Psychiatry & Psychotherapy Podcast - How to Retire Happy with Dr. Osorio

Episode Date: August 16, 2020

On this episode of the Psychiatry and Psychotherapy Podcast, we continue our conversation with geriatric psychiatrist, Dr. Osorio, to talk about retirement—specifically, how to retire well and happy.  She recently published a book for people in this transition: Stop Freaking Out About Retirement By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com. Sign up, sign in, take the test, and the certification is email to you in seconds.

All right, welcome back to the podcast. I am joined today with Dr. Carolina Asorio. And she was on a previous episode on geriatric psychiatry. Gosh, that was like almost a year ago probably. Like when you started this. Like when I started, yeah. And today I'm having her on to talk specifically about retirement. Yeah.

She wrote a book that is coming out, like literally, I think around the exact time that this will be released. It's coming out August 17th. It is called Stop Freaking Out About Retirement. and give us like the elevator pitch of this book. Right. So basically how to reach new goals and enjoy your life when work ends. Yeah. That is the subtitle.

Let me just let me just like say a little bit about Dr. Sorio in case you don't know Dr. Sorio. She is incredibly loved by the residents, first of all. Like I don't know one resident who could say one bad thing about you. So we do this. I do some research on the Connection Index, and we look at how empathic, how psychologically safe, the level of quality of feedback the attending gives the resident, and educational lines,

which is kind of like therapeutic lines. And Dr. Sorio scores like seven out of seven, you know, like the top scores. Oh, that's so good to hear. Yeah. I love it. Yeah, you score very well. And then she also went through undergraduate, went through medical school,

went through four years of psychiatry residency, and then she did one year of geriatric fellowship. So she's a geriatric psychiatrist. So this is like the most education you could get about taking care of the elderly. She runs a program for geriatric patients. So it's like three days a week. I think it's shut down during COVID.

Am I right about that? Yeah, that's right. Yeah. We're looking to reopen it soon. Soon. Okay. Looking to reopen it soon. Here in the L.A. area.

And this is a great program, lots of good outcomes, enjoy sending patients to her. And so this topic in particular, tell me about what kind of grabbed your interest about this topic. What kind of got you passionate about this topic? Right. So what happened is that I started noticing a couple of patients coming to my program, and they were struggling with severe depression and anxiety for the very, very first time in their lives. And the pattern that I started noticing is that these people were having these symptoms when they were facing retirement. And I was like, wow, this is pretty amazing in terms of like, how can people get this bad just about retirement?

And so I decided to start asking my friends, you know, older friends that I have on their 50, 60s about why were their thoughts about retirement. And some of them would say good things. and some of them would say, well, I know this and that who's struggling with that. They're thinking about retirement, but they're all anxious. They don't know what to do or how to move forward. And so then I thought, well, you know, I only see the rare ones who get ill and end in medical treatment. But I bet there's a lot of people out there who probably is struggling with the thoughts of retirement, but they're just not talking about it.

And so I start asking random people out there, and I would say, if you, would see a book about how to deal with anxiety or worries about retirement, would that be a great topic for you? And they would say, oh, absolutely. And so that kind of triggered me that I felt like there are this untouched population out there that they don't need medical care, but they just need some sort of help

in navigating this area of transitioning in life because it's a big one. And you know the unknown sometimes can cause a lot of anxiety. Yeah. Yeah, I'm thinking right away about patients mine that have retired well and patients that have not retired well. Correct. I think most of the books out there on retirement that I've seen are like how to invest and money and, you know, I'm sure like that's an important topic, but that's not what this

book is really about. No, right. So the book is for those individuals who financially are well to retire. Right. So this is nothing to do about finances. this has to do with the emotion, the feelings, the thoughts, and the beliefs that will affect your ability to enjoy that face in life. So most of the individuals at this book release for those who already have set up their retirement financially well. Okay. Yeah. I mean, you know, whether it's

Social Security or whatever pension or whatever retirement that they're going with, even with having the financial means to retire well, a lot of people, people don't retire well. Exactly. Yeah. Yeah. So okay, you and you alone, you and you are not alone. Mm-hmm. Do a lot of people feel alone? Yes, a lot of people feel alone because what happened is that it's a topic where everybody said, oh, retirement, how many times do you talk to your friends? I can wait to retire. Retire is awesome. And then when they're thinking about really retiring, they're like, well, I'm scared of these. I don't know if this is going to work for me.

And then they start feeling lonely because they hear other people talking positively about retirement. So they don't share their feelings or what they're thinking because they feel, why am I feeling this way when everybody else is talking how great retirement is? So it starts to become very lonely. Yeah, it's almost like in medical school when you're the only one struggling and all your classmates are putting on that image, like we're doing okay? Absolutely, yes. Is that the same thing that's going on here?

Exactly, exactly. And so this is all about these transitions, right? Medical school is a huge transition, right? When you are facing all this amount of stress. But anyways, who doesn't want to go to med school, right? And so you start feeling this way and you don't talk about it because everybody is happy about being in med school. Yeah.

And so you start to feel lonely. I think it was only until when I became like an attending and I started seeing medical students, I started thinking to myself, oh, there are this many people struggling. Yeah. And I just never knew it. Right. Because no one talks about it. No one talks about it. Yeah.

Yeah. And so I imagine this is another one of those topics like that where it's like, you know, the people who may be struggling with like, what are my goals going to be? and they don't really know what their goals are going to be. Correct. Maybe they've been busy raising kids. They've been busy working. And then all of a sudden, those things are not there. So how do you help people find good goals in these years?

Right. So like I mentioned in many places on my book, there's not like one silver bullet to fix this. So it's really the process. And what I'm giving individuals through the book is that time to process and to introspect and to work within their, themselves because it's through the process that you discover who you really are and what your

values are and what your goals are going to be after you make this, you know, transition. Yeah. So, okay, so this is a book written for people who are going through that process. So people who are facing it, right? Like, let's say, you know, I am 65 and I'm ready to retire and everybody keep telling me, hey, you can retire. You have everything to retire. Just retired.

But I'm not really sure if that's what I want. to do or I'm scared of doing it because I don't know how can I make my life worth without working. So that is just one, one case. And the other one is people who actually said, I'm going to retire at 70. And 70 comes and they retired and they're just sitting on the chair and they have no clue what to do with their time. And then they start becoming anxious. So there's many different scenarios. You see those people in your clinic?

So I had a handful of them, yes. Yeah. It's like maybe that would be fun for a day or two, right? Or a week or two weeks, but then it's like one month in. Yes. Yeah. And I'm sure also with COVID going on and everything, people have been forced to retire a lot of the time. Yes. So that is a true. That is very true. A lot of people are now being faced with this thing about retirement sooner because of COVID or we're going to lay you off or you're going to need to take some. some leave of absence and they just feel like the better option is to retire, but they have no direction on where to go from there. Yeah. Okay.

So how do you help someone make maybe an assessment on what their goals might be or like what might bring them a sense of meaning and purpose? Right. So, you know, the first thing that I, actually you said assessment, the first thing that I do on the book is I give them an assessment. And so there is a series of questions from, you score them from one to seven. It has to do about your beliefs, your expectations, your values, your spirituality, how are you doing socially? And so the very first step is to bring into awareness what is really working or not working in my life.

And then that's where the assessment comes in place. They start seeing the numbers and then they're identifying those areas where they're doing poorly or those areas where they're doing better. And so that puts at a front phase the areas that you need to work with. Because, you know, every individual is absolutely different. And so again, there's no cookie cutter here. It's you look into yourself. You see this assessment. And from there, you start working towards changing.

So you go through this like biopsychosocial. spiritual process. Yeah. And, you know, we'll go through some of the cliff notes, maybe some of the pearls that we can just kind of give to people listening. And if you're interested, you can, you can dive deeper. Let's talk a little bit about the bio. So, like, what are some of the things you're looking at, the assessment that you're doing to help someone optimize their biology? Right. So because of my training, I have tremendous amount of experience working with older adults and I have many years of amazing wisdom collected from them. And so one of the things that I very, very, very much focus on is on health span. So you hear on the news and you hear this new

movement about lifespan, right? We know that we're living longer. So the life expectancy in the United States had increased tremendously. But the problem is that people are not thinking about health span. So amount of years in your life, that you spend without any disabling disease. And severe or disabling disease is a disease that can cause either death or decrease of your level of functioning. So I focus on those amount of years. So when I talk about biology, I talk about preserving that health span.

Yeah. So that's exactly what I focus on. So when you enter retirement, you want to live 80, 90s, but you want to be healthy as best as you can. So there are things that you cannot control for, but there is a lot that we can control for. For example, diabetes, we know that 75% diabetes is lifestyle. Yep. So those are the things that I touch when I talk about biology. Okay, so how do you, like what kind of movement, what kind of exercise? Right. Has your data sort of that you've dug into, like what kind of things are you recommending? So one of the things that I make very clear on this chapter when I talk

about movement is that, you know, a lot of the times people think, well, I cannot exercise. I'm too all for that. Or I have never exercised. Like I'm just a bookworm, right? So they're their beliefs and they're holding them from actually start, you know, engaging in physical activity. So what I do is I make a differentiation between what is exercise and what is physical activity. Okay. So, for example, physical activity basically is any kind of movement of your body, right? So if you're a person that you spend your whole day for 20 years sitting in an office, and then on the weekends you're just watching TV, your physical activity is bare minimum.

And now you're 70 and you want to retire. Well, you can start moving. You don't have to go to the gym. You don't have to have a set of exercises in order to reach a goal. You just need to start moving. So let's say you get a footstep tracker and you check your footsteps for one week. And you notice that every day you're doing about 500 steps. So what about if you increase by 50 steps the following week?

And little by little you start moving your body more. And so that is what we talk about physical activity. And in a way, what I'm trying to do is making people aware that when we talk about fitness, we're not talking about just going to the gym and working out really hard for an hour every day. Exercise is a set of movement that are designed specifically to reach a goal. So, for example, if I want to run a half marathon, so I have a set of trainings, and I'm going to go do this exercise in order to reach that goal. And at the end of the day, with both, what you're trying to do is increase your fitness level. Because the moment you fall ill and you have a poor fitness level, your ability to bounce back is less.

100%. Yeah, sarcopenia, you know, low muscle mass is one of the biggest predictors of, you know, ICU delirium, poor ICU outcomes. The, one of the things that really has changed the way that I think about elderly people in exercise is that strength gains can be made. Absolutely. And older, older people may need more protein. They may need to exercise. And, you know, like, let's say you were to squat. as an older person.

It's like, okay, you can gain strength probably twice a week. So you could put a little bit more weight on that bar to, you know, and you could do that twice a week. You could slowly gain strength that way. Someone who's in their 30s, maybe three times a week would be what I would recommend. But as you get older, two times a week, specific muscle group, you can get stronger. So I like how you talk about progressive starting wherever you're starting and just adding just a little bit because how you get stronger is you just increase the the load just a little teeny

bit right so yeah it's like people are people are also i think used to working out a certain level when they're young and then when they get old it's like well i'm going to work out exactly what i did when i was young and then they try that and then it destroys them for two weeks yeah so it's like no don't do that try to just have a more progressive thoughtful routine yeah and it's it's You know, I mean, I have experienced this even. I mean, I'm in my 40s and I already noticed a change. So the way how I train now, like if I, let's say, if I don't work out for, let's say a month or two, when I go back, it takes me longer to go back into the fitness level I was before than when I was on my 20s. Oh, yeah.

So, I mean, it is going to happen. That's the reality. But it doesn't mean that you cannot do it. Yeah. Okay. So next thing was food. Yeah. That's a big thing.

American diet, you know, one of the most healthy diets of all life, of all time and place, right? It's called a sad diet. Oh, what is that? Standardized American diet. Yeah, what is that? Sad diet. It's processed foods, hot dogs, burgers, fried potatoes. And it's, yeah, it's like pizza.

Yeah, mm-hmm. You know, Coke with your pizza. Okay, so what kind of recommendations do you make to people? what have you seen successful? Because honestly, like, I have a hard time convincing people to change their diet very much. Yeah. So again, remember, so it's incredibly hard. So I myself have explored this journey in so many different angles.

And we know for sure that plant-based has like the most outstanding evidence. But this is the problem. How long can you sustain plan-based diet? Right? I tried it myself and I couldn't do it because I was raised, you know, in a country where there's a lot of meat and all of these other products. And so what really matters is whatever you can sustain. So I think it's also important to make the difference between what is vegan, what is vegetarian, and what is plant-based. So vegans are people who don't need any animal products at all, zero, right? Vegetarians, they don't eat meats, but they can have like eggs.

and dairy. And then plan base is people who can eat meats, but their focus is on the plants. And so plan base seems to be the less strict from all of them, but it's still difficult. Now, saying that and knowing that information, if you are all for it or if you already are one person who's doing that, fantastic. You know, congratulations. But if you can't, then there's other alternatives. And so that next other sort of lifestyle in terms of nutrition, you know, is the Mediterranean diet. It has tons of wonderful information on brain health, which is usually what I focus on.

And also, there has a lot of good evidence when you mix Mediterranean diet in the low sodium diet that they do for people with hypertension, which is called the dash diet. And so when they combine these two, it shows that it decreases tremendously chronic illnesses like diabetes, hypertension, decreasing your risk for strokes and heart attacks.

And so I talk about the Mediterranean diet and I give some good bullet points, but it's just more, again, it's information. Yeah, yeah. I've seen a lot of the data on the Mediterranean. It seems to me that it's really hard to decipher some of the data on like meat because a lot of times when people eat meat, they're also drinking the soda. They're also having the fries. you know, so is it the meat itself that is bad for cognitive function? Is it just, you know, trying to get a lot more of those oils that are in like avocado and nuts that are so good? Yeah, do you have any thoughts? No, so I think doing research in nutrition is extremely difficult because for many times it's hard to blind people on what they're eating. And so I know that nutrition research is a hard one. And so whatever research is out there, you want to really know how to read that findings,

because many times they have a lot of limitations. But I do know that you need to do what you can sustain. And if for you having no meats is not sustainable, then you're going to need to work with that. And, you know, Mediterranean diet, they have meat. They consume meat. They consume mostly fish. And then plant-based people will have from time to time, you know, a piece of fish or their chicken, they tried to avoid it,

but plant-based can also have those components. Yeah. You know, there was this one researcher who talked about dementia, and, you know, like I was reading his book, and he's very plant-based, and I look at one of the citations, and it's like comparing, you know, vegetarian diet versus, like, the common American diet

and, you know, vegetarian diet wins. And I looked at the study, though, and they had a third arm that he didn't even report, which was like a vegetarian, with like chicken and it was did just as well as the vegetarian but he didn't report it so i i sometimes am like it's like depending on who you're talking to you know they've kind of looked at the data because there's a lot of people who are like really in this like low carb diet keto diet um and it's it's like some of their studies on the diabetes is it's pretty it's better than the other stuff you know so i don't know

do you um do you have any thoughts on that yeah so you know again um Again, you pick and choose. I think that you have to read a lot and get, like, this is one of the reasons I like to hear your podcast is because you usually put a whole bunch of studies together. And then you talk about them, and I love that because I don't have the time to do that. So then I hear your podcast and it's very informative. And then I get to make my own decisions. But, you know, again, we are trained professionals.

Yeah. But for the people out there who are lost in this big ocean of information about nutrition and diet and what to do or not to do, constantly, constantly, we know Mediterranean diet always is a good diet. Yeah. And I can also confidently say that trying to get away from a lot of the refined sugars. Oh, absolutely, yeah.

Trying to think about processed, eliminating the processed food. Like if that food didn't come from an animal or a tree, you know, like what is that food, right? It's like this is a super refined flour, which, you know, is pretty yummy once in a while. Yeah, and I personally, myself, I don't believe in very restrictive lifestyles. Okay. So we're not talking about orthorexia. No, absolutely not.

I like my ice cream. But, you know, I have this base where I try to watch what I eat. And then from time to time, I'm going to have my little treat, absolutely. Yeah. Okay. Let's keep going. Sleep. Tell me about the importance of sleep, Dr. Soria.

My favorite topic ever. So there was a study done by Dave Ramsey on people who were retiring. And in this study, he interviewed this amount of people, and 56% of them were losing sleep over worrying about retirement. So when you don't sleep, what is happening is that your body is going through very bad stuff, you know. Your hormones are off and your hormones. can have long-term consequences. And so when your brain is not healthy and is not rested, there are a lot of bad things can happen.

So we know that insomnia can increase your risk for Alzheimer's. Because when you're sleeping, your brain is actually clearing all those toxic proteins that accumulate and then can eventually turn into Alzheimer's. And so if you're not sleeping for many years, then definitely you're not, you're working yourself to have, you know, negative consequences. is later in life.

Not sleeping can worsen your mood, can present as a depressive episode when it's only just insomnia, can make people very impulsive, reactive, moody, grouchy, and then it can affect your relationships. So sleep is basically vital. It's like a vital sign.

So, okay, what do we do then? Well, then what do you do then? Just start working in small steps, right? Give me some small steps. Dr. Sorio, I'm having, Not me, but have this patient, insomnia, you know, not exercising. Well, no, so there you go. So that was my recommendation for this week.

It was like, let's get you exercising, let's get you moving around. Yeah. So, you know, again, it's a series of things. So you have to really, so you watch for your sleep hygiene techniques, right? So you want to avoid electronics two hours before you go to bed. And this is usually what I tell people, because this is where people, they will go to bed on the phone or on the tablet and they will, you know, surf until they feel like they're sleepy. So this is actually really bad for sleep. It's not going to help you fall asleep. And then you're going to spend more time in bed without sleeping.

And when you talk about cognitive behavioral therapy for insomnia, the number one thing that you're working with your, in patients, is you're working on the amount of time you spend in bed. without sleeping. You want to make that time shorter and shorter and shorter. So there are different ways that we can do that. So one of the things that I tell them is if you go to bed and it's been 20 minutes and you're not sleep, you need to get out of the bed, go to a different place in your house, put a dim light, and start reading a boring book. And then that will help you feel tired and sleepy.

So shortening that time is going to be crucial to help people overcome insomnia. Okay, so this would be a bad book to read for that period of time, right? Please don't do that, yes. This will keep you up. Yes, because there's homework here and then there's things you need to think through. Yeah, this is probably best done over like a cup of coffee maybe, first thing in the morning. Okay, sleep. One of the other things is, you know, what do you think, Dr. Osorio about this over-the-counter sleeping medication?

Right, yeah. Well, you know, unfortunately people think that because it's over-the-counter is not bad, but these over-the-counter medications, especially for people as we age, it affects our brain negatively. So Benadryl, everything that has the component of Benadryl, even like Tylenopium and all of that stuff, it actually can cause cognitive problems. Yeah. So totally, totally bad stuff to take for sleep. you want to train your brain to be healthy.

And that is why, like the American College of physicians, their number one recommendation is cognitive behavioral therapy for insomnia. Because that's the best data. Unfortunately, number one, it takes some commitment. And number two, it's not as easy as writing a script of something. But I think this is very important because I have seen so many elderly people who come in, come in, who are on some form of Benadryl, Devinidramine. Exactly.

And it is literally, number one, making them more confused during the day. So the whole day they're cloudy. And they don't even know it until like three or four weeks after they get off of it. And they're like, oh, my brain is a whole lot more clear. Absolutely. And so as people get older, it's not just those medications. guys, I will put a list on my website in my resource library of all of the medications that cause cognitive dysfunction. I have an Excel sheet. You can go look up the meds. You can go to the,

you can open up the Excel sheet, look for the find, you know, thing, look up a new med, see if it affects your cognitive function. I did this painstakingly with the medical student. We went through all the medications. I should share this with you. We should do a whole episode on this. So this is something also Dr. Sorri was very passionate about. I know because she's a amazing. I get in her patients off of benzodiazepines. She does it very slow. She taught me to do it over the course of like six months to a year. It's good that, you know. Now, the only caveat over the counter is melatonin. Okay. Melatonin is actually a good supplement to take. And for some people, it's not going to knock them off. And some people feel like they're knocked out when they take

melatonin. But it's a very good supplement. It's very good for the brain. How many milligrams do you go up to? So for people who are 65 and older, I do from 3 to 10 milligrams. Three to 10, yeah. Okay, that's right. Okay, let's keep going. So bio-psychosocial, spiritual. So psycho, let's go there. So we're talking about the mind.

Correct. You know, we're talking about what do you believe about yourself? How do you feel about yourself? Tell me a little bit about how you assess this, how you would. sort of coach someone in this. Yeah. Right. So the psych I had divided into two subgroups.

One is your emotions, and then the other one is your mindset. And so the part of the emotion has to do with trauma. And when we talk about trauma, people will say, well, but I have never been in an accident or I have not been in war, but trauma can be even smaller things. Trauma can be a divorce, trauma can be not passing an exam, trauma is a very personal thing.

It's something that only each individual can define, and we should never compare my trauma to your trauma or anybody else. So working through this process of the emotions is one way that I coach, and the other one is the mindset. Okay. And so in mindset, you have beliefs, expectations, optimism, and then you have what Carol Dwegg talks, who is a big PhD researcher on mindset,

which is the growth mindset and the fixed mindset. Okay, break that down. Like, what is, how do you define fixed mindset? And then how do you move from a fixed mindset to a growth mindset? So fixed mindset is, for example, you know, let's say like you have parents and your kid in elementary, you're not doing really well in math. Your parents will say, well, you were just not born for math. That's what we call a fixed mindset. Versus having, you know, you're not doing well in math.

and then maybe your parents said, well, you're not doing well in math yet. So what that implies is that you can get better, that you can improve. Yeah, effort. That effort can pay off. Yes. That you can have free will to make a change.

Exactly. Yes. So a lot of us, like I was raised a lot into a fixed mindset, but once it became into my awareness and I realized, oh, actually I can change or I can do better. So that's why. what happened with me with running. I always thought, I'm never gonna run a 5K, that's impossible, right?

But then when I found out about this fixed mindset and growth, then I start download my app on my phone, and I start walking, then jogging, and then I made half marathons. And so that took me from a fixed mindset into a growth mindset. Yeah, I like that. So how important is that in this phase? Like, what does that look like?

for someone entering into retirement specifically. Right. So, I mean, and again, a lot of these beliefs and thoughts we have come from childhood or come from our own culture. So maybe things like, well, I'm too old or I'm too old to do that or too old to do this. Or I don't know. So I'll just give you an example. I had a patient that was a lawyer and he was forced to retire.

and he was getting very depressed because he didn't know what to do with his life. And I would ask him, so what else can you do? And he would say, well, I only know how to be a lawyer. I don't know anything else. And so I start helping him to change that into what else he can do. And so eventually what he did is he started to volunteer in smaller organizations. And then he found meaning and purpose again, even without being a lawyer. And so that kind of, you know, beliefs, thoughts and that stuck mindset was able to shift.

And then he found again meaning and purpose through retirement. That's an example. That's really cool. So it's like getting unstuck. So specifically if you're feeling stuck, you know, sometimes just realizing like, oh, I do have a fixed mindset and I don't really need to. Exactly. I have a fixed mindset because of cognitive distortions because of things that I started to believe, stories about myself that I started to believe, which aren't true.

The stories we tell ourselves so important. So important. That makes a huge difference. Tell me a little bit about the reticulating activating system. Yeah, so the reticular activating system is a part of our brain. that in medicine, we commonly know it as the part of the brain that makes you breathe and be conscious, right? So that's that area of the brain. But what commonly we don't know about this in medicine is that the reticular activation system is like a set of neurons.

That what they do is when something has been pointed out to us, you start seeing this everywhere. So it's like when you buy a new car, right? So I buy a red Ferrari. Now I see red Ferraris everywhere. Right? Because now it's at the front of your consciousness. So basically, this is what they call the law of attraction, right? Okay. When you start thinking about something and you start visualizing it in your life, eventually you can attract that in your life.

So if you start saying, I'm too old, I have a lot of pain, I'm going to be miserable in retirement, you will be all that. Yeah. You will be all that. My bone, I have bone on bone pain, Dr. Buter. And I'm like, oh my gosh, no one is bone on bone. It's just not, it's not a thing, guys. The doctor that told you that, that is not a thing. And so people start to believe these narratives, like, about their pain.

And then that takes life on of its own. It is, yeah. You know, and so, yeah, then any little, like, bump or pain or, you know, thing just kind of like is lighting up the red alert system like when I first started lifting I would get spasms and I would freak my mind would freak out because I would be like oh my god something is really really wrong and that would create more spasms which would create more pain and I would be like debilitated but now I get a little spasm and I'm like oh it's a spasm okay that happens And now you have grown in your lifting.

It gets on. It goes, you know, I just move through it. And it doesn't create all the spasms for my brain freaking out, right? Okay, what about the limbic system? Prefrontal cortex. How does that relate? Okay. So that again has to do with trauma usually.

And so let's say you grew up in a household that was, you know, I mean, I wouldn't say like totally, bad, but, you know, let's say your father always yelled. Okay. So when you grow up, anything on your environment that might make you unconsciously remember your father yelling, it's sort of like your amygdala telling you danger, danger. And so you can become reactive, right? And so the amygdala is like the reptilian brain, is that instinctual. All the animals have an amygdala. animals in the wildlife need to have a very strong amygdala because that's how they survive. But for us humans, we have this other part of the brain, which is the prefrontal cortex, which is our thinking brain, our social brain, is that part of the brain that maybe said,

oh, maybe you're amygdala, it's telling you danger, danger, but then your prefrontal cortex go back and said, no, you're not in danger. This is just somebody that is screaming, but you're not in danger. So you're able to regulate your emotions and you're able to contain your behavior. and not responding like an animal instead of fear, either running or freezing or fighting back. So we need to have this communication between the amygdala and the prefrontal cortex has to be very healthy.

There are a lot of things, chronic stress actually makes that prefrontal cortex thinner and thinner. There was a study done among medical students because who else has severe stress. And so what they did is they did this functional, images of their brain where when they were instead of stress. And then they did give them a course on coaching some kind of activity and then they decreased the stress level and then they repeated those functional images. And they show that when they were in high stress level, their prefrontal cortex activity

had changed. It was like more on the low activity. And when they did the relaxation, the coaching activity that they put them through, those that prefrontal cortex was more brighter. And so that is how stress affects our prefrontal cortex. And when your prefrontal cortex is not working well, guess what is really strong? So you're a meadal. So you're going to be overreactive.

You're not going to be able to focus. You're not going to be able to pay attention. Then your productivity is going to go down. And then you're not going to perform as you would like to. So when you are in a moment where you're transitioning and you're constantly worried, That is a stress and that affects your prefrontal cortex, make your amygdala stronger, and it's all a vicious cycle. Yeah.

Yep. So how do you break free of that, especially in this? If you're struggling specifically with that in the midst of retirement, how do you break free of that cycle? How do you activate that frontal lobe? So you activate it by doing mindfulness meditation. Okay. And so I hated it.

I still have struggle with that. It's really hard for me. because I'm a very type A person. But when I build my practice and I started to do it consistently, it totally changed my life. So, you know, you start with very, very, very few minutes. I thought mindfulness meditation was to leave your mind in blank until I found this amazing app called Headspace.

Okay. And it taught me that when you're meditating, your brain is full of thoughts. because as your long breathe and your heart beats, your brain thinks. So meditation is not about having a blank mind. And so if you are not familiar with mindful meditation, headspace is a really great place to start. No funding or endorsement money from them. Absolutely nothing.

Yeah. Yeah. So this is a good option for people to kind of get them into that. I actually started with Heart Math. and a biofeedback device, inner balance, and just looking at that while I was doing the breathing. I also started with walking and just paying attention to the bottom of my feet. For me, that was really easy.

Yeah, so using your senses as mindfulness, mindfulness eating, you know, all of that, anything that brings you in the present moment, it's a way you are making your prefrontal cortex stronger. We should go do some mindful eating again at the, that nice restaurant down the downtown yeah absolutely that was really yummy um dr osirio covered for me while i was on vacation and said i'm going to take you out to dinner to celebrate or to thank you and she's like yes we have a good excuse to do that yeah you want to work with people like dr peter

okay um yeah so moving back to sort of smart goal setting okay how do we how do we kind of start to think about what might be some good goals for people who are going through retirement? So, you know, you can choose whatever, you know, anything of what I have mentioned, right? You can choose a thought, you can choose a eating habit, you can choose sleep, whatever you want. And then you want to go in the book. And there is a little page there where it teaches you on how to set up those goals in a smart way. And so number one, remember that what you want to do, it really is going to matter to you, right? Because if you reach for a goal that you don't really care for, you're more likely than not to complete that goal.

And so when you set up your goals based on your value systems, you will actually be able to reach that goal in a more effective matter. And so the value system is extremely important. And it's something that when we go on our day-to-day, we start to forget about. So, like, even when you come to work, what are my values when I work, right? So now that am I retiring, what is going to be very valuable for me when I retired? So, for example, maybe for you spending good quality time with your grandchildren. So you use that value and you set a small goal. You put action steps.

And then you find a way where you can come back and realize if you actually accomplish it or not. And anytime that you make a plan, set some goals, activating that frontal lobe again, right? Dorsolato, prefrontal cortex, planning. Planning. That's good. Okay, the third pillar, biopsychosocial, friends, and gratitude. So how do you recommend facilitating, finding good friends, building those good friendships? That's a very, you know, especially when you're facing retirement, right, you're getting out of your circle of friends, right?

because all your friends probably were at work. And so now you're left with this idea of, okay, I'm not going to work anymore. I'm not going to see them anymore. And there are many things that you can do this. You can continue to communicate with the people that you worked. They were closest with. A lot of the times what I've noticed in my experience is that people started to isolate from their family members because they start feeling like they were a burden.

So reactivate that, you know, social engagement with your family. Yep. There's data that even in apes, grandparent apes prolong or create a survival advantage for the baby apes. Wow. And I think grandparents are fantastic and needed. And, you know, in America, we're so focused on the individual. We're focused on working hard. community, friendship, so important. And I'm thinking about in this season, COVID season, right?

So we're like not hanging out as much. Any thoughts on like if someone is listening to this, they're retired? It's the middle of COVID. They can't really go be with their family because maybe, you know, their kids are like working in the ER or something where they don't feel like they want to get their parents exposed to COVID or something like that. Yeah. Any thoughts? How can they still facilitate those friendships?

Yeah, so, you know, a lot of creativity I have found among a lot of people through this COVID situation. So I had like this one of my patients, his son, it was his birthday. And his son, it was a doctor and they didn't want to be with their grandparent, with his father and his wife. So what the wife of the son did is she called all the family and told them we're going to give him a birthday surprise Zoom dinner. So my patient, who was the old man, his son didn't know that this was going to happen. And so everybody at home brought food and they made their own dinner. And then they all put Zoom together and they all had a glass of wine. And then when the son came from work and they opened the door, the white had.

had bought balloons and a cake, and everybody was ready via Zoom. And so they did like this little celebration. Oh, I liked that. Which I thought it was beautiful. Very creative. Very creative. Yeah.

So there are many ways you can do videos if you have access or you can do telephone. You know, maybe you go through your list of contacts and you see, oh, I haven't talked to this person in a long time. Maybe send them a text or give them a call. Who knows? You know? Yeah.

I personally try to reach out to a couple of my close friends. at least once a month who have left the area. And then, you know, I think, I think just realizing, like, people you may, you know, meet in different contexts, they want friendship too. And I think that people are just kind of like, a lot of the times not thinking, like, oh, like, they have their own insecurities. So maybe getting past your own, like, the insecurities of, like, just kind of reaching out, you know. You talk in here about how a lot of people have this idea that money will bring them happiness, but really it's more friendship. So many things. So many things, right?

Yes. Yeah. So, you know, that is a little moving more into the last pillar, which is spirituality. And what I talk in spirituality has to do with very, I'm very influenced by this man called Victor Frankel, who was a psychiatrist. he survived the Holocaust and he lost all his family in the concentration camps. And so he talks about the dangers of having the pursuit of happiness because the reality is that in life, bad things are going to happen. It is for sure.

Life is unfair. That is another thing that is what it is. So if you're trying to find happiness when you're suffering, that's not going to. So how can you be happy if you lose a child or how can you be happy? happy when you lose your job, right? But if you pursue meaning, you will find meaning even in the worst circumstances. He did that. He actually was able to find meaning through his experience in the Holocaust. So maybe during that time, you're not going to see it. So for example, my brother, who was younger than me in 2019, had a stroke. And I was absolutely devastated. During that time,

I couldn't see anything, but, you know, I was just in so much pain and agony. But now when I look back, I found I was able to find so many meaningful things that came out of that. That is amazing. Yeah. And so that makes me more resilient. Happiness, happy moments are going to happen, for sure. But meaning will be able, you're going to be able to find meaning in so many different areas. Yeah.

So looking for the meaning, realizing that. there can be meaning even in the midst of suffering, you know, maintaining for Victor Frankl, I like how he continued to give to those people. Like one of the decisions he made was to stay in the hospital and to continue helping these people. He had this option to leave. And then he found out everyone who left died.

And so he could have left, right, thinking that he was going to be free. but he stayed to help and that saved him. And, you know, thinking about the ripple effect, right? Like, you know, you have no idea how you're impacting people. I've had these mentors who are 80, 90 years old. Dr. Tar, who's in this 90s is one of them. Harvey Elders, another one.

You know, people who have been amazing mentors. And so I think, realizing that as you get older, you have gifts to give. Absolutely. You have gifts to give. And even if some people seem busy, even if some people seem to not want the gifts right away, you know, you still have gifts to give. So thinking about where you can give those gifts. Yeah.

Is there anything else about spirituality which really jumps out to you that you'd like to highlight here? Well, you know, it's all basically, you know, talking about meaning and purpose and life in general and where we each one of us are going to find that. Spirituality is different than religion. And for a lot of people, they come together. For a lot of people, it's one or the other. And if you even look at the biggest religions, what they're trying to do is somehow finding meaning in the world, right?

And meaning, and like if you look at Buddhism, they're trying to find meaning through pain, right? That's what they teach. And, you know, I'm a Christian. And so for me, a lot of my meaning and purpose comes from my faith. And so, again, it's into each one of us where we're going to find that spiritual component in our lives. I'm not here to tell you X, Y, or C, I'm here to tell you how can you find that in your life. Yeah. Yeah, that's good. That's good. So, You're in your 40s? Yes. You're thinking about retirement?

I have been planning retirement for many years. Okay. So are you going to be like traveling? Like, what does this look like for you practically? So I have long-term care insurance already. Okay. So in the case, I need memory unit is there for me. Oh, man.

I have a lot of money invested in retirement. So financially, I think I have a pretty solid plan. And then what I would like to do are two things. Number one, I would like to go back to school to study ornithology. Whoa, really? Yes. And then I want to volunteer in little schools of little kids and teach them about birds and the beauties of nature. You can teach my daughter about birds anytime.

Oh. She would love to hear. Oh, man, that's fun. So I think that will be extremely meaningful for me. Yeah. And completely different of what I'm doing right now. Completely different. Yeah. Wow. Okay.

So, and then the other thing is I want to get a big dog and training for search and rescue and travel with my dog and help people when there's disaster or whatever. So do you want to hear what my like ideal? Absolutely. Retirement? Yes. Okay.

I wake up, go to a coffee shop for three to four hours, read articles and books and prepare. But you're doing that already. And prepare for podcasts. Yeah, but just, oh, no, I don't have a three or four hour block like ever in the morning just because I have kids and everything. so it's like it's always late at night. No, but I think just like sitting there, drinking a cup of coffee, you know, like reading a book, thinking about like, you know. Those are goals.

Future things, right? So, you know, if you want to support that earlier, you can support my Patreon, which gives me more time to work on podcasts. And you can sign it for CME. That'll give me more time to work on podcasts. And maybe that'll happen earlier for me. I don't know. Like if, I think it would be great someday if I could spend half of my week working on these things, have my week doing clinical care.

So, Dr. Sorio, it's been a pleasure. Thank you so much for having me. I think, I think there's a lot here. There's a lot of nice quotes. Got some Victor Frankel quotes, some Nietzsche quotes in here. There's lots of things to work through that are beyond what we can present here. But I hope this was valuable in and of itself to anyone who's listening. If you have someone, a patient,

who's going through this, maybe sharing this episode, we're going to have a write-up on the website that will be done, you know, and we'll have some resources in the resource library. Like I said, we'll get that Excel sheet up there so you can look at the medications, see if any of the medications you're on are causing cognitive dysfunction. Dr. Sorio works here in L.A. and her program's here. So there's lots of resources here for you guys, and we'll leave it there. All right. Thank you.

Thank you.