Psychiatry & Psychotherapy Podcast - The Big Five: Extraversion

Episode Date: November 3, 2020

In this last episode of the Big Five personality model series, we are going to focus on extraversion which is the positive emotion dimension associated with gregariousness, charisma, enthusiasm, assertiveness, and social ability. By listening to this episode, you can earn 2 Psychiatry CME Credits. Link to blog. Link to YouTube video.

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 emailed to you in seconds.

All right, welcome back to the podcast. Today I am joined with the same group that did the Big Five agreeableness, and we are doing Big Five extraversion. Okay, so this is a really, really fun topic. Extroversion over the life course, genetics, neuroanatomy. We're going to talk about high and low and how that relates to careers, how you might, how that relates to relationships, behavioral interactions, pathology. psychotherapy, you know, how we might interact with someone who's higher or low for psychotherapy. So joined with me is Ryan Hollis, Adriana Alvarez, Carl Wallencomf, and Kyle Logan. Ryan did the majority of the digging on this, and then we all kind of came together to get this done. And so, Ryan, take us a little bit into the introduction. Right. So I think I'll just dive right into some of the traits that we're looking at, high and low scores of extroversion. So extroverts, they like people, prefer large groups and gatherings. They're usually a bit more assertive, active, talkative. They like excitement and

stimulation. They tend to be a little bit more cheerful in disposition. Whereas the low scores, a little bit more reserved, independent, even-paced, prefer to be alone. And, you know, they're not exuberant as the extroverts, but it doesn't necessarily make them unhappy or pessimistic necessarily. Yeah, that's really good. Okay, so to really help you understand this, we're going to go through how we scored, and we're going to go through the domains. And so hopefully this is helpful to give you guys a really sort of more tangible working idea of what this construct really is. And so these domains are used in the most extensive versions of the Big Five personality type, and we took that big extensive version, and so let's start with the first domain.

Right. So the domains are warmth, gregariousness, assertiveness, activity, excitement-seeking, and positive emotions. Kyle, would you like to start us off with warmth? Warmth is the facet of extroversion, most relevant to issues of interpersonal intimacy. So someone scoring high in extroversion, they smile easily, outgoing with strangers, strong emotional attachments to friends, enjoys talking to others, likes most people they meet, takes personal interest in others. So one of the strengths of someone high in warmth is they're warm and friendly. Someone low in this facet, they do not enjoy chatting with others. They can be perceived as cold and distant. And a strength of being low in warmth could be,

they do not hastily invest in non-reciprocal relationships. Yeah, so let's see, how did we score? I scored about two standard deviations above the mean, so I scored very high in warmth. Would you say you hastily invest in non-recipical relationships? Probably, but I think as, yeah, I probably gotten better. at that, like looking for how to make things reciprocal. But I mean, it's not always going to be

reciprocal, you know? Like, I think a lot of times, you know, you give and you hope that that like helps someone grow and help someone become a better person. And that's good if that's accomplished. Yeah, what do you think? Kyle, do you think I'm a high in warmth? I think you're high warmth. I think, you know, the podcast is evidence of that. You're always talking to new people and very interested in them. Yeah. One of the things, what's happening in my personal life is I'm moving, I'm moving to Florida. And in this process, I'm realizing how many people I'm connected to here in California. And it's, it's a big thing. It's a big thing to say goodbye to so many people that you're like connected with even if it's like you know you're only slightly connected with them like my coffee guy

you know like we talk once in a while but it's not like we're really close um yeah adriana i saw you were very high in this one as well yeah um so i i really am the kind that um i have extremely strong attachments to my friends especially that has gotten me you know into hot water in the past with non-recipical relationships, but I feel like that is a very small percentage. Most of the time, I have a very strong group of people around me to support me, and I support them. And that's like probably like my favorite thing in life is just spending time with friends and family and making those attachments stronger. Yeah. Yeah. I think that's why I enjoy more of outpatient psychiatry because I get to build those long-term relationships and why it makes moving so hard

because I have to say goodbye to people I've been working with for like literally 10 years. Okay. Holus, you scored a little high, like one standard deviation above the mean. Definitely. I'm like pretty open to new relationships. I love talking to new people, pretty much like everyone I meet, generally speaking. So I think that's definitely pretty accurate. And Kyle, you scored half a standard ovation above the mean.

It's not as high as us. But I would say you're warm. Yeah, I think I'm warm too. Probably because you're critical of yourself. Probably because you're a little critical of yourself. Oh, man. Okay. And Carl, you scored one and half standard avisions above the mean.

So you scored pretty high? I think so. I think I'm pretty warm. with people and try to be really friendly with them. You're very extroverted, like, in how you, like, communicate with strangers. Yeah, I think that's true. I mean, I often try and connect with random strangers. I'll make a joke to someone if we're on a subway together, things like that.

Yeah. About how awkward it is when people talk on Sunfways, you know. Yeah, I don't think there's a week I go by without, like, getting connected with new people. So it's like, there's a real joy in that, I think, for me. I think for me, there's like a certain, like, rush when I can make a stranger laugh. Like, that is, like, one of the most, like, gratifying things to me is, like, yeah, like, Carl said, like, if I can crack a joke and a stranger laughs, like, yes, nailed it. You know? Yeah.

I know for sure. Long before I ever got to know Carl a little better during the podcast here, he would always, do stop in chats and, you know, always remembered my name and everything like that. Very, very warm, very warm. Okay, let's go on to number two, gregariousness. Who's going to tell us about gregariousness? Adriana? Yeah, so gregarious people, you know, generally really enjoy the company of others and the more

the merrier. and people who are lower tend to not seek social stimulation or they'll actually try to avoid it sometimes. So these are the people that are low might prefer working alone, doing things alone. They somehow find social gatherings to be boring, which to me, like, it just does not compute. But some of the strengths of this might be they can benefit from alone time and quiet contemplation. But people that are high and gregariousness like to be around people, enjoy parties with lots of people, yearn for others if they're alone too long, and might, you know, enjoy being in spaces where there are a lot, a lot of people like popular beaches, things like that. So these people can kind of bring a refreshing energy to a room. And that would be a strength that I would point out.

Yeah. So people who are low in this actively avoid social stimulation. So, you know, if you've scored low being an extrovert and you've scored higher and being an introvert, that doesn't mean that you are low in gregariousness or low in this sort of idea of extroversion. So I just want to put that out there. You really have to take the test to see where you score compared to other people. How did I score? I scored very high, like two standard evisions above the mean.

Not quite as high as you, Adriana. Yeah, I scored very high. My score was 72, which I think is extremely accurate. I love to be around, or as I like to say, I want to be where the people are. Yeah. Like, that's very much me. Yeah.

And the more the merrier. So yeah my wife who scores probably a little bit average on this She likes to have like birthday party with like one couple She'll pick one couple you know we're gonna go out to a nice dinner I would prefer to have like all my friends I could possibly get in the same place right And yeah that's that's me being high in gregariousness I think I can remember times in my life where I wasn't around a lot of people and how hard that was like studying when you're like studying in a um a cubicle and you're just like you know

from six in the morning until 10 at night you know medical school just like in the books not not fun PTSD. You're not fun. Third year was a lot more fun for me. There's like teams. There's like you know you're interacting with nurses with social workers with like other residents and attending. that was a lot more fun for me.

Yeah, I'm about one standard deviation above the mean, and I definitely agree. First two years of medical school were pretty rough for that same reason. I found that actually being alone was, you know, not good for my productivity because I needed the people to motivate me to study. You know, I could study as long as I was around people, and they were also studying. But, like, if I was at home, like, I don't want to do this. I don't have motivation to.

go like yeah yeah so that's that's a good that's a good point and you know a lot of these people who are higher in gregariousness and covid season are just like really suffering right they just have a hunger to interact and if like me as a psychiatrist is the only person that they're like interacting with then it's like really really intense like you feel that right and so if you're a provider out there and you're listening to this and you have gregarious patients and you feel drained by the end of the day, maybe you're average, you know, or maybe you are gregarious, but it's just a lot to have that sort of gregarious hunger, right? Like, human contact.

Kyle, you were, I think, average on this? Yeah, I scored half standard deviation above. I like people. I like hanging out. I do enjoy personal time as well, so I think I'm average. Would you like big groups or small groups, do you think? I like small groups better. I would say.

And then Carl had the same score as me, 55. Yeah, I found this interesting. I think it's because I was kind of middle of the road and the test on talking about times when I like to work alone versus being around other people. I love big parties. I love being around other people and I feel a lot of energy. But I do find that I'm often kind of fatigued at the end of the week based on a lot of people time. And when it gets to the weekend, I'll often want. to just kind of be by myself for significant periods of time,

just reading or watching TV by myself or writing. I think this shows that, like, you, the way that I see you, Carl, is like you're very, you're very outgoing. You like to be around people. You have, like, that sort of energy around people. So you can have that, right, and still be lower on this because it's not, like, necessarily energizing. it's not like maybe it's life-giving, right?

Or it maybe is a little bit draining after a while. Yeah. Yeah, I've definitely had situations where I invited a bunch of people over and sometimes some of my closer friends who are a little lower on this get a little perturbed because I'm just inviting everybody I know and, you know, their dog and their friend and they're, you know. Yeah, no, I think this is something I've had to work out in my marriage, right?

Is that no, I'm not going to be inviting a ton of people over, which is why the garage gym is so useful for me, because I can invite people over into that space, and it's not like it intrudes upon my wife's need for a little introverted time. So, yeah, it can kind of be a, if you have a strong mismatch or even stronger maybe, then you have, like, one very extroverted

and one very introverted person, it's like, okay, how do you help them accept each other for where they're at and maybe you know if it's a birthday maybe the introvert you know makes that exception to like the big party and just goes through it with it whereas when it's like normal sort of interactions with people maybe the extrovert says okay I'm okay with one

one couple we're hanging out with or one smaller group of people so it's like learning how to sort of find those needs right get those needs met I actually found that you know after hanging out with a big group of people, it's harder for me to fall asleep because I just have so much energy and I'm living, you know? Right. And it's interesting to think about the perspective. Like, you know, a lot of people get really drained at the end of the day from being around people.

But for me, it's the opposite. So. Yeah. Yeah. Let's see here. The next one is assertiveness. Assertiveness. Carl, did you want to take us through assertiveness?

Yeah. So assertiveness is one of the subdomains of extroversion, wherein high scores on this facet are dominant, forceful, and socially ascendant. They speak without hesitation and often will become group leaders. Those who score lower on assertiveness prefer to keep in the background and let others do the talking. So those who do score lower,

sometimes they have a difficult time taking charge. They'll let others talk before speaking up, and they may have the weakness of not standing up for their own rights. But the strength of being low in assertiveness can sometimes mean that you do not need to follow another person in order to be confident in their choices. They may not just go out and say them out loud, but they may be confident internally. High scores of assertiveness are often dominant and forceful. They tend to dominate conversations and take a lot of time in them. And they're often labeled as leaders and confident in making decisions, but there can be weaknesses and group dynamics if one person dominates too much through conversation or

assertion. Yeah. Let's see how we scored assertiveness. Carl, how did you score? In the whole Big Five inventory, this was my highest score of 76 over two. and a half standard deviations above the mean. So this was my highest one out of all the other, even sub-demands of all the other big five.

So to me, this makes a lot of sense. I think when I am around people, I really like to engage in conversation and talk and share my ideas. And I think that's been helpful in a lot of ways. I mean, I'm able to connect in that way. I think I really get my ideas out there and people will, you know,

sort of have to respond. on to them to some extent. But I've also found like a significant weakness in this in my sometimes interest and passion for a topic and my willingness to just go out and start talking about something will often push other people to the margins. And I think has actually been dangerous in some of my relationships. Push them to the margins in what way. What does that mean? I think sometimes I'll just talk about ideas that I'm passionate about so much. I'll give an example. In college, say in like writing classes or English classes, say in a 50-minute class, there were times when I'd find that I would talk for like 10 minutes, just my cumulative

responses to the class time, because I really love the material, and I was really willing to just get out there and say what I thought about the reading and the ideas that we were talking about, and then realize, like, I'm actually, in some ways, weakening the ability of my classmates to engage with the material. So I found that to be kind of interesting personally. And so one thing I actually did was write down my, when I spoke last and then try and keep myself from speaking for like 10 minutes. Like I just log in the clock, write the time down just like, Carl, you got to stop, man.

Wow. Okay. Yeah, that's some good self-control there. Yeah, that is. For your assertiveness. Kyle, you scored. Kyle and Ryan scored low on this. For me, like, I feel like I can be assertive if I feel really strongly about something, but it's not like the most natural thing for me.

Yeah, same here. I think I would definitely prefer to let others talk generally, not because, I think just mostly just because I'm just interested in what other people have to say maybe. And I think... Is the podcasting pleasurable for you, too? Yes. you enjoy that okay yeah definitely despite despite um being lower on this because like i definitely see carl enjoying it i'm eating this up it's awesome i was going to start a podcast after this oh man for me it's it's easier to be like a more assertive on this kind of stuff because we we are doing you know

looking through all the articles i do have opinions here so i feel like it's in this sense setting. Yeah. Yeah. Yeah. Interestingly, Adriana, we were talking about this earlier, and Adriana felt that she thought I would score higher on this. Yeah, I was surprised that it was low. I expected at least average, just, you know, in having worked with you for a little while now. I wouldn't characterize you as, you know, low in assertiveness. You know, it's pretty. Ryan, this is where, like, I feel like I want to get someone who knows you really well to actually do the test for you. And look at the discrepancies.

Yeah. Yeah. I scored high in this. I scored about a little bit more than half a standard deviation above the mean, so not like incredibly high. Not like Trump, probably three standard deviations above the mean. What do you guys think? But I scored half a standard deviation above the mean. And yeah.

I was surprised. I actually scored higher than you. Yeah. And I was surprised by that because I don't think I would use the words dominant or forceful to describe myself. But I do really enjoy taking on leadership roles and expressing my like opinions, especially if I'm really passionate about something. I'm the kind that will like low key kind of force it on people, but not to a super extent.

But I do really like to make my ideas known and make things happen. So I think that might be why I scored a little bit higher. But I was, yeah, I was very surprised that it was higher than you, Dr. Peter. I mean, you are the psych interest group president. Yeah, I guess that's true. Yeah, I was not the psych group interest president. I was the president of my freshman class. Oh.

But, yeah, I think you're being a little, a little modest here. Well, it's interesting. Why did I score so low then? It's, yeah, you know, has it, this is, maybe I would score higher, right? Just like Ryan would score higher if someone else was rating me on this. This question, lets others talk before speaking up. That's my job. I like listening to people professionally. I may talk a lot on this podcast, but a lot of my, like, the way that I believe psychotherapy is best done is that a lot of your questions are to express that you are listening deeply to someone. So in psychotherapy, I feel like I probably listen and let other people's talk a lot more. So maybe that's why I scored higher in that one. And I don't know about forceful, assertive. Like, I don't know, like, there's something like a little bit negative in some of those words to me, you know, so maybe I didn't want to align with those words. Yeah. Tends to do most of the talking in conversations. I don't think that in my normal sort of day-to-day

conversations, it's probably more even with people who are my peers. Yeah, so maybe that's why I scored a little bit lower on that. Okay, did everyone tell their score? Who didn't tell their score? I think everyone told their score. I think we did. Okay, let's go on to the next one. All right, so the next one is activity. So high score is more of people who have more of a rapid tempo, vigorous movement, sense of energy, and need to keep busy. They lead fast-paced lives. A low score is a little bit more leisurely, relaxed in tempo. Not necessarily sluggish or lazy, though.

So some of the strengths of someone whose high in activity would be their ability to be really productive. And those who are low, their strengths is just to be laid back. Who scored the highest in this one? I think Adjana did. Yeah, mine was about a standard deviation, or one and a half standard deviations above the main. Actually, you know what? If you look at your raw score, Adriana,

this is something that's interesting. So going back to assertiveness, my score was 20 or it was 23. So even though you were much higher than me, it's comparing against other females. Oh. Which I think probably leads like 23, So if you look at the raw score, you still did, oh, Carl scored substantially higher than you on a certainness if you look at the raw score.

So the point that I'm trying to convey right now, sorry, that was a little bit sort of incoherent, maybe if you're listening to this, is that females and males actually have a different bell curve. So when we're talking standard deviations, we're talking about against your own gender. So, okay, let's get back to activity. I, Adriana scored one and a half standard evisions above the main. Right. I think that's pretty accurate. I do generally like to be active and, you know, I feel like I have a lot of energy. But I also do take time to, I think in general I'm kind of phlegmatic and more on the laid back side,

but there is also this other side that's very energetic and, kind of anxious and so it kind of depends on on what mood i'm in really okay yeah i scored about one and a half standard invasions above the mean and i i definitely do not say i live live a laid back lifestyle i do a lot of things so yeah are you guys surprised at that not at all no they're not in no they're not surprised let's see carl how did you do So I scored 49, which is average. Right in the middle. Right in the middle.

And this was kind of strange to me because I think, like, looking at the characterization of activity, I think some of my favorite things to do are just like sit alone early in the morning. It's dark outside. Just drink a cup of coffee slowly. That's how I spend my free time on the weekends. But during when I'm trying to be high productivity, especially in medical school, I act quickly, move quickly, walk quickly, like try to do things fast with high energy. A single point of evidence is that out of the, I think, eight glasses that my roommate bought at the beginning of medical school, within the first year, I think I'd shattered six of them by trying to wash dishes too quickly. So I think that like And I've broken like multiple bowls

Because I'm just like I'm just like I think that's more a testament to your strength I'm not understanding your strength Carl is like this like six foot seven Like probably comes from a family of previous Vikings Like huge man He's a huge man

So I mean there's just a part of me that wonders Like I do think I do some things in a hurry that I should probably slow down at, and it's probably counterproductive to break all of one's houseware. Yeah. All right. Yeah. Who scored the lowest in this?

I did by far. I think I scored the lowest that anyone scored on any facet out of all of us. You scored very low. Like we're talking about like two and a half standard deviations below the mean. Ryan is one of the most laid back people. I know. You know, I'm not surprised by this actually. actually. Yeah. Oh yeah. This is unsurprising to me as well. Definitely. Still gets work done.

Well, thank you. Thank you. Really laid back. Okay. Wow. So what do you do on like a typical weekend? Like, what is your dream weekend look like? I mean, I think because of things that we'll talk about in a minute excitement seeking, it might not be what's what you expect from someone who's super laid back. Because I like love going to like cons. or, you know, something like super stimulating like that. But at the same time, like, I just love chilling and just listening to music or even like listening to the waves on the beach or something like that. And that could be like just my enjoyment, just chilling for like an hour or more. Okay. Nice.

I'm thinking life is going to change for you guys when you have kids, by the way. It's like sitting alone with a cup of coffee. in a quiet moment. Yeah. I don't know. I don't think my kids will ever match the number of dishes that I've broken, though. So I still will try to be the remaining champ for that. Okay.

Six glasses of a very high number, Carl. Very high. I think so. I think you'll be surprised at the amount of entropy that kids can create. Okay. How did you score Kyle? 54, almost a half standard deviation above. Huh.

Okay. Yeah, Kyle, it's interesting that you scored pretty much average on everything here, except for assertiveness, a little bit lower, only half a standard deviation lower, it's not that lower. So these kind of all flow together for you. Yeah, do you agree that you feel like your average on this one? Yeah, I feel like I can be laid back. Never will I be as laid back as you? Sometimes I'm like, oh, I need a, yeah. Yeah, no, that's true. We'll be hanging out. not to be like, oh, man, let's just chill.

And he's like, no, I need to grapple, like, now. So that's fair. Carl, you got something? I just thought, I think it's interesting to see these things is average, because I do see Kyle, like, even while we're working on these podcasts, is like pushing the ball forward in very, very calm ways. They aren't, like, overly assertive or overly demanding. But he just kind of keeps things moving, and he acts with, like,

intention and I think creates a very productive environment. That's true. Yeah, I think that I would score you actually higher on this, Kyle. I think you're actually like a natural leader. Just the way that you interact with people and you're very like supportive but still have expectations. Yeah, and it's interesting you don't need to be high and extraversion to be a leader. there's actually a study of like presidents of Fortune 500 companies and you know you would assume from how Harvard teaches their business classes that they're trying to produce everyone to be an extrovert but actually there's a lot of them that are more introverted so there's this kind of extrovert ideal I think in our culture like this is the ideal to be like outgoing and gregarious and you know but it's not necessarily what is.

going to win the race. Yeah. I think we'll definitely dive into that a little bit more later on. Cool. Okay, so next we have. Excitement seeking. Excitement seeking. Yeah.

So high scores on this scale crave excitement and stimulation. A high score likes action, enjoys roller coasters, craves excitement, enjoys doing things just for the heck of it, likes loud music, enjoys sporting events. And a strength can be, they can bring a excitement and fun into group settings and parties. A low score might not enjoy vacationing and busy and flashy areas,

avoids horror films. A strength could be their level-headed and provides a calm nature to relationships. So Ryan scored one and a half standard deviations above on excitement-seeking, but very low in activity. Yeah. And I see that sometimes, like, if there's, nothing planned to do, Ryan's the most laid back person ever. Okay.

But he actively wants to go do really exciting things. So it's kind of interesting for me to see this interplay of like being very low activity and very high excitement seeking. Yeah, that's interesting. Yeah, how did I, I think I scored low. I scored half a standard aviation bullivine. I don't like horror movies. I like vacationing in more desolate areas that are just really beautiful.

I can enjoy roller coasters from time to time, but I don't necessarily seek out skydiving or any of that stuff. Yeah, for me, I'm pretty into most of these things. Not necessarily roller coasters because I have a fear of heights. But definitely crave excitement. Love being spontaneous, just doing whatever, just because listening to loud music, going to sports events, all that kind of stuff.

Just love it. Yeah, I probably would prefer to be home watching the sporting events. Oh, no. If at all, I don't watch much sports. Carl, you scored average? Yeah, I think that's reasonably true for me. I like vacationing in areas that are, you know, maybe active, maybe visiting a city or something like that, but I really like focusing on beauty, as you were saying.

I don't think I pursue things that most people would characterize as exciting. Like, I really like reading. And I like some sightseeing, but I don't need to go to, like, really energizing things. Now, perhaps uncharacteristically, in medical school, one of my main forms of, like, entertainment was I'd try to go to multiple concerts per year. So I'd drive to L.A. for, like, concerts to see. Right, but what kind of concerts are we talking about here, Carl? I mean. I don't think they're going to be washing at these type of concerts, are they?

Well, well, I, you know, I went to some, I went to Odessa. Like, that was a, that was an awesome concert, very loud, a lot of excitement. So that was one of the better experiences I've had. I wouldn't say I do that all the time. Adriana scored pretty high on this. Oh, yeah. This is, this is me to T. Like, if I can live in Disneyland, like, I would.

Because that's just, like, that is my environment. Like, the people, the rides, the excitement. I just, I crave it, I love it. You know, I tend to gravitate towards, I love, like, playing sports and everything, but I really gravitate towards, you know, more the extreme, quote unquote, sports, like, you know, longboarding and, like, snowboarding and just recently got into rock climbing, things, things like that, just, you know, constantly trying to, like, push my limits. So I don't really like horror films.

It was a very specific thing, but other than that, I'm always looking for excitement and stimulation. Yeah. Interesting. Yeah, I think for myself, like for me to get excited, I could get excited over a book because I'm high in openness. Like, I can create the sort of the fantasy of the book. I can create that in my mind pretty easily. and I think this is probably why the research articles can be exciting for me like honestly like when we hit like that like research article in agreeableness on empathy and stuff

I was like this is really cool you know Ryan's over here being like mosh pits are cool but this is work I don't know maybe maybe I'm wrong about that I think

if I'm not interested in the topic it can get like that. But when it comes to psychiatry, I'm pretty engaged. Yeah. Let's see. What's the last one? The last one is positive emotions, Adriana. So people that are high in positive emotions, you know, laugh easily and often are very likely to experience, you know, joy, happiness, love, excitement. They're generally optimistic, maybe bubbly, and strengths of this is being, you know, cheerful and high-spirited. So that's, I think, in general, the life experience that they're more likely to have overall. It doesn't mean that they don't have other emotions, but.

Yep. And you scored the highest in this. Yeah, I scored very high. I feel like I am generally pretty bubbly. I love to laugh and make other people laugh. And I try to be optimistic, you know, as much as I can be. Ryan, you scored the highest in this. You scored two standard evasions above the main. Yeah, I'm not too surprised about that one. I think all my friends think they're hilarious

because of how easily I just burst out into laughter. Oh, man. This is fun, right? I feel like I'm getting to know Ryan here. Oh, man. I can definitely see that, Ryan. Oh, yeah, definitely. I don't know if I feel joy in my body.

I just feel bubbly all the time, man. Cheerfully optimistic. Lafs easily. Okay, you scored very high, and the laughs easily. I scored very high. I scored one and a half standard deviations. Not quite as high as Ryan, but I scored high. Yeah.

pretty optimistic it's pretty pretty hard to uh burst my bubble although sometimes i do how'd you doing this one carl i on this one i scored 64 standard deviation and a half above the mean i it's interesting you say i don't know if i feel joy in my body like reading that line feels joy in their body i think that perfectly describes how i felt like that's a line for me i feel like i feel like i feel joyful. I don't identify with bubbly, but I feel like a deep reservoir of positive emotion. I just feel good about things and try to really preserve that and that it bursts out through a lot of laughter. I mean, my roommate, Matthew Hagueley, has been on these podcasts before. We'll watch a TV show together. I am like bellowing laughter at almost every situation. And Matt, well, you know,

he'll have some little chuckles. Every now and then he'll laugh really loudly. There have been times watching things when I'll start crying from laughter, just unstoppable. So I just, I love it. I deep joy. Yep. I feel that. I feel that. Let's see.

Adriana, you scored very high. Yep. And then Kyle, average. I feel like it depends on the day how I would answer these things. You scored half a standard of vision above the mean, so a little bit leaning towards you know, these things. And I don't know though. I feel like you get excited a lot about things.

I know. That's what I said. Like, I think it depends on the day. Yeah, maybe so. Probably just was having a normal day. Maybe you took this a couple weeks ago. Maybe you'd be hiring this now after. Now that ERAS is sent, oh, I feel way better.

Yeah. How does that feel, yes? Bubbly. Bubbly. Yeah. Comparatively, I do feel bubbly. Interesting. The perspective, the word.

bubbly to me has kind of like a almost like a feminine like connotation and that might be why some people aren't um as willing to characterize themselves as that or not for sure yeah do do do does not like to use the words fantastic or amazing i i carl i use those words all the time like fantastic is one of my favorite words. I use it in text all the time. Me too. Sometimes I need to be a little bit more self-conscious of the fact that like maybe this particular situation isn't fantastic. Oh man. I mean a lot happens in fantasy novels, right? So I feel like you can really use it widely. Actually, one of the strengths of being low in this is that you are more realistic about, you know, the potential endeavors and disappointments of life. And it's not about being in a fantasy world. It's

about, you know, being in real life. Yeah, I have a hard time accepting that. Yeah, you know, I think, um, I think like, you know, to realistically see bad events that are happening sometimes takes a little bit of a smoldering depression, you know, like a kind of like a dysthymia, Winston Churchill, which I want to do an episode on him just because of the fact, you know, his history of mental health issues, you know, being able to see that Hitler was a bad character and that this was not going to go well for Europe, right? And being kind of a siren to the society. And then you get like more optimistic people in the culture saying, no, this is, this is, you know, this is not bad. This is going to be okay, you know. What do you think, Carl? I, one thing I like to think, you know, I want to legitimize myself in every way possible. But I feel like the joy in my body can sometimes react with ideas I don't like or think are dangerous to my joy. So I think sometimes, like, I'm sensitive to, oh, you know, I don't feel right reading this idea or thinking about this social change. And it like causes my joy to warp a little bit.

So I think sometimes there's a tuning that occurs there. Right. I think openness probably has a big influence on your kind of acceptance to certain ideas and stuff like that. So these probably interact in some way. And Carl was saying that sometimes the joy that he feels in his body is damaged by ideas. So he doesn't want to be associated with someone who would be accepting of Hitler. I think is what he was trying to get. Oh, I guess, yeah, yeah. So I guess, I mean, one way I might characterize it, I feel like the joy in my body is almost like a fire alarm, and there's a sensor, you know, in my body that when, like, the noxious gas of a bad idea interferes at that sensor. Okay, yeah, yeah.

And the joy in my body, like, alarms. It's like, oh, this is a danger. Let me try to get this. Are you saying, like, when you're, like, presented with the world, and it's not as cheerful and optimistic than you think it is. You don't want to believe that? No, I think what he's saying, and I feel the same way with Carl, is that, like, okay, I may be higher in this,

but when there's a bad idea, you know, I think I can quickly be like, oh, this is, I can be like, the propagation of this idea may be very, very toxic, and there may be downstream effects to that. You know what, I'm also not, like, overly optimistic about, like, life in general for most people life in general for most people is suffering i'm not i'm not really optimistic about my future being like you know i could die you know like i i'm very sort of aware of mortality and i'm not going to do do certain things high risk things because i'm aware of my mortality so

it's like i'm optimistic but in a way i'm usually optimistic about people like i believe that people can improve get better like so when i have a really depressed patient in front of me like i know I never, like, lose that optimism, you know. Is that how you feel about individual people or how you feel about humans in general? I think humans will do horrible things to each other, you know, and that's the history of the world, right? And it's a tragic part of the world, right? But I think that individually when I'm working with someone, you know, like I would like to believe, and I do believe that this person can make transformations in their life, you know, even if they have had more darker moments

or more darker thoughts, you know, like I think that this person could potentially, you know, improve and move into a better place. So. I think that's very important from the, you know, the psychiatry standpoint. It's, if you don't believe in your patience, it's a little bit harder to think that you can make a change. change and for them to believe that they can make a change. Yeah, and I fight against it in the residents, honestly, like, when I notice any tinge of, like, jadedness that's sort of popping up, especially like there's certain populations, people who go back and forth through the psychiatric hospital multiple times, people who, you know, are sort of not improving, right? One of the

things that residents don't realize is that the patients that are improving, you don't see those patients. You'll see the patients, especially your first two years as a resident. You'll see the patients that are frequent flyers in the hospital. They're coming back. They're not getting what they need, outpatient. And I've seen a lot of these patients improve quite a bit. And so as an attending now with like sort of seeing the longitudinal aspect of people's lives, you know, I have a patient who was a white supremac who was when he was manic specifically when he was manic so when he was in a bipolar manic phase he would get white supremacy tattoos all over his body he was homeless and now he's he's married someone of of color and he's raising kids of color and he's got those tattoos off of them

and you know you would never recognize the person he's become so i feel like whenever i see someone i always feel hope for that person and i see that where they could be and i think that where they could be and i think that that hope really does help me carry through some of the darker, you know, aspects of people and their character, right? So, yeah, I don't know what you call that. If that's realistic optimism, maybe it's not always realistic, but it's, I think it's the optimism that's necessary for the change to occur as well. Some therapeutic optimism. Therapeutic optimism. Yeah, there you go. Quint a new term. Okay. Well, let's get into the bulk of this episode.

and believe it or not, we are now going to go through roughly 25 pages of single space notes that go through the studies of extraversion and really hopefully now take you from like, okay, we understand what extraversion is to now how does it, what does the science actually say about it? And the cool thing about this is they've been doing studies on this for like decades. And so we can just go through those studies. and make you into an extroversion extroverted extroversion expert. Okay, cool. Okay, so we're going to start out with Kyle talking about extroversion over the lifespan.

And so what we know about this in general is that extroversion decreases. And Kyle specifically talked to us about this British study that was a cross-sectional study, a very large study, looking at two different populations. Yeah, so it's over 14,000 participants. They found a linear decrease in extroversion over the lifespan with a difference of 7.6 T units, so 0.76 standard deviations between the youngest and the oldest, the youngest being 16 years old and oldest 86. And a similar pattern was seen in a German population of over 20,000 participants. And this difference was, 0.36 standard deviations between the youngest and the oldest.

Interesting. So there's a slight decrease over age, decrease in extroversion. This is a T score. So with a T score, a 10-point shift is like one standard deviation. So yeah, you're right, go. So this next study, this one's from 2006. It's one of the largest meta-analyses of longitudinal.

personality change. And it has 92 studies over 50,000 participants. The meta-analysis used a modified version of the big five that split extraversion into two domains of social dominance and social vitality in order to increase the number of studies that could be included. And kind of the correlates of that, social dominance is equivalent to assertiveness. And social vitality is roughly equivalent to like gregariousness, activity, positive emotions. So, the meta-analysis showed social dominance increased throughout the lifespan up to the age of 40, then plantos. And cumulatively, this increase was over one standard deviation.

And the authors attributed this to getting started in your career, you're getting more knowledgeable in college. And it kind of goes along with getting ahead in life. you have to, you know, it's reasonable to think that you gain some kind of assertiveness. And so this is good, yeah. Yeah. Because this is assertiveness that comes with competence, right? Yeah. Like I'm probably more assertive now than I was as a resident.

And hopefully that's the case, right? Because otherwise you have a fairly overly confident, you know, person operating as if they know more than they don't, right? Sometimes the most dangerous clinicians or professionals are those that don't know what they don't know. And so, you know, as you gain more experience, you realize what you do and don't know and you feel confident in what you do know. Okay. And then the other facets, social vitality, they actually had a, like a bit of a decrease over the lifespan. And this had most of the other facets in it. They had a, the two notable, spots they decreased is after 20 and then after 60 another decrease yeah yeah i mean you see a lot more

activity in people in their early 20s right and then after after the 60s you have a little bit of a decrease as well in things like gregariousness right things like that so another um interesting finding in the study is that males and females did not have a difference when it came to to the mean change of, you know, social dominance or social vitality. And this is in contradiction. This doesn't support Gutman's crossover hypothesis. He hypothesized that women increase in assertiveness throughout their life more so than men. And men, like men have a higher baseline level of assertness.

And men increase in agreeableness more so than women over their lifespan. So that's what he hypothesized, but that's not what they actually found. That is not what they found in this study. And the authors said, he made this hypothesis, I think, back in the 70s. And now every co- like the younger cohorts are actually more assertive than the older cohorts. So if you look at the graph below, and he thinks this might have switched that over because, you know, there's more women in the workforce. They follow more similar life trajectories. I think it's a good, a good trend there. Now, it is true, though, that the lower agreeableness males tend to, tend to use more the domineering type of, you know, strategies. And women in general are going to be a little bit more agreeable. And so that's where I think women need to train their negotiating tactics and learn how to be a little bit disagreeable.

Yeah, it certainly looks like you can train assertiveness when you look at this graph and how it develops over your life. Just diving into a career, you will be more assertive over time. Yep. All right. Yeah. So, Ryan, tell me about the neurological base for extroversion. Right.

So I looked at a study done in 2019 by Lee. They took an MRI and a personality inventory. They took the MRI and personality inventory first and then once again two years later. and they found that extraversion had a significant positive association with gray matter volume of the left caudate nucleus body. This area, of course, participates in the brain's dopaminergic reward system, and of the facets of extroversion, gregariousness, and excitement-seeking were the biggest mediators of the gray matter volume extroversion association.

And it kind of suggests that the caudate nucleus, this might be related to the sensitivity that people have towards rewards. And it could be a structure that is critical in extroverted behaviors. That's really cool. That's really cool because you think about like, actually the thing that comes to my mind is like, Wobutron be propion or giving someone a little bit of like, like sometimes that elicits more positive types of, you know, enjoyment. in things. So if someone's depressed, maybe the SSRI brings them out of the depressed thoughts,

but then they don't have those positive things. And so you increase their dopamine, norophenephrine, which is hitting those targets. It's increasing the reward system. And so, yeah, I can see this in myself, higher extraversion and then higher rewards for things that may be not as rewarding for some people. Did this article excite you? Or was it? I was pretty excited about this particular one. Yeah, the caudate nucleus really, you know, it gets me. Learning about the caudate nucleus. Activated your caudate nucleus.

Okay. All right. Tell me some more. The other one I wanted to talk about was Schaefer 2012. He talks a little bit about extroversion and the somatosensory response. He explores the theory that the behavioral differences between extroverts and introverts can be explained by overactive cortical activity. in introverts, and it kind of requires the introvert to constantly compensate for that overactivity.

Activity in the primary somatosensory cortex was measured in response to non-painful tactile stimulation, and they assess personality with the five-factor model. So through neuromagnetic source imaging, they revealed that the less extroverted the participants were, the higher cortical activity, found in the primary somatosensory cortex in response to the non-painful tectostimulation. And this relationship was particularly valid for the right hemisphere of the brain. Wow. So that may, yeah, that that also fascinating to me because you have this kind of increased lighting up to stimuli, right, to sensations in someone who's more introverted that they're going to look

for less rich sensory experiences and they're going to enjoy those. whereas, you know, maybe I can sit down at a coffee shop and study for someone who's really introverted, they might want, like, to be in the stacks of a library in, like, this very quiet, quiet area, you know, because they just are more stimulated by sensation in general. All right, let's jump to how extroverted people act in relationships. So to discuss how they act in relationships, I found a study by Tav at L in 2016 that examined extroversion and relationship satisfaction in college students. So there were two studies that were a part of this, and participants completed personality test and recorded relationship satisfaction. So in the first study of 206 participants,

relationship satisfaction was recorded daily for three weeks, and they found extroversion correlated with family satisfaction, R of 0.22, friend satisfaction, 0.33, and romantic life satisfaction, 0.19. And then the second study recorded relationship satisfaction twice weekly for two months and found extroversion correlated with friend satisfaction at 0.26 and romantic life satisfaction at 0.31. Yeah, so a little bit, what for this initial study, the highest was friend satisfaction. So, you know, the more extroverted friend probably is more, you know, gregarious, more outgoing, wanting to do more.

And then for this second study, interesting, like the romantic... Yeah, it took over. The romantic part took over. Point three, it's not like a huge correlation, but it's there. Yeah, yeah. It's there. And, you know, you always hear about, like, people saying, like, oh, I really want, like, a partner who's, you know, outgoing, loves to do fun things, you know, like, wants to explore the world.

Right. Right. Those are all like extraversion ideals of that person, right? And it might be that since the first study was over just three weeks consecutively, but the other one was more spread out, that might be a factor in, you know, how relationships have progressed romantically or maybe not, but it could be something. Yeah. Okay. Yeah, what's next? So additionally, meta analysis done by a Heller in 2004 looked at relationship between personality and satisfaction in the domains of job and marriage and overall life satisfaction. So in the results, they found pretty sizable coefficients linking extroversion to both jobs. So job was a 0.19 and marital satisfaction of 0.14.

And Extraversion was found to have a correlation with life satisfaction of 0.28. Hmm. So a little bit higher... With overall life. A little bit higher life satisfaction in general. Okay. Yeah. Any surprise there for you?

For me personally, no. I think Extra Rich tend to look for the most enjoyable things in life and really appreciate that. It's kind of like a seeking. So this didn't really surprise me. And like whether they like necessarily their job or their marriage, it's more like they're in life looking for the most stimulation and the most, you know, excitement. I'm looking at this and I'm looking at it with that codyte nucleus there, Ryan. And I'm thinking, man, that dopamine area, right?

A little dopamine, a little increase in those things, right? Yeah. I'm also looking at this, like the other person. personality types that we've already discussed, neuroticism with job satisfaction, negative 0.24, so the more neurotic individuals had decreased job satisfaction. And the other openness, it's like no link, agreeableness, 0.13, conscientious is 0.20. So conscientious is pretty similar to the extraversion. which I guess makes sense if you put a lot of your worth into your work ethic and getting things done

and you know following that kind of regimented life it's very conscientious that's very much in line with you know having a job and performing well in that yep marital satisfaction you had neuroticism negative 0.26 correlation so once again more neurotic individuals were not as satisfied with their marriage. Extroversion.14. So not a huge link there. Agreeableness. Point 24.

Conscientious is 0.22. So a little bit more with agreeableness and conscientiousness and not much with openness. All right. So let's talk about extroversion mediating followers' behavior around leadership. Right.

So I thought this was interesting. So what they found was in a study done by Manzani in 2014, they examined extroversion and participants or the followers preference between two leadership styles. So first was the authentic leadership style, which focuses more on relationship building and leadership, whereas the transactional style relies on compliance through kind of a rewards and punishment system. So in this study, they found that authentic leadership, which is more focused on relationship, gained the most loyalty from followers, and highly extroverted people were less loyal to leaders in

general, and that was a beta negative 0.18. And highly extroverted people preferred the authentic leadership style to the transactional leadership style, and that beta was 0.37. So the really interesting thing that I saw from this is, so being, low and extroversion, there wasn't much preference for either leadership style. But when you got high extroversion, there was a strong preference towards the authentic leadership style. So overall, the extroverts were not very keen to responding to authority, like leadership in general. But when they were highly extroverted, there was a strong preference

towards the alter-takes style. Towards the relational sort of leader, you know, to someone who is kind of like willing to engage them on a personal level. Right. Interestingly, in some management courses, they tell people to not make friends with people who work under you, to not be relational, to be fair. To be fair. And that's kind of like how different companies teach their employees to be. I think that's, it just doesn't make sense to me. Yeah.

You know, at the end of the day, like, if as a leader, I can't be relational with people I work with, then I don't know if I'd want to do it. You know, like if I had a company that told me not to be relational, so I definitely think I probably focus on more of the relational stuff, especially with you guys, I mean, other than food that I feed you guys once in a while, but I'd probably feed you irrespective. It's not like I say. and you're doing better than the other medical students,

you get dessert as well. Yeah, I think maybe part of it is because maybe the more highly extroverted people do end up seeing the leader as like a friend and so are more likely to be loyal to them and follow what they say rather than an actual authority figure. Yeah, yeah. I think the hire you go,

up in leadership probably the more that that stuff matters. Like especially when you have choices. You know, when you have a lot of choice in where you work and what you do with your time, like unless you feel really connected with someone and you feel like they're going to treat you fair, you're probably not going to stick around. Wow, that's cool. So, you know, if you were listening to this and you were a business leader or into business and you had a highly extroverted person that works under you that maybe, you know, you could see this person venturing out on their own. It's your relationship that's probably going to keep them in connection with you rather than just venturing out on their own. Okay, let's keep going.

So I wanted to talk a little bit further about life satisfaction, drawing a little bit off of what Adriano was saying. So we want to turn to a few other advantages, disadvantages of the spectrum of extroversion and diving a little deeper into life satisfaction. Kim at all in 2018 sought to find an answer in life satisfaction data from Canada, the United States, United Kingdom, Germany, and Japan. As their premise, they noted how life satisfaction may interplay with personality. I mean, sort of the person, environmental fit theory that a person who will have better vocational fit between environment and personality, and that can be improved if the personality and the environment fit well and are rewarding. And that their well-being will improve if a situation is conducive to a personality type. So they were a little

critical of some previous studies that correlated extroversion and life satisfaction as having small correlation sizes. And then some of the prior studies used only student samples. I do think there's a joke that most of psych research is based on students in North America, you know, age 20, aged like 18 to 22, because that's most accessible for research. So they made that little criticism and sought to correct for some of those things. And so they did five different studies. They looked at a Canadian student sample. They looked at two U.S. samples, both in students and in a representative national sample, and then samples from the United Kingdom, Germany, and Japan, looking representationally at samples from the whole country. And they found, again,

that the beta or effect size of 0.2 was really kind of stuck around in all of these locations. So a positive effect of being extroverted and having improved life experience. But there were some interesting variations. So in the United States, the effect size was around 0.2, but sometimes ranged up even higher. And that was pretty stable. But then there were some declines as you go to other countries. For example, Britain had actually a fairly low beta of 0.126. Germany was 0.078, and Japan's beta value was 0.153.

So smaller, still positive, but a smaller effect size between extroversion and life satisfaction. And the way that they kind of conceptualized it, they suggest that there could be significant cultural overlap between extroversion and how it improves life experience. Noting that the United States and a lot of North America tends to be both very individualistic and socially mobile. So people have a lot of mobility in their residents. They'll move around a lot and they're very individualistic, which means that if you're moving to new locations and required to be extroverted to succeed in business and in professional lives, it is very adaptive and helpful to be extroverted because you're constantly making new or regularly making new relationships to get further in your careers. Whereas in other

places, for example, Britain and Germany, though they are still somewhat individualistic countries, there's less residential mobility at times, was the suggestion they made. So possibly just considering kind of the cultural overlaps and what kinds of personality traits are like, are good vocational fits and environmental fits. Excellent. Yeah. So basically with North America, you move around a lot because there's tons of different cities you can go to.

You move to college. You move to this. You move to that. Whereas in Japan, Britain, Germany, you're kind of more geographically, you know, there's probably a couple different places you're going to be, but not too many. And then because there's more mobility and you're meeting new people and your network and that networking pays off, you may enjoy your job more if you are an extrovert in the U.S. There's also, you know, in this book Quiet by Susan Kane, she talks about the extroversion

culture in the U.S. and how that's sort of idealized with the individualism. And that may play a part as well, I think, in this. We wanted to move on and look at some other possible advantages, and this also has some job satisfaction effects here. So social relationships are an important way that we talk about extroversion and introversion, but also like effects and employment. And we wanted to start, I mean, I'm a medical student now, so this is really specific to me, but I think you can do the dangerous task of extrapolating some findings here. And so there is a study done by Shrekkenbach at all on fourth year medical students. And she and her colleagues studied 245 medical

students in their fourth year of training, coincidentally, our year of training. And they assess the students' personalities using an abbreviated Big Five inventory. Then they had the students take an analysis, a test that tests for nonverbal accuracy of facial expressions. So testing the students for their ability to notice emotions and notice nonverbal interactions. So their ability to empathize and understand what someone's going through. Then the students were placed in a surgical objective structured clinical examination called an OSCE. This is a testing format familiar to students, but essentially these are cases where a standardized patient is used and students will come in and see these cases. And the cases are standardized among all students and often across schools so that you can get a good representation of a student's ability to create rapport,

do a clinical analysis through a patient interview and then debriefing with a patient. So they had these students, they got their big five and then assessed their ability to do empathetic assessments. Then they had them go through an OSCE, and then they had the standardized patients then rate the students using the consultation and relational empathy scale. So they had the standardized patients rate the students on their ability to impact. empathize. And interestingly, they found that a student's emotion recognition ability was not related to the standardized patient's perception, and students' extroversion was not associated with a standardized patient's interpretation of their empathy. However, when they did a regression model based on

when they put together emotion recognition and extroversion, they found that the standardized patients significantly rated those students as having higher emotional ability and empathetic ability. And the T value for that was 2.32, and it was statistically significant. So they comment that essentially students who are both extroverted and are able to assess emotional emotions and their patients may have an advantage with patient rapport building. And they hypothesize that this is because standardized patients, like real patients, often want empathetic individuals, but people who are also authoritative and able to take a sort of clinical role to say that are able to engage closely with a patient and really be up front and

talk openly about things, but also acknowledge emotions. So they sort of suggest this, and I wonder, even though this is in a medical student sample, I think that this is applicable to different kinds of trainees and it could be valuable for different programs. And if you're a teacher to think about your students and offering students who may not be as extroverted some tools with how to maybe appear that you are in order to get better rapport building with patients well i i think it would be easier to train the emotional recognition um you know micro expression you can learn that in 10 20 hours of disciplined work through the app that i made a motion connection and there's studies that have been done not on my app but on similar things where it increases EQ um specifically

students who were already good at oskis, it did improve their score even more in one study and in patients with like schizophrenia and improve their social skills and stuff like that. When I train residents on how to recognize micro expressions, you know, we'll watch real patient encounters. Actually, Adriana got to see that yesterday. It was so cool. Yeah, Adriana got to see that yesterday. And so what we do is we slow the video down, show the emotions and then show what might be going on in the patient. The thing is, is it takes a lot more time to use it in a way that's therapeutic. And most people are not recognizing these things anyways. Like, it's just going on so fast. So it could take months, I think, to even a couple of years to

really learn how to use the knowledge of the microexpressions in the therapeutic context. But the first step is really to get it like 100% where you see it, you know what the emotions are. And then from there, it's like, okay, how do you use it therapeutically? That's something very challenging. So, yeah, just some of my thoughts based off of this study, like, can you train gregariousness? You know, I would say even more than probably assertiveness, like gregariousness and excitement-seeking, you know, just someone who's like present and just excited to be around other people, right? that's going to rub off to some degree, especially with standardized patients. And then you can pick up your energy temporarily while you're around people.

Like most people can. It's exhausting. If you're doing it all day and you're like an introvert, you're going to need some, you know, self-care by the end of the day. So, yeah, I don't know about like training people to be more gregarious. If that's like a good end goal. But yeah. Okay, let's keep going.

Kind of a fun study, a possible disadvantage here to extroversion, that links pretty well with what Ryan was talking about earlier with activity in the Caudate nucleus and some differences between introverts and extroverts and their brain activity. So Kilgore at all in 2007 noted that there is some interesting research that demonstrates that extroversion is linked to basal activity in the reticular thalamic cortical loop. Specifically, prior research has shown that there are relations to arousal based in introverts and extroverts. Specifically, introverts tend to have higher tonic cortical arousal than extroverts, with a subsequent hypothesis that introverts may be more resilient to sleep loss than

extroverts. That's what Kilgore at all hypothesized. So they studied a group, a small group of 23 adult military personnel. They gave them one of those revised neopersonality inventories and then subjected them to 77 hours of continuous sleep deprivation and then assessed them for vigilance. And then they did a kind of double-blind simultaneous method where they gave half of the group caffeine to see how vigilance was mediated by chemical stimulation. And then they assessed vigilance by giving them this portable reaction time test, sort of a handheld test where it tests. your ability to react. So what they found was kind of interesting. As you'd suspect, speed performance on their reaction time dropped throughout all sessions, sort of obvious,

and caffeine did improve the response times. However, extroverts declined significantly more in their speed performance overnight, and that was a partial correlation coefficient that corrected for caffeine of negative 0.56. And subsequently, on later nights, introverts and extroverts did not significantly differ. But this is kind of interesting just to think that extroverts on this first night of sleep loss are significantly slower in their reaction time than introverts. And they think that because introverts have this higher basal activity in the corticothalamic loop there, that maybe they're better able to mediate sleep loss because they have this higher activity there versus extroverts who have.

this kind of lower activity and so maybe a little more prone to sleep loss. It's a small study, but an interesting finding. It's interesting, yeah. If you have someone extroverted, make sure they're getting good sleep. Yeah. Right? Okay. Yeah. I feel more confident in my need for more sleep after this study. Yeah. Thank you. Yeah. I actually was a part of a study where they kept me up for a very long time during residency and then they subjected me to like all these little like cognitive tests and stuff. And being sleep deprived is like it really does change your cognitive function. It changes your reaction time. It's pretty amazing how much sleep impacts things. And I have a lot of patients who come in and like the first couple weeks of treatment in my partial program, they're sleeping like,

they tell me they're sleeping like four or five hours a night. You know, and so getting them that sleep, early on, even if it's through medications, I think does help them absorb what's going on in class better. Helps to be more present. So sometimes we'll add something and then take it away a couple weeks later. Okay, let's... Last thing I wanted to talk about is a partial disadvantage, kind of a risk factor type of issue to think about. There is a study this year by Marengo at all in Italy, and they looked specifically at neuroticism, and extroversion and their interactions with possible social media addiction.

So they used Facebook, passive Facebook user data, and they started with 10 students and then tried to kind of snowball a sampling method to a larger number through like an online form. And they ended up concluding their study with over 1,000 individuals and responses. Most of them were women out of about 1,000, over 700 were women, and about 81% were ages 18 to 25. and then they had them do a brief personality profile, specifically looking at neuroticism and extroversion. And then they calculated the number of social media updates that were posted on Facebook, and then also the number of likes that those updates received. And what they did is they used status updates as an indicator for a need for self-expression, and then the positive social feedback received as likes was seen as a mediator for,

for the need to receive positive affirmation. And essentially, they just made a brief comment that they found that neuroticism was directly associated with social media addiction, though not so with extroversion, which showed a correlation with number of likes. That is, that extroverts received more likes on their posts, which you could sort of intuit based on more relationships. But they just sort of wanted to conclude in their study that people who score highly in neuroticism and extroversion may have a predisposition towards social media addiction

simply in the need to post more online and the desire to receive more likes so if you have a patient who scores high just be aware that that could be a possibility so if someone gets a lot of likes they're probably an extrovert they could be yeah probably know a lot of people yeah also found that women receive more likes in the study yeah and also more um more attractive people people receive more likes, right? It's horrible. What our kids are growing up in, you know, this like age of instant judgment.

Yeah, it's pretty scary, actually. Like, if you ever watch the documentary, the Social Dilemma on Netflix, that kept me up for days. Tell me, what kept you up about it? Just the statistics on, like, suicidality and children and adolescents, like, that was very scary. How social media has influenced, you know, politics and world events is pretty significant.

Just the fact that we're being manipulated in so many ways on such a constant basis subconsciously is, like, kind of, I don't know, it's chilling. Manipulated? Or is it that, like, okay, so, the way that I understand a lot of these algorithms is they show you what you want to see. Right? So I had a patient who was a female who was like, yeah, I checked out his like Instagram. I could tell what kind of girls he was into. I'm like, what?

She's like, yeah, I looked at his phone. I pulled up like, you know that like little thing where you just kind of can do the random scrolling of whatever stuff? Explorer page. Explore page. Yeah. So she pulled that up and she immediately knew what kind of girls he was into, which is kind of a, it's kind of a, it's kind of a, unique. What do you think? Yeah, I think it's pretty interesting. I was actually curious if you have like particular rules with your kids about social media. My kids are not on social media. That's the

rule. I mean, they're super young. It's a I think like if, if you have like a good friend group that your kids have and you talk to the parents and be like, hey, how will we keep our kids off of social media like as a group you know that's probably the biggest win just wanted to point out that i was listening to um an interview with jonathan height who is a psychology professor at n yu does a lot of research on moral psychology um that is actually one of the suggestions that he gave in an interview is is you really need to coordinate with a lot of other parents and kind of all get on the same page in order to present a combined front which i think is an important point that's interesting you know okay so here's a couple of facts about social

media and then I'll get back to what I was kind of hinting towards about the algorithm. Only 5% of social media use is actually social interaction. So it's actually not very social. Most of it is for entertainment. That's what most people are doing on there and comparing and, you know, it's a whole another world. So the algorithm shows you what you want to see. And the reason why it does that for YouTube, for the social media for Twitter, is to

keep you on their platform, right? It's very simple. How do we keep you on our platform? How do we get you to give us free attention so that we can pop in an ad here and there, right? We can't spam you that much, but we want to put ads in. We want your attention. It's all about attention. That being said, what happens, and I think they talked about this in the social dilemma, was that if you're into one type of thinking, because that's the way you're thinking, that's what it shows you more and more of. And then you become more polarized in one direction, right? So think about this with the elections going on. You're probably going to hear this somewhere before the election. Are you in that category of people who have over the last couple years been pushed more and more

towards one direction. You know, are you able to see both sides, right? And I was kind of challenging you guys earlier this week. And some of you kind of like, I could tell, like didn't like the challenge. But can you see why people are voting for the other person? That's the question. If you have, if you think that everyone else is voting for the other person and they're complete idiots, then you're not watching both sides at the same thing, okay? Which is like you're lacking, you're lacking an empathic immersion in the other way of thinking about the world, right? And so what's happened is we've had two sides that have split further and further. And the scary thing is this may continue to go on.

And what happens 10, 20 years from now? When you haven't been seeped in one side of the argument for five or six years, because that's about probably when this started. but it's more like 20 years right people think they don't know what's real or fake now if things continue on this road here's some of the crazy thing like if you look at the people who are in doing some of these shootings it's not like they're antifa or in some like white supremacist group there a lot of times just kind of like not in a group in average but they've just kind of like drifted into one camp further and further, right? So that's the interesting thing to watch, okay? I mean, some cases,

it's like, yeah, you have these kind of more extreme groups who really, really believe what they believe to the point of potentially doing some destruction to property or harmed others. But what about the people who are just kind of in these sort of echo chambers and drifting slowly? And I see this in marriage therapy I do with couples. I see this in family therapy, like the family dynamics that are being created. And yeah. So anyways, okay, that's a little interlude. Interlude.

Hopefully it was interesting to you. I just want to give like a brief shout out to my high school friend, Gabriel LeBoe, who is the editor of our little high school newspaper. And in 2010, he wrote a little editorial article on the danger of search algorithms, learning your preferences and then sending you down rabbit holes in search engines. So I just want to give a little shout out to him that 10 years ago he was writing about this problem. That's really interesting. Okay.

Let's talk about mental illness. So I think this is the most interesting part of this topic for me. So I'll just kind of go through what I found. So Watson at L in 2009 did a meta-analysis looking at extroversion and the correlation with different psychopathologies. They found that extroversion was significantly positively correlated with histrionic personality disorder and that correlation was 0.33 and narcissism. So in an older study that was in this meta-analysis, the correlation was not significant at 0.9, but in three newer studies, extroversion and narcissism had correlations ranging from 0.31 to 0.40. They also found negative

correlations between extroversion and avoidant personality disorder, and that was a negative 0.49 and schizoid personality disorder, which was negative 0.46. So if you wanted to completely avoid the narcissist, you could just look for someone like two or three standard evisions below the mean? Right. An extraversion? Is that what you're telling me? Well, you have to go searching because they're probably not out in the open. Where would I search for those people? Probably like... You're like a coffee shop in the corner.

No, not a coffee shop. No, not even a coffee shop. Library? Maybe a Dungeons and Dragons like online chat room. See that? Social media right there. No, I can't. Okay.

Nothing wrong with Dungeons and Dragons for my fans out there who like that. Okay. Interesting about this is look at the correlation. This is not equal causation. You know, these aren't 100% linked. So you could still be low extroverted and be narcissistic. You could still be, the correlations are a little bit higher for avoiding personality disorder and for schizoid personality disorder, then, you know, those are like point, almost point

five. Yeah, it's pretty significant. And you think about, I think about those disorders is like you're looking at someone who's probably two or three standard deviations below the mean in extroversion. And then they're probably, the risk probably jumps up. way higher for that. Oh, yeah. Okay, keep going.

So this meta-analysis also looked at each facet of extroversion and the correlations of those with the different psychopathologies. So histrionic personality disorder had the highest correlation with gregariousness, facet of extroversion, which is, that was cool seeing, like, specifically where it hit the hardest, which is 0.35. avoidant personality disorder and schizoid personality disorder had the largest negative correlations with the warmth, gregariousness, and positivity facets, ranging from negative 0.35 to negative 0.48. Avoidant personality disorder had an additional negative correlation with the assertiveness facet, which was negative 0.39. Cool. Yeah.

I um it's funny because I I told you to look these up because I thought these would be actually the links that we would find and they're the ones right yeah okay um interestingly you have things like antisocial personality disorder not linked one way or the other um you know what is linked to negative extroversion social phobias point three seven Dysthia disorder, 0.29, depression, 0.28, panic disorder, 0.28. Obsessive-cubulsive disorder, 0.27. So some of these more like anxious, depressed people. Interestingly, that narcissism linked, but not psychopathy and not Machavelianism. Yeah, I thought that was interesting also. That's interesting because those usually run together. Right.

psychopathy, if they have low affective empathy, that's uniquely linked to psychopathy, not Machiavellianism and narcissism. Then if they have that, then they'll usually have the Machiavellianism and the narcissism. Okay. That might be because, well, I think this just points out how truly important agreeableness is in these and distinct. I mean, all three of them have low agreeableness, but the narcissist will likely be extroverted. Yeah, so narcissists more extroverted. Because, you know, you have the sort of that gregariousness.

You're going to have other types of personality of stuff if you're not extroverted. But the correlation is not huge. Right. It's like 0.3. So Carl, just because you're the biggest extrovert here, doesn't mean you're a narcissist. I would not say you're a narcissist. Okay, I just want to like affirm you in that. One time my buddy called a little worried.

One time my buddy called me and he's like, hey, do you think I'm a narcissist? Like, I'm just like really, really worried that I'm a narcissist. The time of day was this call? What time of the day? Yeah. It was a normal time. I don't know. And I'm like, well, tell me more.

Like, what's going on? He's like, well, you know, just. And dude, this is the guy. This guy, like, he's very extroverted. Very extroverted. But he thinks about others. Like, that's what he does for a living. You know, he literally is in like full-time thinking about others type of job.

And I was like, did you're not a narcissist? He's like, usually narcissists aren't very concerned that they're narcissists. The narcissist would be like, I'm not a narcissist. Like, what are you talking about? Actually, I'm curious. What do you think the statistics are for narcissists in medicine? it's probably higher in certain jobs with low agreeableness, right? So like more of the, you know, honestly, the jobs that collect the narcissists are the jobs

where you need confidence in the face of death, like utter confidence. And so that's where the low agreeableness will be the most advantageous, right? So if people are literally dying around you all day long, every week of the year, every month of the year, you know, like these are the types of fields that are going to collect people who are low agreeableness. And you know what? That's the people who are going to survive, you know? Like, like, think about all this. There's certain types of specialties, surgeons, you know, like subgroups of surgeons where you have more people die. than usual. That's going to collect the low agreeableness because those people are going to be able to

tolerate just the loss of life more easily. So, yeah. What do you think, Ryan? No, that's just, that's pretty interesting. I'm curious about what facet of agreeableness you think that like makes it easier to deal with that? Low affective empathy, specifically. So we, you get more towards that psychopathy spectrum, you have very low affective empathy. And so you're not feeling into the loss of other people's emotional worlds. So when you have the family just completely distressed, it's not going to physiologically translate from their brain into your brain. Right. You know, so the people with a very, very high affective empathy will feel into the other person's experience so much so that if it's traumatic for them, it'll be.

traumatic for me. But if you're not feeling into their experience, it will not be as traumatic for you. Good question. Ryan has that sort of desire to push against, to try to figure out things, you know. Appreciate it about that. It's my low straightforwardness, I guess, again. I think that's good. I think it's good. Hopefully you feel the psychological safety to disagree. Yeah, I think I do. But my low assertiveness kind of messes with that sometimes that's why i have to look at you and catch you in that moment you know when you're like you have that sort of questioning look that's my effective empathy saying like oh ryan's over there he's got some like got some thoughts he probably doesn't want to share okay let's keep going so uh this next study it's about narcissism and extroversion

it was too recent to be included in the previous meta analysis but it split narcissism narcissism up into like grandiose and vulnerable narcissism. And the correlation was higher. And so with grandiose narcissism, the correlation with extroversion was 0.61. While with vulnerable narcissism, the correlation was negative. It was actually negative. 0.24. Yeah.

Interesting. I think I bet. Okay. So the vulnerable narcissist, I call the Chihuahua narcissist. It's the low self-esteem narcissist. And they tend to be, yeah, like a little bit lower extroversion, right? And very, they don't have that confidence with that like assertiveness and sort of dominance, right? Whereas the high self-esteem narcissist, okay, this is where I part ways a little bit with Kohut.

Okay, so Kohut thought everyone who was a narcissist at low self-esteem. And I think that there are like high self-esteem narcissists. Like there are the people who like underneath the narcissism is not the chihuahua. Underneath the narcissism is more like a pit bull, right? It's more of the fighter. It's more of like maybe could have been something like a tribe leader, right? And, you know, if they don't do their own personal growth and don't grow past kind of like being able to see other people's needs, be able to read other people, be able to see that, that, you know,

well, let me, let me say it this way. I've, I've had a couple of patients who are like in this category. And my approach is sometimes to convince them, idea-wise, that helping the greater, the greatest amount of people will give them the accomplishment of their goals. so I'm trying to move them from a mind shift right from the mindset of meeting their own needs only is like the end of all goodness right to like seeing that like the more people you help actually will give you the most satisfaction downstream and and that takes time that takes time so sometimes in this type of therapy it's a little bit less it's a little bit more you're challenging them and they like to be challenged a little bit.

Not too much, but they like to be challenged. If you're too passive, then they just feel like they can walk over you. And they feel like, like often they're not coming in for therapy initially. They're coming in for benzos. They're coming in for Adderall, right? They're coming in for some sort of like stimulant,

something to optimize them, testosterone or something. I don't know. Now that patients don't ask me for that, but that's the kind of like mindset, right? Is this vulnerable narcissism harder to diagnose? No. I mean, it's not maybe the picture of narcissism that you would have based on pop culture. In pop culture, they call it the covert narcissist often.

So it's like the secret narcissist. You know, it's the medical student who's dating someone who has no, no time to meet their needs, and they demand that their needs are met. And then if they're with someone who's super high trade agreeable, that the trade agreeable person thinks to themselves like, oh, should I be just like giving them all their needs and not meeting any of my own psychological needs? So I've seen that even just the last month, you know? Not from you guys.

Okay, from like, you guys aren't telling me about your relationship. So I don't know about that. Okay. Ryan's like, are you talking about me, man? Single, single. You're single. Okay. Okay.

So, yeah, the covert narcissist, it's harder for people to recognize. If your dad was a covert narcissist, you may wake up a couple years into a relationship and realize that the person you're dating is a covert narcissist. Dun, dun, done, right? That's mind-blowing. Okay. Let's keep going. Extraversion and ADHD.

So this study by L. at Al in 2017, I looked at genome-wide analysis of personality traits with six genomic loci. And they found that high extroversion specifically had a correlation with ADHD of 0.3. So it wasn't super high, but I think it's still sizable enough to, note. And to me, that makes sense because the excitement seeking and the high stimulus seeking, I feel like both kind of go hand in hand between extroversion and ADHD. 100%. And I would say if it's hyperactive ADHD, it's probably even higher. Oh, yeah. Than this. It's the inattentive ADHD that might be not as extroverted. But most of the true

hyperactive combined type ADHD that I see they come off very high extroversion high energy people if if someone seems very depressed they're probably either the depression is probably the first thing you treat and that might actually solve their attention issues so keep going anything else from the study covered an array of different pathologies. There are more of other psychiatric disorders such as bipolar disorder, you know, major depression, things like that. But not, they weren't as closely linked to extroversion without other things. So check out, check out the handout. It'll show you all the details. I will put the graph in. Let's move on to Therner. for maladaptive extroversion.

Ryan. I looked at a study from Boucher, 2019, some meta-analysis. So they did this study with the intention of finding the association between different personality traits and mental health treatment outcomes. Generally, higher extroversion was associated with favorable outcomes overall. They looked at a few different outcomes. Significant statistical heterogeneity suggests extroversion. Expression is positively associated with outcomes such as lack of symptom severity, symptom decrease, improvement,

aggregated improvement, which includes things like their BMI, the weight gain, their overall improvement, symptoms, lack of symptom severity, et cetera, and also their overall positive outcomes. Extraversion also had the greatest positive impact on overall outcomes. And notably, extraversion was not strongly associated with better interpersonal outcomes. Working Alliance had an effect size of 0.04. Individuals are found to be more willing to participate and communicate openly and honestly in treatment. However, these attributes do not actually translate to building a therapeutic relationship. Coping skills actually had the highest association with extroversion, 0.11.

and extraversion have the strongest association with symptom decrease, 0.15. Yeah, there's either pretty small correlations across the board. Yeah, but it's, you know, maybe when you're getting into two standard deviations or you're getting into like it just doesn't seem like this is going to have that big of an impact on like if the therapy is successful or not. Yeah, they went on to talk about a little bit about patient type, and the correlations were kind of low here as well, but they did find that in the inpatient setting, favorable outcomes were associated with lower levels of extroversion, and in the outpatient setting, it was higher levels of extroversion. We're associated with favorable outcomes. Yeah, so the higher extraversion associated with more favorable outcomes.

So once again, that's a correlation of like 0.11. It's a pretty small correlation. Right. And then also in treatment length, we found that with four weeks or less, there was a negative correlation to higher the extraversion. And when you went up to 6 to 11 months, you got a 0.16 correlation with higher extroversion and positive outcomes. Okay.

So now we'll move on to talking a little bit about maladaptively high extroversion. I looked at an article from Gore 2011. So some of the things that we expect to see here are exhibitionism. Gagiariousness can unfortunately lead to things like attention-seeking and inappropriate flirtatiousness, usually in things like histrionic personality disorder. Assertiveness can become pushy, authoritarian, narcissism, and interpersonally dominant in antisocial. And excitement seeking can become reckless and risky.

Presidol, in 2013, takes us through some things to consider during therapeutic interaction and maladaptively high extroverts. He mentions that patients may present with long-term exhaustion of their interoperative, interpersonal relationships. This includes suspected infidelity due to consistent pursuit of outside social endeavors causing friction in their romantic relationships. Also, he mentioned to consider the frequent comorbidity of substance use disorder secondary to their excitement-seeking and risky behavior. Their propensity for social interaction could also reinforce their substance use. and in our differential for maladaptively high extraversion,

we must distinguish these patients from bipolar disorder. You should be able to appreciate from the history that the patient's frantic energy, thrill-seeking, and interpersonal dominance are not interrupted by periods of withdrawal and low energy, and furthermore, their symptoms will be confined to interpersonal relationships. Interesting. Yeah, I'm thinking from a lot of these things, because of how our society characterizes someone who's more narcissistic, people don't really think

histrionic as like a category and pop culture. Like I don't hear that very much, but I hear narcissistic. I think someone who's very high extroversion may get sort of cast in that sort of picture. Actually, well, how do you know someone's a narcissist? It's your patient's X. partner, you know? It's like, it's so pop culture right now to think that your ex was a narcissist that like, I, anyways, you guys have to be in the field to know what that means. So it's like, I'm thinking as I look at this, okay, first of all, I, the link is there, right, between narcissism, 0.3, somewhere on there, histrionics, up point four, somewhere on there. but that doesn't mean that you could be extremely extroverted and and have meaningful long-term

relationships with people because you seek you seek their value intrinsically right and you want them to move forward in their domains of life and irrespective of moving you forward in your domain of life right so i defined someone as a narcissist if they in the end like it's only about them they're only thinking about their own moving forward and those people will burn relationships out as time goes on. Someone who's histrionic, like this, the way that they tell their stories is very sort of excitement oriented. Like, I've never seen someone have so many just interesting explosions of interpersonal dramas,

except, you know, someone who's really histrionic. And they use that to captivate people and to pull people into the story, right? So they're great storytellers often. I find it interesting in this article how they talk about how these people might be more, people high and extrovert might be prone to more like affairs and more like substance use, whereas if you look at the link between substance use and extroversion, it's not that strong of a link in the prior paper. So I think what they're sort of aiming at is more of the pathologies that could be associated with extraversion,

but not necessarily associated with extroversion. I'm also curious because I'm not sure how. the big five model takes into account disorders that are not personality disorders, like, you know, ADHD. So someone that would, you know, maybe score high, you know, excitability and extroversion and maybe like high in impulsivity would come out to look histrionic, you know, on the test or something like that. But actually it's just characteristics of ADHD, which is a different type of disorder. Yeah, I think what you're aiming at is the specificity of the test, right? How often are we missing that this person is just highly extroverted, right?

And maybe they're not ADHD. Maybe they're not narcissistic. Maybe they're not histriotic. Maybe you have a highly extroverted depressed patient, you know? And so I think this is where this construct of extroversion can really be helpful in, like, understanding people, right? Because there's like this bell curve of extroversion. and they may not have any personality pathology in this domain, right?

And so if all you see is histrionic narcissists, all you see is the personality disorders, all you see is the DSM, you may miss these very normal places where it could be like a strength, right? So then do you pathologize gregariousness or, you know, outgoingness? And that's, that would be, or low gregariousness, you know, or low outgoingness. like, do we overly pathologize it rather than seeing like, okay, this is just part of this distribution

in the population? So, yeah, what were you thinking, Ryan? I guess I was just thinking that, I guess I wasn't totally sure about what these tests actually say about personality disorders. I mean, do they claim to be able to diagnose them? I wasn't really sure about that. No. Okay, okay.

That's what I thought. Like if you just take the big five, you're not going to be able to diagnose a personality disorder. But what the big five will tell you, and the readout that I got is like, like it says, like, your chance of having borderline personality disorder is really low because people with borderline personality disorder do not, you know, have the types of, you know, personality that you have, right? or the chance that you would have something like blah blah would be higher right so it does give you that but it's like how how are those things diagnosed they're diagnosed by a clinician and if they're diagnosed in research they're diagnosed usually by the skid which is a very detailed personality inventory so the skid personality which when i go through personality disorders in the future i'll i'll take

people through the skid and show it show people how it's formally diagnosed in the research which is really important because then you can look at, you know, how then the studies line up with the gold standard of diagnosis and what that means. But yeah, I would always put it back on the clinician to give a formal diagnosis. In your experience with borderline patients, have you found that they also are good storytellers like the histrionic ones? Sometimes, yeah. The borderline patients can be, especially like, Like, like, you know, you talk to a person who's been dating a person with borderline presizer. And it can be very exciting.

The attachment can be almost instantaneous. The passion, right? The person with more of a narcissism may enjoy almost like a revelry that the person with borderline has. The person with borderline desires this deep attachment relationship, right? Problems happen in the future when the person with borderline for a sadist disorder, like has these darker parts of their trauma that then get sort of activated by the attachment. So that leads to things like splitting all or bad. So you go from being an angel to being the devil.

You go from being all good. and this glorious night, this hero to being like this just horrible, horrible person, right? And then it just takes you through that turmoil, right? Which can actually be a little bit seductive. You know, it can be like a little bit enthralling. It's not boring by any means. It's evoking a lot of emotion in you. And I've had patients who go into conversion disorders over this.

Like they'll be dating a borderline, and that is the only thing that I can find that led them into conversion disorder. like straight up psychogenic seizures in and out of a hospital. And it becomes part of the borderline's way of attachment, which is with that partner, right? Which is very interesting. Ryan's, Ryan finally, I finally got Ryan's attention. Okay. He's the,

well, yeah. No, it was actually a patient that I had, um, that who just seemed to just like have like, the most horrible life I've ever heard. And like he just, it just seemed like every time I talked to him, there was some new trauma that he was telling me about. And I was trying to figure out where, like, you know, if it was gamey or where that was

coming from. Well, okay, yeah. So you're probably picking up something there. Because sometimes people who have been mental healthized who are borderline, how do they get their attachment needs? by telling the same story over and over again. Do they actually get dissociated while they're telling you the story? Sometimes no.

Sometimes they're telling you the story with a little bit of glee. I'll remember this person who gave a talk about her horrible relationship backgrounds, and she went into gruesome detail in front of this audience of 50 people. And the audience was in this agony, okay? But I looked up at her at this moment of the audience being in agony. and she was in revelry. She was an absolute bliss because she felt connected

to the audience, right? So, yeah, sometimes it's more than just more than telling you the story to overcome the story, right? Right. Sometimes it's, this is how I get my attachment needs met. And so what do we do as clinicians then? okay what we do is we give attention to real congruent emotion and so we look for it and you may not

find it for a while but if you don't give attention to the things that don't evoke in them and in you therefore some sort of like congruent experience then the question is like where is the congruent experience and so this is where i go back to it's either in the artwork the writing or the word written or the words that are coming out. And for some people, it's only the artwork. And so get them to talk about their artwork. And now they're translating congruent artwork into congruent speech or get them to write about their artwork.

Now it's translating congruent artwork into congruent words. Okay. So I could go on about that. Okay. All right. Yeah. Anything else from this episode that you wanted to point out? Yeah, I thought that he had some good suggestions about interventions for maladaptively high extroversion.

He talked about providing frank interpersonal feedback about the thoughts, emotions, and reactions that are elicited by the client's maladaptively extroverted behavior. Because usually these patients are egosentonic. and this kind of gives the patient a chance to gain some insight into their personal issues. And then they're able to go from individual interpersonal therapy to group interpersonal therapy. And then once they're in that situation, they're able to kind of, well, I guess their maladaptive behaviors are kind of drawn out in the group. And it gives them a chance with their newfound insight to sort of practice how to confront those behaviors. Yeah. No, I, okay, so what he's describing here is someone who's higher in extroversion. He is

going to tell them his experience of them, his interpersonal experience of them. So what is actually going on between them in the here and now, he puts words to that. And Yallam talks about this. And then what you would do in a group is you would do like a Yallam interpersonal group therapy as well, where then you would have the group members speak truth to their experience of this person. And the group therapy and the individual therapy is a microcosm for life. So if this guy is pushing the buttons of everyone in the group, you can guarantee that's going on in every domain of their life. Right. And so this is where that interpersonal therapy is so rich because no one gives them that feedback in a safe empathic way, right, in a way that actually causes growth.

They also recommend cognitive behavioral therapy as a key tool during this process, and also mindfulness skills would be another effective addition, because it can kind of give the patient a way to acknowledge their maladaptive cognitions, like when they're actually happening. And also behavioral goals of increasing alone time and or refraining from speaking for a proportion of a given interpersonal interaction can be helpful as well. Carl, you were talking about that. Yeah, so that's kind of funny because that's literally a strategy I've used on myself.

Oh, man. So this is for maladaptively high extravers? Okay, that's good. I think, I think, um, taking, being in, being the one that gives therapy probably taught me this, you know, taught me this to some degree. It's like you're, you're practicing a meditative stance listening to someone else over and over again. And you're trying to subvert your own needs, right? Your own sort of desires to the person that you're actually listening to. Okay. Yeah, let's talk about maladaptively low extroversion. What do we do with us?

All right. So usually in maladaptively low extroversion, this is like a patient who's a little bit more familiar to clinicians, shy, introverted, kind of loner. They don't really have too many feelings towards the majority of activities and relationships. The things that Presnell suggested for this therapeutic interaction was to consider that they do have an increased. lifetime risk for social phobia, major depressive disorder and schizophrenia. And their prognosis in these can actually be a little bit poorer just due to their lack of social support. As well, they should begin with individual and move into group interpersonal therapy. And this is so that the provider can make a concerted effort to establish trust and alliance with the patient. so they can then discuss group therapy once that's started. And something to note is that during interviews with these patients, you can't assume that these maladaptively low extroverts will volunteer even important information.

So sometimes you have to ask more specific questions and not ask as many open-ended ones. Behavioral therapy and skill training are effective therapy modalities in this population. This therapy should be informed by the provider's understanding of the specific deficits in extroversion that are hindering the patient's function, as well as the factors reinforcing them. And in order to obtain that information, you can have the patient undergo a five-factor model assessment followed by functional behavioral analysis. Interpersonal and behavioral therapies may be supported by pharmacological treatment. This is article Tang at all 2009. They performed a placebo-controlled test in which adult patients with moderate to severe major depressive disorder received placebo, or they received paroxetine or cognitive therapy.

And what they found was that with an effect size of 0.63, paroxetine increased. extraversions significantly more than placebo. And this can be crucial in helping these patients establish new healthy behaviors. That's interesting. Yeah. And it just goes to show that treating the depression can move someone to being, from being like internally, like the final common pathway of someone who's depressed is to not go out very much, to be isolated, to not interact with a lot of people.

So it seems to me that like actually treating the depression. increases the extraversion. Yeah, and that's interesting. I knew I should have read the other article about this because I just read a little bit of it, and they were trying to say, actually, that the extraversion increases independently from the depression treatment.

Yeah, so it's, I mean, what they're saying there is that the depression scale and the extraversion scale are not fully linked, right? It's not like their core. relation is like 0.9. It's like both of them are improving but for because they're measuring different things. Yeah. All right. We are at the end of this episode and I hope that you have enjoyed this Big Five series. It is just really awesome to put this out there to you guys. Hopefully you find it entertaining, fun. And also education.

where you're kind of like, okay, that's kind of where I am. And, huh, I can take that away from my own life. And now I have this sort of way of thinking about people a little bit differently, thinking about people in terms of their different personalities, that they're different than myself, and that, you know, my personality and their personality can kind of uniquely lead to either different good things or different things that might be a little bit more trial-oriented. And maybe, you know, counterfeiting. transference, right? How does counter transference sort of spark up when you have someone who's very different personality than your own? So I will leave it here. And if you want, go to the website, you can download the PDFs for these episodes and dig into them a little bit more. The PDFs do

have more information than the actual episodes. So I hope you find that educational as well.