Modern Wisdom - #507 - Dr Julie Smith - Overcoming Stress And Anxiety

Episode Date: August 1, 2022

Dr Julie Smith is a Clinical Psychologist, online educator and an author. Bad days will come. Stress and burnout and feeling down is always a potential threat. So, it's vital that you understand the right tools to recognise this, deal with it and bring yourself back to a balanced mindset. Expect to learn whether depression is actually caused by an imbalance of chemicals in the brain, what most people misunderstand about anxiety, the most important things to avoid when you're feeling down, how a bad morning can be turned around, how to improve from a place of growth not a place of fear and much more... Sponsors: Get 10% discount on your first month from BetterHelp at https://betterhelp.com/modernwisdom (discount automatically applied) Get £150 discount on Eight Sleep products at https://eightsleep.com/modernwisdom (discount automatically applied) Get the Whoop 4.0 for free and get your first month for free at http://join.whoop.com/modernwisdom (discount automatically applied) Extra Stuff: Follow Dr Julie on Instagram - https://www.instagram.com/drjulie/ Follow Dr Julie on TikTok - https://www.tiktok.com/@drjuliesmith  Get my free Reading List of 100 books to read before you die → https://chriswillx.com/books/ To support me on Patreon (thank you): https://www.patreon.com/modernwisdom - Get in touch. Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx YouTube: https://www.youtube.com/modernwisdompodcast Email: https://chriswillx.com/contact/  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello everybody, welcome back to the show. My guest today is Dr. Julie Smith, she's a clinical psychologist, online educator and an author. Bad days will come, stress and burnout and feeling down is always a potential threat, so it's vital that you understand the right tools to recognize this, deal with it and bring yourself back to a balanced mindset. Expect to learn whether depression is actually caused by an imbalance of chemicals in the brain, what most people misunderstand about anxiety, the most important things to avoid when you're feeling down, how a bad morning can be turned around, how to improve from a place of growth, not a place of fear, and much more.

Don't forget that you might be listening but not subscribed, and it is the best way that you can support the show. It also makes me very happy, and it will mean that you might be listening but not subscribed and it is the best way that you can support the show. It also makes me very happy and it will mean that you will never miss an episode when they're uploaded. So just go to Apple Podcasts or Spotify and press the subscribe button. And thank you. But now, ladies and gentlemen, please welcome Dr. Julie Smith. Have you seen this most recent study about the impact of SSRI's and the serotonergic system

and how it's related to depression? I think there's been lots of news headlines going on, but I think it's not unusual for there to be headlines about things like medication. So to be fair, it's not something I've hugely engaged with because I'd sort of rather go to the source of which I haven't been to yet. So yeah, I try, in general, I try to sort of steer clear of some of the headlines partly because they can get it really, really wrong. But I assume there's a brand new study. It looks like it, yes. So this is from the conversation.com. Depression is probably not

caused by chemical imbalance in the brain. This is the people that have done the study. The serotonin theory of depression has been one of the most influential and extensively researched biological theories of the origins of depression. Our study shows that this view is not supported by scientific evidence. It also calls into question the basis for the use of antidepressants. Most antidepressants now in use are presumed to act on their effects via serotonin. Some also affect the brain via noradrenaline, but experts agree that the evidence for the involvement of noradrenaline in depression is weaker than that for serotonin. There's a bunch of mechanisms. Basically, things are now up in the air, and chemical imbalance is something which appears to be being criticized and looked at with

a lot more cynicism. Yeah and I think it's not the first study to sort of indicate that and there's been you know there are sort of you know books written on it and things over the years but I mean from someone who's who's not a medic so I'm a psychologist so we focus on sort of psychological formulation and looking at how people can manage their mental health through skills work and therapy. Actually, you know, it does sort of ring true that, you know, there are some people that might come along with the idea that it's something that is wrong with them. And you know, there's something in my brain that's not right and I need fixing. And there's other people that don't necessarily come along with that conceptual idea of of things that are happening to them. And often we'll work for, you know, whatever idea somebody has about the origins of their distress.

We tend to item to work from an individual basis. So whether there is or there isn't, an exact sort of biological cause, actually, I've never come across anybody. Once you hear somebody's story and everything that they've been through from the word go, I've never been through that whole process of hearing somebody's story without then thinking, of course, you feel this way. Look at everything you've been through. Why wouldn't you?

It'll be strange if you weren't suffering the effects of that trauma or this relationship or whatever that person had been through. So I've always been able to, you know, from the psychological perspective, I've always been able to make sense of people's distress through their life story and what's happened to them and the way that they are sort of choosing to cope with it and their different sort of coping mechanisms. And by adjusting some of those, we can have massive transformations and how people function. Well, let's say for a second that the serotonin theory was correct and that is what happens.

I'll be very, very surprised if the person with even the worst serotonin in the world but was getting up on time and had great relationships and was eating and drinking right and trained and got sufficient sunlight and that person is going to be unbelievably resilient. And the same for the person that has the perfect serotonin balance in the brain, if you kill their sleep for two weeks, make them eat terrible food, keep them in a dark space and give them no friends to be around or work, it's meaningful to them. I challenge the happiest person on the planet to not feel depressed after that. Exactly. And it's sort of strange this idea that, you know, the chemical balance in your

brain is the start of everything. Actually, it's also a reflection of what's happening around you and in your life. So, yeah, if you change your behaviour, you can change your brain chemistry. Well, our medication can be really effective at doing that. There are also lots of other things that we can do that we can take control of that impact our brain chemistry as well. Andrew Heudman came on the show a couple of weeks ago and he's got this quote where he says, you cannot control the mind with the mind and he's just talking about the fact that our brain states are intrinsically linked to the actions that we take, to the way that we do things to the way that we

do things on a daily basis, and then actually getting out of the mind and into the body is something that's maybe quicker than, and then not trying to think our way out of whatever problem it is that we're facing. Yeah, certainly the sort of the skills that tap into the physical sensations are often the first that we would teach in therapy partly because they are quick acting, they are really easy skills to learn and ones that you can then use whenever you need to. Like the sort of different breathing techniques and you know, Andrew women talks really well about this sort of the different ways you can use breathing to kind of calm anxiety and stress and those kind of things, which is really, really helpful. So they're often the first things that would be taught to somebody who came to therapy, for example. I think while you can influence the mind through the mind,

it's a more long-term strategy, so it's stuff that takes more practice. You know, you can learn a breathing technique in 10 minutes and then use that forever. But also, you can learn how to change your relationship with your thought patterns or your past, and that's the stuff that takes longer. But also has an incredible long-term effect. What do you think most people get wrong when trying to understand anxiety? What do they get wrong? Possibly the idea that they can influence it, that it's a feeling like any other, and that when you have that feeling, you don't have to be at the mercy of it. There are lots of things you can do to influence the

intensity of it and bring the intensity of that down so that you can function at your Bet, you know, we can use that threat response and that stress response to our advantage and it helps us to stay alert, to perform, to do what we need to do, to survive, all of those things. But we have to sort of understand the system and work with the system rather than against it. So if we try like any other feeling, if we're trying not to have it and we're trying to squash it or numb it out, then that's going to cause more problems than if we allow it to be there and use it. Frontage. What about the opposite? Let's say that somebody was feeling anxious and you wanted to prescribe them a way to make that feeling be as intense as possible to last for as long as possible.

What would you get somebody to do that was feeling anxious that could make it worse? Well, that's interesting because there are lots of things that we do that we think make anxiety better, but it actually making it worse. And the number one thing I would say there is avoidance. So when we feel anxious, our body is telling us to escape and then avoid that thing, right? Because that's how I'm set up to help us survive. And that works, right? If you're in a situation where there is a threat to your survival,

it makes sense that you get out of there, get safe, and then don't go back. But in today's society, and where there are lots of psychological threats, your brain works the same. So if there's a threat to maybe sort of abandonment or rejection or if you feel that you're going to be humiliated in a situation, you have that same response. Your brain says this is not safe, you get out of here and you don't go back. But if you do that with your workplace or social situations, and you don't go back. But if you do that with your workplace

or social situations, then you don't end up building your confidence in the work situation. If you avoid it, it gets harder to go back, right? It builds up that anxiety even more. So when we avoid the thing that we fear, the anxiety gets worse over time. And often that's why, you know, in treatments, exposure or graded exposure is part of overcoming all sorts of anxiety disorders. I think people presume that exposure therapy is for a fear of snakes or some of that phobias, you know, like real in your face stuff, but the fact that it exists for emotions as well, for situations that presentation you've got to give in front of the group, that boss that you hate having a conversation around. And I guess, you know, to a more intense period, even just going out

of the house, going to shops, stuff like that. I think a lot of the people that listen to this podcast will be high functioning individuals, there'll be people that are doing really well. But if they look back to whatever five or ten years ago and they didn't have the tools that they have and they realized just how fragile they were at that point, you go, well, hang in a second here, this is the complete gradients to this and everybody is always playing at the level that they're at now. Yeah, and that's where we can really learn from all of these incredible tools that are taught in

therapy. They're also helpful for everybody else and who may not be in therapy or may not even feel that they need therapy. Actually, if there's something you want to master and it makes you nervous, as much as you possibly can, the only way to build your confidence in something or to reduce your anxiety about something is to do it more and more and more. The things that we do every day become our comfort zone. If speaking in public is going to get any easier for you, the only way to do that is do that more often, but we do it in a graded way. So don't expect yourself to go and speak in front of 10,000 people and be okay with that. You build up to it. So you take that first sort of layer outside of your comfort zone that feels difficult, feels like a challenge,

but is manageable. You do that and you repeat it again and again and again until that feels like nothing really. It's just easy. And then, you know, then your comfort zone expands and there's another thing that feels more of a challenge. So you do that. So you work up and up and up and you sort of get closer towards those things that initially, you feel like a worst-case scenario, but when you get closer to it, it doesn't feel so extreme. One of the nice things about making progress, I think, is that you can look back at the things that used to be a challenge to you and barely even remember that they were something that was difficult. You know, you look at them now and it's just, it's absolutely nothing.

And yeah, I suppose that that exponential growth that you're talking about is precisely because of that, that it starts off with something small and then you gradually take bigger steps. And then after five or 10 years of doing personal development, you look back and you go, I can't even believe that I don't even think about that thing anymore. Given the fact that thoughts a lot of the time, especially anxious thoughts, cause us to obsess and mentally do thought loops around them,

what's the solution to break the cycle of anxious thoughts? Well, I guess, first of all, the don't do is don't try not to have them. You know, if you're trying not to think about something, you're already thinking about it. And so if we, you know, thoughts arrive in your mind because your brain is constantly taking an information from your outside world and then offering up to you

ideas of how to interpret that. And they are ideas, they're theories, they're concepts, they're stories, maybe they're influenced by memory as well, a lot of the time. And so that's where they are one possible perspective. And so the way that we kind of then shift our relationship with those thoughts is to understand that

and acknowledge that even as thoughts arrive. So, you know, one big sort of sort of biased thought pattern you would have when you're anxious is catastrophizing. So, your mind goes to the worst possible case scenario and it plays out for you in your mind like a horror movie on repeat and that becomes the idea that this is going to happen because I've thought it now. And we kind of take on that thought as if it's absolute truth and we run it over and over again. And then our anxiety gets worse and worse and worse. But if we acknowledge that thought as a catastrophizing thought, which is a bias, right? It's your brain offering up the worst-case scenario because you're already feeling anxious.

Then we take some of the power out of it by acknowledging that it's not a given fact, it's not the one true reflection of reality, it's one possible way of looking at this and there are others. So by doing that, you're just stepping back from it and you're allowing yourself the possibility of seeing things from another perspective. But without that, it's, you know, if we just accept every thought that arrives as fact and a true reflection of reality, then it has much more power over how we feel, then what we do and how we behave and all of those sorts of things. So, I think it's about shifting your relationship with thoughts, not trying to stop them from arriving, but allowing them to arrive and then seeing them for what they are, which is one story.

Why do you think catastrophizing would be adaptive? Because if you're in a dangerous situation, if we go back a thousand years and you're in a dangerous situation, then if you cannot predict what might happen in this situation, then you might miss something and you're out of there, you know, you're gone. So actually, it is your brain working at its best to keep your, you know, your brain's sort of main function is not to keep you happy and calm, it's to keep you alive. So it's there to tell you, I know what, you know, the worst possible thing that could happen

in the situation, I'm going to present it to you. And then our job is to work out, is that likely? Are there other perspectives here and then what am I going to do about it? So it's kind of like the negativity bias, but projected forwards onto events that haven't occurred yet in an attempt to mean, make sure that we are regularly not going to push ourselves towards something that may end up killing us. Yeah, so if I go up onto the cliffs by the coast and I'm walking with my children and my

child, I'm already aware by the time we step out of the car and that the cliff's still 50 yards away, but I'm already thinking someone could fall over the edge. And that is the way I keep my children safe, right? You go to the worst case scenario, and that enables you to act in a way that prevents that bad thing from happening, whereas if you never had the thought in the first place, you might not put the safety behaviors in place. But I guess the trick there then becomes to work out

which of those sort of thoughts are warranted as a, you know, something that may happen and is likely to happen. Small child's near cliff, probably worthwhile thinking about. Exactly, right? But if it's a, if it's a different situation, if it's a, you know, I just know, or I've got pain in my leg, maybe there's cancer there, you know, you kind of jumped to that worst case scenario, whereas the possibility of that is less likely. And so we can never have certainty, right? It's always ideas that our brain is offering up to us

and we have to be able to tolerate that uncertainty of not really knowing exactly what's going to happen. But balancing our choice of behavior and safety behavior with how we want to live our lives. So if I feel anxious about going to the supermarket and the worst case scenario is, I'm going to have a panic attack in there and feel humiliated. And from that I then make the life choice never to return to a supermarket. That's probably going to significantly impact the quality of my life if I'm not able to get food

when I need to and those sorts of things. So it's always making those sort of judgment calls around when am I going to respond to that feeling and when am I going to make choices based on my values. Have you looked at the behavioral genetic stuff around depression and its heritability? How do you mean? So it seems like the heritability of depression from parent to child is a lot higher than I would have thought, not higher than behavioral geneticists would have thought because they always knew that it was everything's highly heritable. But I just think about, you know, when it's the person that's terrified of going to the shops, that seems like such an extreme response.

And it seems like the sort of thing that would almost be difficult to learn without being primed prior to that, without having a predisposition toward that. And it's just one of the things, since learning about behavioral genetics with Robert Plowman, who was the kind of the granddaddy of it a couple of years ago, it really has given me a lot more sympathy, I think, for people that have differing mental states. And that includes people that are unbelievably extroverted or confident or whatever, because a lot of the things that we have have just been imbued to us through our genes.

But that, it doesn't really matter, whether you do or don't have it, that's the game that you're playing. Those are the rules and the physics of the system that you're working with. And you don't get to change that. From the moment that you're born, you don't get to change that. What you do get to change is the top level stuff in terms of the inputs, in terms of the environment, in terms of blah, blah, blah. But yeah, it just, the range of ways that humans can mentally show up doesn't surprise

me, given the fact that we're so varied when it comes to our genes, our exposures, our environments and all of that. Yeah, and you know, as a psychologist, we always see, you know, those sort of genetic vulnerabilities as rather than fate potentials. And so, you know, you could come into the room and no one has any idea whether you've got a genetic vulnerability to your situation or not. So we work the same with everybody. So it's, yes, if you have a genetic vulnerability or you don't, we can still impact on the expression of those genes through everything you do and everything you put into your life and everything

you take out of it. And so I think sometimes the danger of sort of making that the dominant part of a conversation mental health is that people can feel hopeless about it. You know that I've experienced you know about the depression throughout my life, therefore it must be inherited and therefore I'm doomed to have it for the rest of my life. And actually if that person was to go to therapy and learn some of the arsenal of tools that are available to prevent relapse for depression and to manage mood. And, you know, those things can be transformative. And I've seen that. I've seen people sort of pull them back from situations

that you would never believe people could pull themselves back from. And we have no idea whether they had the genetics for that or not. We just did the work and made the change. And so I think I have to, in my practice, believe that that is possible for everybody. I think it's the same as the broken brain serotonin system that it's incredibly disempowering. That was why I loved Johan Harri's Lost Connections. It was the first book. I know that there's criticisms of that book and some of the research and stuff, but it was the first book

that I'd read that put the lion's share of your mood in your hands. And I just found that to be, as somebody that was suffering with depression throughout his 20s, I thought it was so great to hear that, because it made me think, okay, like, I've got control over this. And yeah, the same when people walk through the doors of your practice, they need to believe

that they can walk out of their making changes. And they can, I mean, I've had some friends that have been in some pretty dark places, and then they've put the work in, and they come out the other side, and they're un changes and they can. I mean, you know, I've had some friends that have been in some pretty dark places and then they've put the work in and they come out the other side and they're unrecognizable. If that guy can do it, if he can turn it around, then I'm pretty sure anybody can. Yeah, and I think in some ways that's been the bulk of my work clinically has been seeing that transformation in people where they arrive in the Theravirune, believing that they're getting something wrong about life and they're not doing

things in the way that everybody else seems to be, because they feel terrible and feeling that they have no real control over that. And once they learn that there are things that can really, really help, and some of it's more difficult than others, but actually there are some sort of pretty simple things you can put into your life and make sure you prioritize, that can make a huge difference. And once people, you know, realize that potential to have some more of the sort of locus of control within

themselves and their own choices. It's just transformative for so many people and that's really why I started sort of showing videos and writing the book and that kind of thing was to just make some of that education available to people. How is stress different from anxiety? So when we come to sort of stress and anxiety, it's really about how we can sexualize those experiences. So we have that one threat system that we, you know, everyone talks about the fight or flight and we talk about that when we are often

discussing kind of anxiety. But I sort of, I love the, the sort of concept of, let's say, let's say you've got a meeting at work and you've got an hour before then, you really need to go to the post office, so you dash down there, you get there and you know you've got just enough time to post that thing and then get back to your meeting. But you arrive and there's a huge line, there's a huge queue that you've got to get into in order to post your parcel.

And you immediately feel this rush of, your heart's pounding, the sweaty palms, and you're suddenly hyper alert. Am I gonna get back in time for my meeting? And what's happening there is your brain is increasing your level of alertness, is using that stress response to enable you to reprioritize if you need to and think about do I need to be here or do I need to go back and make sure I get to

that meeting in time. So it's really, you know, we would conceptualize that sort of situation as stress, I would say. When we talk about it and use the word anxiety, it might be similar physical sensations, you know, the sweaty palms and the heart pounding, but it's generally going to be more associated with a threat. So, you know, maybe you were due to speak at that, you know, work meeting in front of a hundred people and you would be absolutely humiliated if you were gonna be late.

And so the idea of public humiliation would fill you with what you would probably call anxiety. It just feels more threat-based. And so I think there's still a lot of work going on about understanding whether those two responses are very different biologically and whether we can find those markers, but I think really it's how we conceptualize it. And often when we talk about stress or anxiety or any other feelings, a lot of people ask me, how do I know if I'm feeling this?

So how do I know if I'm feeling that? And often the answer is, it really doesn't matter. If you're feeling something and you give it a word, you give it a label. That's already helping you to cope with it. Whether that label matches other people's label for their feelings or not is not so important. If you're able to give words to how you feel and label those things, then you're already helping your brain to process it and understand it and predict what that means for you in the future. I heard about young kids in primary school

being taught mindfulness practices and I think that they were naming them as the kind of different characters, Mr. Blue or Mr. Green or the nasty pirate or something like this. And you're right, it kind of shows how stupid the kids are naming their emotions, colors, or about pirates. But there's nothing that's inherently any more virtuous about that word than calling it stress or anxiety. The choice of letters that represent the emotion is totally arbitrary. And the distancing that you get, this is the beautiful thing of noting when it comes to meditation. You notice a sensation arise in consciousness. You note the fact that it is a risen and then it falls away. It's the noting fact that actually matters. It's not the words that you give it.

Yeah, it's just like the sort of thought bias labeling. By just giving it a label, what you do is you step back from it. You get a bit of a kind of bird's eye view which enables you to see it for what it is, which is not who you are, it's a sensation, it's an experience that's sort of washing over you, if you like, and by doing that, we, I mean, in the book I talk about the, the, it feels like such an old movie now, but I remember the Jim Carrey movie, The Mask, And he kind of, the mask looks like nothing. It's just this kind of old wooden mask. But when he holds it close to his face, it kind of grips around the back of the head.

And then it impacts on everything he does, everything he says, everything he feels. And it's a bit like that with thoughts and emotions. When they're sort of here, and we can't see anything else, and we just absorb that as, you know, that is fact, this is all I'm willing to see and feel, then it impacts on everything. And the idea of kind of giving something a label or stepping back from it and observing it. So observing that it's an experience that's washing past us, it's like, you know, when Jim Carrey kind of takes the mask off and he just holds it at arm's length, it's just a mask and it's no longer got the same power.

It's still in his hand. It's not far away from his face, but it's just enough distance to give him that perspective to see the thing for what it is. I think one of the most important things I've learned about reframing stress and I guess you could call it anxiety as well is how much of an effective performance and answer it is as soon as you stop judging yourself or fearing it. Some of the best performances that I've had, whether it be on the podcast, whether it be at work in my previous job, has been geared by the fact that I'm stressed by it, like

unbelievably stressed, but a lot of it, if you can learn to be excited by it and I actually have now, I've got a couple of big things coming up over the next couple of weeks that I'm going to be borderline terrified to do, but there's a part of me that can't wait for that. And I was never in a adrenaline junkie. I'm not riding motorbikes and jumping off cliffs and stuff like that. I'm not not one of those people, but one of my friends, Bridget Fethas, she's a female comedian and she has a little mantra that she gives herself before she goes on stage. She says, I'm not nervous, I'm excited. I'm not nervous, I'm excited.

And that reframe for me as well is like, I'm not stressed, I'm excited. I'm not anxious. This means something to me. And all of those opportunities, you know, it doesn't matter how many cups of coffee or neutropics or special combinations of vitamins I take, I can't replicate the amount of focus and attention that my body's going to give me by it dumping tons

and tons and tons of neurotransmitters and hormones into my body. So I should be thanking it. I should be going, look, yeah, it's narrowing my focus, but it's narrowing my focus because this is the thing that I'm focused on. Yeah, yeah, absolutely. And it's such a great example.

I mean, that's an example of sort of reframing. And again, when we were talking about, can we change the mind with the mind and stuff like that? And I think that's an example of when you can, that you could do all of these sort of, breathing exercises, but if your main aim is to just get rid of that uncomfortable feeling, then you're going to lose.

You can bring down the intensity of it, but if you're, I don't know, about to go on live TV, you're gonna feel anxious, is all brand new to you and this intimidating situation, and there is genuine threat that if you don't stay alert and do the job you need to do, you could be humiliated or you could be upset about it. So you need that stress,

and I think that's where we change our relationship with uncomfortable feelings, whether that stress, anxiety, sadness, whatever those sort of uncomfortable feelings are. If we're willing to have them and use them to our advantage and take them with us, then they don't hold us back. When I talk about the sort of TV example, when I did that recently, I felt that stress and I acknowledged that was going to help me do a good job, so I took it didn't, I didn't try to get rid of it. I used the sort of breathing techniques to keep it at level where I could focus. I noticed the catastrophizing thought, so this could go really wrong.

I follow the way. And then I put my... This is going to go terribly wrong. And then you notice it and then that enables you to let it go and refocus on the thing at hand. So, you're willing to have that feeling, it will take its natural course, which is to rise and then fall again. Do you suffer or have you suffered more with any self-doubt or with dealing with criticism now that you've had all of these extra eyes on you, obviously going on TV and talking and then I mean TikTok, I wouldn't like to guess how many millions of people you're reaching every month on there

Is that something that's a risen for you or have you been able to cope with that? Yeah, I mean it's it's a human thing isn't it? And I think that's what I say about a lot of these tools is They don't Make you invincible. They don't ensure that you're gonna have a problem free life and you're never gonna be touched by By doubt or grief or stress ever again. They are tools to apply to those situations that you will never have to be faced because they are part of life. And so, yeah, I mean, throughout this whole, I've never had any ambitions to be a public person. I just started sharing the educational aspect of therapy because I

thought, actually, everyone's finding this really helpful. Let's make it available. Why should people have to pay to come and see people like me to find out basic stuff about how the brain works? And so I wanted to sort of make it available. But yeah, I mean, then, you know, quite a little introvert who's used to working in a room with one person at a time, that was pretty kind of exposing.

You then are forced to use the tool to practice what you preach, because you probably understand as much as I do. Putting yourself out there will expose any insecurities or it will invite that voice of self-doubt to creep in. So yeah, I've had to use the tools as much as the next person. You are spending at least a portion of your time on TikTok, making sure that the videos look right, that they've gone up correctly, probably checking comments to see what do people think, what are the issues that they're coming up against, ideas for the new videos and such forth.

How are you mediating your relationship with technology, with social media, with the super normal stimulus mechanisms that it's giving us to ensure that it doesn't impact your mental health too much? I've had, I think something that's hugely helped me is that I had this clear reason for starting that was just to be helpful and to make some of this really incredible information that's available in therapy available to people who might not have access to therapy so that they could enhance their own mental health. And I, it's been my mission all the way along to stay close to that. So each video had to have some thread of value in that front. So whether it was very entertaining and engaging or not,

it had to have some level of message there that could be helpful to people and so a seed. So that's helped a lot because it enabled me to not worry too much about how I looked or whether it, you know, a sounded right or, you know, those kind of things that, especially as a female online, there's huge pressures to, you know, look certain ways and the sound certain ways and all of those sorts of things. So it always enabled me to sort of come back to that whenever they sort of pressure creeped in. I was able to come back to this is the reason

I'm here is to be helpful, that kind of thing. So I think that always helps me. I think also that I started this a little bit later in life as well, that I already had a firm sense of who I was or who I am and my values in life. So always coming back to what matters most to me. I'm a parent so having, you know, children and understanding. I think I always try to shift to, when I'm in a difficult scenario, what would I want my children to have the strength to do or believe about themselves in this situation? Because I know that they won't do what I say, they'll do what I do. So I have to live that if I want them to, you know,

be confident and to face uncertainty or face criticism with self-believe, then I have to sort of live that out for myself as well. One of the things that I've re-friend recently around smartphone use was from it being an addiction to it being a compulsion. And I think if I actually look at the behavior, for most people, including myself, overusing your smartphone is a lot less like an addiction and a lot more like compulsive behavior. You pull your phone out of your pocket without thinking about it. You're already moving your fingers around the screen without even thinking to the place where you know the thing that you want that you need to get.

Now yeah, sure, perhaps the reward mechanism that's pulling that through is dopamine. But it does feel a lot more like a compulsion. And I think that even though this is, again, arbitrary, like we said earlier on, reframing the terminology that you use from addiction to compulsion has really changed. This only happened over the last couple of months perhaps. It's really changed the way that I see my smartphone use. I think, look, it's just compulsive. It's the same way as if, because I spent so long, I did five years at uni and whatever, 11 years in full-time education before that. If I put a pen in my hand, it starts spinning

through my fingers. I don't think about it, unless I think about stopping it, I can't stop it. Yeah, it's just a compulsion. Yeah, yeah. I mean, because of my clinical work, I would sort of have a slightly different conceptualization of a compulsion in the sense that, so within OCD, for example, that compulsion is the thing that you feel you have to do because if not, then something bad is going to happen. So it's often based on a kind of threat response. But, you know, I would certainly definitely see that that sort of, it could even be the case, actually,

with a phone that if I don't take my phone with me, I mean, I have that, even if I got for a run, if I don't take my phone with me, what if something happens at home and my husband and the kids need me and it could be 20 minutes before I get back, and you kind of, but it wasn't that long ago that that was just something you did.

People could live without you for half an hour and get through it, but there is that fear of, if I haven't got ultimate connection to everybody, I know something could happen and I won't know about it. There is something about that. And then there's a sense of freedom. You know, if you go somewhere and you lose all signal and your phone's just, you know, obsolete, then there's a sense of sort of relief and freedom from that, isn't there? That there is this sort of fear of, if I miss something, if I miss an email, that's really important, what's going to happen? And so maybe there isn't elements of that, but also there is that habitual thing of, you just pull it out, you backpocket

50 times a day and glance at it, because you have been doing that for five years or whatever. That's why I don't understand people that go on planes and then connect to the Wi-Fi. You have the opportunity now of being completely liberated from access to the outside world for three to ten hours or something. That's for me is bliss. You load up a bunch of stuff onto Kindle, read through some things, listen to a podcast, make some notes about stuff. That's my favorite time.

But yeah, I think it's very strange, the fact that we feel like the world is so interconnected and even safer now than it was 20 years ago. And yet there's this ambient level of anxiety that we need to constantly be contactable and available. There's another concept that I learned actually by, I call Benjamin Hardy and it's called the gap and the gain. And I've been thinking about this a lot as I was going through your book. So he talked about the gain being you comparing the place that you're at now to the place that you were at previously.

And the gap being you comparing where you are now to the place that you were at previously, and the gap being you comparing where you are now to the person that you want to be. And he writes about most people living the gap rather than the gain, and he says it's like running toward the horizon, that every time that you take a step toward it, the horizon moves one step further away. And it just made me think that I think a lot of the messages that we get about self-worth and what success looks like, especially from social media, is inevitably comparing living in the gap. It's living in that difference between where somebody else is.

This was really highlighted when I did my first Thanksgiving here in America in November. It's an entire day that's built around gratitude. You go around the table individually and you sit there and you say, so it's one of the things that you're most grateful for. What were your huge just wins this year? Why are you so happy about things at the moment? And all of that together just, it really resonated with me. I think that that's something that a lot more people should try and bring into their life, that model.

Yeah, and I think it's a lot of what happens in therapy actually is getting a balance of those things. So sometimes someone will have just a natural habit of doing one or the other and what we do is we often notice it. So we'll look at a path, you know, you keep going there, what's the impact of that? We'll step back from it, observe it, and then try the opposite and see what the impact of that is. And so we're never trying to completely not do something or only do the other thing. Actually, there's merit in doing all of those at different times with

a certain, if they're constructive, you know, if there's a certain goal in mind. So it is helpful to look back and say, look how far I've come, but it's also helpful to look forward and say, okay, where next? And it's often with what sort of flavor are you doing that? You know, are you, are you constantly saying, I'm not, I'm not there yet and I'm not there yet and then therefore you're sacrificing how you feel today and being present and potentially being happy in the moment. Or are you, are you saying, you know, that's where I'm aiming for and here's where I've been, yes, I'm on the right path, this is what's next, you know, without that without filling it with kind of self-loathing or self-criticism that then holds you back.

It's always looking, I love looking at all of sort of the psychological work with sort of sports psychology and mind and professional athletes, you know, and if you think about, I don't know, we've just had Wimbledon here in London and if you think about a professional tennis player, they will do exactly that with a coach. They will look at how far they've come and they will look specifically up what has helped them to come that far, so far, and what they need to hold on to. And then they'll look at where they want to go next, what the hurdles are, and how to break those down, and what strengths are going to help them to get there. And so it's always just balancing those, but I think the key to having that balance is being aware of what you're doing in the first place.

It's all about awareness. It's noticing. So rather than being stuck in your head, it's sort of watching what happens in your head, saying, oh, wow, look, when I'm constantly thinking about that past event, then I'm held back. Or when I'm constantly moving the goalposts for my future, I'm actually, I'm not living in the present and I'm really unhappy or you know it's only by getting that bird's eye view of everything including what's happening in our own heads that we can kind of see it way out. Talking about things from the past that keep coming up, how can people not be too defined by previous mistakes?

I think you know when it comes to the to the mind going back and that tendency to ruminate, rumination is one of the big maintaining factors for depression and it will predict relapse and those sorts of things. If you have that tendency to go to the past, something you regret specifically or a painful, and then just churn it over and over again. And so that kind of ruminating that happens. I think, again, there is that element of awareness, so being able to notice when you're doing that, so that you can choose whether to keep engaging in it, or whether to step back and do something different. And sometimes people will employ a really simple tool where once they've noticed that they're

doing that thing, they literally kind of say stop and they put the hand up and they say it out loud and then they activate and they do something different. They move on and they focus on something in the present so that might be any activity that sort of grounds them in the hair and now or movement and exercise is great for that that shifts you into your body as opposed to your mind and those kind of things. So, but yeah, I mean, rumination is about sort of past events is a really big predictor of, you know, sort of relapse for depression. So it's really important to tackle that. Given the choice between getting a night's sleep or going to the gym in terms of resetting

my mood, I would choose going to the gym. I think that I have more bleed from night to morning than I do from pre-to-post workout in terms of the way that I am. And yeah, I think that it's not for everybody, but for far more people than would realize it. If you go and play a game of tennis badly or something, even with just a friend, try and focus as you're trying to hit the ball desperately across the court, the fact that you've got something in your hand, it's tactile, it smells, it sounds, you're moving, you're sweat. Just that, I think, is such a big element of it. That's what I appreciated about Hubertman's work.

That, yeah, maybe I think that you're probably right on balance that there are elements, especially if you look at CBT and how effective that can be for people. Like that is about reframing. I'm not doing a CBT with my hands. But that's definitely getting into the body is something that's interesting. Another interesting thing that I liked that you did was you talked about turning bad days

into good days. And this was something that I was doing when I had low mood throughout my 20s that one of the wins that I would put down in my journal was that I had a good bad day. And it was so funny to see that pop up in your book as well. Yeah, I mean, there's a whole sort of section there on, you know, shifting from those bad things. Often there's that misconception that if you're working on something, that every day should be a little bit better than the last.

And often, this is a classic sort of example or something that will happen in therapy. Someone will start making progress quite quickly and they'll see a bit of change just from the fact that they're coming to appointments and they're talking openly and it feels safe and those kind of things. And then, you know, things all happen because life happens, right? And you have a bad day or a bad week. And then they feel low. And you tell yourself when you're in that place, that chorus started.

I'm back at square one, I've got to start all over again. And half of the sort of lesson that you learn is you're not back where you started, you can't undo the progress that you've made so far. Part of that journey of being well is having bad days and then bringing yourself back to baseline and back up. And so, you know, it's not that you work on something and then every day is just neutral and fine. It's that you learn these skills to be able to sort of haul yourself back up when you've had a tough day because you know the things that work and you

know the things that will keep you stuck. So it's all about sort of having that awareness of yourself and what works for you so that you can respond to those bad days rather than never having them. What about mood pitfalls that people should look out for? I think, yes, movement is a huge one. And actually, when I've worked with people who have severe depression, often in sort of a cute hospitals and things. A one-horse try worked out, we had the benefit of having a lovely garden.

And in appointments for people, I would start by walking around the garden with them, as we talked, because simply getting your body moving starts to shift things and it starts to, you know, it doesn't take all your problems away. It doesn't change your situation, your circumstances, but it starts to shift your biology and can bring someone to a level where they're more able then to engage in the more complex psychological stuff that's going to help them longer term.

So you get this incredible shift from any form of exercise. And I think it's such a shame that exercise exercises been sort of over the years made to seem like it's supposed to be just this ultimate graft where you put yourself through grueling pain in order to look different and be more aesthetically pleasing to other people because it creates this sort of impression that exercise has to be that way. Exercise can be putting on music and dancing around

your kitchen with your family. You can be moving your body in any sort of way and that's going to help. It's going to make your, it's gonna shift your biology, it's gonna shift your how you feel, all of those sorts of things. So I think part of the work that we do is

helping people to increase their level of movement without it feeling like a chore or something that you've got to endure because when you're already enduring depression, that's that's enough already. I suppose as well, there's this brutal feedback loop on it comes to mood that low mood causes people to move less, to do less, to not eat, to not contact other people, which then creates a cycle of worse mood, which is that sort of ever-increasing spiral. Yeah, absolutely. You get stuck in that cycle of, you know, low mood gives you the urge to do the things that keep you stuck. So it will, you know, you're wake up for whatever reason.

It could be anything that's induced that low mood. It could be something huge like grief or it could be something like, you know, your dehydrated or your child was up a couple of times in the night and so you haven't really had enough sleep. And so you wake up feeling groggy and low. And then you have the urge to call in sick or you know, not meet your friend later on or skip the gym or

do all of those things. So you have the urge to kind of close everything down and avoid doing the things that actually in the long time are going to help you. Just being aware of that again, just knowing that increases the chances that in that moment where you get to choose, you could choose the right thing. That's going to help you in the long time. You won't always, right? Sometimes you'll still go around that cycle and you're kind of, you know, suffer the consequences of that mood-wise, but sometimes you'll acknowledge, yes, I know that I have the urge to not answer my phone to my friends and family when I'm low, but I know where that leads. So today I'm going to force myself to do it and then you get the benefits of it. What have you come to believe

about what a meaning for life consists of? So that's a sort of a fairly big section of the book and it's something that's often looked at in acceptance and commitment therapy. And I find that a lot of people who come to therapy with a limited idea of what's really going on, they'll say, you know, I'm okay, but everything just feels empty, I feel a bit lost, I'm just not really sure where I'm going, there's just no meaning in anything. So many times that has happened where life has pulled someone away

from what's meaningful to them and what matters most to them, because that's what happens, right? And so in therapies like act therapy, acceptance and commitment therapy, you just help someone to get clarity on what matters to them and what their values are. And that can be quite sort of crudely done. You know, you can write things down on a piece of paper, split your life into the different areas, in a maybe intimate relationships, family relationships, parenting, career, learning, creativity, faith, all of those different things that fill people's lives. And you just write down words, bullet points, ideas, not what you want to happen to you,

but the kind of person you want to be in the area of your life through good times or bad. How do you want to show up? How do you want to show up as a parent, a colleague, a partner, all of those kind of things? So it's not a goal that you achieve and then it's done. It's a path that doesn't really end but you always try to stay close to it. And when you do this kind of exercise and these kind of values check-ins, I'll put in the book, you, okay, you acknowledge these are the things that are important to me in this era of my life. And how closely am I living in line with those at the moment? And if the answer

is not very much, so if you rate it as really high in terms of how important it is to you, but in terms of living in line with it, it's pretty low and there's that gap. It just gives you that indication that you can shift direction, and it might be some small decisions that you make about your day to day life that shift that direction so that you feel you're living more in line with the person you want to be and the life that you want to live and the contribution that you want to make. A lot of people I think feel like they have control over the surface level stuff that they do, so they're maybe habits and the way that they show up on a daily basis, but not the larger direction that their life is moving in.

What about making large meaningful changes in life? Is that simply a case of day-by-day steps or is there something else missing from that? Well I guess you know you can make huge big life-changing decisions but often they're broken down into those smaller steps aren't they? And and and actually when you're looking at life decisions in terms of your mental health, we always ask why that's why people get so frustrated with therapy that it takes a long time, right? Because that's how we work. We don't often sustain big grand changes and gestures that are life transforming overnight. The changes we can sustain are those smaller ones that enable us to

make a shift that we can sustain every day, and then once that becomes habitual, then we can keep that going, and without too much effort, and then we can shift onto the next change. So we create big change most effectively and sustainably with lots of small changes that add up. I certainly see that in myself. The person I am now versus the person I was 10 years ago, five years ago, even three years ago, it's very, very different. And that it's so strange how change works that it just creep up on you. I actually don't realize that it's happened until you one day, something causes you to reminisce about the way that you would have dealt with something previously or about a memory of a situation

that you managed to get yourself into and the way that you responded to it. You go, it's really kind of hard for me to recognize that person and that mental state. I always thought it would be cool if you could take snapshots of the mind in the same way that you can take a photograph. And then you could go back and visit the old texture of your mind from five years ago, 10 years ago, because it would be so stark, the difference, the things that would have captured your attention, the thoughts and the concerns that you would have had about yourself or the world or whatever. And now you're a million miles away from that. But it's hard to go back and remember that because you're not that anymore. And there isn't that photograph to go back and view.

Yeah. And it's like a sort of finding some old journal, isn't it? And then reading about the things that you were worried about, you know, 10 years were a kid and you think, oh, it seems like such a huge period of time between then and now. And actually, it's a really useful skill to be able to create future self-memories. So, where you imagine yourself in the future, in detail, and you look back at the choices that you're making now or are about to make and you consider how you would feel about that. What choices, if you're putting yourself into a set of five years from now, what choices would you be most proud of and how would you feel about that and what would be the focus of your attention, the main focus of your attention in the future self and what would you be like and why and what choices would have held you back and what things would have

propelled you forward and those sorts of things. So that can be really helpful again in focusing on the choices you're making today and making sure that they are benefiting you in the long term as opposed to responding to how I want to feel today. The best thought experiment that I think in terms of working out what would be a good way to spend your time or the things that you should focus on is to think, okay, at the end of this year, what would have happened for me to look back on this year and consider it a success?

And that little bit of distancing, little bit of future planning, little bit of sort of reflecting, I did that with COVID during the lockdown. Okay, what would have happened by the end of lockdown for me to look back and consider it a success? And it was so good. It was the by far all of the planning, all of the journaling, all of that stuff was good for the daily practice, but in terms of big picture stuff, I just thought, well, okay, what would I have wanted me to do? And it's you. It's you. You know, you know you pretty well. You know what you would have wanted you to do, but it you? It's you you know you know you pretty well You know what you would have wanted you to do, but it's just that little bit of distance. It's that little bit of future planning

Yeah, and it's so useful to be able to ask yourself in any difficult moment What response will I be most proud of in this situation? How can you know and and and situation. And it sometimes just gives us that guidepost to shift our direction and behave and turn up in the way that we want to as opposed to sort of reacting and feeling out of control. Dr. Julie Smith, ladies and gentlemen, if people want to follow you online and check out the stuff that you do, where should they go? Either Instagram, YouTube, Dr. Julie, and sharing lots of sort of insights from therapy that people can use in everyday life. Julie, I appreciate you.

Thank you. And you. you