Psychiatry & Psychotherapy Podcast - Performance Enhancement with Dr. MaryEllen Eller

Episode Date: April 17, 2018

Our bodies are "wired" to perform. Learning how to consciously modulate your internal sympathetic state is the key to unlocking optimal performance. The autonomic nervous system (ANS) facilitates survival by generating the fight-or-flight response and promotes recovery following activation (the ability to relax). The ANS achieves this by balancing two complementary systems: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). For example, your ANS is currently adjusting your pupillary diameter, respiratory rate, blood pressure, heart rate, skin conductance, sweat production, sphincter tone and postural muscles (just to name a few) to allow you to focus your eyes to read this information without passing out, falling over, overheating or urinating on yourself. For PDF with full notes on our discussion and breathing: https://psychiatrypodcast.com/resources By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join Dr. Eller on: Facebook: @PhysicalTherapyRX Instagram: rxpt_ Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. I am here today with Dr. Mary Ellen, Eller, and she is a very, is a soon-to-be graduating fourth-year resident. And we have done a little project the last couple weeks together,

kind of preparing for this, talking about performance enhancement. So specifically, this is going to apply to athletes and also people who are performing at a high level, whether it's like a musician or, I don't know, maybe even some sort of public speaking or, I don't know, What are other examples of performance? I think for performance, we really easily think about very elite athletes or people at a high level that we look up to. But you and I perform every single day when we show up to work.

And so realizing that this can be for basically anybody, I think it's really important. Yeah. So tell me a little bit about how you got interested in this. So my background before I went to medical school was always, I grew up as a gymnast. I competed as a gymnast and then I transitioned into coaching and then throughout college and for several years into medical school I worked as a performance consultant for gymnastics where any elite team could call me up and I would come. I would work with their elite athletes and we would look. So the scoring in gymnastics is very skills-based. And so once you get up to the elite level, you want to be able to optimize and get as many points as possible. But a lot of times they would call me in because people had kind of reached their limit. And so at that point, my focus was very much on gymnastics. And as I transitioned into medical school, I realized that there was a lot of questions that

before I hadn't even had the knowledge to know to ask. looking at kind of the reasons why we did some of the things that we did. So that was kind of the starting point for me that got me interested. And as I discovered psychiatry and discovered how fascinating of a field it was, I realized that there was a lot of overlay between what I had been doing as a consultant and what I was doing now professionally. So as you went through four years of medical school, And now almost done with four years of psychiatry residency.

Yeah, tell me how has your sort of paradigm shifted from before to now? So beforehand, you do things very anecdotally. You do things because you've seen them work. You know they can work. But I never understood the reason behind why we did what we did. And I was very limited because I didn't have the knowledge. based to ask good questions. Throughout training and being able to understand more of why we do what we do, why and how the brain works, it allows you to ask better questions and dig a little

deeper so that when you're hitting that wall, even as a consultant where you're running into that wall of, I don't know what I can do with this person beyond this point, being able to ask good questions is often what you need to break through that barrier. Yeah. So how, so you're talking about a lot of your psychotherapy training in particular and just kind of your understanding of the brain and how the brain works. Right. A lot of physiology and a lot of psychotherapy as well. Okay. So tell me, like, give me an average client that comes to you. What are some of the commonalities of things where they get stuck? Right. So for a lot of people, and usually one of the first questions I ask people is, number one, what is it that they want me to help them with?

And within that, the question is usually when they are performing or when they're in practice, where do they find themselves hitting a wall? And for a lot of people, whether it's working with a triathlet or working with someone in CrossFit or in gymnastics, a lot of the biggest issues come from training itself, not being able to push themselves hard enough, not being able to find the motivation to get to where they need to be in training, and then showing up to an actual performance and feeling that they haven't prepared adequately. So, okay, so let's say you had someone come to you and they say, you know, Dr. Eller, I'm having a hard time just pushing myself in practice.

I'm having a hard time doing what I think I need to do to be able to perform at the highest level. Okay, so where do you go from there or what comes next? So it's, it can be challenging. there's not a perfect template. But for a lot of people, what we need to decide is whether this is a physiological reason why they're not being able to push themselves or if this is a mental issue. If this is something psychologically that they're not able to push themselves through. For most people, it's a combination of both. And one of them is going to take a little bit of priority over the other. But if I walk into practice not believing that I can do hard things and not having the

external motivation of a crowd cheering for me and I'm in the middle of a workout and it gets hard, I'm going to stop. I'm going to feel physically like I can't push myself through that. So for somebody who as soon as things get tough feels like their body is giving out on them, a lot of times building in positive self-talk or building in mantra to get them through that mental block of being able to push themselves without that external motivation, a lot of times that can be kind of a breakthrough for them. And for other people, they literally do hit kind of a physiological block. For most people, it's not being able to find enough activation in the beginning of their training. So that really quickly on, they feel

drained because things just start so slowly. And instead of getting this kind of even spread of energy throughout their training. It's this low trough followed by this dramatic peak trying to keep up with those first couple minutes of movement and then suddenly they fizzle out really quickly. And so what we would try to do with them is try to bridge that gap and make it more a more level energy,

kind of energy use throughout their training period. That's interesting. So the kind of the two, The two big categories is sort of pushing through mental toughness. And the second one would be physiologically peaking too early in the practice or not being able to get revved up enough. Is that? Right. And for each person, it's going to vary a little differently.

So the biggest thing that we look for is sitting down and in the initial consultation that we do really looking for patterns. because people will find that there is a very predictable pattern within whatever it is that they're doing. And this could be an athlete who maybe in playing tennis has the same pattern every time they're training, but in school they find themselves doing the exact same thing, where maybe as soon as things get hard, they lose the motivation. And so it's usually not limited to just training or just performance. It's a pattern that we can see play out throughout their entire day. Yeah, I see, so, okay, like let's say you had someone who, you know, when it gets close to game day,

they're able to really focus and concentrate and do the work. But, you know, four or five months out, it's like so hard. They have no sort of like drive to do it, you know. How do you like talk to me about how you would help that person get revved up to do it? And I'm thinking of both athletes, but also I'm thinking. of like people who need to study for months on end before a test, but they can't focus, they can't concentrate. So one of the big science or big theories that we look at that I found really interesting

is the science of motivation. For a lot of people, they don't understand or have a clear vision as to why they're doing what they're doing. So if you tell me that I have to go out and I have to exercise because I have a major race coming six months from now. On one hand, yes, that big picture, it's, it's fairly motivating. But it's too far away. It's too grandiose. And the steps to get me from where I am right now to get me ready for that thing coming six months away, whether that's some major athletic event or my board exam, right? It's too big. It's too far. And so for a lot of

people, to be able to shift them from an external motivation to more of an internal motivation, you've really got to break it down for them so that every single day they can have a very clear goal as to what it is they need to accomplish. Once there is a clear goal, it's a lot easier to find the motivation. But if I'm not, if I am not 100% clear as to what it is I'm training for, what it is I'm preparing for, why I have to sacrifice my time today for something so far down the road. If the vision isn't clear, the motivation is not going to be there. So I hear meaning.

What is the meaning of this labor that I'm doing? What is the meaning of this hard work? So, or what is the purpose? Right. You know, that reminds me of when I was at UC Berkeley, I rode under two coaches, Jeff Bond and Steve Gladstone. and both of them, you know, we'd be training, yeah, nine, 12 months before the big race, you know, and really only national championship is what matters in their mind.

And nine months out, they would be saying before practice for about 10 minutes, they'd almost be yelling at us, like, today is the race day, today is game day. You know, whatever happens today will be played out a year from now. You know, every stroke, I'm trying to not use expletives, but every stroke, every stroke matters, right? And it's like that kind of like getting a bunch of guys at six in the morning revved up to actually like bring their full concentration, their full motivation. And I think most of us really believed it. Like we really, like a group of like 20, 30 men really believed that that morning was so important towards us. and our future, you know, victory.

Is that the kind of thing you're talking about? So that can be part of it. The issue that a lot of the athletes that I work with that we run into is that they don't have that external force with them to motivate them every single day. And so if you're not able to recreate that situation on your own, a lot of times you're going to fall flat. And you're going to really limit your potential

because if that external motivation is pulled away, right? you don't have that coach yelling at you for 10 minutes telling you, this is game day. We are creating this right now. This is real. Get in the game. Put out 100% of your effort, right? Yeah. If that is pulled away and it's just you sitting there in a boat all by yourself,

what can you do to train yourself to become that coach for yourself? To get your brain to shift into that mode to believe that right now, six months ahead from nationals, every single stroke matters. Yeah, because I think a lot of people don't have that sort of external, you're calling an external factor, external locus of control almost as well, like someone else telling me how important this is to moving into your own mind, internal locus of control, this is super important. I'm going to focus.

I'm going to bring meaning to this. And it's interesting when you're in a point of suffering, I think, and physical sports brings you there because fatigue brings you there, brings you into an aspect of suffering. It's like you really start to have that daily, it's almost like a daily struggle. Like, why am I doing this? What am I doing?

And that's really tough. That's really tough. When we look at athletes that we really admire and we dissect mental toughness, which a big part of that is being able to have that internal locus, is that internal motivation. They live to suffer, which sounds really masochistic and strange. But when you're able to get your brain to a point where you realize that suffering is the gateway to your success,

a lot of times those people have such a strong drive to push themselves to that place on a daily basis because they know why. They have seen the purpose. When you see someone, in the world of gymnastics, who wins their first competition, three months following that competition, you're going to have a hard time getting them out of the gym. Because suddenly they know what victory feels like.

And they know their competition. They know what they have to do. They know what that feeling was. Yeah. So trying to be able to replicate that so that you can win sooner is kind of the goal. Right. Right. Okay.

So let's say, let's talk about. the breathing techniques, like, because I think those are easy to just kind of share with people who maybe are, you know, trying to learn this for themselves. Like, let's say you wanted to rev yourself up before practice, get yourself a little bit pumped up. What are the breathing techniques that you would tell them to do? So the science behind breathing is very complex, and it's something that I've been really invested in studying for a while. And it is frustrating because there's we know anecdotally that this works. There are some studies that have looked at what is most useful,

but it's not a very hard science. So really the best reason or the best explanation to know what it is that we're going to try to mirror is to look at your baseline physiology. And then at what point are we most prepared to do the task at hand and then trying to replicate that? So what that means is if I'm, trying to rev myself up, right? I need to find an access point to get in to increase my sympathetic tone, which is basically I need to activate my fight or flight without hopefully having an actual stressor right there. So when you look at the physiology of sympathetic activation, what you need to do

is find a way to increase your respiration rate. So for most people, what we tell them to do is they need to hyperventilate. They need to hyperventilate for 30 to 45 seconds before taking one big deep clearing breath. And then from that point, they should be set to go. That is usually enough for most people to activate that sympathetic tone enough to find the energy they need to get revved up, to get the motion going. So for hyperventilation, we're not talking about panting like a dog or anything like that. You're you're basically going to speed your breathing pattern up to about 20 to 30 breaths per minute. So what that means is an average of one second in one second out for 20, about 20 breaths. And then from that point, and this takes training because the first time you do

that, you're going to feel lightheaded. You might get some tingling in your fingers. That's not the goal. We don't want to feel like we're dying. But you do, want to get to a point where you do feel your heart rate increase, a lot of people will start kind of perspiring. Without training, the first couple of times you do it, you're going to feel a little bit of a panicky feeling. And you need to practice this before you actually need it to work. Because if you go into a workout feeling panicked, you're not going to perform at your best. So it needs to be controlled. It needs to be controlled activation. The other part to that is the clearing. breath. So after you've done those 15 to 20 breaths of hyperventilation at that increased rate,

you're going to take a very, just a regular breath in, which is usually about three to four seconds of inhalation, with a very strong forced exhalation, which usually is going to last for about eight seconds. You're going to clear out all the air in your system until you feel like that deep knot in your belly. Okay. And at that point, you're going to hold it for about, for most people, it's about 10 seconds, basically until your gag reflex kicks in. And at that point, you're going to start breathing normally and your sympathetic tone is going to dramatically increase, which has primed your body to start releasing energy stores at a much more maintained rate instead of having a giant spike a minute or two into your exercise routine. It's going to get

your heart rate ready to go. Your oxygen capacity increases at that point. So as soon as you do start moving, your body has already been primed and you're ready to go. Okay. Yeah, one thing that that occurs to me as we talk about this is you probably don't want to do this in water. No. I would recommend trying it before you get in the water. Do it before you get in the water just in case you pass out. Yes. Because I've heard all sorts of breathing stuff that people do before they go underwater and stuff. And yeah, it's really dangerous unless you have like people there to, you know, pull you out if you pass out. It's, it is incredibly important. And the other thing that you have to realize, especially when you're working with athletes, is they are so competitive

that if you tell them to do something for 10 to 15 seconds, they're going to do it for 45. They're, they, many of them are of the mentality that if a little is good, a lot is better. Right, right, right. So you need to practice this in a controlled setting, and you've got to be good at it before you try to actually use it. Let me come back to why we talked in the past about doing this is important. It's because a lot of times in practice, when you're far out, you need more stimulation.

It's hard almost to get into that fight and flight. Whereas at game day, you're almost too much. much into fight and flight. Right. So we need to rev ourselves up in the training, and we need to actually calm ourselves down in the actual performance. Correct. So, okay, you've been doing this for a while.

How do you help someone calm down before an actual performance? So when we look at calming down, we want to look at the time during our day when our body is at the most peace, the most rested. And so the period of time that we want to emulate the most is as your body is transitioning from being awake to being asleep. And so if you're looking at that period of time, the initial transition into sleep, that's where you're going to have very kind of irregular breathing. You're going to have a lot of forced or prolonged exhalation because as you're transitioning to sleep, your body's CO2. point is rising, right? And so this is where we have those same clearing breaths. We're going to start with the clearing breath instead of hyperventilating beforehand. You're just going to have a

normal inhalation with a forced exhalation, which you usually get in about over eight seconds. You're going to hold the exhalation in the body at the body when at the bottom where you're feeling that not in your stomach. You're going to do that for about 10 seconds. You're going to repeat. that for about three cycles. So over a period of about a minute, you're going to take three breaths with the focus being on a prolonged exhalation and holding with that empty feeling. So how many seconds in, how many seconds out, how many seconds holding? So it's just a relaxed in and the exhalation, you want to extend it over about eight seconds. Okay. And hold it at the bottom for about another eight. Okay. And you do this three times.

You do this three times, that is going to start to activate your parasympathetic tone, which is the opposite to your fight or flight. That is the transition that your body starts to make when you're going from an active state into rest. As your body transitions into that the most restorative part of sleep or rest, what you see is a very regulated, slowed breathing pattern. that the best way to emulate that is a very relaxed. It's going to be a four-second inhalation. Seven seconds you're going to breathe out, eight-second hold,

and you're just going to continue that pattern for about seven or eight breaths. For this to work for a lot of people... Wait, so at first you said three breaths, and now you're saying eight? So it's going to be three of those deep clearing breaths. Through the deep clearing breaths. We are holding out the bottom. Okay, all the way out. Correct.

And then you're going to transition into a four, seven, eight breathing pattern. Okay, without the deep exhalation? Right. So you're going to breathe in over four seconds. Okay. You're going to hold it at the top for those seven seconds. Okay. So you're holding it at the top now.

Okay, I get it. So you four seconds in, hold for seven, seven, breathe out, for a right? And then breathe out over eight. Eight. Okay. And this is the best pattern that we have right now to emulate that transitional period from awake to sleep. And then that 478 pattern emulates that restorative stage in sleep where your body is most relaxed and you are conserving your energy stores. You've got to practice it before it works.

The first time people try to do. regulated breathing. A lot of times they'll end up getting sympathetic activation, regardless of what the breathing pattern is. Yeah, I've noticed that when I'm training people, it's like they almost hyperventilate if you're, and it's like it takes a while to get this sort of calm breathing. Right. And a lot of times you're not going to be able to hold that pattern for very long or be able to do the extended, you know, breathing out over eight seconds or holding it for 10 seconds at the bottom. A lot of people are going to have to start slow and work themselves up to those extended periods, or else what happens is you feel like

someone just threw you 30 feet underwater and you're just gasping for air and you start to panic. So it's something that you have to have very focused and intentional training to be able to get to that point. But the cool thing is, is when you have mastered that, it is those breathing patterns that signal the deeper parts of your brain that it is now time to rest. It's time to restore. and the more focused attention you have, the easier it is to start training your body so that even if you are about to go compete, your brain can transition from flight or flight

into this rest, restore, conserve energy, kind of mindset. Right, right. So the breathing changes the respiratory sinus arrhythmia. which is a natural sort of calming pattern that comes from the nucleus ambiguous in the midbrain. So part of the brain, the base of the brain, which regulates and keeps us calm, is able to kind of turn on. I think the baseline is a fight and flight because we're always ready to sort of escape danger. But if we can change our breathing, we can calm our bodies down. which is what people need before performance, whether it's test taking or, you know, performing in front of people or performing in sports.

What happens to some of your athletes who don't know how to calm themselves down before they perform? This is where you see, like, choking. If you've ever seen an athlete or been watching sports, you hear the sports commentator refer to somebody as. choking. This is your sympathetic nervous system going haywire. These people are prepared. It's not like they got there by accident, but there's something that happens when you haven't focused as much on your mental game or you don't have a set, you know, prepared routine in place to keep your brain in the game that a lot of times people feel like they've been hijacked. What we've looked at as far as the studies go, 95% of people's training, and these are looking at elite, like Olympic level athletes,

95% of everything they do revolves around physical training. Their nutrition revolves around physical training. Their sleep schedule revolves around physical training. Everything they do, they focus so much on getting their body prepared, and very, very few of them have a very rigid or even routine mental game preparation. So being able to focus on The simple things like breathing patterns, teaching people how to check in with their body, to monitor. A lot of times when I first start working with an athlete, what I'll tell them is for five minutes during the day. And this can be five times for a minute apiece. I want you to just stop and pause.

And for one minute, not try to regulate your breathing, but just check in and see what is happening with your breathing pattern. And as you're doing that, just to jot down. either in their phone or in a journal, whatever they have handy, what their overall emotion is. Are they feeling calm? Are they feeling activated? Are they feeling restless? What is the emotion that goes along with that? And a lot of times what people notice is that there's a variation, and it can be very slight, where for most people, their set respiratory rate is about 16 breaths per minute. When they check in in a time and they're breathing maybe 13, 14 breaths a minute, a lot of times they'll report that they're feeling more calm, they're feeling more relaxed. Maybe this is when

they were sitting down stretching or maybe watching TV relaxing during the day. Or other times when they were feeling more stressed, maybe they were doing something they did enjoy, that respiratory rate goes from 16, maybe up to 18, 19, or 20. And this is all happening on an unconscious level. But if you learn to pay attention to what your body is doing naturally, it can give you really good insight into ways to modulate your feelings. And being able to adjust your breathing rate from 18 breaths a minute down to 16, if that's all it takes to get you from feeling activated to feeling more kind of centered and regulated or feeling less activated and instead more calm, that's a pretty simple fix. And for a lot of people, it just requires some focused attention to get in the habit of checking in

and then actually having a plan in place of what to do when I'm feeling this way. Yeah. So one thing that kind of comes to my mind as we talk about this is when people get kind of overwhelmed when they're performing, I see a lot of medical students with test anxiety, nurses with test anxiety. And, you know, one of the medications we even give for test anxiety is, like, like a beta blocker propanol. Right. 20 milligrams, you know, half an hour before a test, you know,

it lowers the sympathetic tone so they don't get too revved up. Right. The other thing, if they're more patient and willing, is to do like biofeedback, like the breathing, kind of help them learn how to calm themselves through breathing. And what I think is happening as I listen to more of these stories is they go into the fight and flight. And it's as if like a bear is right.

right in front of them. Right. And, you know, a lot of people perform well in, you know, sort of running when that bear is right there. Right. And so you need to be in a certain level of fight and flight to run fast. But when you're actually trying to do something like, you know, take a test or, you know, do public speaking, having that bear right there can actually be like, you know, shunting blood from parts of your brain into your muscles and not helpful.

And I think what happens if people get even more sort of stress, like the bear gets even closer, is they feel, they go from the fight and flight system into the, it's the parasympathetic, but it's the dorsal part of the midbrain. So it's the dorsal motor nucleus of the parasympathetic, which is like kind of like, shutdown mode. I call the shutdown mode. It's like dissociation. They, they just, you know, the parts of the

brain that shut off are like the frontal lobe, the right anterior singular, right corpus callosum, you know, parts of the brain that feel the body's sensations, so they may feel lightheaded, they may feel disconnected from their body. And at this point, this is more like the freeze response. This is the part where you like, you know, you see the tiger and he's tackled the gazelle and the gazelle goes limp, You know, the gazelle goes limp, the mouse goes limp when the cat's playing with them as a physiologic defense against death. Right. You know, so I think that this is the point when people get really, really, really dysfunctional. You know, they're basically, they feel completely stuck.

They feel frozen. Right. And they're not able to, you know, continue to run. They're not able to continue to fight. They feel overwhelmed. They feel hopeless. They feel helpless. They often feel a sense of shame.

And this is where I think people really cave. If you had someone who went through this a couple times who had this significant shutdown, what, first of all, have you had people with that in sports? Have you had this sort of, I know I'm calling it maybe a different thing, the door. The polyvago theory kind of speaks to this. But what do you do with a person like this? how do you help retrain them so that they are not afraid of this happening again, right? Any thoughts on that?

So it's a really complex question. The biggest thing that people need to know is if you're in a position where you've been pushed to that, the only way to avoid it is to train yourself to catch it early. Because once your brain goes there, it is incredibly difficult to pull yourself in that moment from freeze into becoming functional again. There are a lot of ways that we could push you to that point in training. We could make things so mentally tough that we push you to freeze or push you on the verge of freeze.

Push you on the verge of freezing. And I think that actually is what I see really good coaches able to do. They push you close to the edge and they teach you that you have the capacity to move out of that zone. Right. it would be almost unethical to push somebody there in your very first time out. Oh, absolutely. You need to give people the appropriate tools and the training because if you take that person who's been there, you know, they've showed up to competition and they froze.

To turn around and do that to them again and then try to coach them through that when they're in that moment, it's not going to be successful. And so being able to teach people how to regulate, and again, this is where looking at the patterns comes very much into play. It's very similar to the way you would do a behavior chain for a borderline, where we've had this behavior, and we want to figure out why it happened. So we go with as much detail, step by step, looking at all the events that led us up to that moment. And for a lot of people, that may, in athletics, that may have been something that started 12 hours beforehand.

And we might need to go all the way back there and start. start really looking at what their game day behavior, what their game day routine is going to be, and start building in confidence that, you know, I've looked at what happened and I've traced it all the way back. I know where it started. And now I've got 12 hours in my day to build in prevention. So I don't end up in that same place again. Building and routine is the most helpful thing for pulling people out of that. Again, we're not going to be successful if we look at just freezing and we go, one step back and say, okay, well, you're on the verge of freezing. What was the one thing that pushed you over the edge? If all we do is give you a tool for that one thing, we've really limited your ability because we don't know if it's going to be that same thing the next time around. It's the same thing in gymnastics. Like when you're looking at a skill and you're trying to fix something, it's really easy to pick the one big major thing that went wrong, right? So if you see a gymnast coming off the bar and you say, let's say they fall on the landing, and your

response to fixing that is just stick the landing. But you don't look at the grip, you don't look at the body mechanics that led up to the fall. You've missed the bigger picture. So you've got to scale it back and you've got to take it back as far as you possibly can and then start building in corrective techniques to give confidence and to keep the brain and your body in better control so you don't get to that point. The delicate balance in this is that with every sport, there's an anxiety curve. And like you were saying, we definitely need some sympathetic activation to perform at our best. And every sport on that sympathetic curve, right, where you have, if it's an S-shaped curve, below the line, you have your parasympath activation, you've got calm relaxation,

then you have your sympathetic tone coming up, and then it peaks, and it starts coming down, and that's where you're in freeze, right? Some sports, you need to be able to stay on the lower end closer to the parasympathetic activation. So if you're looking at sports, maybe like NASCAR, where you're sitting and you're driving for five hours straight, you don't want to be on the high end of the activation curve. You've got to keep yourself calm. You've got to keep yourself controlled. You've got to conserve energy for an extended period of time. You want to minimize the amount of energy that your body is putting out so that you can divert as much attention to your frontal lobe to making really critical decisions.

Mm-hmm. Gymnists land in the middle of that curve. They've got to have sympathetic activation, but they've also got to be able to stay calm enough to maintain critical thinking. Because for gymnastics, if one thing is off, you've got to be able to fix that immediately to be able to keep going.

If you look at action sports, action sports need to be much higher up on that curve, much closer to that freeze zone, then, you know, maybe the opposite being, NASCAR. You know, if you look at, yeah, skateboarding is not a great example. Fighting. Fighting.

Clifting. Something like that where you actively need to turn your frontal lobe off a little bit to be able to do these things. You're, a lot of it's muscle memory. And a lot of it's like, yeah, you're in complete fight mode. You're in, you know, I mean, yeah, you need a lot of sympathetic discharge because that's really going to help you in those moments, yeah. And it's usually those are shorter things.

Like we're talking about five, six minutes. Right. And you need your body in that point because you probably are going to be injured, right? If you're an MMA fighter, if you feel every single punch that lands on you, you're not going to last as long as you need to. Yeah. Yeah. Wow, so interesting.

So one thing that I recently discussed with this, with this guy who trains physicians and medical staff on how to not go into that sort of dissociation freeze mode is, you know, simulation center. So the head of the anesthesia department here, you know, he'll take his guys down once a week actually. And he has him go through a series of 30 simulations that he's built and, you know, trying to stress them out because, you know, 99% of the time in anesthesia, you're like, it's the calm. And then that 1% of the time, you need to be prepared for the freak out moment when things go bad. And you need to be able to respond and have your full frontal lobe engaged. Absolutely. You know, the part of your brain that you're thinking,

calculating, organizing part of your brain needs to be there. So simulation center. Another person I was talking to was talking about how sometimes when you start to get in that frozen mode, he would tell them to do something that they know how to do well. So, you know, as like a trauma person, you might, you know, check the lines that you know how to check the lines. So you have like a routine that you do, a sequence of things. Like if you start feeling dissociated, okay, do the things that you know how to do well, even though you probably don't need to do them again just to kind of ground yourself. Right. Another person that I, uh, I, uh, I, uh, I've talked to about this, they talk about a lot about, like, feeling your feet on the ground, you know, coming back to your senses, coming back to, you know, like in rowing, it was come back to feel each independent stroke, feel like what it feels like to be moving the water, feel the tension in your body.

Because feeling yourself in movement actually activates the part of your brain, the right interior singular that the right corpus close and the parts of your brain that go offline when you dissociate, when you go into that. that freeze place. But I really like, and this was kind of a novel thing in our discussion, I really like how you talk about what are you doing 12 hours before? What are you doing six hours before? You know, because I think a lot of the times that, you know, what you're doing hours before really can prepare yourself. One thing I have some people do for test taking anxieties.

I haven't go for a long run in the morning, a very slow run, like more of a periscentep of not a sympathetic run, but to get some of their sort of energy out. Right. Yeah, so it's really, really interesting. So I also think about baseball players on how they have so many, like, different things that they'll do that are very, like, super suspicious. Absolutely. And people will laugh at them, like, all the, like, the routine that they'll do before a game,

you know? Right. But maybe this is what you're talking about, and they've just found it on their own. So it's really interesting when you look through the, the sports psychiatry research. And one of the sports that has the most case studies, the most research behind it, is actually baseball. Because it's a really unique situation where you have extended games, right? And their games, their games occur in the evening. So it's a set of patients that, or clients, that they have to be activated. Their schedule is so off cycle. Right. So they practice

during the day, and then their game starts at 7 o'clock in the evening, and often will go till midnight. Okay. For each individual athlete, there's so much downtime in that game. If you're sitting on the bench waiting to go up to bat, you know, you're sitting there, you might be sitting there through an entire inning, and you might not get called up. Right, right. But then how do you harness the energy when you are up to bat, right?

When you've been sitting there maybe for the past 15 minutes trying to conserve energy, how do you harness that? How do you activate yourself enough to be ready? to be focused enough, to have enough energy to actually be up to bat and run when you've been sitting still for the last 15 minutes. And for a lot of them, what you've noticed, those kind of odd, almost superstitious-looking behaviors have become ways that they have been, they've found personally that work to maintain their focus and their concentration, that allow them to divert energy and kind of broaden their focus when they need to, when they need their brain to relax. And being able to shift gears because it's one of the sports that requires the greatest shifts in energy conservation to activation and mental focus from a very broad to a very narrow range. And so it's a really unique population to look at and study of people who have learned techniques of how to control their energy and their attention. Yeah.

It's fascinating. Wow. that also makes me think of when I used to compete in wrestling in high school on my own without anyone telling me to do this. I used to lie between the bleachers pretty much between every wrestling match. So we'd have like four or five wrestling matches in a day. And for a two, three hour period of time, I would just be lying between the bleachers. And like people would be like, what is he doing? Is he sleeping? I wasn't sleeping. I wasn't able to fall asleep. But I would lie there and I was able to calm myself and I think conserve energy. Right. And then right before a

match, like I would go from being like almost lethargic. So like, you know, revving myself up, jumping up and down, you know, or like, you know, doing sort of different types of behaviors to rev yourself up. Okay. Yeah. Really interesting. Any other thoughts that you have from this? It's a world that you can get lost in. And the thing I like the most about performance, is, well, we look to athletes as the people that we would like to emulate the most, right? We kind of put them on a pedestal as kind of gods who have accomplished and achieved greatness in the world of performance. We can learn so much for them.

Because like I said earlier, every single one of us is performing to some level, every single moment that we're awake during the day. And so the more we learn, the more intentional. we are about building in good behaviors that allow us to modulate our own physical and mental response to things, the more able we are to bring our best self to the world. Yeah. So can I bring this into a more personal realm and ask you like, okay, so what do you see as your performances that you do?

And how do you prepare for them at this point in your life? So I continue to do CrossFit. So as far as athletic performance, that's one of the biggest areas that I am able to actually implement a lot of these skills in a way that is very physically tangible. Okay. Because I know if I can regulate my breathing through an 18-minute AMRAP, I can turn around and I can sit in an hour of therapy. And I can use those skills to keep myself calm, regardless of what my patient is bringing to the table. Or my kid has thrown a fit in the middle of the supermarket on the floor, kicking and screaming. Yeah, yeah.

And my default sympathetic tone activates through the roof to the point that I would like to run away and hide in a corner because I am embarrassed and full of shame. It allows me to regulate that as well. To know, like, that's not what I need right now. This is not a bear about to attack me. This is a small human. He needs me to be in the moment with them and needs me to model how to regulate. And so being able to activate those skills, to calm myself down so I don't end up running and like hiding in the other end of the store. That'd be terrible.

I feel like it allows me to bring my best self to that situation, which is not my natural response. but is a better response. Right, right. And, you know, parenting books talk a lot about, like, regulate yourself before you try to regulate your children. Yeah. You know, having time ends, you know, like if the child's super elevated, you know, like sometimes we'll take, I'll take my kids in, have them sit on my lap in another room and say, okay, we're just going to sit here for two minutes and let's do some calm breathing. And then after they're calm, we'll talk about what happened. and see if they can come to a point of, you know, okay, are you ready to go apologize?

Or, you know, like, hopefully it's not just to make Daddy happy, but, you know, that they understand what's gone on. Right. And why, you know, they don't want to be hurting their brother or, you know, what not. So, yeah, that's really interesting. So you're taking these skills to some degree and you're bringing them to your professional life as a therapist. the ability to overcome the stresses in your sports life helps you overcome the stresses in the room with your clients. Right.

And I think the biggest thing I've realized is that the most important part is being able to bring focused attention. Your body does this stuff naturally. And so if you're not aware of what's happening to yourself internally, if you're not able to check in, if you're not able to ground yourself, none of these skills are going to be useful because you're not going to know when to use them. Or by the time you know, like, oh, yeah, I'm panicking right now. My world is getting smaller. My vision is going black.

If that's the moment you try, like, oh, yeah, deep breathing might help. It's too late. And so being able to monitor your internal state so that you can catch these things early. is by far, prevention is far better than trying to cure things when it's too late. Really good points. There was a really good book I read a while back on talent is overrated. And it talked about disciplined focus over time, internal and external coaches. So having internal coaches, being able to coach yourself, being able to accept feedback of your imperfections and coach yourself in the process.

but also having an ego that's amendable for external coaches as well to be to be able to receive feedback and having disciplined focus. And I remember a coach telling me that it wasn't just about, you know, hundreds of hours in a boat over the course of, you know, a month that would make me a better rower. It was bringing my full concentration and my full attention to each and every one of those strokes. And I think I think the same thing is true for anything that we want to perform better at, whether it's connecting with people. Right. You know, in psychotherapy and or, you know, performing in sports, performing in our relationships, you know, to some degree. I mean, like,

you know, bringing your full attention to your partner. You know, I have to go home at the end of a day after listening to patients and I have to, you know, listen. to my wife, you know, and feed that relationship and bring my full concentration there as well. Well, let's say, you know, someone listened to this and they wanted to connect with you, hear more about this stuff. Do you have any way, what's the best way of reaching you? And I'll put that in the show notes. So at this point, we have a Facebook and an Instagram feed where people can go ahead and

like and follow us. there will be additional information, kind of maybe a toolkit that people could go and access through that. I am working on putting that together right now. We'll put in the show notes her links to her Facebook and her Instagram. And as other resources come up in the coming months, I can just update that. So they'll be there as well.

So Dr. Mary Ellen Eller, Thank you so much for coming on. And I imagine we will have future discussions. Perfect. Thank you for having me. This was a great topic and super interesting for me, at least. So if you like this, check out the show notes. Check out the links there.

And, you know, let us know what you appreciated. Let us know what you learned. We'll put up a post on our social media sites, those hers and mine on this episode. you can jump on there and throw up a comment, any questions that came up, and we'll try to address it. And, you know, we're real people. We're out there. And I hope this helped.

All right. Take care.