Passion Struck with John R. Miles - Dr. Rubin Khoddam On: The Importance Of Holistic Mental Healthcare EP 85

Episode Date: November 30, 2021

This week’s Passion Struck podcast features Rubin Khoddam, Ph.D., a Clinical Psychologist who specializes in the treatment of addiction and trauma and mood disorders, such as anxiety and depression. He and John R. Miles discuss the importance of holistic mental healthcare and examine Cognitive Behavior Therapy, Cognitive Processing Therapy, and Prolonged Exposure for PTSD, as well as Dialectical Behavior Therapy and Acceptance and Commitment Therapy. New to this channel and the passion-struck podcast? Check out our starter packs which are our favorite episodes grouped by topic, to allow you to get a sense of all the podcast has to offer. Go to https://passionstruck.com/starter-packs/. Subscribe to the Passion Struck podcast: https://podcasts.apple.com/us/podcast/the-passion-struck-podcast/id1553279283. Have You Tried Talkspace? Talkspace: The online therapy company that believes that therapy should be affordable, confidential, and convenient. Join over 500,000 people who have used Talkspace for online treatment with their licensed therapist. Get $100 off your first month when you visit talkspace.com and use promo code PASSIONSTRUCK at sign-up. LINKS *Website: https://copepsychology.com/ *Instagram: https://www.instagram.com/cope.psychology/ *Personal Instagram: https://www.instagram.com/drrubinkhoddam/ About This Episode’s Guest Dr. Rubin Khoddam Dr. Khoddam started COPE after growing his private practice and recognizing the need for quality, evidence-based mental health care. He has personally handpicked each team member and psychologist at COPE and is passionate about helping those who come to COPE learn the skills, tools, and insights they need to be able to do their life’s work. ENGAGE WITH JOHN R. MILES * Subscribe to my channel: https://www.youtube.com/c/JohnRMiles * Leave a comment, 5-star rating (please!) * Support me: https://johnrmiles.com * About: https://johnrmiles.com/my-story/ * Twitter: https://twitter.com/John_RMiles * Facebook: https://www.facebook.com/Johnrmiles.c0m. * Medium: https://medium.com/@JohnRMiles​ * Instagram: https://www.instagram.com/john_r_miles PASSION STRUCK *Subscribe to Podcast: https://podcasts.apple.com/us/podcast/the-passion-struck-podcast/id1553279283 *Website: https://passionstruck.com/ * Gear: https://www.zazzle.com/store/passion_struck *About: https://passionstruck.com/about-passionstruck-johnrmiles/ *Instagram: https://www.instagram.com/passion_struck_podcast *LinkedIn: https://www.linkedin.com/company/passionstruck *Blog: https://passionstruck.com/blog/

Coming up next on the Passion Struck Podcast. And so, part of what makes it hard to reach out for help is because then it's taking that very thing that I'm working so hard day at night of to not look at, to not see, to not acknowledge. It's me actually looking at it straight in the face and saying, all right, it's time to deal with you. Welcome Visionaries, Creators innovators, entrepreneurs, leaders, and growth seekers of all types to the PassionStruck podcast. Hi, I'm John Miles, a peak performance coach, multi industry CEO, Navy veteran, and entrepreneur on a mission to make Passion Go viral for millions worldwide. And each week I do so by sharing with you an inspirational

message and interviewing high achievers from all walks of life who unlock their secrets and lessons to become an action struck. The purpose of our show is to serve you the listener by giving you tips, tasks, and activities you can use to achieve peak performance and for too a passion-driven life you have always wanted to have. Now let's become passion struck. Welcome back to the Passion struck podcast and thank you each and every one of you for coming back every week to learn to live better, be better, and impact our world. If you're new to the show or you'd like to introduce it to a friend or family member, a great way to do that is through our starter packs.

These are collections of your favorite episodes, grouped by topic, that give you a great introduction to everything that we do here on the show. Just go to passionstruck.com slash starter packs to get started. And another way that you can get acquainted with the show is by going to our YouTube channel at John R Miles, which has over 200 different videos. With some unique content that's not here on the podcast, mine sent moments which are two to five minute clips

and also long form interviews. Go check it out on YouTube and thank you as always for your support. Today's episode features Dr. Rubin Codum. Dr. Codum is a clinical psychologist and founder of Cope Psychological Center, an evidence-based mental health treatment center based in Los Angeles and providing care

all across California. He's also the team lead for a residential rehabilitation center for veterans struggling with addictions and homelessness. And in today's discussion we really unpack what is the difference between cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy therapy and how each one is unique in its way of serving those who are suffering from anything from anxiety, mental health issues, to post-traumatic stress disorder. We also talked about acceptance and commitment therapy, integrative behavior therapy especially

for couples and so much more. Thank you for choosing the Passion Struct Podcast and choosing me as your hosting guide on your journey to unlocking and no regret's life. Now let the journey begin. Welcome to the Passion Struct Podcast. I'm so happy today to have Dr. Rubin Codem with us. Thank you so much, Dr. Rubin, for joining. Of course, I'm happy to be here. Thanks for having me. Well, I'm really ecstatic for you to be here because the origin of you joining this podcast is I'm a listener of the Jordan Harbor English show, great podcast if anyone hasn't listened to it. And I happened to hear one of his Friday episodes where he got a question

in from a listener. This one happened to be from a veteran who was going through I guess coping mechanisms from having experienced different trauma in their life and they were heroin addict. And so Jordan used some of your information to give advice to this individual. So I always find it interesting like how people find you. So can you tell a little bit about that story? find you. So can you tell a little bit about that story? Yeah, sure. So, uh, yeah, I got connected to that story because of my work in the substance use trauma field. Um, and so that was a story about a, yeah, like you said, a veteran who has a history of trauma and I believe deployment as well, um, into combat

areas. Uh, and he has also a history of opioid use disorder. So there's a self-medication there that was going on at the time. And so my role in that show, I was, I've sort of helped provide a little bit of information and context with a show. But what I helped do was to frame it a little bit, because I think on one line, we could talk about substance use directly, but it's not really

retrieving the substance use at that point. For this individual we were really treating the trauma and for him there was a lot of trauma there that needed to be addressed and then I think from there then it's about how do we treat it and we have a lot of great treatments out there for trauma cognitive processing therapy prolonged exposure and so my role was to provide a little bit of information around that maybe a little bit of guidance and things to look into. Because although his trauma might be combat-related, we all have our own traumas.

And it's not military, isn't the only way people experience trauma. There's a lot of different ways. So if I could be of any help or service to point him or anybody in that right direction, happy to. Okay, well, I was excited to get you on because I'm doing a series of episodes around mental health and also traumatic brain injury.

And one of the guests I have coming up is Sean Springs, who's a former football player, but he's on the board of Boulder Crest. And they have a new program. I wouldn't say new, but a different approach. They focus on post-traumatic growth as opposed to treating PTSD. So that's also an interesting topic. But the bigger reason I wanted you here is much of the audience, the passion struck podcast, are people who feel stuck in some way in their life, whether that's their board with what they're doing. They've had an experience in the past where they've been battered, they feel hopeless, they're numb.

And so I'm getting more and more requests from listeners to focus and bring guests on who can help explain how do you get unstuck if that's where you're at in your life. But before we go there, I thought maybe a good introduction so the audience gets to know you better is I always like to understand why people go into the careers that they do. And so I thought that would be a great way to start this episode out. Yeah, I mean, I'm going to try to keep it true,

because it goes back many years. But it was actually funny enough. It was in the middle, it started in middle school when somebody reached out to me about helping with a peer mediation program. And so somehow I got connected to that where I was in middle school, helping mediate disputes between six, seven eighth graders.

But I enjoyed that experience. When I enjoy kind of helping understand, me understand what made people tick, what caused certain behaviors, and then what also then caused people to change behaviors. And so that ultimately led me to high school, where I actually started my own, our own program there that ended up being dissolved

for budgetary reasons at the time. So I started it there, that passion continued to grow. I liked it. The problem's got a little bit more complex. Now it's not something untieing, some of these shoe aces, but you know high school drama. And then that led me to applying a college as a psychology major went into the honors program, wrote a thesis around, psychology major went into the honors program, wrote a thesis around, you know, substance use treatment outcomes, applied to grad school doctoral programs for PhD in clinical psychology, and then ultimately I took two years off, and I, well actually I applied, I didn't get in anywhere, I took two years off, I worked at the VA doing substance use research,

applied again, got into USC where I did my doctorate, completed that, and then now I work at the VA helping manage leading a 30-bed residential treatment facility for veterans with homelessness and dealing with addiction. And then I also have a private practice called Cope Psychological Center, where we help on an outpatient basis people with addiction, trauma, as well as other mood disorders. So individuals and couples.

Okay, well I think that's a great background for what we're going to discuss next. Now one of the things I'm trying to bring with this podcast is authenticity and talking about my personal experiences because I often think you're best. You help those who you once were. So unfortunately, like many people, I've had far too much trauma in my life, ranging from combat, physical assault, and other things.

But my story is one where, like many people, I thought I could do it on my own. And there was such a stigma when I was in the military about going for any mental health assistance primarily because I was working for military about going for any mental health assistance, primarily because I was working for the National Security Agency and other intelligence organizations, and there was always the threat that they would take away your top secret and higher clearances. And then when I went into the civilian world, I found just tremendous pure pressure when I was coming up on people looking down whether it was someone with ADD or any mental health issues.

So, I internalized this literally for 15 years and it took a 2017 incident where I walked into my house on an arm burglary of my house, had a gun pointed directly at me, that it kind of not only brought that trauma to the surface, but kind of unearthed all this stuff that I had been suppressing. So, it's long-winded, I'm giving it out there to the audience because, you know, maybe there's someone else who's in that exact position where they've just been trying to push this down, but I can tell you, you know, when I look back upon this, the effects that I was doing to my physical health, my mental health, my spiritual health, relationships, my family, you know, was just a devastating. And I guess my question to you, because you focus on this, is why does it take people like it did me so long to deal with their stuck points or those issues? And what's your advice to them? Well, I think it's, I mean, first of all, I really admire and appreciate your vulnerability and sharing that story because it's that kind of authenticity and vulnerability that I

would imagine has helped you get to this side of it. And that kind of will help others as well because now you provided a door to know for somebody else who's listening to say, I'm not the only one who experiences. And it doesn't have to be an arboravari or deployment, but it could be their own trauma. So I just want to first of all say, thank you for that. Second of all, I just want to say, you know, it takes a lot because it's scary at the end of the day. If it was easy, everyone would do it.

But when we're thinking about any trauma, the thing that maintains a trauma is avoidance. That's the fuel to the fire that keeps it burning. And when we avoid it, it feels good, right? Because our trauma keeps us on alert. It keeps us activated. It keeps us hyper vigilant. It keeps us on guard, it keeps us anxious, it keeps us irritable, because we want to protect ourselves. Like God forbid, it's something else happened that I can be prepared for it. And so part of what makes it hard to reach out for help is because then it's taking that very thing that I'm working so hard day at night of to not look at, to not see, to not acknowledge. It's me actually looking at it straight in the face and saying, all right time to deal with you.

And my advice to people is it's not also as scary as it might seem. Yes, it's work, yes, it takes time, and also it's not necessarily about being thrown into the deep end. Maybe it's just about, you know, dipping your toe into water a little bit. And then after you dip the toe, maybe it's the foot. Maybe the foot becomes, you know, the calf and so on and so forth. So that it acclates you. Because in the same way, if you go scuba diving, diving and you don't, you know, slowly go up, the pressure will get you and you get the bends, right?

So you have to slowly adjust at each level that you're at. And trauma treatment is in some ways the same way, where you want to take it one step at a time. And I think if you think about all the way you have to go, it becomes overwhelming. But if you just focus on that first part of the road before the curve hits, that's all you got to get to. And then there will be another curve past that. But if you could just get to that one piece, then that would be, then that's all you got to do. And then we'll worry about the rest from there. But let's just focus on this here. We will be right back to the Passion Start podcast. Did you know that the majority of people

who have a mental illness do not seek or receive treatment? I know I put it off for years. Why? Because I thought I would be judged and seen as weak. I doubted it would work. Had too much pride and thought I could solve my problems all by myself and feared confronting the issue and having to change.

I know firsthand that facing those problems isn't easy and you don't win a prize for doing it all alone. Getting professional help isn't weird or weak, it's smart, it is as important as hiring a personal trainer to help you with your physical health, but finding the time to fit in therapy can seem impossible for those of us who can't even find a minute for ourselves. That is why I recommend Talkspace, which makes meeting with a licensed therapist a convenient, secure, and stigma-free experience, right from your phone, tablet, or computer in the comfort of your house. And unlike traditional therapy, you can message your therapist 24 by 7 via text, video or voice, no need to wait for a weekly appointment. Join Talkspace today and start

moving forward with a single message. Just visit Talkspace.com and you'll get $100 off your first month when you use promo code passion struck at signup. That's $100 off at topspace.com promo code passion struck. Thank you so much for listening and supporting the show. Your support of our advertisers keeps the lights on around here and I realize that all those codes and URLs can be tough to remember. So we put them in the show notes for the episode. Please consider those who support the show and make it possible. Now, back to passion struck. Yeah, it really is an avoidance issue, and it's not just, I think, people dealing with trauma. It seems like there are many people who

are just stuck in life. They feel complacent. Or they're, they feel feel safe or sometimes they just feel like they're surviving, but they don't know how to get to the other side of that. So, I wanted to go from there into there are a couple different things that you specialize in. One is cognitive behavioral therapy. Another one is cognitive processing therapy, another one is prolonged exposure therapy. And I'm going to start with the two that are specific to PTSD. So what is the difference between CPT and prolonged exposure? Yeah, so good question. So CPT and PE, they sort of target the trauma from two different angles. The CPT approach, cognitive processing therapy, targets the trauma by recognizing the beliefs and the cognitions, the thoughts that keep you stuck. So it's sort of the rules you've created for yourself. So maybe it's a rule is, you know, I can't be in crowded places or if I'm in a crowded

places, I'm going to lose control. Or maybe if I'm not in control, then something bad's going to happen or someone's going to take advantage of me. So it's looking at these unconscious, subconscious thoughts that are driving our behavior, but we don't always have awareness of. So it's shining a light on it. Exposure takes a different approach and it looks at the behavioral piece. What is it that you're actually avoiding? What is it, so for example, is it crowded places?

Is it emotional intimacy? Is it certain people places or things? And so that takes a behavioral exposure approach to create a hierarchy of things that you might be fearful of so starting from like something that might be a 10 versus something might be a 100. Maybe a 100 is that feeling of, you know, I'll use like a common example among veterans is like being in a concert, a crowded concert, right? That might be the 100. But if this you might be going to the grocery store in the middle of the day. And so slowly working up the chain, I figured what a 10 is, a 20, a 30,

and every 25, a 35, all these little nuances to work our way up. So like I said, they're both effective in their own way and it often, the approach to one, depending on what myself or any one of the clinicians in my practice takes, differs by the patient. One, what the trauma was, how complex the trauma was, if there are many traumas, and also just the style of the person, because some just may stay a little bit better and some may resonate with one over the other. Okay, and I want to go a little bit more into these and do it through my personal

participation in them. I did want to just say to the audience, you know, for me a huge avoidance issue was because of my combat trauma, I would avoid events with veterans, which you may think is crazy because you would probably think they would be your best support group. But what I found is when you went to an American Legion or a VFW post or something else, you tend to almost immediately get asked, you know, what did you do? And then from there it goes into, you know, starting to share stories of combat or other things. And for me, the result of that would be,

it would immediately trigger me to have panic attacks. I would have, I would go back and have sleepless nights because it would have all these triggers that came about just as a great example. So when you're going through cognitive processing therapy, I know it can last different amounts of time. Mine was about 15 weeks. I think in general it's somewhere about 12-ish. Yeah. about 12 ish. But when I went through it, it was kind of as you are walking

through it, it's, you know, they kind of familiarize yourself with what the treatment's going to be. You get a workbook. And then one of the first things that you have to do is figure out how to write stuck points because I found when I went into it, I was kind of giving the result of the stuck point, but not necessarily the stuck point

that was causing the result if that makes sense. Right, right, yes, that makes total sense. And then from there, we went into a number of different sessions on then how do you deal with those stuck points and then what are the things that it impacts. So I remember going through things where we were looking at intimacy, we were looking at power and control, safety, trust, and other things. And can you just like if the listeners unaware of this, you know, why those four or five specific areas, I think it's safety

trust, power control, esteem, and intimacy. So, if I can, I might even back a step up to to just sort of explain the context around stuck points too, because what I often share with people that I work with is that the process that develops like from a PTSD perspective, what happens after any trauma, the things that people experience is a very natural traumatic reaction people experience. You know, there's that feeling on edge, there's the fear, there's a kind of intrusive thoughts. And I share this analogy with people because I think it humanizes and normalizes the experience a bit, which is I asked

people to sort of reflect on the last time that you got into just a tiny car accident, like a fender bender, anything like that, because what happens in those moments, and you tell me if you disagree, but often comes even just after like a fender bender after you experience that, you kind of are replaying that in your head a bit of like wait how did that happened did I do this did they do that how to you know and you're kind of it's cycling in your mind right and then when that's cycling it often can lead us to feeling on edge it could feel and that's the second piece of like a traumatic reaction there's the intrusive memories through the replaying, the second piece being the hypervigilance playing on edge. When you get back in the car, you're just a little bit more anxious. It's the second piece.

The third piece of change is you. Changes your thoughts about, are you a good driver? Are they a good driver? Can I trust people in the road? Maybe you start avoiding that path a little bit, which, and that avoidance pieces, that fourth piece. And that's the piece that keeps that trauma, like bit, which in that avoidance pieces that forth piece. And that's the piece that keeps that trauma like I said in motion. That's what keeps the fuel burning.

And so part of what you're describing is understanding what it is at that thought level, at that motion, at that cognitive level that's keeping us stuck. And so what I often share is if you never get back in the car, all of those thoughts, all those emotions are going to grow. So if you have a thought of like, I can't trust drivers on the freeway or I'm not a good driver or, you know, extrapolating to maybe the type of driver that I was driving there, those type of people aren't good drivers, right? Those become the stuck points that we start to look at. And so we look at, like you said,

there's five areas. There's self-esteem-related thoughts. So something related about you, your abilities, your sense of self, there's thoughts related to power and control. So if I'm not driving, then something bad's going to happen, right? So that might be an example of power and control. something bad is going to happen. Right? So that might be an example of power and control. A safety related thoughts that freeways aren't safe, the roads aren't safe, LA drivers are bad or wherever you live, I live in LA, so I could say that. There's what are in intimacy, so that could be emotional intimacy, that could be physical intimacy, that could be sexual intimacy. So I don't feel comfortable opening up to people. If I open up to people, they'll take advantage of me.

And then there is trust. And trust is oftentimes especially in the context of trauma we tend to paint a broad breaststroke over. I can't trust anybody, or I can't trust drivers. I can't trust somebody to drive for me, I can't trust drivers at night, you know, and so we extrapolate these really big and strong beliefs to the world at large oftentimes in the context of the trauma. And what we hope to see is one taking each of these stuck points and breaking it down to recognize, okay, one, let's contextualize it, because oftentimes in the

context of the trauma, those weren't stuck points, those actually made sense, and maybe to some of something made you feel safe and protective and did protect you. But when we're no longer in that trauma, that belief can actually do us more harm than good. And just to close out what I'm just going to say is like the analogy I often make you off and make for that. And you'll see, I make a lot of analogies, because I think it just, it helps me understand the process. And I think it hopefully helps the people I work with. It's sort of like taking an antibiotic. In the context of an infection, if you take an antibiotic, what happens, John? It saves you, right? It protects you. Yeah,

you're going to get better. Yeah. You're going to get better, right? It saves you, right? It protects you. Yeah, you're going to get better. Yeah. You're going to get better, right? But if your infection goes away and you still keep taking that antibiotic, what happens? It no longer is effective. It might do more harm to you than good.

You become resistant. It starts to cause more damage. So it's important to contextualize these things. That those stuck points that we have, it might work, it might have worked in some areas, and it might have not only just worked, but it helped you survive. But in other areas, it might be causing you more damage. And let's look and let's examine whether that belief you apply to here is actually true over here. Does that make sense? is actually true over here. Does that make sense? Yeah, it makes sense,

because for me, on the other side of it, now I've become a lifetime member of the VFW, and I am seeking out those things that were once traumatized and to me. And I think you're right, had I not done the therapy, I probably would have never started the passion struggle. Or any of this to happen. Now on this show, I've had probably 43, 44 guests now and a huge component of them have

had to overcome adversity, some sort or another. And one of the things that I found that's very common is how often people don't self love. I can't tell you how many people we've had on the show who were like, I didn't even want to look at myself in the mirror, much less praise myself. Why is that such a big issue and is something that you find with a lot of your patients? Well, it's not something we've been taught. I think it's just it's unfamiliar. And so when

especially for people who have experienced a lot of complex trauma and what I mean by that, especially in the context of like childhood trauma and not feeling safe as a child, not feeling safe as, and then badly into unsafety as a young adult and as an adult, to learn how to love myself when maybe my primary caregivers or those around me didn't know how to show or actually actively didn't show love. Because it's one thing to actively not show it through abuse.

It's not a thing to be sort of negligent just not know how to show love, right? So then we're asking people to do something that they've never been taught to do. And so what I think of as self love is also self-compassion and giving ourselves a little bit of grace that, you know, I may not be doing things perfectly but I'm working towards it.

I may not be doing things perfectly, but I'm working towards it. I may not be the best at this, but I'm putting in all of the right steps. I think part of what self love is, I think it's changing our perspective from reaching a certain destination to also being appreciative of the process. That process within ourselves, that self growth process, that I'm not trying to, self love doesn't happen when I get here, when I attain this, when I receive that, but self-love is a process that I embody, that I work towards embodying, as I'm working towards my values. And it is hard, it's uncomfortable. We all struggle with it, myself included. There are times when life hits me upside the head, and

then self-love goes out the window. That's part of learning how to do love and give back to ourselves, what we sometimes give to others could be the hardest thing of all. But it's also a path that we must go down for us to get the hearing we need. Yeah, and if so, you were someone in the audience and you're struggling with this, what would you suggest to be the initial step they could take to get on the path to facing some of their self-limiting beliefs? Because I truly believe, yeah, if you're going to be kind to others, you can't do it unless you're kind to yourself first.

Right. So, I mean, that's a great question. It's hard to know our own personal blind spots, to your point of like, how do we begin to recognize our self-emitting beliefs? It's like sort of saying, try to change lanes without looking over your shoulder. We can't see what we can't see.

And so part of it is sometimes we need that neutral third party, like a therapist, like a coach, like somebody outside of us to help point us in that right direction. And it requires a level of openness because then when we start to actually look, we might see things we don't like and we might see things we purposely try to avoid.

And that could be trauma, that could be a lot of things. And being able to be open to the idea that maybe my perspective may not be the perspective that's most serving me at this point. So I would say number one, getting somebody else to kind of support you, whether that be a therapist, whether that be a close friend, whether that be somebody else, but somebody that could help you mirror a reflection to help guide you. The other I would say is is just beginning to embody a sense of openness and humility that the way I approach my life may not be the way that's most serves my highest and greatest good. And then the third thing, which is probably

the hardest thing to do, is begin looking at the interaction between your thoughts, between your feelings and between your behaviors. So how is my thought that, if I can use your example John, how is my thought that if I go into VSFW posts, and I'm going to make a little take creative liberty a little bit, but if I go into VFW posts, I'm going to lose control. I'm not going to be able to handle it, right? How does that thought right there affect what I do, and how does that affect how I see it, right? Because I might then feel anxious, and what I might end up doing is avoiding it

So so now I have a cycle that becomes like a So I think of the recycle logo those three things feed each other now And I need to get out of that cycle either need a change of thought or any a change that behavior So sometimes we need to think our way into different behavior and sometimes we need to behave our way into a different thought And either way works, but we got to we need to behave our way into a different thought. And either way works, but we got to find which direction works best for us. And if, and if can't quite do it yourself, which it's hard for most people, because it's different, find somebody who can help you. Okay, and I think that's a great explanation and also a very good lead in

And I think that's a great explanation and also a very good lead in to the next topic I wanted to get into, which is, and now we've talked about CPT and PE. And I think you just started introducing some aspects of cognitive behavioral therapy, but how is CBT different from the other two? the other two. So CBT is most like CPT and I love it's the alphabet of therapy so I know it's confusing. The cognitive behavioral therapy, well actually let me reverse that, cognitive processing therapy which we just talked about is really just a more specific form of cognitive behavioral therapy. So CPT is a trauma-focused CBT intervention, really. So cognitive behavioral therapy is a more general intervention that looks at how our thoughts, feelings, and behaviors all relate to each other and how that affects trauma, our anxiety, depression, substance use. It's a more generalized intervention that cuts across a variety of mental health issues. So like I said, I named off quite a few of them, depression, anxiety, substance use, trauma.

And then underneath a cognitive behavioral framework, there are more specific treatments, like CBT, like PE. So I think a CBT is the umbrella and then that is probably cuts across the most and other things and then we have more specific interventions that target it. So for example, like PE targets more the behavioral piece from a cognitive behavioral perspective and cognitive processing therapy targets the more cognitive piece if that makes sense. Okay, I think that does. And then there is one other treatment that I don't think you do as much work in, but some people believe helps as well, which is EDMR.

I know the VA now no longer uses it, but EDMR is very different from any of the things we've been talking about. So yeah, EMDR, I move EMDR. EMDR, I would move in desensitization record. So that is also a trauma treatment. So EMDR is most like one part of prolonged expoter. So I'm not an EMDR expert.

And the reason is so yeah like you said the VA, the two front line treatments for trauma in the VA and across a lot of medical centers is cognitive processing therapy and prolonged exposure. EMDR has components of each what it has is this like eye movement

piece and I'm not going to pretend to be an expert on this at all, but I think it's through the recounting of the trauma as you sort of move your eyes along the this light device thing that I'm butchering, but that it's recounting that your trauma through looking at this light. And that's one piece of prolonged exposure minus the light, because what's actually been found with EMDR, the mechanism of change, you could take out that light piece

and still have some effectiveness in the research with the recounting of the trauma. So what that tells us is that what is helping people heal through EMDR is the reliving and the exposure of that trauma and through new learning of learning about different things about themselves that experience in the world at large. And that is what's at the core of prolonged exposure because it's the match and all exposures, it's hurting yourself back in the height of that trauma and recognizing perhaps

a different perspective that you didn't realize before because you've avoided it for so long. So yeah, EMDR has similarities to pieces, but the prolonged exposure essentially takes the effective parts of EMDR and boils it down in a bit more of a succinct way, is my understanding. But EMDR, I will say, EMDR has a great PR rep, whoever the PR rep of EMDR is great. I've never seen one treatment get so much publicity,

but I do like to say PE and CPT are really the frontline treatments for trauma. And I just wanted to do kind of a shout out that if there are veterans listening to this, first responders, law enforcement, other people who've gone from trauma, I can't tell you, since I've been more vulnerable about talking about this, how many people I am finding are just like I was. And specifically because I deal mostly with veterans, how many people who've been in combat

who all share the same symptoms, same issues. And, you know, I think that there used to be this big push to use pharmacology intervention. And that's what led, I believe, to a lot of people coping by resorting to, youing to drugs and alcohol instead of taking them. I'm not sure if there's any truth to that, but it's one evil over another. But if you are a person who has a coping mechanism through drugs or alcohol, what, who has a coping mechanism through drugs or alcohol, what, you know, how do you recognize

that it's not just, you know, something that you're doing, you know, out of habit or it's something that you're just not doing socially and that it's really become a coping mechanism. That's a great question. If I had an easy answer, I probably wouldn't have the job that I have. What I often share with regards to that question is, it's not like with addiction or substance

use. It's not like cancer. We could go in with cancer. We might be able to use a really fancy MRI or CAT scan to look at where the cancer is, how big is it, where has it spread, right? That's, it kind of tells us when we do one of those internal audits, what's there. We don't have that same capability with substance use.

So we have to rely on other ways to kind of guide us. And I often ask that question for people I work with. We don't have those capabilities, but how would we know when that one, that thing you do has now turned malignant, has now become something that's become a problem? And usually what people identify is a few different areas.

And I, one is, you know, maybe it's sort of causing you problems in your relationship. Maybe now, with your partner, with your friends, with your family, they started to notice some changes in you. Maybe they start distancing. Maybe it's become some conflict around it. Maybe that's one thing. Maybe the second thing is, are there health problems? Now, is there liver issues, cirrhosis on an extreme level? Do you just have more, you know, are your blood, blood, what's it called? Blood draws coming back are, all right. So things like that, what about work, you know, is it affecting your work at all?

So looking at all these different domains, legal problems, is it causing you, you know, DUIs? Is it, is it, have you built physical tolerance? Have you built withdrawal so that when you stop using you end up feeling some kind of way? Obviously, I'm extreme former seizures, but even more so, getting shakes of, shakes a little that maybe some nausea, maybe some headaches, maybe some lesser due, which is to some extent natural. But looking at all these different areas and various domains to see how pervasive has the substance used to become in your life. And that's how we kind of know. At what point of re-using from relatively, I don't know, it's almost not the right word, relatively common social drinking experiences that people have to You know what somebody might label as a substance use disorder. Where does that line tick? And that's it's not something I mean, I could obviously say from a clinical perspective

But that doesn't do any good if the person does it see it from a personal experience? And so that's what I often try to explore with the person I'm working with is in what areas have you noticed things shift? Interesting. I just happened to read an article about Vietnam War. And in it, one of the things that at that time the Secretary of Defense discovered was that somewhere between 22 and 28% of all service members who were in Vietnam were heroin addicts. And the study went on to show that the result when they came back home, because there were a lot of people worried that they were going to bring this heroin addiction home with them. But the result found that over 90% of them, when they came back to the

United States, broke themselves of their heroin habit, which is a much, much higher outcome than is in the general population. And they said a lot of it had to do primarily because the circumstances with which they found themselves under stress, fear of going into battle, whatever it may be, and how available the heroine was when they got into, back into their lives in America, that change of circumstances, changed their behavior. And I thought that that was an extremely

interesting finding. Right, it's interesting there's three things in that. I think one is the removal of access, the access is change. Number two, it's also removal of the primary stressor that may have been causing it. And the third is now engagement and alternative activities that can substitute for the higher the hit of a heroin, of using. And that's part of what also addiction treatment looks like. It's now that you've kind of stopped using whatever your substance of choice is.

There's gonna be a bit of a void because now there's that time energy that was spent on obtaining, using, and coming down from the effects, that is going to be left to fill. And so, part of my work in graduate school and post graduate school school is to understand what are the types of activities or to what extent do engaging in these alternative activities help with reducing the effects of substance use. And that's what you see is like by engaging in more healthy, pleasant activities, you naturally see reduction in substance use.

And there's a lot of other variables that are factoring to that. Obviously, there's a lot of economic privilege involved in that. There's access privileges and things that affect that. But if we could find more ways for people to engage in healthy alternative pleasant activities that can ultimately help reduce the risk of maintaining or progressing a substance use problem. Okay, and I wanted to give you a shout out.

I was doing research on you prior to coming on. I, I found out that you're a Google scholar. And one of the articles I looked at was because many of the listeners are parents was the impact of adolescent marijuana use on intelligence. I was one of the articles that you were cited for. And I thought that might be an interesting topic because I know, I have a son now who's 23, I have a daughter who's 17,

and they say marijuana use is extremely prevalent. So how does that impact your intelligence over time if you start that? I mean, that's a good question. So there's a lot of, there's some conflicting research on that and let me preface it by saying, I'm not, that's not my expertise

is the marijuana intelligence field. But I will say that I think in the study that you're referencing, we didn't find, I mean, there's a bit more nuance, but not as many differences in intelligence as we would have expected. However, there's a lot of variables I could account for that. And I will say, I think that there's still a lot more research that

needs to be done. And part of the difficulty is marijuana is classified as a schedule one drug. And so it sometimes makes it harder to do research. And there's also so many different strains and so many different types of marijuana that complicate the relationship. However, from what my understanding is, is that cannabis obviously does affect our ability, and I'm not just referring to intellectual ability,

the extent to which that's short-term, and in relation to the acute intoxication versus how much of it is chronic, is still unclear. There is a study that's being done, a multi-side study that I believe might be the largest funded study by the National Institute of Health, directly my old advisor from college, called the ABCD Project. And I forgot what it stands for, Adolescence.

Oh God, I'm going to mess it up. But ABCD Project, and what it actually looks like, is from the ages, about nine to ten, all the way. They follow everyone for ten years. And they're looking at pre-substance use and post-substance use changes to their brain and they get MRIs every year. And so they're actually going to be able to have really great data that might be able to speak to that question a little bit more about the real acute and chronic effects of substance use and the changes that

might incur on cognition, on brain development, and so on and so forth. Okay, well, thank you for that. Now, now another area of expertise I saw that you had, and it was something that I had never heard of before, or just may not be familiar with, was acceptance and commitment therapy. And can you describe what that is and how it helps people? I love, so act for sure. So a lot of people just refer to act or ACT, acceptance and commitment therapy.

And what I love about act is that it's a bit different. You know, with each of these treatments about goodness of fit and finding the treatment that works. And for some people who are sometimes, you know, we all, some of us are more emotional minded, some of us are a bit more rational minded, some of us live somewhere in the middle. For those, sometimes for people who are overly rational, sometimes it could be good to kind of step out and use act as a treatment approach because what act does is It essentially takes, you know all of these stuck points all these beliefs we have we could spend all day kind of recognizing

The pros and cons of it the validity of it the utility the accuracy of it is this true. Is it not true? But we at the end of the day can Feel like it's true, right? And sometimes it's just that that that makes us it's hard to get out of that loop. And what acts approach does it's it takes a step back and says rather than challenging that thought, let's just notice how one how often that thought you've been struggling with that thought. How long has that thought been driving a lot of your life? And we could spend so much of our lives living these suffer that thought or making that experience go away or making

that feeling go away because I don't want to think about it. I don't want to seal it and all this stuff but what that does is that it takes away from living our lives. And we could either, we can't simultaneously in some ways get rid of a thought and live our lives, right? And so what it's saying is, let me figure out what are my values. Let me accept all of the uncomfortable thoughts and feelings that I have because oftentimes these are thoughts that continue and continue to come up and how can I develop a greater level of acceptance

around it, so it's acceptance strategies and also recognize how I can, are you still there? Yeah, I'm still here. Sorry. I lost you for a second. But how I can also learn to change my life. Knowing that these thoughts and feelings are here, knowing that it may not go away, how can I still live the life that I want? And so that's really what it's focused on. And I think it's really beautiful. It's an experiential treatment that really utilizes a lot of metaphors, a lot of exercises, a lot of things that kind of get at that level of,

I hate to say this word again, but that's stuckness that people feel. And it's about not changing the thought, but it's about changing our relationship with the thought, so that we're not struggling with it. So I did want to take you into a little bit different direction. And that is, you know, when I have gone and and sound out a counselor, whether it's been for myself or marriage counselor for our kids, oftentimes there's not a lot of information on the counselors who are out there. So do you have any advice that if you were a person looking for, you know, a psychologist or a social worker, whatever it may be, what would be some of the questions you would recommend asking to see if they're the right a psychologist or a social worker, whatever it may be.

What would be some of the questions you would recommend asking to see if they're the right fit? I think that fitness, regardless of if it's a mentor you use a coach or a counselor, is extremely important. I think the first question that comes to mind is I was like, what's your approach to working with people who, one, have you, have you worked with people who have similar experiences to what I'm describing? Number two is what's your approach to dealing with it? And maybe sort of related to that, what's your style? Everyone has a different style and therapy. Some take more supportive therapy styles, some trying to support

build people of which has value in and of itself, and some people have more directive styles, more assertive styles. And it also depends on what you're looking for. Are you looking for somebody like, hey, I want to go and go out for some short-term treatment and really focus on these symptoms, or am I looking for some more longer-term work that might involve some short-term, let me help me feel that, and then also grow that into long-term. So I might ask, how long do you usually see people?

Some people kind of aim to see people for a few months, get some work on their symptoms and move on. Oftentimes, other people are just trying to or want to see people kind of indefinitely. So I would ask, have you treated people with my experience, what's your approach, what's your style, when usually see people, how long do you usually see them? And even when I get asked that question,

I don't have a straight answer because of various, some people I see for very discrete amounts of time. Some people, it's discrete that turns into longer. Some people, it's discrete that comes like booster sessions every once in a while. So it varies quite a bit, but hopefully through all those things, you get a sense. But more than anything,

I would just pay attention to what, how does it feel when you're on the phone or the video call or in person with them? Do you feel comfortable? Do you notice yourself holding back? And obviously a part of that is natural because it's a new person, but notice how the energy of that feels when you're in that room. And pay attention to your own self because at the end of the day, it's about a fit for you. It's your life and what you need, so don't be afraid to advocate for yourself and what you need. Okay, well that's great. And I will put these in the show notes, but if someone Dr. Ribbon wanted to reach out to you, what are some

ways that they could do that? Yeah, so you could, our website, my website is www.coppsychology.com that has my, my information is all the providers in our practice who all do the treatments that we talked about in this podcast. My personal email is Dr. Rubin at Coppsychology. That's drrubn at coppsychology. Cope Psychology, that's DRRUBIN at Cope Psychology, or you could call our General Line 3104538788. Okay, and if there is a veteran who's facing a substance abuse issue, can you just touch on the program that you're with at the VA? Because I'm sure they're across the country, but if they if they feel they need that how do they? Get in touch.

So every not every VIA has it, but it's called the domicility so domicility residential Recovery treatment program. So Variety of VAs have it throughout the country and what I would go is Like our VIA has a welcome center to get connected to care there. And usually the VA is generally like a HMO primary care model. So I would go to whoever your primary care is

and suggest that you're interested in a higher level of care residential treatment specifically. And they might be able to point you in the right direction or connect you with social work or another mental health professional to help you. Okay, well great. Well, Dr. Ribbon, thank you so much for coming on the podcast

and sharing your wisdom. Thank you so much for having me. I hope, you know, for anybody who's listening, I hope you're able to get the help you need or point someone in the right direction that might get the help they need. I wanted to thank the audience for all your support

of this podcast and helping us reach a point. We're on a monthly basis. We have over 100,000 downloads between YouTube and the podcast and we are growing at 25% month over a month. So thank you so much for all your support and also for all the five star ratings and keep giving the show, which we have over 1400 of today.

We appreciate the support so much. Now let me cover a couple of the other episodes that we mentioned during today's show. During the month of October, we had three great episodes that were all about brain health. One was with brain health coach Cindy Shaw. I had another one with former Ohio State All-American, first-round NFL draft, and pro-bola Sean Springs, who talks about his involvement, and how he is trying to prevent head injuries,

and also why he became a board member of Boulder Crest. And lastly, we have on famed neurologist Dr. J. Lombard, who talks about new treatments that are out there for approaching ALS Alzheimer's, Parkinson's disease, and traumatic brain injury. So much great content, and as I said at the the beginning the podcast, there's a topic you want to hear or a person that you would like to see us interview. Please DM us a passion strike podcast on Instagram or reach out to us at info at passionstruck.com. Thank you for being here. Now go out and become passion struck. Thank you so much for joining us. The purpose of our show is to make Passion Go viral. And we do that by sharing with you the knowledge and skills that you need to unlock your hidden potential.

If you want to hear more, please subscribe to the PassionStruck podcast on Spotify, iTunes, Stitcher, or wherever you listen to your podcast ad. And if you absolutely love this episode, we'd appreciate a five-star rating on iTunes, and you sharing it with three of your most group-minded friends, so they can post it as well to their social accounts and help us grow our passion start community. If you'd like to learn more about the show and our mission,

you can go to passionstruck.com, where you can sign up for our newsletter, look at our tools, and also download the show notes for today's episode. Additionally, you can listen to us every Tuesday and Friday for even more inspiring content. And remember, make a choice, work hard, and step into your sharp edges. Thank you again for joining us. you