these things is is vital right um you know what we're
00:35:00 really hoping to accomplish through the types of work that we're doing is really shifting that Paradigm so that there's a deeper sense of Education across the board that this is not a an addictive substance that this might very well will be one of the most potent things that we have available to keep your person working in their Department right as opposed to this is staying in their system long into the next day which it doesn't these things have short half-lives right it's a half-life so the half-life Academy is just like hours I
00:35:28 think two hours three hours right around there like this thing is it's gone it's out of your system right so we're somebody going back onto the job the next day they are not being influenced by this okay right so there there's these you know I think a lot of the issues around this is that there's a lack of Education all right and and that's that's the biggest danger because when people have false assumptions about something that is you know really potentially um you know beautiful beneficial and and
00:35:58 can keep somebody in their boots doing their job day to day we want to make sure that people know the right information about it right you know there's there's so much misinformation yeah and when they stay in their boots and they're getting the job done like what effect does that have on post-traumatic growth and transcending trauma right it's like then they got to show up and not be named broken right right then they got to complete the job the mission and not be named broken well and I think that's one of
00:36:29 the ways organizations have really failed to responders in the past is if I were on the fire ground and I broke my leg I'd get put in an ambulance I'd get treated well I'd go to surgery I'd go to rehab I'd get limited Duty or light duty while I was coming back so I don't lose my sense of identity I don't feel weak I don't feel like I'm not contributing anymore but if somebody says in the past I have anxiety or I have depression they're treated oftentimes like an outcast oh you're weak you might be
00:36:56 contagious we don't move them off duty we don't put them in a role where they can still contribute and have that sense of accomplishment meaning and purpose and inadvertently I think organizations out of fear and misunderstanding or lack of information have not only increased the stigma but really increase the personal injury yeah yeah it's so funny too and it's you know for for departments not to see and appreciate the the effort and aim of the you know the individual seeking care is so silly I mean look left and right like for them
00:37:28 to be treating this individual who is trying to strengthen themselves as if they are a liability because of depression anxiety trauma history whatever you know whatever it is is so silly because the likelihood that they have experienced that in in waves or at different parts of our life is so insanely High these days that it's like show me somebody who hasn't dealt with this right this person has the the intestinal fortitude to name it and to say I want to be doing things differently so that I can keep doing
00:37:58 this right and so the the response of penalizing somebody by you know calling their security clearance into question of stuff like this is just it does not make sense to me it's really you know this person is trying to optimize their performance and show up and we were talking you were talking about how you know how this really strengthens the individual let's talk about how it strengthens everybody that this individual is helping on a day-to-day basis right like exactly let's talk about the quality of their interactions
00:38:25 when they perform High everybody that they interact with is touched by that on some level right everything they put their hands to is affected by the performance that they've committed themselves to it's I think that you know being able to educate various people as to the safety the profile you know how this stuff can be done productively is going to go a long way over time in these you know various agencies and departments understanding like okay you know I would way rather have this person go through a
00:38:55 short period of treatment and come back stronger than before than to lose this person entirely or medboard them out it's just like it doesn't make any sense to me that the hope that that gives yeah you know the to see someone overcome adversity like that's infectious right no but we you know we call these things invisible wounds and it's like you know we we don't believe in magic but like it's invisible we'll just act like it's not there and like you know maybe it will go away it's like yeah one what's the stats
00:39:24 one in three people suffer it's getting close to that yeah I mean it's yeah pre-pandemic it was one in five yeah people suffered with you know but that was a free pandemic yeah it's got to be a lot closer to one in three you know and you know we're talking about how this impacts their ability to do their job on the day-to-day but think about their families who sacrifice and worry about them watching their loved one significantly stronger going out to work with you know that that renewed commitment to what they're doing having
00:39:54 them come back and stay engaged with their families like who would not want that yes and you can feel our excitement about this right yeah absolutely I mean it's in your knowledge trauma I'm not passionate about it trauma sucks right it's right it's it we're so afraid of trauma it's like well I think we should might be maybe we need to shift and be more afraid of not transcending trauma because you know when as as a parent so I I've had nine joint surgeries and one spine surgery and you know sports related and
00:40:24 motorcycle crashes and and I know that my kids now get to see that I went through hell and they see that I kept walking and I got through it like it's not just avoiding trauma like that's it's not a resilient right we want we want to be able to say yes this happens and there's a way to go through it and that teaches a kid like that's when resilience becomes a multi-generational you know experience absolutely and we want we should be fostering that more and not running away from it because it's like this bad thing
00:41:00 yeah leaving that Legacy on our family members as opposed to you know our family watching us find the bottom of a bottle you know but it but saying I need this help I can't think my way through this I'm going to reach out like that that becomes the norm right and who doesn't want to leave you know that kind of a legacy with their children this is how you handle adversity what I never heard that concept of multi-generational resiliency but the data I didn't either I just made it up good job anywhere here
00:41:32 but you know the research is out there that if a parent commits suicide then their child is 50 more likely to take their own life and and that's the generational Legacy as opposed to resiliency yeah think about that this person that's supposed to role model for them chose this as a response you know does that model that yeah it's it's automatically normalized because copycat syndrome is real yep and it happens in the negative yeah right and it's powerful in the negative because we have this biological
00:42:05 propensity to have a negative bias and that's that's biological right like it pays more it makes good sense to pay more attention to bad things than good things because our whole nervous system has one job he makes it survival right so so we want to look out for the bad things because bad things kill us and you know when you combine these things like negative bias you know role modeling and or copycat syndrome it's like like we better be paying attention about how we affect when all of these are stacking so I love the way you have
00:42:37 resource stacking as a Counterpoint to that so you've talked a little bit about um well we've talked about barriers to utilizing psychedelic assisted therapy are there risks to it and and is it for everybody well definitely not for everybody right and everything has its risks right I think that um there's nothing that you can ingest from the medical community that doesn't have some risks right but you work hard to explain those risks with patients and mitigate them the most common risks with ketamine is a transient hypertension so
00:43:12 the blood pressure goes up while the infusion is taking place um you know is this an issue no not generally we can manage that with a an as needed medication where if the blood pressure you know goes above a certain number we can treat during you know during session and I actually order those medications ahead of time the other one is nausea right so teaching our patients say listen don't eat anything four hours or so before your treatment right and and I'm ordering you this Zofran that you can have during
00:43:42 treatment if you start feeling nauseated but you know that's that's another thing that's that's beautiful about IV infusion is you can control the pace of that right so we can mitigate in a lot of different ways so risks oftentimes are part of this discussion is you know here are the side effects that you can experience we know what to watch out for we're watching you the whole time okay I think that's another difference between the way that we do this and other places you know the provider is going to come
00:44:10 back and check on you every 15 minutes or so to take a set of Vital Signs like that's not good enough right that's not good enough like what if this person is having an adverse response it needs to wait 15 minutes because you just walked out the door right but they're in a state that they can't even vocalize right like so that's you know being able to do this stuff the right way is essential and you know to mitigating any risks you know there are certain medical conditions that would preclude somebody
00:44:38 from getting ketamine which would be uncontrolled hypertension you know this person's blood pressure is off the charts and nobody's been able to get it under control whether with diet exercise or medications I'm going to be less inclined to put that person in a position to have that transient high blood pressure but also closed angle glaucoma right if there are issues with the small vessels why am I going to put my my patient at risk right so it was really very few patients for whom this is not an option
00:45:09 from a psychiatric Diagnostics diagnosis standpoint like a primary thought disorder like a schizophrenia or a schizoaffective disorder you know delusional disorder acute Mania right somebody was acutely experiencing Mania this is not going to be a great idea right this is not what we're going for advisable yeah yeah there's so many other things to do that like let's lead into that work right so I think you know it it while it's a small percentage of people who I I could think on one hand in the last year the number of patients
00:45:44 I've had to say like this isn't for you right this is the you know and don't worry about that right because these things are right so we'll lean into that stuff but but yeah that's that's how we handle that great well and I think a lot of people are curious what does a treatment look like what does a treatment protocol look like you spoke to the half-life and the duration Academy and in the system but what does the treatment look like in its own yeah excellent question so um once the patient comes in for their
00:46:10 treatment our RN who is providing the the ketamine treatments is an amazing 10-year ICU nurse and just knows her way around this space so well she's starting an IV line on the patient once we've already gotten their Vital Signs we know how everything's looking and she combines the the appropriate dose that I've ordered typically we'll start off with a half a milligram per kilogram of the patient's body weight and that is mixed in a saline bag and then the infusion begins right and the patient is
00:46:43 comfortable in uh in our reclining you know leather chair and and has access to weighted blanket and we can really do a lot of ambient work that's curated towards we were you know like we were discussing earlier creating that biological sense of safety so that the person has the opportunity to let themselves really go into the treatment but they typically last 60 to 90 minutes okay we block off a couple of hours just to give somebody time to kind of come back to themselves fully we really do encourage our patients while they are
00:47:16 coming back to themselves let's start writing let's start behaviorally activating let's start thinking about how we can capitalize on what you just experienced you know we're working with as I said earlier their their ride to make sure that they have a ride home um you know some people will need to Uber if they don't have anybody they and bring them but we're making sure that they are fully back to themselves and fully oriented feeling like they can you know press forward but it's it's you know we will do this in these treatment
00:47:48 series for ketamine we do the based on the literature we'll do six treatments okay and we'll do those as close to a two-week span as possible to really optimize the effect of the the treatment itself I tell my patients like we were talking about traversing that path forward and backward right that that becomes a concrete tunnel after after a while right and so like after that you know Fifth and succession when you have your sense of like okay I know what's going to happen I know how to use this and
00:48:18 apply it I mean it's really fracturing that concrete and bringing it down so you can walk other paths um but that's typically how we'll do it so six treatments in series over two weeks time 60 to 90 minutes um you know and then all of the Preparatory coaching and Aftercare that we've discussed and you know sometimes people will come back as I was saying earlier for maintenance you know whatever I have a combat vet who comes back monthly and this is one of the things that really keeps them dialed in
00:48:44 with his family right and then I have other people who never come back again right so you know they they feel like they did enough work with this that they got what they needed out of it so there's really a broad range of how people either engage in single series or engage in maintenance so it's very individualized yes okay all care should be individual okay good point fantastic this is what's not happening in mental health care right and I think this is why patients hate going to see a psychiatrist because it's
00:49:12 you know they're not listening they're not doing the detective work that they need to to figure out where things are coming from and it is it's so not tail it's the antithesis of tailored care right right so that's one of the the things that is really important when we are putting this together we're having conversations and trying to figure out what this person's needs are okay you know how do we get this person where they're trying to go right well and you had mentioned earlier that sometimes ketamine's not the suggested
00:49:41 therapy I know you mentioned TMS earlier yeah how does that work yeah TMS is so cool and like this you're going to get me on a topic that I could do like you were saying how long right and I geek out over this stuff because I really do um My First Love was neurology and and functional neuroanatomy is so exciting and as we learn more and more we appreciate just exactly how these modes of therapy are a completely different approach to what we're doing on a day-to-day basis but transcranial magnetic stimulation is the utilization
00:50:14 of sort of a small version if you will of like an MRI coil right does anything touch you when you go in for an MRI scan no it neither does it in TMS right it's housed within a plastic helmet that sits over your head but the the electrical current that's being sent through the coil that's housed in that helmet is very specifically shaped and it creates an electromagnetic field that stimulates functional neuroanatomy and so when we have been depressed or anxious or or having uh you know this trauma history
00:50:47 Etc there's a lot of different applications for TMS it affects our functional neuroanatomy certain structures start performing in an underwhelming way okay right and I think that when the brain is not functioning the way that it can it does require more stimulation with medications right so one of the excellent properties that TMS has is that you know oftentimes we are able to sort of back off doses of medications that patients are on and in some cases stop some medications altogether and through that work but it's a longer time
00:51:20 commitment right we do this five days a week over seven weeks um yeah yeah um and that's that's the reaction now we're going to get on that reaction you know and I tell them like you know yeah that's that's a commitment right but if you're going to go if you're going to go lean into something and spend some time with it right you can have everything in life you can have the job the spouse the house you know the car the like you name it fill in the blank your physical health you if you don't have your mental health you can't
00:51:53 enjoy any of it right and it speaks to that treachery right like how many days a week are you suffering and for how many weeks I love that like this is what the Mind does that's so simple whoa seven weeks it's like I've only been suffering for like four decades you know and so so it's like you know we want to we want to challenge that stuff and and that you know I love that you responded that way because it's like that's that's normal right that's like this this is really we have to be all in if we want
00:52:24 to get better yeah right right I mean at whatever level the intervention is it it's full contact we got to be all in man and think about the things people spend money on too good point to feel better yeah oh my goodness right like the you know the sort of Shop Therapy the vacations this and that they they spend money on thinking that it will make them feel better or that it will sort of the the pain or the sorrow and man people go people go all in financially for that I don't even bat an eye or
00:52:55 think about it and it doesn't take them anywhere from A to B you know if not for more than a day or two right so I think that um you know having these conversations with patients and saying right like we want patients showing up who are like yeah no I'm ready to work right because we can't fix right people we don't want to fix people we want to strengthen them and teach them how to fish instead of coming back all the time for their fish right like love that I want to teach my patients we want to
00:53:23 teach our patients how not to need us right like let's let's get into that work but somebody needs to be ready to to come in and do the workers I'm telling you when you apply these these power tools particularly when you do TMS and ketamine and combination the results are insane that is super cool it's the most gratifying thing to watch and it's my favorite time to say I told you so I love that that's great so is TMS more indicated for anxiety or can it be used for a variety the cool thing about the the company that we work with
00:53:50 brainsway is in a category of their own there's a lot of different companies that make TMS machines but brandsway is the only company in the entire Market that does deep TMS so because of the strength and structure of their coil they can reach three and a half times deeper than the standard TMS machine can and when you can reach subcortical structures you really open up the array of issues that you can treat them right we can get a lot more specific with the areas that we're going after and you
00:54:21 know so they make more helmets than just the one coil right so they've I mean they've got tons of them I mean that probably 17 elements who knows I mean they just um they're always doing their work and their research that's the other thing that I really enjoy about working with them is it's so empirical okay it's so research driven um but yeah so I mean now it's just it's not just anxiety it's anxiety depression OCD PTSD right there's there's even protocols written for you know cognitive enhancement for ADHD for Ms
00:54:55 um you know for autism uh symptoms like there's just so such a broad application with something like this and when we talk about the durability of the effect um you know that's the the most impressive thing to me you know right we talk about the effects of doing a ketamine series lasting between a month to two um you know in terms of the actual you know the the effect of the treatment itself that's why it's so important to do really great work around it capitalizing on that but the durability of a series
00:55:27 of TMS is you know like they've done studies looking at you know six months 12 months 24 months post completion right and over half of their patients are still in remission of symptoms two years later right what else do we have that does that and you've been working with friends with brainsway since you had Aurora right since before since since in residency training you know that back in in Florida um well I was 2015 to 2019. yeah so he's been working with brains away for a long time a long time yeah yep and and so
00:56:00 like understanding how this works how it's applied um how to optimize those treatment protocols that they've developed is really key because it's you know there is there is an art and a science of medicine right right exactly you know being able to optimize the way that my tech performs those day-to-day treatments and engages those brain areas that we're trying to treat so that we can optimize the outcome is really important too so it's just that the work around this is so much fun and you know
00:56:29 but you know we talk about 80 percent response rates for ketamine for depression we talk about you know 72 to 76 percent uh response and remission rates here for for depression you know when you combine TMS and ketamine it's insane you know I have yet to see somebody not do extremely well it's incredible but the you know they're they're whatever stats around that but I don't know that there's any study specific to doing ketamine and brainsway deep TMS but I'll tell you in in practice it's better than 90 wow and and
00:57:07 this has been a field plagued with you know ineffective treatments for decades right you know and so when you see that as a provider if the literature wasn't enough to verify its safety and efficacy seeing my patients faces and watching them that's just yeah find themselves is that's enough right there it's clear you're both very passionate and so knowledgeable about this I love the way that you're really relying on the empirical evidence and enhancing it with your clients responses their testimonials
00:57:41 um the looks on their faces that's the best wait that's fantastic well is there anything else that you would want responders to know about ketamine assisted therapy about TMS healing recovery you've been so eloquent about a wide array of I would say that we we here at Mind Spa and many people who who understand this demographic your work is hard and that is putting it so lightly and it it is it's a heavy Mission and we want to make sure that you remain committed to doing it in the healthiest way possible so
00:58:24 that when you're showing up you're showing up to everything at your best and everybody that you're interacting with is is benefiting from that so you know don't be mistaken that your friends and colleagues in the in the profession are not dealing with these issues too right absolutely people put up any number of facades to make it look like they've got it all put together but I'll tell you right now on the inside everyone is is dealing with the heaviness from that line of work and that's the beauty and courage and what
00:58:50 they get up and go and do every single day so you know don't don't just continue to suffer with that suffer well get stronger and dive into work that's going to make you really love and and sustain your career in the ways that everyone who does this line of work is hoping to see I love that yeah I mean we don't know what we don't know right we get into a field and we think one thing and then the field shows us something very different and it wears on us and like what's what's us well where's on our mind our brain our body and our
00:59:33 nervous system and and it keeps wearing on us it keeps being reinforced our families and their nervous systems right bodies Minds you know get you know affected and so you know we're so appreciative of of the people that got into it for whatever reason and we are we have a heartfelt interest that you may not have known what you were getting into and you know we want to just provide some space we've said some light like let's just keep trying you know um to get you to perform you know the way that you want I mean you most people
01:00:18 aren't going to get out of it they might show up to work every day and wish they could get out of it but it's like you know it's like reality right there's pensions there's there's life and people say I can't take it one more time and then that happens within 48 hours and you're like uh you know and you have to keep going and so we just have to keep trying together right um and being able to to have providers encourage you and having the will to correct providers and say like hey like that's not how I see
01:00:48 it it's like okay cool like let's let's see and how you see it and let's see what type of intervention we can come up with but we got to keep trying yeah you know I hope I hope people can keep trying because it's a hard it's a hard job and it's often thankless and oftentimes the people we work with yeah so many of them can't even because of their clearance they can't even tell their families about what's going on let alone would they want to even if they could because it's like the the worst you know things that they
01:01:18 have to see even it's just like well there's there's even ways around that where we can process things like that without talking about it you know that's where that whole the evolution of you know talk therapy cognitive therapy and somatic therapies can really kind of get artistic is so we can process it without talking about it but like we got to keep trying yeah we got to keep trying because they keep trying yep right I mean yeah let's let's keep it real too I think that it's it's important to be receiving care from
01:01:49 people who do understand your demographic yes right and and people who understand that we are not better than you because we know what we know we just you know your job we know our job right and and we're ultimately at the end of the day just two adults sitting down and working on this this human condition that we're all we're all constantly bumping into all day so you know I think it's it's important to make connection with people who are you know who are also real good absolutely when I'm struck by the
01:02:17 cultural competency here I you're both obviously not only very well informed with the science and with the application of it but you do understand the populations that you're targeting the military the veterans the responders and it's really refreshing to see because I think that allows you to establish the Rapport that contributes to that sense of Safety and Security yeah it makes a big difference we're trying to Suffer Well too yeah well just being so open about this is The Human Condition it doesn't matter
01:02:43 if you have a doctorate it doesn't matter if you're an EMT a firefighter or a cop yeah that's important none of us is immune I don't care what you are death doesn't care at all how you're degreed at all and you know that's kind of one of the the main factors of trauma is death is present and Randomness is present the feeling that we don't have control like our nervous systems have severe allergies too random events that we don't have controlled over that involve death like our nervous let's let's find any creative way we can
01:03:18 to stay as far away from that as possible right and and we can't get away from it right like we got to get into it you know we need to let death become an advisor in a way so we can grow through it you know and look at life a little different yeah because because pain death um even trauma these things are not the enemy right they it's part of life they are part of life and while they can really wreak a lot of Havoc um learning how to manage that well so that you continue to grow personally and continue to see the success you deserve
01:03:54 is is everything love that [Music]
