Speaking of Psychology - Reducing the risks of brain injury, with Kim Gorgens, PhD

Episode Date: October 2, 2024

Every year, there are more than 2.8 million traumatic brain injuries in the U.S. The risks of brain injury among youth athletes, pro football players and military veterans have all made headlines in recent years. But other populations are at increased risk as well – including people in the criminal justice system and domestic violence survivors. Concussion researcher and brain health advocate Kim Gorgens, PhD, talks about how to identify TBI, what happens to the brain when you get a concussion, what we should we be doing to protect athletes and help them recover, and what could we be doing to mitigate the harms of brain injury in often-overlooked populations such as domestic violence survivors. Learn more about your ad choices. Visit megaphone.fm/adchoices

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Google Fi Wireless is not subject to data traffic deprioritization during times of high network usage. Every year, there are more than 2.8 million traumatic brain injuries in the U.S. The risks of brain injury among young athletes, pro football players, and members of the military have made headlines in recent years. But other populations are at increased risk as well, including people in the criminal justice system and domestic violence survivors. Today we're going to talk to a neuropsychologist about what researchers are learning

about the prevalence of brain injury and how, best to prevent and treat it. So what constitutes a traumatic brain injury? How common are TBIs? What happens to the brain when you get a concussion? What should we be doing to help protect athletes from brain injuries from youth sports to professional leagues? What effective therapies do we have to help people recover from TBI and what could we be doing to mitigate the harms of brain injury in often overlooked populations such as domestic violence survivors and prison inmates. Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life.

I'm Kim Mills. My guest today is Dr. Kim Gorgens, a professor of psychology at the University of Denver, where she teaches psychophysiology, clinical neuropsychology, and the psychology of criminal behavior. She has worked for decades studying and treating brain injuries in populations, including youth athletes, prison inmates, and survivors of domestic violence. In addition to her research, clinical work, and teaching, she's an advocate for TBI awareness and helped draft a 2020 concussion law in Colorado. She also lectures and speaks frequently to the media about brain injury, and her work has been featured in outlets including U.S. News, Newsweek, and Scientific American.

Dr. Gorgans, thank you for joining me today. Kim, it's such a pleasure. Thank you so much for having me. I think this is the highlight of the year for me. Wow, that's saying a lot. It really is. I love that it's the Kim and Kim show. Oh, perfect. Yeah, we work that out. So let's start with a fundamental question, which is, what is a traumatic brain injury, how do doctors know when somebody has had a TBI and not just a knock on the head? This is a great question, and there's really two component parts to the question as you, just asked it. A brain injury is any insult to the brain, and that means it includes the whole of the universe of traumatic brain injuries. Those are injuries that are caused by the application of some

external force or blow to the head. We also talk a lot more recently about blast injuries, so a hyper-pressurized wave of air. It also includes all the ways the brain can be damaged by being deprived of oxygen. We call those anoxic brain injuries, as is the case strangulation, near-lethal overdose with synthetic opiates. The second part of your question, though, is a much more nuanced one, which is, and how do doctors know when you have one? And the reality is we don't have great gold standard diagnostic tests for brain injury, particularly for mild brain injury. At this point, there's one new FDA-approved test, an Abbott test, that is available in some settings, only in emergency rooms, only in settings with laboratories that are designed to run this test.

So a lot of us in the research space, it's like a gold rush to find some easy, guard, standard way of identifying someone who's had a brain injury so that we can say to that person, here's how you need to be careful as you recover from brain injury. In the short term, though, what we're left with is subjective complaints of the person who is injured. And of course, that opens the door for other ways that we minimize symptoms, where the culture of whatever we're doing at the time encourages us to walk it off, for example, or where it might be too dangerous to disclose having a brain injury in the case of interpersonal violence. And it makes it really difficult for people who sustain brain injury to feel the validation of the health care system,

because there isn't a way to say, well, indeed, you've had a brain injury. So, diagnostically, any alteration of consciousness is a brain injury. So if you struck your head, or if you were strangled to unconsciousness, that is a mild brain injury. And determining how long that loss of consciousness was, it may be a more moderate or severe injury. But at a minimum, any alteration of consciousness is a mild traumatic brain injury. So what happens to the brain after a traumatic injury? I mean, is this something that you can sum up easily or are all brain injuries different? I love that you pointed that out.

And in the brain injury world, Kim, you hear a lot of people, and clinicians especially, say, if you've seen one brain injury, you've seen one brain injury. So there is something very idiosyncratic about people's response. to brain injury, but uniformly, across the board, mild injuries are metabolic injuries. They're inflammatory injuries. So much like an injury anywhere in the body where the body's response, your immune system's response is to mount an inflammatory response, to mobilize tissue repair, and to heal the injury. That same phenomenon happens in the brain. We don't resolve inflammation in the brain as quickly, and neuroinflammation is associated with all manner of

really negative effects, things like mood disturbance and behavioral discontrol and cognitive complaints. So the inflammatory aftermath of injury is where the really devastating effects come from. Now, Kit Sports are an area where we hear a lot about TBIs. Is the problem just football where young players sustain a lot of head injuries, or are there other sports that are also dangerous when it comes to TBIs? Such a great question, and I am so struck by how real this is for your listeners who maybe followed the story just this last weekend about the young player in Alabama who died after being taken to the emergency room from the field after sustaining a brain injury. And we don't know a lot about that case. And thankfully, there are few,

of them, less than 20 a year where a young athlete dies really on the field. But when we talk about youth sports, we talk a lot about the kinds of forces that the kids on the field are exposed to and the way their bodies are exposed to those forces and the way their brains are exposed to those forces. And your brain is pretty well designed. In fact, the most well-protected structure in the entire body is the central nervous system. And we're pretty well designed to withstand lateral impacts. So deceleration injuries where it's where your brain comes into contact with a stationary object and there is a lateral application of force.

What the brain withstands very poorly is rotational force. And rotational force gets conferred where part of the body spins and that that force gets conferred to the brain. If you think about the whisk to kids playing youth sports, is not so much about lateral impact to their helmet, per se, but it's a way that they get checked in the body and that force gets translated to their head. The risk is especially high to younger athletes where, A, their neck musculature is not as strong as older, more robust athletes, and B, where the size discrepancy between players is much greater. Some kids have hit puberty, some kids haven't.

And so the way that those forces get conferred in the brains is rotational. And you see a lot more damage from that rotational force. Some kinds of sports happen to be lend themselves to more rotational injuries in the style of play. So that's body check and football and being tackled. It's hockey. But it's also importantly, in our concussion biomarker study, we realized that we were seeing a lot of divers with cognitive complaints. And we thought, well, gosh, we had to even include them. They were in our control group originally.

But what we realized for divers was hitting their water from higher dive points actually was a lateral impact to the brain. So it isn't as simple as tackle sports, but it is most dangerously rotational. impact, but it's really, at the end of the day, any impact to the brain, the accumulation of those impacts over years and years is associated with poor outcomes. So that speaks to the question of protective equipment. I mean, like, you have protective equipment in sports like football, but you can't wear anything protective when you're diving. So is equipment an answer? Or, I mean, what is the answer for these other sports where it's really not so much that somebody has conked you on the head?

you're just doing the sport. Right. And we saw this when the NFL got rid of the checking rules or added checking rules so that you didn't have helmet-to-helmet-spearing. And youth football added heads-up style of play. This is about 15 years ago now. But kids were trained not to use their helmets in the course of play. So heads-up play.

And it reduced injuries. tremendously at the NFL level, that it had no impact whatsoever on the frequency of concussions in youth sports. So the answer isn't as simple as equipment or playing differently. Certainly, helmets have made a dramatic difference. And there is a whole argument to be made about helmets. And this conversation plays out at the NCAA level and high school level with women's lacrosse. And many of your viewers will know this, but women's lacrosse is not required to be helmeted. A lot of advocates pushed for it to be helmeted at the NCAA level. And a lot of opponents say that helmeting girls playing lacrosse would lead to an increased incidence of brain

injuries because the style of play would be different. And, you know, I appreciate that there are really two trains of thought there. There is no question that the injury is sustained by unhelmeted lacrosse players are more severe than they are by helmeted players. So on the clinical side, I'd argue that there's something to be wearing helmets. But it's also just about the sport itself. The risk is embedded in the style of play. Are there other steps that could be taken to protect players? For example, I was reading about the role of hydration in preventing TBI. What about strength training? And what kind of training to coaches need that maybe they're not getting right now?

It's so key. It's so key. That last point is such a good one. And with coaches, when we wrote our concussion legislation here in Colorado, we were the seventh state to do that. And the first state to, you know, include junior high school athletes. And our legislation required coaches, not only school coaches, but also intramural and pee-level coaches, community coaches, to be trained in how to recognize, identify, and manage concussions. So that's a really important point. So having an educated coach, and sometimes that's parents, sometimes that's someone who stepped in for a coach to cover, having that kind of education is key. Recognizing those injuries when they happen so that we can really quickly identify the needs of these kids is paramount. Otherwise, the rest of your question is, like, what can we do to better protect athletes? And it's strength training has great data. So it's

physical therapy. It's all kinds of strength training designed to be. that cervical spine, the musculature in the neck for kids, that's associated with fewer concussions as those kids are playing contact sports. Also training kids in things like flag football before they play contact football has some data to suggest that that yields fewer concussions. And there is just a really important point that I want to underline here, which is there was no question that the most healthy activity for kids is physical movement and exercise. It's everything about brain health. And sometimes this conversation gets mistaken for a conversation about we shouldn't have kids playing sports.

And that, quite frankly, is absurd and would be the worst thing to ever happen. There is a way, however, to play context sports, in particular, in ways that potentially are safer. to ensure that we have the newest generation of protective equipment available to the kids, regardless of the funding of their school district or the kinds of resources available to those kids, for example, those two component parts we're still kind of striking out on. So if we could do better, we could meaningfully track a change in the frequency of these injuries and make a determination about where our efforts are best spent. Your summer starts now with Memorial Day deals at the Home Depot.

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What I hear you saying is we're not telling parents to pull your kids out of football or other contact sports, but is there an age at which it's appropriate to get started? I love this question. There is, you might know Robert Cantu, he and Anne McKee and a group of other researchers are at Boston University. They head up the Center for the Study of Traumatic Encephalopathy there. They have been very outspoken in this area, and I think some of their points are informed by certainly decades now of research to suggest that there is a cumulative risk to contact sport athletes, sustained not by a single injury, but by hundreds of thousands of sub-concussive blows over the course of a career.

And they're seeing those changes in athlete brains, even when those athletes do. in their 30s, for example. So their research suggests that there is something we don't know in its entirely about what happens at the time of brain injury, and particularly for people who sustain, again, these are hundreds, if not thousands, of brain injuries. Robert Cantu has made the point that the frequency with which people who go on to develop dementing disease played youth sports is much high. and his suggestion is based on what he sees in the pathology reports of brains that people donate

to their center for the study of brain-related disease, is that there isn't a reason for a junior high school and younger kids to play contact sports. So play flag football, play ultimate frisbee. And these all have some requisite risk to them, too. and kids can collide and sustain brain injuries, but it isn't the kind of brain injury that's embedded in the style of play. And also in high school, kids are stronger. The size differences between athletes are relatively minimized

where they've all more or less hit puberty. And so you minimize the impact of some of those differential rotational forces. So I tend to err on the Robert Cantu size, and say, like, is there a safer way to play a non-contact sport in junior high? And for the Pingui Pop-Whorner level, you bet. Like, do they go on to become as adept high school players? Yes, we don't have any reason or any piece of data to suggest that they're less

skillful playing contact football, having come up through the ranks playing flag football, for example. Let's change gears for a minute and talk about treatment. What happens then? What do you do with somebody where you've seen that this person has had a traumatic brain injury, multiple traumatic brain injuries? What do we do to mitigate the long-term and short-term effects of this damage? It's so key. And this is the point about identification of brain injury. And people think oftentimes it's just enough to know that someone had a brain injury. The reason you want to be able to identify a brain injury when it happens on the field. for example, is because you want to intervene and wrap that kid in a whole community of

support to promote recovery. And that means that they minimize the risk of sustaining another injury before they're fully recovered from that injury, that they are managing the symptoms of that injury optimally. So getting enough rest, but not too much rest, that they are able to return to the classroom on a schedule that works for them and that they can manage the need-related complaints. And they're prepared to manage the irritability that often comes with a brain injury and that they're informed and their parents are part of that team. And teachers are part of the return to learn plan and coaches are part of the return to play

plan. And with that approach, you see kids return to baseline where kids, kids, don't have this kind of 360 degree support, they would turn to play too quickly. The risk for even worse outcomes after sustaining another injury is much higher. And that's true for really mild injury. So sometimes kids get a really devastating set of consequences from what looks like a really mild injury that might not even have caught the attention of a coach or someone on the sideline, for example. So in a lot of cases, our research with youth sports suggests that we battle against a culture, a kind of warrior-like culture where the incentive is, and certainly

this is true with college athletes who have a scholarship on the line, the incentive is to get athletes back out onto the field of play as quickly as possible. And we sometimes foreclose some of that recovery on their behalf. And depending on how many times we do that, the likelihood that they can get back up to wherever they were at baseline changes. So the treatment then amounts to just rest and vigilance. I mean, is there more than that that you can do to somebody who has had a traumatic brain injury? Yeah. It's all their anti-inflammatory intervention. It's stress management. It's getting optimal sleep. So not too much rest. We used to recommend like this is about rest and sleep as much as you. Well, first we used to recommend like, oh my God, don't let this injured kid fall asleep.

Whatever. I remember that. Which is like impossible for families and really hard on kids. So that did not pan out. And then we said you should get as much rest as possible. And we realized like, oh, turns out that's not super helpful either. So this means it's seven and a half to nine hours of sleep in a 24 hour period. of time means being really vigilant about getting that sleep and all the other anti-inflammatory interventions. It's optimizing nutrition. It's using mindfulness. It's managing headache pain appropriately. So this is really, I think in the psychology world, this is where psychology can really shine. We treat inflammatory injuries better than anyone. Depression is an inflammatory disease. So we're really well prepared to meet these kids or anybody with an injury where they're at.

But we tend to think of it as a kind of like, you're going to sleep this off and get better instead of like, we know from biomarker studies that the metabolic effects of even a single mild injury in kids take about three to six months to resolve. And that when those same kids sustain even another mild injury, it can take 12 months for those injury markers to resolve. So it can take longer than kids even feel symptomatic for it. So best that we get them as close to back to baseline as possible before we send them back into the classroom and back into the field of play. Now, my intro, I mentioned a couple of other populations that also experienced traumatic brain injury that maybe a lot of people don't think about. And I'm talking about survivors of domestic

violence in this case. How common is TBI among survivors of domestic violence? And can you tell our listeners about the work you've been doing with this population? It's so important. And Kim, what I love about the way that you're approaching this is it's the perfect segue. So listeners think, I know something about brain injury because I followed a conversation that was spearheaded by NFL wives originally and then by NFL players and their retired player unions. We've seen the documentary and we have a kind of pretty robust public discourse about brain injury, about concussion, which is mild traumatic brain injury. What people may not realize is that brain injuries are more common than that in other populations. So the risk to people in

violent relationships to sustain brain injury, traumatic and anoxic from strangulation in particular, is extraordinarily high. And I'll share with you just one piece of data. I'm part of the big study here with my colleague Anne DePrince. She wrote a brilliant book. It's called Every 90 Seconds about the experience of women exposed to intimate partner violence in particular. But Anne and I, I'm a traumatic brain injury researcher and as a trauma researcher who has a whole career of working in this intimate partner violence or IPV space. And we brought our forces together to look at the frequency of brain injury, traumatic brain injury, and anoxic or strangulation-related brain injury. And we thought, well, let's drill into the phenomena and see how often it happens. in almost 100% of violent relationships, women are exposed to traumatic brain injuries.

We thought, okay, well, maybe that makes some sense. What we weren't prepared for, though, is when we asked about strangulation, I had been working for years in criminal justice settings. I thought, well, I'm hearing a lot from women about their experience with strangulation, but maybe this is a low-frequency base rate event. when you pull women who are in violent relationships, 70% of them were strangled in their most recent episode of domestic violence. So the frequency of brain injuries for these women is really stunning. I make the point, I had a 2018 TED talk about brain injuries in the criminal justice

system and I make the point that women exposed to interpersonal violence look like retired NFL players in terms of the burden of symptoms they have in terms of their injury history, but they don't have the benefit of retirement benefits, a pending liability settlement, a documentary on TV, public sentiment and support. So there is a really shocking public health crisis among people who exposed to violence. And we've really only just begun to make eye contact with this scope of that problem. Now, I watched that TEDx talk that you did about people in the criminal justice system with TBI and the numbers that you cited were also astounding. Can you talk about that work and what's happening in the penal system that so many people are experiencing TBI and what's being done to

help them, if anything? We've been doing some of this work in Colorado for this is like our 12th year maybe looking at the prevalence of brain injury history and the comorbidity of other problems, mental illness, substance abuse, recidivism, treatment failure, and really looking at this complicated relationship between all of those variables. What we noticed, and several researchers in the decades before we started our work and more researchers since then have recognized that the prevalence of brain injury history in settings like the criminal legal system is disproportionately high than is true in the general population. And I'll just do a quick little aside. And if you look at CDC data, the population prevalence of all brain injuries is about 8%. And that includes the kind of uncomplicated injury that you recover fully from and you don't expect to have any risk for. long-term poor outcomes. So the risk of the likelihood that people have more significant injuries is

much lower, but all injuries is about 8%. When you look in jails, for example, Jail's prisons, community corrections, the numbers are much higher. And in Colorado, our number across all adults, we looked at just about 5,000 people in the criminal justice system here. That number was 54%. of all people in the criminal justice system. And it varied depending on the setting. And we published a lot of these data, and I know you'll share those links, but importantly, in some of our female-specific program,

so there was a repeat female offender program in one of our courts that was part of our research study. This was a small group. These were women who had recidivated with a second violence. offense, 31 women, 30 of them, had a significant brain injury history. And the rates of violence related brain injury is much higher in a criminal legal population than in the general population where that rate is between 9 and 10 percent in criminal legal settings. That's 80 percent of all the

injuries. It is, and the outcomes for people with violence-related brain injuries are much cooler than other kinds of injuries like sport-related injuries or motor vehicle-related injuries, for example. And what we know about people who also have a brain injury history is that they tend to present with really complicated comorbidities. In our research, among people in the criminal legal system who have a significant history of brain injury, so these are more moderate to severe injuries, 76% of them have a significant history of substance abuse. 74% have that trifecta of mental illness, substance abuse, and brain injury. 100% of them had significant suicidal ideation, but about illness 40, 39.4% that population

had made at least one suicide attempt, which is about 39 times higher than is true in a general population. So it's a way to, as a kind of clinical shorthand, it flags risk for poor outcomes. We know that people who have a brain injury are more likely to reoffend, they're more likely to need more services on their release. And we've been doing some really great programming here in Colorado to change that trajectory by identifying the brain injury, identifying treatment need and changing the way that kind of care is delivered, all treatment as usual, and then making referrals for community-based resource facilitation, which almost every state has available to people with brain injury at no cost. And we have some great data to suggest

that you really can change that trajectory for the most vulnerable people reentering their community. So it's about treatment for mental illness. It's substance abuse and relapse support, it's harm reduction, and it's delivering all of those strategies in a way that accommodates someone's cognitive strengths and weaknesses. So it's repetition for someone with a memory deficit. It's inviting them to paraphrase and summarize for someone who may not have been paying a lot of attention. It's seating someone facing away from an open door or window if they're inattentive. It's really, really basic stuff, but it probably accounts for why treatment failure rates are so high is people that don't know any different. We deliver

treatment in criminal legal settings as a one-size-fits-all blanket. Everybody piles into the room. We deliver harm reduction curriculum or relapse prevention from a book. We do CBT strategies from a manual, and we can do better. And it turns out that when you tweak things just a bit, then the likelihood that your interventions land and are successful is much higher, and we can keep people afloat longer. Now, we haven't talked at all about the military.

What is the prevalence of TBI in the military? And is that being handled better differently because the government and the VA, they do a pretty good job of treating their people? Yeah, and the VA has really led to charge on a lot of this research, identifying the risk for brain injury, identifying the comorbidity between brain injury and PTSD, for example. The VA has gone a long way towards identifying the characteristics of people most likely to develop PTSD and have complications from TDI when they're in combat so that we can identify people with vulnerable. brains as we think about it a lot more and more. And the VA has really been responsible, this VA Department of Defense, for leading a shift in culture around stigma and access to care.

What is largely true, and we see a lot of returning service personnel and retired military in our criminal legal populations too, is that there is still, for active duty folks, significant disincentive to reporting brain injury and certainly significant disincentive to reporting brain injury when the returning home from a deployment, because it delays ultimately their ability to rejoin their community and families. And there still is a culture of shake it off, and rub some dirt on it that makes it hard for people to disclose when they're really struggling. And certainly we see that in the PTSD world, and we see that with the horrifying suicide rates for our military service personnel and retired veterans. It is, I think, a really sustainable effort to destigmatize.

conversations about brain health and they've done that a lot on thinking of research on the gut biome and I think it just is we're approaching it from different angles that make the conversation easier both for our military service persons, their families for providers. You're not going to know if you don't ask and being willing to have that conversation. And I'll say this and I know we'll talk more about this in the realm of psychology, but a lot of people think about brain injury and think, well, that's not part of what I'm qualified to treat. And really, when someone has a history of brain injury, you're not treating the brain injury at all. You're treating all of the inflammatory side effects of the brain injury. It's mental illness, it's depression, it's depression,

It's relationship chaos. It's substance misuse. It's all of the things that we really are trained to do. And they may have cognitive consequences of their brain injury. That means we have to deliver our interventions in a way that is just slightly different than maybe our standard operating procedures, military pun intended. But with just that little change, our data suggests that it yields a tremendous pace. payoff. Well, speaking of the work of psychologists, are we doing enough to train the up-and-coming psychologists to know enough about traumatic brain injury to really treat people effectively

when they come into their practice? Here in Colorado, this was not that long ago. Kim, I am horrified to say, I think this might have just been six years ago or so. And this is true in many states. In Colorado, there was language in our Medicaid. language that ruled someone out from receiving Medicaid-funded behavioral health services if they had a history of brain injury. So if that person had a history of brain injury, they were directed towards brain injury-related services, even though what they were presenting for and what they needed were treatment for depression, treatment for substance misuse, any manner of behavioral health services. And Annamoribas fought really hard with the Hickpuff team here in Colorado to change that

law. Because that law was on the books for so long here and is still on the books in many states, there is still a prevailing kind of headwind among behavioral health professionals that brain injury means something separate. Like, oh, I had no idea that you had a history of brain injury. I need to send you to someone who specializes in brain injury. And the truth is, this person needs someone who specializes in the treatment of grief or in the treatment of adjustment disorder. Those things are really paramount. And certainly the priority at that time to reduce the risk of really catastrophic outcomes for this person, brain injury or not. So just to wrap up, what's next on your research docket?

What are you working on now? What are the questions you still want to answer? We're really excited to support lots of people doing great work. There's a team, Pennsylvania and New York, who are looking at a really great double-blind, placebo-controlled study of brain injury resource facilitation. in a maximum security men's prison. We have a pilot program here going in women's prison, and we have two really exciting, entirely stakeholder-led pieces of legislation in the last few years,

one to screen everyone a Department of Corrections for brain injury, the other woman who had a history of violent relationships who wanted to be sure that no one went through what she did, so her bill is to screen all victims of violent crime for brain injury. And that's really a game-changer. because then we could deliver care aimed at treating the actual brain injury, not all of the fallout of the brain injury. What is exciting, though, on that stakeholder side is to see the ways that this conversation is changing the way stakeholders talk about themselves and what they want from providers and their expectations for care. And this is true on the VA side and among military and service personnel.

It's true for us in criminal justice. And it is really exciting to see communities talking about brain health in ways that are empowering and destigmatizing. I've got a colleague here in Colorado. His work is in a new book by my colleague Annie Leontas is called Sex with a Brain Injury, the best ever first person account of recovery from a brain injury that has a really adept through line with historical figures from Harriet Tubman and all the presidents whose names you'll recognize. In any case, this colleague of mine here in Colorado has really started a horror community revolution. What he found is that by talking about brain health and history of brain

injury, it was a way to address unmet need for treatment for mental illness and treatment for historical trauma. And it was less shaming. And it's gotten community members to the table. And we've deployed counselors to neighborhoods that have been understandably mistrustful of psychology. And it's really been a beautiful thing to see people take ownership of brain health and to recognize how high those stakes are. And we realize also that untreated brain injury. makes inflammation worse and untreated mental illness can also aggravate inflammation. And, you know, in that way, it's a really destructive cycle. So I've been really proud to see stakeholders intervene to Tobigar in ways that psychology maybe has fallen short, and we could

learn a lot from them. Well, Dr. Gorgans, this has been really interesting. I want to thank you for spending time with me today. Kim, this has been a highlight. I so appreciate you. And thanks for the invite and if people need any more info or I can be helpful, they can find me here at the University of Denver. They can find me at APA. And I just really appreciate the airtime. You can find previous episodes of Speaking of Psychology on our website at www. www. speakingof psychology.org or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you've heard, please subscribe and leave us a review. If you have comments or ideas for future podcasts, you can email us at speaking of psychology at APA.org.

Speaking of Psychology is produced by Lee Weinerman. Thank you for listening. For the American Psychological Association, I'm Kim Mills.