unPAUSED with Dr. Mary Claire Haver - Train Your Brain To Thrive Through Menopause

Episode Date: June 23, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Sue Varma, a board certified psychiatrist, distinguished fellow of the American Psychiatric Association, and author of Practical Optimism. They open by taking on a question that sits at the intersection of psychiatry and menopause medicine: why do some women thrive through the most difficult biological transition of their lives, and what can the rest of us learn from them? Early in the conversation, Dr. Varma shares a finding that reframes everything: only 25% of people are born optimistic, and there is actually a gene for it. The other 75% have to learn it. Dr. Varma explains why optimism is not toxic positivity, what practical optimism actually means, and why both extreme optimists and extreme pessimists end up paralyzed into inaction in different ways. She also addresses what happens when depression, anxiety, and brain fog layer on top of the hormonal changes of menopause and perimenopause, and why so many women are being undertreated as a result. Guest links: Dr. Sue Varma (Instagram) Dr. Sue Varma (Facebook) Dr. Sue Varma (LinkedIn) Dr. Sue Varma  Books: “Practical Optimism,” by Dr. Sue Varma “The New Perimenopause,” by Dr. Mary Claire Haver “The New Menopause"⁠ by Dr. Mary Claire Haver “Joyspan,” by Dr. Kerry Burnight “The Relaxation Response,” by Dr. Herbert Benson For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

I want to be clear that what optimism is not. Telling someone, just look on the bright side, right? That's what we often associate with optimism. Yeah, everything will work itself out. That seems toxic to me. 100%, right? That is toxic positivity. Telling someone to look on the bright side without first understanding the depths

and the gravity of what they have been through, right? Like that to me is dismissive at best or toxic positivity at worst. Optimism simply says that there is the potential for good things to happen, right? And practical optimism says, let's turn those positive outlooks into positive outcomes through action. The views and opinions expressed on unpaused

are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. My guest today is Dr. Sue Varma, one of the foremost mental health authorities in the country, and I have been wanting to have this conversation for a long time.

Dr. Varma is a board certified psychiatrist, cognitive behavioral therapist, couples therapist, and psychopharmacologist in private practice in Manhattan, and a clinical assistant professor of psychiatry at NYU Langone. She is also a distinguished fellow of the American Psychiatric Association, which is the highest distinction that organization bestows. And she is the author of Practical Optimism, the art, science, and practice of exceptional well-being. Before any of that, she was the founding medical director

of the World Trade Center Mental Health Program at NYU Langone. She sat with civilian survivors and first responders across every point in the trauma continuum, from complete devastation to some of the most remarkable resilience she has ever witnessed. And she started asking a question that I think about in my own practice. Why does some people thrive despite profound adversity and what exactly are they doing that others are not?

That question is why she's here today. Because I see this in my clinic every single day. Women navigating one of the most significant biological transitions of their lives, often without any support, often having been dismissed for years and being told that what they're experiencing is all in their heads. And here is what I cannot stop thinking about. Same labs, same symptoms. And while some of them are falling apart, others are still standing, still building, still showing

up fully for their lives. I want to know what is in their toolkits. And then I want to figure out how to give it to every woman who walks through my door. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics in gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes to thrive in the second half of life. Starting something new will always feel

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Wayfair, every style, every home. Dr. Sue Varma, welcome to Unpaugh. Thank you. So great to be here. So we're going to jump right in. Yeah. So early in my clinical practice, when I was just out of residency, and before I really understood the neuropsychosocial effects menopause could have on a woman,

these women would come in somewhere in midlife, anxious, struggling in a life that they'd built that they were previously managing really well. And I didn't know enough to say, oh, maybe this is perimenopause or maybe this is hormonal. And I just would send them home with a pat on the shoulder and it's all in her head. Right. And then your work and realizing, you know, some of the later data on how menopause affects the brain, you know, made me realize we're kind of asking the same questions in our work. Like this is a really significant biological transition for women, and some of them are absolutely thriving through it and doing great, but a lot of them aren't. And like, what is the difference and what is the toolkit that they need

to make that happen? So take me back to the World Trade Center Mental Health Program. You were the first medical director there. Yes. What did it actually feel like to sit with those people? I can't imagine. Heartbreaking. Yeah. So on 9-11 itself, I was a medical student, and I was training in a New York City hospital. And I remember being in a patient's room when literally on the TV you're seeing the first plane crash. And like you're stunned, you're speechless. Like we're all looking at each other. And then next thing we know, we hear an attending say on the loudspeaker, discharge, discharge, discharge. Anyone that can go home that's well enough to go home, send them home because we were expecting thousands of people. And in the hours afterwards,

anyone that could go home that already had a discharge plan in place, went home, but we waited, we waited, and we waited, and no one came. And it was so devastating, so devastating, because people there that day had family members who were working in the World Trade Center, colleagues, you couldn't get through to anybody, cell phone lines were crossed. So in the days after myself, friends, my now husband, boyfriend at the time, we all volunteered in whatever capacity we could. Some of us went to the morgue. Some of us went downtown. Some of us got trauma training, which is what I did. I knew I wanted to go into psychiatry. And so when I'm becoming the medical director, it wasn't at that moment. It was years later after finishing

my psychiatry training. And I got recruited for this program. And I was like, how? There are other bigger world experts who have training. And they were like, no, you're the person we want for this position. And it was a very humbling experience because I'm in New Yorker, born and raised. Like, I very much feel connected to what happened. But it didn't matter where you lived at the moment. I think, you know, no matter what part of the country you were, we saw with 9-11, that when it comes to trauma, simply being exposed to images on TV, right? Like, that stress, it is contagious. There's something to be said about that. And so I'm meeting these folks and I've known what they have gone through, right? And when we look at trauma and we look at the

number of losses that you've had. So if you have lost your job, if you had health problems, and most of the patients coming in had multiple health problems. So they were living down there. There were folks who were involved with rescue and recovery. So I treated first responders at that time. We only had one program. So I was treating both civilians and people who are working and living down there and police, fire, firefighters, all of it. And the more losses you had, So if you had asthma, you had GI problems, insomnia, PTSD, anxiety, domestic violence, substance abuse, job loss, financial loss, physical limbs, you know, lost. Family members died. All of that just added to the level of stress. And a lot of these people had prior history of trauma in their life. So we saw that women were more impacted than men. Women are more likely two times or more likely to have PTSD. And how you managed in the aftermath. What was the story you told yourself? That really had an impact. So so much of what I learned in meeting

these patients, believe it or not, were not only the patients that I treated, but I think I learned more from the patients who never actually made it into our program. So there were a group of patients who would get screened every year for anxiety, for depression, for PTSD, and they never met criteria. So I was like, what is going on? Who are these resilient folks that are so buoyant that like they went through one of the most devastating calamities in our history. And yet, they're smiling. They're coming to the clinic and bringing patients with them who were too scared to leave their home because that happens. A lot of people didn't want to take public transportation. They didn't want to come to the city. And that's typical in trauma, the avoidance, hypervigilance,

nightmares, flashbacks. So they had agoraphobia. They didn't want to leave. They couldn't even make their medical appointments, even though they desperately needed it. And yet there was a subset of folks who went through the same losses that day and yet came in healthy, happy, and supportive of the other people. So I said, these are the people that I need to study. I want to treat my patients, but I want to understand who are these people and what they're doing right. And over the course of the years, I realized that they had this sort of optimistic framework on life, which was this idea that bad things can happen. There's an acceptance, right? And that's why I call it practical optimism, because it's not just accepting and resigning, because a lot of extreme optimists, they do that.

They just resign. They say, like, oh, yeah, things will work themselves out. But practical optimists say they're very aware of the negative things that can happen, but they're prepared to handle through their agency, through their problem solving, right? They're very clear through their processing. So I basically had come up with these eight pillars. What are these people do? How can I learn? Because I don't consider myself a natural-born optimist, right? And I learned when we wouldn't know that at the time. years later that there's a genetic component to optimism, right? Like only 25 of us or 25% of us are born optimistic. The rest 75% have to learn it. And this genetic component is that the OXTR gene

or the oxytocin receptor gene, right? Wait, what? Yeah. There was a gene for optimism? There is. And, you know, you doing the work that you do oxytocin is such a part of, right? And who would have ever thought that? Well, explain to our audience what oxytocin is. Yeah. So oxytocin is a cuddle and bonding hormone that you see, you know, in orgasm, in cuddling with your baby, and it's what bonds us. It's what makes the milk let down, you know, what triggers labor. We, yeah, we use oxytocin a lot. And oxytocin, you're hugging a friend, like, it's the social glue, the connection in

our society bonding between mother and child, breastfeeding, sex, all of it. And that this oxytocin receptor gene codes what was so interesting to me was that really what it codes for is social skills, the ability to ask for help, right? Agency. And this is something that all of us can learn. So even if you didn't fall into this 25% glass half full mentality, you were born with a set of skills that some people have, but the rest of us who are not born with it, 75% are not going to be born this way. Seventy-five percent of us are going to be more at risk for depression because we have this glass half-full thinking. If you don't stop your past, pessimism in its tracks, it will lead to depression. That is a fact. The question is how much pessimism,

right? So I'm all about risk management is just trying to narrow the amount of pessimism that you have, trying to catch it early, and trying to flip the switch on it. I'm still, I'm still like processing that we have a gene for this. Okay, keep going. I am so, so practical optimism. That practical words doing a lot of work. I was always under the assumption that this was, some people, were just born this way, and the rest of us were not going to be happy. Yes. But that's not true. That's not true. And so the interesting thing is, so I want to be clear that what optimism is not, telling someone just look on the bright side, right? That's what we often associate with optimism. Yeah, everything will work itself out. That seems toxic to me.

100%, right? That is toxic positivity. Telling someone to look on the bright side without first understanding the depths and the gravity of what they have been through, right? Like, that to me is dismissive at best or toxic positivity at worst. Optimism simply says that there is the potential for good things to happen, right? And practical optimism says let's turn those positive outlooks into positive outcomes through action. So there are a group of people who are, have blind optimism, right? That's not what we're talking about. That extreme optimism where the person I'll give you an example, and you must see this in your practice. I see this a lot in male patients, right, in family members that I know who go to their primary care doctor. And the doctor will say,

yeah, there's some things, you know, your numbers are a little bit off. Your hemoglobin A1 C is a little bit high, cholesterol. And the patient comes home hearing, it'll all work out. Nothing is too bad right now. I'll figure. Like, I can make a few changes and we can, yeah. Yeah. Or the doctor's like, I'm not so worried right now. Let's come back in three to six months. And they don't change anything because they bury their head in the sand because they're so positive. They think they will. Oh, okay. Yeah. They think it'll be fine. It'll be fine. And they're dismissive, right? And on the other hand, I have a lot of patients with severe health anxiety where they'll say, I know I have a mammogram due this year. I have not scheduled it. And I was like, what are you waiting for? It's going to be

horrible. I said, tell me a little bit more. Where is this thinking coming from? Just give me, what does the evidence suggest in your family? Who has breast cancer? Who has cancer? No, nothing. Nobody. I just cannot deal with the knowledge. So that extreme pessimism that it's going to be horrible. I'm going to get cancer. I'm not going to be able to handle it. That is the extreme pessimism, and the pessimism, pessimists also don't act. So if you see these two ends of the spectrum, the extreme optimist buries their head in the sand because it'll all figure itself out, the extreme pessimist is engaging in avoidance and procrastination and also burying their head in the sand because they don't want to see potentially the bad things, right? And they also end up getting

frozen in their tracks. And what we need instead is to marry a little bit of healthy skepticism, right, that the pessimists bring, because we do know that pessimists are more accurate, They do more thorough research. The problem is they become paralyzed into inaction. And marrying the two, I always say that optimists build the planes and pessimists build the parachutes. And we need both. All right.

Let's talk about how we, and I'm thinking me, can make a mess of things. Like what I see in practice and especially like the conversation around waking, right, patients know, we don't have to tell them, work out more or less. You know, patients know I shouldn't smoke. Patients know I should do these healthy behaviors, especially if they're in social media, right? But they can't seem to make themselves do it, right? And so neurologically, psychologically, what's actually happening in that space? So 75% of the time people know what to do.

If you ask them, what are the exercise guidelines, what's the nutrition plan, what should you be eating? They know it. The problem is that we make, each individual, we make 30,000 decisions a day. And 200 of them are about food, right? The problem is that every time you are reinventing the wheel when you're making a decision, okay, I'm waiting for my motivation to happen, right? I'm waiting for some inspiration for me to go to the gym. You are then engaging your prefrontal cortex.

And that is your CEO. It is very expensive. You will not be asking your CEO to clean the toilets. I hope not, right? Like that's a mismanagement and a poor use of resources and poor use of cognitive resources. So the prefrontal cortex should make a decision one time. And that is where your intentions lie, your goals, your big picture thinking. In order for a behavior to stick, it must become automatic. There has to be this switch from intention to automation. And we can talk about one of the steps that are involved. But the reason the big picture thinking behind the automation is that then that behavior becomes bundled and it becomes this sort of package that then lives in your basal ganglia. And that is for our audience, what is the basal ganglia? It's like the more primitive brain. And there's not much thinking involved. So if you're somebody like I have never, for me, my basic things that I don't even think about brushing the teeth in the morning and brushing the teeth at night. Like that automatically happens. There's no expenditure, right? So it's free. So if you want to be able to, because I think in midlife, so many of our resources mentally, right, we're so tapped in so many different directions, not only because we're the sandwich generation, like half of people in. in their 40s, 60% of women, especially, are part of this generation where they're taking care

of elderly parents and minors at home potentially, like less than 18. So we're the sandwich. The stress is on both sides. So we already have a lot of things pulling on us cognitively, managing a lot. So the last thing you want is your basic health habits to not be automated, right? So you just want it on like a regular feedback loop. And even something as simple as putting your sneakers on, that is the first step so that the basal ganglia, that part of your brain that has that habit automated. It's like, oh, I know where you're going. I will take over from here. I've got this. Like I'm just thinking back to the early days if you had help when you were raising your daughters. If your mom, like that feeling when you're relieved in the

morning, when you've woken up at 4 or 530 and somebody comes to your front door and they're like, I got this. You can go to work. Right. It's that, that's what the Beasel Gangley will do. And the way to do that is to simplify by lowering the entry barrier. So I think one of the biggest mistakes I see is that people say to themselves, I'm going to start doing a 5 a.m. hot yoga class. I was like, all right. Yeah. Yeah, they overcommit. Totally. And I'm like, do you like yoga? No, do you like hot yoga? I like it even less. Do you like getting up at 5 a.m.? No way. So I was like, help me understand how this is going to happen. I am not personally a 5 a.m. hot yoga class. But what I am is a, you know, 11 a.m. cycling person. I might be a 4 p.m. gym person. I might be a 6. So do what's realistic by lowering the

entry barrier. If you're not a morning person, don't do it in the morning. Whatever it is that you're not a person of, don't do that. And what is the, make it too small to fail. Not too big to fill, make it too small to fail. So lowering the entry barrier, doing something with a friend, we have seen studies where you take two people and you say, all right, let's say you're going to climb this incline. They show a person a fictitious incline. Are you capable of doing it? What do you think of this incline? Knowing, even if their friend isn't there, just invoking the idea of doing an incline with a friend, all of a sudden made the incline steep, perceptibly lower and less difficult. So just the knowledge of I'm not alone. I've got somebody with me supporting me, someone who's

got my back, someone who's encouraging me, somebody wants me to win. That is going to make you more likely to take on challenges and to perceive those challenges as being far less. One of the biggest things that happens in anxiety is, or worry, or not being able to start a new habit is that we overestimate the magnitude of the challenge of the problem. Okay. And we underestimate our ability to handle it. And I think that's something that really happens to a lot of women in midlife when you were talking about this switch of someone who can so capable. What's happening and where we're losing self-esteem is that all of a sudden everything seems insurmountable. That. Yeah. I describe it. My patients, you know, it took me years to figure out this pattern. But, you know, these were high performing,

very complicated lives, and they hadn't managed. Like the ups and downs, the normal day-to-day stuff. And then the patients were coming in saying, I don't feel like myself. I feel like the rug's been pulled out from under me. And suddenly these day-to-day tasks become insurmountable for them. And then they get paralyzed. Totally. So how can you reduce the magnitude of the problems, just the perception of it, right?

And then boosting your sense of can. hand-do-ness, your sense of agency. So it's that gap that feels so big. And so there are several ways of doing it is, you know, number one, breaking the task. I remember my dad's a child psychiatrist, and I remember this trick that he would always do with us. And it got old after a while. I got the point after the first time. But, you know, he would take a stack of those number two pencils that we used to fill out our scantron sheets with, right? And he would wrap a rubber band around it. And if I would tell him my problem, he would literally pull out that stack with the wrapper of a brand around. And he's like, take the stack. And I would take the stack. And I took it.

from him and he's like, break it. And I'm like, dad, there's like 12 pencils. What do you want me to break? And then he's like, break it. And I'm like, I can't. And then he's like, I didn't give any rules. Do what you want. And I was like, ah, I get it. You want me to take out one pencil at a time and break one pencil at a time? So just ask yourself, what am I doing right now? Because I do this a lot. I look at a big problem and I'm like, I can't. Because there's 40 steps involved, right? So if your plan is, I want to commit to an exercise, whatever. Forget about figuring out which gym you're going to sign up for. So there's something called, I don't know if you've heard this term, satisfacers, no, maximizers. No. So this has to do with like, okay, I would love it. I have a little quiz in my book, but basically it's asking you, what is your

decision-making style? Are you somebody who likes to do a lot of research and wants to know every little detail about something? Because my mom was like that. Trying to find a car with my family shopping? Impossible. But does this have a moonroof? I'm like, mom, when did you need a moonroof. Are you, like, going to be dancing out of the ceiling? She's like, no, but I just want to make sure that we get a good deal, right? And the horsepower. And I'm like, do you, what do you actually need? My dad, on the other hand, and a lot of men when they shop, they're satisfacers, good enough. And it's like a combination of two words. Like, this is a satisfactory, is sufficient? And it's, it'll get the job done. My dad would go anywhere and just the store, like, that's why the men's

clothing, you know, it's at the front of the store because they go in and they're, they know what they want, and they're done. Is this good enough for now? So if you're trying to walk, forget about the gym, because I'll do this a lot. I'm a maximizer, so I'll try to look for optimized for everything. Oh, it's a membership good. Can I get out of it easily? What's the cancellation policy? And I'm like, girl, just start walking, right? Like, that's free. That doesn't take a lot. So lower the entry barrier, lower the number of decisions that need to be made. Because a big part of habits is this idea of identity formation, like, is this behavior a part of who I am? And the easiest way to do that is just to start acting in a very small way. If you're someone,

let's say you live in an apartment building and climbing stairs is the only activity that you can do in the stairwell of your building. Do it in your home. If it's the five-minute walk, anything that you can automate, even if it is very small and inconsequential to anybody else, just that idea that I walk after meals. That's the big thing I'm hearing is like to the glucose spikes if you want to manage that. The data around a 30-minute walk after dinner is like astounding. Start there, you know, because you will then be the walker in your mind. And that is so important because, again, that identity formation, so when I was talking about that, we want to take it out of the prefrontal cortex, which is, oh, my God, there are 100 steps involved. I got to find out about

the cancellation policy of the gym. And if I go on vacation, you know, all of those micro details, it is too much expenditure. You want to make it in the simpler, more reptilian part of the brain, which is, let's just get this done. There's no thinking involved. And every time you take a step, there's a little bit of dopamine surge. And that dopamine surge says, starts to facilitate and lay down tracks, you know, in the neural pathways so that it becomes automatic. There's no thinking involved. So we do get a little boost of dopamine. People are thinking, I need to wait for motivation to strike me like lightning, right? And what we don't realize is this concept in therapy called behavioral activation. You put the cart before the horse. You know when motivation comes

after you act? Action begets more action. We found that people who exercise regularly have a greater sense of purpose in life and people who have a sense of purpose in life are more likely to exercise. So if you don't feel a sense of purpose today, go for a walk. Go for a 15-minute walk. You're going to come back, energized, you're going to have a sense of agency. I'm a capable person. I get stuff done. What did you do? I went for a walk. That was the most important thing. That's all you did. Yeah. And when I tell this to patients the first time, they laugh at me. They're like, Dr. Rami, you really think. Well, I mean, the mentality is like, what's the point? It's a 15-minute walk. It's not going to any calories and all that, but like, it's not the point. You know, I think we're missing the point

of exercise. Yes, and of agency and making you believe that you're a capable person and making it a part of your identity. Because one thing I should say is there's this whole idea of the default mode network and maybe we can talk about that and that is the ruminating part of the brain. Here's the thing nobody talks about enough in midlife. We become experts at pushing through. The hot flashes, we deal with them. The brain fog? We joke about it. The aching joints, the interrupted sleep, the exhaustion, we power through. And the bladder leaks? Somehow those become something women are just supposed to quietly live with. They stop running, stop jumping. They think twice before workouts, road trips, long walks, or even laughing too hard

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and then she accepts that that's her, you know? Is that an ostrich optimist as well? I mean, they can become that. I mean, to me, that feels like gaslighting, right? Like being told you're fine and you're minimizing and dismissing a person. So that's more like an, I understand that the doctors are well-intentioned. They weren't trained, right? And it's limited, right?

So they're just going off of the knowledge I have. And for some people that can be reassuring to say, okay, at least I know it's not something that's within your domain. These are the five doctors I went to, and there's nothing in their domain that they can fix. Because that's what I would say. But I would tell this woman to not be the ostrich optimist, right? Because you clearly know that there's a disconnect between how you feel and how you want to feel. And that, to me, is where motivation comes in. I don't think women feel like they have permission to want to feel differently than what they're been given. Yes. I'm going to say something which sounds contradictory to what I want to say.

On one hand, I think a sense of acceptance in life is important, right? Like, change what you can and accept what you can't. I remember one of the things that came out of my work with 9-11 survivors was telling somebody, like, you know, just go back to work. And they're like, but the world is not a safe place, you know? And how do you argue with that, right? Like, there could be another attack tomorrow. How do I know? And I realize that as a therapist, like, I also have to create room for acceptance that.

one of the things I learned in my Eastern upbringing is a question to ask yourself when you feel super, super frustrated and you feel like there's nothing else you can do. Ask yourself, is this a problem to be solved or a truth to be accepted? So if you've lost someone, a loved one, and you're grieving, you can't bring them back, right? You can't undo a tragedy or a horrific situation. So in those circumstances, when I say when a person feels completely helpless and they have tried every which way, I think in those moment, sometimes acceptance is useful. But at the same time, that's where the practical optimism comes in. It's like acceptance for now, right? So let's say I've come back from my fifth doctor's appointment and everybody is saying to me, there's nothing. And that's happened to me. I've shared that with you.

Like, I had a problem and doctors are telling me, you're fine. But I knew that something was not fine. But for that day, I was like, I just need to go home and sleep. Right. Like, I have been through a lot. So it's okay to have micro buckets of acceptance, right? In that one day, you've come back from your fifth doctor's appointment, and on one hand, you feel reassured, okay, it's nothing. I'm not dying. I'm not dying. Yeah.

And then on the other hand, you're like, I will come back to this tomorrow, which is, but I'm not and I need to continue my search. So I think a lot of times, for example, with therapy, people dismiss therapy and they're just like, I'm done with it because they had one bad experience or two or three. And I say keep looking, right? Like, it's, keep looking for that provider that can see you, that has the expertise, that is trained, watch videos, get recommendations and referrals from other people,

but don't give up. So yes, there is an element of the ostrich, but I also just feel like this woman is also being gaslit. Yeah, which I guess makes it worse. Yeah. You know, there's a cycle that you describe that I want to make sure we cover clearly for everybody listening.

The woman who cannot follow through on her commitments to herself. And that failure, like, she just, the shame starts, you know, and what society, is telling her she should be doing and God forbid she gets on social media and looks at these unrealistic expectations. How do you break that cycle? So I think first recognizing what that emotion is, which is the shame. Shame is very toxic and you've internalized other people's

values and they're not necessarily even your own. And I was mentioning the idea of the default mode network, which is it's a part of your brain that's active when nothing is happening. When you're just sitting there and you're daydreaming. And it's meant for you to sort of have some introspection and, you know, self-referential thinking, what we call, like thinking about yourself and your habits and awareness of the self. It's what's happening in your brain when you're not doing an activity. But in these negative loops, it can go down and you can start ruminating. And you can say, I'm hopeless, I am helpless. What's wrong with me? I mean, I see it in clinic. And that's the main reason I'm pulling out tissue for patients is

there is so much shame and they feel like failures. Their body's failing them. They're not able to, you know, commit to the nutrition, the exercise, but like also they're struggling in every relationship as well with their children, with their parents, you know, and all of this is being stacked on top of them. Yes. And they keep taking on more and more and they just can't manage it. Yes.

So, you know, it's not something if, especially I think if you've been conditioned to think that you must be a high performer in every aspect of your life. So some of it is these narratives and these scripts that we've been given. You know, I know I grew up with that, you know, like you have to serve everyone else. So it's like you're dismantling and deconstructing an entire worldview, right? And it's collapsing. And it is an opportunity, I think, for a rebirth of sorts to say once something collapses, it's like imagine I would hate for this to happen to anybody, right? But let's say your house just, I mean, that's a tragedy, right? But like, using it as a metaphor, so it, it collapses. And they're like, okay, here's some insurance money to build your dream house.

What do you want to do? We're going to put you up somewhere temporarily. We're reconstructing this house. We're rebuilding it. And I look at therapies and opportunity for that. Like, a person may come to see me because of a job loss, because of a divorce, because of a relationship problem. They come in for one specific problem. But then I say, let's look at the rest of your house. Let's look at the foundation. What is the foundation on which this house, your whole self-esteem, your whole sense of self and character is built on? And self-compassion is not woo-woo. There is so much science behind it. When we look at self-compassion involves saying to yourself, I'm aware of these negative thoughts. I'm just going to be aware of them. No one is saying that they're

true. I'm just going to be aware of all of the negative things I'm saying to myself. then on some level there is going to be a certain amount of acceptance that I think I'm a shitty person. All right, now what? What are you going to do? It's like, imagine you're talking to somebody else. You're like, all right, bring it on. Say what you have to say about me. Once there's a certain amount of acceptance of the negative self-talk, but also a desire to want to rewrite this, you then start to say, you have to say to yourself some form of self-compassionate, like rewriting the scripts. I have been dealt too many cards. I am going through a lot of changes in my body right now. It is not my fault. This is very unfair. I say this to my husband. I'm like,

you're lucky that you get to keep a lot of your testosterone or whatever, you know, like until your God knows how old. Like I have said to him, I feel like this is very unfair to me. Why are the hormones that are not just for reproduction, right? I'm done with that aspect of my life. I have kids, but I need my estrogen and my progesterone to function. I want to functional function at my maximum capacity. I feel like this is the stage when you're in your 40s and your 50s, when you're you have maximum regenerative capacity. They talk about IQ. They talk about empathy. They talk about resilience, worldview. We know that there's a dip in our happiness. There's like a U-shaped curve where 47, they say 48 is the lowest point of that happiness. And it's only going up from there afterwards

because we do an audit. Well, let's go back to that. Hold on, hold on. Where's this from? What the graph? I see this clinically, but I've never heard anybody talk about this is the nadir for women. And that is the age of peak perimenopause. Yeah. So the maximum zone of chaos. So go back to that ground. Yes. So looking at populations and happiness, like, you know, of course it's subjective ratings, but 47, 48 is the lowest point. I mean, when you're younger, you think your whole life is ahead of you, you're in your 20s. And by your 40s, whatever plans that you started out with, sometimes they don't work out. Sometimes the plans that you had, like, I'm going to have this marriage or this children or this job or financially. So some of it is what's happening in

your life outside. And some of it is also the true. changes hormonally, but it's with men and women, right? So it's more than that. It's sort of like midlife, I think you're taking an audit of this house and this foundation. And do I like it? Do I like me? Who am I? We become the sandwich generations. We're not really in touch with our friends. Like, you know, I think about when kids are in college, that's the time high school college when you are in your peers company. And that's the most amount of time you'll ever spend with people your own age. And then it's like when it comes to friendships, it's kind of downhill from there. I hate to say it. And we do know that if you want to look at somebody's health in their 80s,

look at what their friendships and their relationships like or like in their 50s. And that is going to project peak health. And this whole midlife period, I feel like this is such an opportunity for us to revisit all of these values that have been handed to us and reconstruct and rebuild. And there is a rebuilding. So from 47 to 48 from this nadir, the you goes back up because the people that you do take, I don't want to say take back, but that you invite back into your life, you choose. I mean, boundaries. Yeah. Yes.

I've done this exact thing. I was at my absolute lowest, I think, at 47 to 48 and had to rebuild. And now I'm a menopause specialist. And now I have built this incredible life. I've put up boundaries. I've cut people out of my life that did make me happy, you know, and my own family members. And it's okay. And I've given myself permission to.

Stop asking for permission for every single thing that I do. I love that. Do you remember what it was? Was it a single moment or a decision or how did you feel empowered to be like, I'm now living? My brother's deaths. So I have lost three brothers, one when I was nine and he had leukemia. And then in 2015, I lost my brother Bob due to HIV and hepatitis. And then in 2020, I lost my brother Jude.

I'm sorry. and to esophageal cancer, stage four. And those were like watershed. Plus, I was like coming out of the fog of menopause, like taking control back of my life, you know? And I may not get these years. I'm like, you know, so Bob was nine years older than me, and I just turned 57 and will outlive both of them.

So all three of my brothers. So this is the year. And I was on a mountain in Norway hiking with my husband and two of our closest friends, on my birthday. And I remember climbing up this mountain and being like, this is the year. Wow. This is it. And like, look at where I'm at. Look at where I am versus 10 years ago. I built a huge community. I've, you know, conquered this social media thing. I've, you know, practicing the medicine. I was born to practice. And I made up the rules myself, you know, and wow, built a company, you know, after age 50. It was just like this incredible moment for me. Totally. That's so beautiful. You took the time. to, like they say, like enjoying the view, like at that moment, to be able to take in a perspective and also gratitude that like...

I have my therapist, you know, which I got way too late, but I have learned gratitude to practice gratitude and like get up in the morning. It's what I do first thing. It's like, what am I grateful for today? I used to write it down and I can do it in my head. And it's usually the same thing every day that I have a job that I love. I don't feel trapped. I don't feel stuck in my life that I have a beautiful family. My kids are healthy and thriving. You know, I have a 33-year relationship that's still thriving. I have, you know, financially stable. Thank God. I'm healthy. I'm healthier than I've ever been in my whole life. And the beautiful thing is like you, you built it, right? So like I always struggle with this idea of gratitude in the sense that like, okay, I can be

grateful. People gave you things. Yeah. But it's like if you built this, you can still be grateful, right? you can, because you have the means, the resources, the mental wherewithal, the emotional capacity to create the life and the support, that combination. So it's like very much something that you created, you envisioned, but you can still be grateful for it. Yeah. Oh, I totally am. I know it can be taken away. My health could go. My family's health could go. You know, we've lived through that. And so I'm just, I'm grateful for what I have today. But it's interesting. For the listeners, I'm thinking about trauma and tragedy, right? And that, when I asked you, how do you, how how are you so happy, right? And how have you built and how did you give yourself permission?

I think it's helpful for people to hear that sometimes it comes from the darkest moments and that you build a new foundation. I totally did. I'd never thought about it that way. But yeah, I was like, I'm giving a gift that they weren't given. I'm getting lives years that my brother's never had. What am I going to do with that? And it just becomes so easy to start cutting away the things that don't matter are making me a better. person and really putting myself first, taking care of my own needs, and so that I can be a better support to the life that I built. I mean, there's a big reframe, right? Like, I think when you, what you're talking about, what you've asked me before is there's a lot of, like, victim mentality, like, in terms of

how do I, how do I not get in my own way? I think one of the things that happens in pessimism, so this is built on the work of Dr. Martin Seligman, positive psychologist, and he said that when we're, when we're bathing in pessimism, we tend to take things personally. He calls them the three Ps, right? And we think that the negative thing is pervasive. It's in all aspects of our life. And we think that it's certainly get caught in that trap. And we think that it's permanent. And I added a fourth P, which is that all of that makes us passive. So the bad things that are happening in my life are my fault. They're never going to go away. And it sucks all around. How do we break that cycle? Because I get trapped there and I have a panic attack.

Yeah. So one thing I say is I talk about this in the pillar of emotional processing. It's a four-step plan. So whether it's a big problem, whether it's a small problem, first identify the trigger. We know time and time again that people that are more granular about the problems in their life that can very specifically pinpoint to the shift in their day. This was the incident that pissed me off. This was the antecedent. This was the trigger. So I call it name it. Name the problem. Name the indecedent. claim it. Where in the body are you experiencing this? Because for a lot of us, we're holding tension in our jaws, in our shoulders, insomnia, and our bellies. So name it, claim it, tame it. So this is where, you know, the actionable items of what helps self-soothe you. And I think a lot of us as adults, when we were kids, we would suck our thumb, we would cry. What is your self-soothing go-to technique? Right? For some people, for me, it's like, I call them Oasis moments, 60 minutes. 60 second meditations. If you can do five minutes, great. But, you know, I had to learn this like on our 36-hour shifts in the hospital in a utility closet, not sexy, not glamorous. Now I call it a

little Zen den. It's like a pillow on the floor. But where can you just in your car? Before you get home, don't enter the house before to the chaos of the rest of your life and the rest of your day and your family without giving yourself 60 seconds to do a deep breathing exercise. Progressive muscle relaxation. It's like tensing and releasing muscle group by muscle group. So what's happening in the brain when you do that? So you're basically allowing for vagal parasympathetic flow. And there was a book written in the I think 70s called the relaxation response. And I feel like there's so many different roads that can help like basically dampening the sympathetic fight or flight noropenephrine.

Our bodies are constantly in feelings of threat. And I don't know why I can definitely see in the peripenopal. phase I'm going through, I'm on edge, and I can't even tell you why. I don't know what the threat is, right? There's no bear coming after me, right? Like, I'm not in school and I'll sometimes have dreams that I've missed the bus or there's an exam. We carry the certain sense of, like, and also surveillance and self surveillance, right? Like, we start to internalize this idea. So when people, when we feel like we're being watched and people don't realize this, it's something I'm thinking about and writing about now is this concept of open kitchen plan. And then now we have an open plan in our office.

So this idea that we're going to be productive, and it all comes from, it's really funny. It was meant as a prison design where the prison guards are watching you, and they could be watching you. Maybe they are, maybe they're not. But the idea is that you're going to internalize this surveillance, and then you're just going to act and do the right thing because you feel like you're being watched. And I think that's what's happening to a lot of women, because of social media, because a lot of us have our brands online. But even if we're meeting up with friends for brunch, oh, what's the cute outfit? So we're on and we're presenting and we're performing.

and I'm frankly sick of it. And also I think when you get older, like there's, you know, that there's a concept of the fomo fear of missing out, but then there's also Jomo, you know, and like the joy of missing out. And it's like reclaiming back your time. If you get invited to an event, like I remember one time being on a show, it was with Kelly and Mark, Kelly Rippa, and I remember her, we were talking about friendships and, you know, not saying no to the invitation. And she made a joke. She's like, I love to say no to the invitation. I want to stay home and do nothing. And I remember not quite, I mean, this was a few years ago, and I like, didn't, quite get it. And now I'm like, I get it now. I understand when you're so overworked and exposed

and talking all the time, all you want to do is just, I don't know, be home in your, like, I don't know about you, but like, well, now, I mean, last year was my year of yes. You know, menopause was, I was writing this incredible wave. I was saying yes to every invitation, every talk, every, we started the podcast, like, and then by the end of the year, I was completely burned out. I had gotten multiple back-to-back viral infections. I had pulled my back with a heavy suitcase. and that was taking a long time to heal. I was just exhausted. And I remember waking up here in New York

in the hotel at 4 in the morning and just being like, I can't. I can't do this. And having come to Jesus with my team of like I have pushed myself too far, we really need to cut back. And like 2026 is my year of no. Absolutely not.

If it doesn't, you know, if it's not a hell yes, like a hell yes, it's a no for us. And it's been amazing. Yes. I like to stay home. There's something so beautiful in reclaiming. your time. And I think for me, the through line with this, our conversation is so much about

agency. And I love what you said about giving yourself permission to not need permission, right? And it's building that foundation. My whole career, I've asked someone permission to do anything. May I see this patient? May I ask for promotion? May I, you know, and just being my own boss has been fantastic. I love that. You know, the last step of, though, I said name it, claim it, tame it. And the last step is reframe it, which is how can I look at this, whether it's finding the silver lining. And sometimes you're not going to be able to reframe. Like, and I said, in those cases, if something so horrific and tragic has happened, you ask yourself, is this a problem to be solved or a truth to be accepted? So that's really important. And not everything, because we talked about

toxic positivity, you can't put a positive spin on everything. But, you know, I'm just thinking about what you're sharing. And I think everyone will have their version of it, like even if they're not, you know, fabulous like you, like doing like me, like, you know, companies and, you know, podcasts and Oprah specials and like all sorts of, but they have their version of, I have, I broke, I have too much, right? And looking at that moment as the reframe, you can look at it as, holy shit, like I'm broken or you could say this is an opportunity for me to do an inventory and an audit of what brings me pure joy and pure pleasure. And I feel like that's kind of where I am right now, where I want to keep my focus and my interest very narrow. I want to focus on

building muscle. How much do you think of that as menopause? You know, like your ability, your realization of the need to have to do this is tied to what's going on hormonally. I think a big part of it. I think, you know, I remember my mom had once said to me that she called it the wisdom of menopause because, you know, she... Your mom talked about menopause. Yeah, believe it or not. But was she a doctor too? No. She was a PhD in special education, but like nobody talked about menopause. Like it was not a thing. Oh, my mother. It was a dark closet. she went and hid in, you know, and they gave her drugs.

It was funny because when we met, we met at a, well, breakfast. Yeah. Conference where Oprah was speaking. And I remember watching Oprah with my mom as a kid. And she had some special, maybe like one or two about how, you know, menopause cracks. You know, my mom had a heart attack. And I think at that on the table, she had anesthesia. And she was not at all one of these people who believes in visions or superstition or anything

like that, very, like, scientific and fact-based. But she was like, that surgery changed. She's like, I came back a different person. And it was at menopause, right? Like when women are dismissed, it's not, women don't die of heart disease. Women don't get heart disease. This is reflux. So she was minimized and dismissed and had like 90% blockage in her LAD, quadruple bypass, came vegetarian, non-smoker, yoga, no like risks other than being South Asian. We've later found out that South Asian women have small coronary arteries, but still. So just the typical being dismissed by the medical system. And she said that it allowed me, whether it was the heart attack, whether it was

menopause, they all happened at the same time, an opportunity to see that I don't have to live by other people's rules. The wisdom. She called it the wisdom of menopause. And but I don't, we didn't talk much more about it, but I just do know that she went through a transition where her eyes were open. You know, she was very hyper-educated for her age and time. And my father and her very both supported each other. They were advocates with child mental health, with women, women's rights. She worked with the first and second prime minister of India to create this model school that started in her nursery, in her living room from a nursery school to four acres, 1,500 students over two campuses. And she just said, I always would do what was expected of me, the obedient,

judyful daughter, helping her parents flying back to India back and forth to take care of them, us, my dad being an obedient, wife, submissive, but at the same time, a very powerful woman. And I saw my parents really support each other. But I do know that, at the end of the day, she played a very, like a deferential role in almost to her detriment with her health. So it makes me think of all the things that my dad is a superager. He walks five miles a day, Peloton waits. And my mom could have done things differently, I think, if she had prioritized muscle health, metabolic health. So I learned from both of them, and I do think that something happens in midlife where you all of a sudden realize,

I don't, I'm not immortal. And that sounds so silly, but I think when you're 20 or 30, it's not on your mind. I'm literally trying to teach my daughter these lessons, daughters, and it's really hard for them to hear it because they're 25 and 22, you know, and hopefully they'll hear it better in their 30s. But this mortality thing, I'm seeing that with my patients. If they are, they come in for the fires of menopause, right? Like the hot flashes, you know, we give them back their resilience.

And then they're like, keep me out of a nursing home. I don't want to be a burden on my children. I want to live independently as long as possible because we're watching the way our parents are aging in general, not all, of course, but like the women tend to have a very poor quality of life for those last 10 years versus the men. And I'm like, that's systemic.

That is not a, that doesn't have to happen. And so I love being able to counsel patients around that. And like you were saying, like the shift of, oh, I should probably be looking at my muscle mask. What is my bone density? Like, what is my cholesterol? What's my LP LLA? You know, what are my risk factors here?

Because medically, we were, women don't have heart attacks. Women, da, da, da, turns out the number one killer of women is heart disease. Yes. And that feeling of like, I think midlife, what is my purpose now? I'm seeing a lot of women, friends who are early 50s and they are living their best life. Like, I love that. I love that. And so I feel like, you know, you know what's really interesting?

Your viewpoint on aging determines your lifespan. What do you mean by the? that. So people who have a positive view of aging on average are living five to seven years longer. And I'm going to check the stats and get back to you on that. But people, when they looked at them, like, do you think that aging is a good thing as opposed to, are you scared of it? Are you afraid that you're going to be a shriveled old person? People who say, I'm looking forward to it. So even just, like, this is where the optimism comes in is having, optimism really is just positive life expectation, right? That I do believe that the best outcome is going to be possible.

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What about the woman who goes to her doctor? And they say you're depressed, you're anxious. Okay, here's your medication, here's your SSRI, which is what I was trained to do, right? I didn't know anything about therapy or, you know, not a psychiatrist. She gets her medication. It's working okay. And then it stops working. And that happens a lot in perimenopause. You know, you develop a mental health issue. You become medicated and then the hormone changes. What should, you know, they go back to the doctor and they're like, add a second medication or increase the dose. But should she be doing something different? Like what can she do for herself?

So first thing is when a patient comes to see me, always ask them to get labs or if they have labs from their primary care doctor. And what I'm looking at is vitamin D level, which all of us are deficient. are living in the northern hemisphere, even if we are darker. 80% of my patients. Yep. And I have patients who are vitamin Ds in the 20s or 30s or that may be normal, but it's low. Vitamin B12. So many of my patients are low in vitamin B12, or it might be right on the cusp.

And their doctors will be like, it's fine, it's normal. But we know that neuropsychiatric symptoms, you can get jitteriness, anxiety, insomnia, depression, low motivation, all from even low normal, right? So if there's any room, you know, and pushing your primary care doctor, and sometimes I'll have to get on the phone to say, listen, I understand it's at the cost, but I do think would it be worth it, whether it's like oral supplementation or if they're able to get monthly injections, I do see a big difference with the jitteriness and the mood. And I think for a lot of women, those are their symptoms. Okay, so vitamin D, B12, B12, thyroid. So TSA, T3, 24, and also CBC,

a lot of women have anemia, and they may have low ferretin for any number of reasons. And, like, even diabetes, chronic diabetes, cholesterol. a lot of the medications that they're on so beta blockers can cause depression. So just getting a full profile of the labs, the medications that they're on, side effects of it, anything like people who have untreated or undiagnosed ADHD, I see a lot of women midlife for the first time or realizing, oh, that's what that was my entire life. I thought it was brain fog for whatever. And sometimes a low dose stimulant could be helpful. Sometimes a low dose stimulant could be making them more anxious. So really just getting a full sense. So I do think that getting the labs check plus asking, you know,

a lot of times people are only getting medications from a primary care doctor, but they're not also in therapy. Okay. And so therapy to me, even if it is six weeks, eight weeks, a short course, we find that even one brief psychotherapy intervention can be really helpful, but obviously six to eight weeks of cognitive behavioral therapy. And I went through this myself, and I found this so helpful when I was in training, we were told, oh, everybody should go to therapy.

And I'm like, okay, with what time and what money? I was working at five different hospitals in New York City and 100 hours a week. And therapy in Manhattan, nobody takes insurance, super expensive, right? So it wasn't until I had my own mini breakdown of sorts that I ended up seeing a therapist. Same. And it was a professor who had given a talk. And I had this vision in my head of therapies Freudian. You have to be on a couch.

Half the time the older male therapists are falling asleep on you and not listening and not paying attention. And you're a psychiatrist. Yes. And this is what you're talking. Yes. And because that was a lot of like the cycle. analytically trained and nothing against her. There's some, there are different modalities of therapy and to each their own and you have to go to what speaks to you. But we ended up having a lecture like I, this was like one of the

lowest points in my life. My mom was diagnosed with stage three breast cancer because of her heart disease. Nobody wanted to give her chemootoxicity and give her heart failure. So I was like, oh my God, she's going to die. Breast cancer is treatable, except she can't get any of the treatments. And I'm already working 100 hours a week and then I'm thinking, oh my God, she's going to die, right? And I'm going to five different doctors and trying to find her someone that's going to treat her. And in the midst of all of this, my legs give out. I can't walk. And there's nobody who can explain. I went to see the best neurologist. They're doing EMGs. They're like, you're totally fine. And I was like, but I'm not fine, right? And that felt like just dismissive, like, go figure it out. And I was like, how exactly am I

supposed to be figuring out, right? I'm not sleeping at all. And I was doing very well in residency. And then we had this professor give us a talk on cognitive behavioral therapy. And he's like, it's short term. It's time limited. It's very action oriented, problem, solution focused. And eight to 10 weeks, it changes your life. And I literally was like, sign me up. I'm like, give me a referral today. And it did change my life because it put me in the driver's seat as opposed to bad things happening. I'm always, I feel one step ahead, right? It doesn't mean that I live life, you know, carefree, not at all.

But what it taught me was number one, cognitive restructuring, which is really important. What we did was naming the antecedent. And then keep... What's an antecedent? So like the trigger. Like, so in my case, it's, oh, my God, I got this, you know, diagnosis on my mom and she's going to die. Right? So that all of a sudden, it's your thought, the antecedent.

The thought is she's going to die. I'm going to fall apart. I want her to meet my, you know, walk me down the aisle and see her grandkids. And, you know, I'm in my 20, so I'm not married yet. And all of these future projections that I'm catastrophizing. And then you're writing down, what are all the things that you're doing, which is I'm jumping to conclusions that she's not going to find a doctor. I'm fortune telling. I'm writing, I'm projecting all of my worries and fears.

I mean, the list just could go on of, and these are things that we all do. There's like 18 or 19, what we call cognitive distortions, mind reading. We assume we know what someone else is thinking, jumping to conclusions, right, fortune telling, dismissing the positives. And so that was a big one, right? When we, it's called negative filtering. You're looking at everything through this one negative lens. And you're minimizing or what we call discounting the positives, which is, I am a doctor. I am connected. I know a lot of people. I can get her help, right? So in those moments, we overestimate the magnitude of our problems. She's going to die versus is underestimating the agency and the control and the power we did have, which is eventually

problem solving, okay, this is where we switch from unproductive worry. So when you're talking about the patient that comes in, what else can we give her tools? We want to give her tools. It's not just sending her with a necessary prescription, which is very helpful. I do think that antidepressants, when you do a thorough behavioral health assessment, is this person depressed? It's not hormonal. Okay, can you send them, can you get them a referral to somebody as wise as you are, right, in their area. Can we rule out labs, but also let's get them skills so that they feel agency again? Because even if it is hormonal, even if they are dealing with vitamin deficiencies, how can we strengthen and beef up their own internal system so that they can respond to the challenge

ahead? So the unproductive worry would be somebody spiraling and being like, I can't do anything. Five people said they can't help her. She's doomed, I'm doomed. We're fucked, right? Like, sorry. Or moving from unproductive worry, which is like, like your car stuck in the mud, wheels are spinning, there's no translation, rocking chair. There's movement, but there's no acceleration. And then productive worry is, now what? Who am I going to call? And eventually we found a doctor who, a lovely oncologist who's like, I'm going to help her.

I'm going to reduce the dose instead of this treatment. I'm going to give her like the smallest amount and let's see and I'm going to monitor her very, very carefully. So the problem is that most people give up before they get to the solution because they end up getting paralyzed by it. So I would say if I'm working with someone, I want to give them tools, because the tools that you get in therapy, they stay with you for life. The medications, once you're off them, you're right back to where you began. So they have an important role in that for a lot of people who are like, I'm so depressed, I can't get out of bed. I'm so depressed, I don't even want to see you doctor in your office. I don't, I don't even want to get on Zoom to

talk to you. So I say that kind of person who is not feeling a sense of meaning in their life, they have lost a sense of purpose. They have lost joy and pleasure in the things that they want used to love, that's called anhedonia. That to me is the hallmark of depression. If you told me, I love swimming, I love golfing, I love playing mashong, I love traveling with my husband, I love going out to dinner, I love getting dressed up. I don't do any of those things anymore. I can just tell you right there that's depression, right? Like, and you need skills. And this is called putting the cart before the horse, where we know, like, when a person is depressed, they don't want to go to a party, they don't want to see a friend. But we do know that once they see that friend,

that it is so rewarding for them that it is like, it's a form of an antidepressant. So I talk about this in like the four Ms of mental health. But putting the card before the horse, pushing yourself to do something before you feel ready, populating your calendar with activities that bring you pleasure and meaning and joy. So looking at your schedule for the week and putting those fun things in there. I think fun has always been the thing that I put last, always. Always. Like family, friends, health, patients, work probably.

first and then everything else, right? But scheduling in joy as if your life depends on it, because it does. Talk to me about the four M's. Yeah. So if I had to tell someone in less than five minutes, I was in a situation where it was the height of the pandemic. It was April 2020, and New York City had reached its peak death toll. And I get a call that Global Citizen is doing a program. And it's going to be a one-night live stream with all these famous Elton John and, you know, I don't know, Oprah and all sorts of J-Lo performance. like a benefit concert. And I was like, great, I'll be watching. And they're like, no, we want you on the show. And I was like, I don't sing and I don't dance and nor do you want to see that, right?

Rolling Stones. Like, you know, like one of those big performance benefits. And they're like, no, we want you to talk about mental health. And I was like, oh, like what specifically? And they're like, we want you to give people tools and calm them down and like, you know, the whole world is scared and broken right now. And I was like, great. How long do we have like an hour? And they're like, no, you have 59 seconds. And I just started laughing. I was like, I'm supposed to give you hope and motivation and a toolkit in 59 seconds. So I called my dad, psychiatrist. And I was like, dad, what do you talk about in 59 seconds?

He's like, it's okay. He'll only take some minute to save somebody's life. And then he hangs up. And I was like, I was like, Yoda, where's the wisdom? I need some practical, tangible tips from my own anxiety here, right? But then I thought about what if I had to prescribe somebody in less than a minute, something that is evidence-based, that is science-backed, that could save their life, that I prescribe to my patients, that I do myself, that I see in my dad this super healthy, super happy,

optimistic, super ageer. What are we doing every day? And I remember that years ago when we had those old school prescription pads, I used to write on them for my patients a prescription. Yeah. And they would be like, they would laugh at me. They were like, I was hoping you would fill my lorazepam, my benzodiazepine, where is my medication? And I would say, this is your medication. And I would write four things, right? And I was like, okay, I need to make it simpler. So I, for the purposes of this talk, I said, okay, we're going to talk movement, mindfulness, meaningful engagement, and mastery. And there's so many more things, sleep, diet.

I don't want to say that these are the only four habits. But these are the four habits that in and of themselves are good mental health, but then they beget any kind of new project that you want to start. This will help you do that. So when it comes to mastery, I say you don't have to be a master at something, but you have to do something that helps put your brain in a flow state. And in that flow state, it's this your neuroepinephrine goes up, which helps you super focused, super concentrated, it improves your mood. And it's this delicate balance between an activity being challenging enough to sustain

singular focus and concentration. And the beauty of that is it shuts out the default mode network. That is the part of the brain that is ruminating and you're not good enough and self-sabotage. So that is how you drown out those negative voices, as focus on something, tentapeutic. 15 minutes a day and then do more of it. That really helps you be in the zone. Pottery, golfing, yoga, whatever it might be, something that you want to get better at. It's challenging enough to keep you focused, but not enough where you get frustrated. So you don't want to get bored and you don't want to get frustrated. So it's this perfect, like it's like a U-shaped curve, like, I'm sorry, inverted U-shape where this at the peak of the height of this inverted U-shape is perfect.

It's, it's, it's, yeah, you're in the moment. So that's mastery. Take up something. And, you know, I do talks to a lot with a lot of young people, like I'll go to high schools and and they'll have a keynote presentation about mental health and practical optimism. And one of the things I'm hearing a lot is teens don't have any time to do anything fun for themselves. They say everything I'm doing is for this college purposes. So doing something that has no benefit to social media, you're not showing off to anyone. It is just for yourself. If you want to post your whatever pie that you made, if that's your thing, do it later.

But that's not why you're doing it. You're doing it for yourself for no other reason just to get better at something. Language is learning language, dancing. We know that there's so much health benefits. and neuroplasticity with dancing and living longer. So mastery, movement, we can, that's a whole other thing, but 10 minutes, lower the entry barrier, keep your sneakers next to you bed, keep your gym clothes next to your back, keep that water bottle filled. I have a separate gym bag where I have a separate set of keys just so I don't forget, like any little thing, a separate set of AirPods, whatever it is.

That will sabotage you. Yeah. So 10 minutes, you have weights and a yoga mat by your bed, strength training. We know you've talked a lot about that. Please invest in your muscle. health. That is the organ of longevity and meaningful engagement. This is by far my favorite pillar. I love talking to people, as you can tell, and connecting with people on a deep and meaningful level. But one of the things that gets scary for a lot of people is I don't have time, right? And I want to connect, but I don't have time. I think of there's micro connections where you can connect with somebody. You're standing talking to the barista, someone walking a dog, a neighbor, a bus driver, a dormant. These are micro connections.

They don't have to be your best friends. You don't have to ever see them again. But think about when you move throughout your day, can you schedule a 10 or 15 minute buffer in your day so that you allow yourself to have these small moments. You're online. You're talking to someone. So anything from micro connections, which are small built in moments of connections, what's random strangers to activity partners.

Don't minimize the person you get to go to yoga with, right? Or that you see them every day or at a class. Like that has value overall. It doesn't have to be the deep and meaningful conversations. But that is really important. Having at least one or two authentic places in your life where the mask comes off, that mask of performance, we don't have to impress this person. And I call this concept, one of the things that I'm thinking about a lot is how we are expected to perform all the time and be visible all the time. These are areas where you can be held.

And I say, as a society, we're seen, but we're not held. we don't have areas and protected spaces and places where we're not expected to be impressive or on or have our hair and makeup done. I don't know about you, but like... Well, my life has gotten more like that. You know, in this new iteration of Mary Claire is I'm performing a lot more than I used to. Yes. And that's exhausting. It is exhausting. And it takes up so much of like that executive functioning in the prefrontal cortex of having to be on. I was telling my husband, I'm like, you and my dad last night. I was like, I came. from a TV interview and I was saying you don't understand how hard it is to be a woman when

you have so much knowledge and information to give. It's not the depth. The number one question I get asked is, what was your lipstick color? I was like, I'm talking about suicide. Why are you looking at my lipstick? Or did you get your pants? Yeah, exactly. Yeah. So meaningful engagement is be vulnerable, be authentic. Schedule an eight minute phone call. You know, like this was something that came from the New York Times and I loved this idea of like they had like a friend challenge and I was interviewed for an energy challenge and then someone else did a friend challenge that week in January, 2024. And I love the person who had offered this advice, which is in eight minutes, just pick up a call. You're on your way home. You're on your commute if it's safe enough.

But that's how you create connection. You're stuck at the airport. Call a friend. So be very intentional about scheduling those connections in person as much as possible. Go to a place where you can drop the mask in the hat. But don't forget activity partners and microconnections because those are like the social snacking as well. And then the mindfulness, this, find your Zendan, create a Zendan in your home. It could be a pillow and a blanket on the floor. It could be a yoga mat. But it's a place that you designate in your home in your life. It could be in your car, but 60 seconds of deep breathing two to three times a day. It just creates these islands of, this is my space, reclaiming space and reconnecting to your

breath. And it also is lowering your heart rate and lowering the cortisol, lowering the norapinephrine that is constantly in the fight or flight mode. Welcome back to another midi pause. I'm Dr. Dr. Mary Claire Haver, host of Unpaused. Today we're talking about something that deserves far more open, honest conversation, sex and menopause. Sex is a cornerstone of intimacy and connection, but as life changes through stress, childbirth, aging, and menopause, so does our relationship with it. Somewhere along the way, there's been this narrative that menopause signals the end of a woman's sexuality, and that couldn't be further from the truth. What it can say,

signal, though, is change. Hormones shift, and that can come with things like lower libido, discomfort, or just feeling off in your own body. Most clinicians were never taught how to evaluate libido, arousal, orgasm, or sexual pain. OBGYN training focused on pregnancy, surgery, and cancer screening. Sexual medicine was not part of the curriculum, and still largely is not. So when women are are dismissed, redirected to therapy alone, or told everything looked normal, it was not because their symptoms were imaginary. It was because the system failed to train clinicians to recognize and treat sexual dysfunction. Women internalized that failure. They assumed it was just aging, just stress, just marriage, just something to endure quietly. It is not. And here's what makes

this even more challenging. So many women are experiencing these changes, yet too few are offered real education, validation, or solutions. That's where platforms like Midi Health come in. Midi connects women with clinicians who specialize in midlife health, including menopause and sexual wellness. Instead of having symptoms brushed off or feeling dismissed, women can access personalized science-backed care, whether that include hormone therapy, non-hormonal options, or simply working with someone who truly listens. Midi Health is built specifically to address the gaps in midlife care. It brings together clinicians with expertise in menopause and related health concerns, offering virtual care that is accessible, evidence-based, and centered on real patient

experiences. Because this is not just about sex. It's about quality of life. It's about confidence, connection, and feeling at home in your body. If you are struggling with low libido, painful sex, or other concerns, know that help is available, explore treatment options, and most importantly, give yourself grace. Intimacy is about more than just sex. It is about connection, pleasure, and feeling alive in your own skin. Menopause is not the end of anything. It is a transition. And with the right support, it can be a really empowering one.

Go to join midi.com. Join M-I-D-I-com and connect with one of their clinicians today. A lot of my patients are really struggling with sleep. And, you know, if it's hot flashes and especially the wake-ups, you know, a lot of them, you know, if they're not lifelong anxiety and and struggling to go to sleep, you know, hormones go do a lot for those patients. But what I'm seeing even with adequate hormone therapy is these middle of the night wake-ups, you know, and we look, is she have to get up to pee, then we talk about restricting fluids and stuff, or if that's being caused by an overactive bladder, you know, we can medicate that.

But so everything's perfect, and she's not anxious when she goes to bed. She falls right asleep, but she's waking up. And this doesn't get better postmenopause. It starts in perimenopause and then kind of keeps. going, what do you think is happening? Like if she wakes up and can't, you know, there's an anxiety loop that starts, you know, yes. Like, how can we help her? So first, just the knowledge that it is normal that the 3 a.m. wake up is happening for any number of reasons. Cortisol is trying to get in action again in anticipation of the morning, melatonin in this stage of our lives for all people

in general, but women especially is going down. So it's expected that you will wake up. But if you don't tie a negative association with it that I am doomed because there's always anxiety, but then there's anxiety about the anxiety or the anticipatory anxiety. We call this metacognition thoughts about your thoughts. Don't label it as anything more. This happens to me a lot when I'll wake up and then I'm aware of the time, but here's the thing is don't be aware of the time. I think the biggest thing that we do is we first look at our... 37. Yeah. That's the time. It's like the witching hour, you know, And so we look at the time. We're aware of it. But where are we looking at the time? We're looking at it on our phone because most of us don't have analog. A clock radio anymore. Yeah. And that's a problem because then you say to yourself, oh, I'm just going to scroll. I'm just going to check my messages. Did somebody email me or call me or whatever? And we do it as a form of distraction or we think that we're hatching up because we always want to be in the know what's happening in the world at this moment. And there's so many problems happening right there. Number one, you're getting activated just by knowing, by simply being aware of the time, that's already activated. Then you have the blue light that's happening. Then you have the messages and the unfinished business loop. So that's

really big. For a lot of women, our brains, I think it's a normal thing, but I think I see this a lot in high achievers, the desire to close the loop. I don't know about you, but I don't like unfinished business. I don't like if I have emails or if they're messages or people that are waiting, that sense of urgency of putting other people's needs, right? That feels uncomfortable to me because I feel like I need to close the loop on that. So do not introduce other people's problems into your own life. Do not introduce them. Do not invite them when you wake up at 3 a.m. So when you get out of bed, the whole thing with CBT and insomnia is supposed to be the gold standard is that when, if after 20 minutes you're not, you're not able to fall back asleep, you're supposed to get out of bed.

And you're supposed to do something extremely passive and extremely boring. So have a wonderful history book that if you're assuming you're not interested, because I find history interesting. But if you don't, find some subject that is either soothing or passive or boring or calming for some people may be folding laundry, right? But it should be in a dark, cool area, get out into the living room, sit for 20 minutes, but do not look at your phone. You will not be going back to sleep, I can guarantee you. It'll be two hours before you'll realize it.

Someone on social media, this is a topic of conversation quite a bit on my social. And this woman commented one time, and it just made so much sense to me. She said, like, just imagine you're a cave person. and you're just going to throw another log on the fire. Like, it's your turn. Like, you woke up. You're going to go take care of, you know, and you're meant to do this.

And you're, it's part of your life. And you're going to throw a log on the fire. And then go back to bed. Check on. You know, you're checking on the other cave people. Everybody's okay. Everybody's asleep. And then you go lay back down.

You know, it's reframing it as, you know, I was anxious about being anxious. You know, I was like, oh, my God, I'm up. I'm up. I can't believe I'm up again and I have to doda-da-da-da-da-da. And like, oh, it's my ancestor, or waking up to go take care of the fire that needs to keep going on night. It and we freeze to death. And it's her turn. Yes. Yes. I love that normalizing it.

Yeah. And I'll just go back to bed and it'll be fine. Yes. It'll be fine. I love the, because you're reframing it and I love the simplicity is it'll be fine because the minute you say to yourself, I've done this before, right? Like I have been able to fall asleep before and I have functioned the next day on little sleep because that's the biggest thing I think people are thinking how am I going to get through the next day? And I would say keep your routine wake time, even if you you had trouble falling back asleep because I think a couple of things end up happening. Sometimes if a person has the luxury of sleeping in, if they didn't sleep well, they will. And then that destroys their sleep architecture for the next day. And then limiting the number of naps. If you

still keep to that whatever wake time you have, the next night you are passing out and most likely not waking up at 3 a.m. So I'm finding a lot of women in midlife are struggling with loneliness. The ties that bound them while their kids were younger, the friend groups, the families, people start going through divorce and, you know, those kind of friendships are breaking up, kids are growing up, moving away, and the things that kind of kept you together in your friend groups, and my husband and I are seeing this, you know, right now in the relationships we kind of built when the kids were younger are now, you know, and I've found myself a little bit lonely sometimes and definitely my patients are seeing it. Can you talk about that? Yes. So, you know, this is kind of peak loneliness when we

would expect it because you don't have those built-in layers. So look at those opportunities. Where's the low-hanging fruit? So that's the first thing I would say, right? Like if you're in a city, like if you're traveling a lot, to be intentional, like I have a friend who does a lot of speaking all around the world. And she has her lists of who is living in every city. And she tries to make it a point to say, I'm here. And I think letting people know very clearly what your limitations are and saying, I only, I'm so sorry, but I only have time for a 30-minute catch-up, you know. And I think we create so much extra work for ourselves to be like it needs to be a three-hour dinner, catch-up.

So one thing that I really loved is this idea of catch-up culture, it's not good for us. Catch-up culture says, let's meet once a year, twice a year, and we'll sit down for four hours and you'll tell me everything and word vomit and I'll word vomit on you and then we won't see each other for the next year. Instead, Bill, like kids, have parallel play, right? So I have to do an errand. Would you mind coming with me, right? Like, I've got to go to the post office.

It'll be our time to count. catch up. So build in opportunities where you can do shared activity together or do nothing together, right? So like, why do we have to get dressed up to go to brunch and make it this whole big thing? Come for a walk every root and eyes. Come for a walk 20 minutes with me every Sunday, right? So make these kind of standing things. If you have one Sunday dinner a month that you can say, I'm going to host, we're going to meet at a restaurant to put things on the calendar in advance, planning trips. If you're in that phase of life where you're lucky enough to be able to afford and have the health, we have a stand, we have like a standing ski trip that we take, like we have a couple of standing,

like one is like a couple's trip that just, you know, no kids. One is like a family ski trip with a bunch of other families. So if you can, and we have friends that are like crazy, they'll be planning 12 months in advance and we're like, okay, that's too far. Let's do six months. So I think the number one thing is recognizing that you're lonely. Some people are biologically hardwild to be lonely. That default mode network, that beats yourself up, it also has a tendency to say, you know,

I feel like there's something wrong. But don't beat yourself up. Loneliness is like a biological drive. It's acute just the way hunger is. It's a signal that says, I am lacking in something that is nutritional and that is required for my sustenance, and that is human interaction.

So planning it in the calendar as much as possible. And knowing that it's not going to, it's not going to drop out of the ceiling into your lap. So if I'm traveling and just like, who do I know in this city? Who can I tell them in advance? Let's keep the plans loose. If I find myself having a 30 minute,

right before I go into a talk, do you mind? And most people are so happy that they'll, you'll think it's weird. Like, I'm getting my makeup done. Can you sit next to me? They'll be like, why would I do that? Don't think about that. I would say most people would be so happy to see you. They'd be like, sure, what do you want me to do? Where do you want me to come? Before we wrap up, the sandwich generation, you mentioned a couple of times, but I really think it's hitting us really hard. And this seems to be unique to this generation. What would be your best advice for someone who is absolutely trapped between parents who won't listen? and children who won't listen.

Because you know best. Yeah, that's the best way to put it. Yep. Oh, my God, it's so hard. It's like caring for the caregiver, recognizing that you are a caregiver. I think that people have this vision of caregiver. Caregiver means I'm glued to my 90-year-old mother's bed day and night

and, you know, changing diapers type or pans or adult, whatever. Let's not what caregiving necessarily looks like. It's different for everyone and recognizing that you're in that phase of life where you also get to be a human being. I think the biggest thing and the hardest thing for a lot of women is they hear me saying, so Dr. Farmer, you're saying me first. I'm not saying that. I'm saying me too.

You get to pull up a chair. You get to eat at the table that you're serving other people at, right? Like that metaphor of you're so busy providing. And I'm saying reclaim your own joy and say to yourself, what would it mean if I didn't visit my mom four times this month? What would it look like if I visited her three times? What if I took back one of those times and went to an exercise class and met up with a friend for lunch or for coffee. I think the guilt is kind of the underneath underlying that I should be.

There's this idea of shoulding on ourselves, like something shitting, right? Like I should. Those should statements need to change to, I can, I will, I may, right? Allow yourself variations on that theme of what is reclaiming my own joy, my own time, my own rest look like. And one thing I would say is if you do have siblings, a lot of times people, this idea of like weaponized incompetence, it's not just our partners, right? It's also sometimes our siblings. Oh gosh, yes. And to say, I'm not asking you for help. Let us put down in writing what each person is capable of doing and let's split the load. What are you good at?

Are you good at finances? Are you good at looking at referrals from, you know, for the parents to suggest doctors, you know, can you go to some of the appointments? So I think like looking at big picture and anticipating these end of life conversations that are so hard to have, like talking to your elderly parents, like let's talk. Do you have money put aside? Because that's a big thing that financial drain. The frustration I'm seeing with our friends and my patience is the parents are refusing to have the conversation. And then there's a lot of catastrophizing on the child's part in that when shit hits the fan, they have to drop everything to go tend. You know, and it negatively affects their life.

Yes. And I love and I have so much admiration for people when they're in their 50s and 60s and they're downsizing and they're like, I don't want my child. They're getting rid of this stuff. My husband and I talk about this all the time. Like, we are going to make this so easy for them. I love that, you know. Yeah. Anything that you can, whether it's like talking about even getting like long-term care, even renewing, like every year my dad will say, this is my long-term care insurance, this is my Medicare card, I want you to have this. This is who to call. These are my, like, where the bank is the bank account, like giving somebody step-by-step instructions of what to do. Because in that moment, they're grieving. When your child is losing their parent, you know, the parent is like, I'm not going to be here, not my problem. And I'm like, no, you don't get to do that. And also like, I do this a lot with my patients where they, will tell me about their aging parents and I'll be like, get your parents this vest, you know, this exercise that's get them dumbbells, help them invest, get them physical therapy, get a prescription for being deconditioned and get them head to toe like training, like muscle mass training, resistance, but anything you can do to say, listen, I'm sorry, and have very clear

conversations. Who do you think is going to take care of you? Like let's say your parent is healthy enough to maybe move closer to you or to downsize or whatever. Just say, listen, you live across the country. I just want to understand what was your vision. Where did you want to to go, would you have someone living in your home? Like, were you expecting me to move back home? Like, it's so uncomfortable because I think there's all these implicit, not explicit expectations. Right. And it's not sexy. It's not glamorous. Parents want to think that, oh, my parents, my kids will come, but they have their own lives. So what are you doing to earmark money, care, insurance, end of life plans, advanced directives, health care proxy? What are your goals? Do you want

burial? Do you want cremation? Do you want to be on a ventilator? Feeding tubes? Like, all of it. Like schedule appointments with your parents and then distribute amongst siblings and uncles. And I think it's really important that our parents have community. Like I always tell, ask my dad, like often he'll stay with me. Like my mom passed. So, but he has a really rich and robust friend network. All the friends that he went to med school with, they meet, they travel. He has neighbors.

He goes out of his way to do things for other people. And they're 10 times like able to reciprocate to him. So I think a lot of people become like old crumudgeons and they're just like. Well, I, yeah. You know, I've watched their social network get smaller and smaller and smaller. Yeah. You know, and my mother lost. Once my dad died and three of her kids died, she just never left the house, really, other than to go the doctor.

And then was depending on all of us to, like, you know, one of my brothers live with her. But, you know, it doesn't have to be like that. And so, and I can see the beginning of her loss of independence. And she's got dementia and has fractured multiple bones. It hasn't been walked on her own in over a year. was when she isolated herself. And often there's cognitive decline and like with the dementia, you know,

it's hard to be, you know, I'm just thinking of prevention to me. It's like that whole saying of like an ounce of prevention worth a pound of gold. Totally. That anything you can do, like I'm thinking in my mom, like macrobascular changes, right? Like she had cardiovascular disease

and we think of this as being limited to the heart, but we don't realize the same blood vessels, go down to your toes, go to your head. So later on, I realized while there was no stroke, but micro-infarx, microvascular dementia, not a lot of people think about or know about, so they have more personality changes

that are subtle, that look like depression, that look like you're becoming difficult, you look like you have OCD, you've become more controlling, more rigid, more homebound, bed-bound. And, you know, being that she was such a, like, force of nature personality-wise, nobody could ever argue with her.

So when she started shrinking and becoming isolated, we're like, okay, well, this is just who she is. She doesn't want to go out. She doesn't want to talk to people. And I don't know what we could have done other than now knowing in hindsight that cardiovascular disease is also affects the brain. It changes you. It isolates you.

It makes you depressed. And anything that you can do to get people when they're healthier to get plugged into volunteering. Prevention. Yeah. And I remember when my mom retired, her cardiologist said to her, are you sure you want to do this? He's like, the people who remain at work after the heart attack are the ones that are the healthiest because you're going to become isolated. She's like, no, no, no, I'm going to India.

I'm helping my parents. live there and she did take good care of them. But this idea of you need to have your own purpose. So I feel like midlife finding a new purpose. If it's not for your kids and if it's not for your career, I don't care if your business is profitable or not. If you can afford it, come up with something to do to put your energy because you are your sharpest and your smartest. You have more agency. You have more capacity, more capability at the stage of your life. You are a wealth and treasure of resources. So don't let society make you. feel invisible or less than. Like I really do feel like this is our best years are still ahead.

Yeah. So I please, I tell people, I understand you might be empty nesters, find yourself a hobby or a job that will keep you busy out of the house, at least 20 hours a week. So for our listeners, you know, what are the top three takeaways from practical optimism you want them to understand? So, you know, practical optimism is eight pillars. If I would ask you to do three, I would say the first one is starting with purpose, having a very clear intention. I say to people, write your purpose in pen, but your path in pencil. And what I mean by that is be flexible of how you achieve it. Some people are like, oh, I have to be this. I have young patients where like, I want to be a doctor. And I'm like, and then they try to go to med school and it didn't work out. And I was like, what's underlying?

You want to help people? There's a thousand ways to help people. And it doesn't have to be this. So being flexible when door A doesn't work, try door B, C, D, E, all the way to Z. Right. Don't take no for an answer when you want to accomplish something. So be very clear. intentional about what your purpose is. The second P is processing your emotions. If you don't manage your emotions, your emotions are going to manage you, and they're going to show up in the form of physical illness. I always say that your body expresses what your mind cannot. So your body is going to become the stress manifestation. So your skin, your gut, all of that. So take care of the emotions by naming, claiming, taming, and reframing. And if you can't reframe, I said acceptance. It's huge.

So there's eight, you know, having sense of agency and proficiency and self-compassion, being present, people is one of the pillars. And then the last one is about practicing healthy habits. So taken as a totality, these eight pillars help you go from intention to execution. And practicing healthy habits is really just a stand-in-for, fill-in-the-blank of what you want would accomplish in your life. And in order for you to accomplish it, you have to automate it. Take it out of the work of your frontal lobe, expensive CEO. We're not going to make them scrubbing. toilets. So automated, and you do that by lowering the entry barrier, by having accountability, whether it's in the form of apps, doing things with friends. So those four M's of mental health, movement, mastery, meaningful engagement, and mindfulness, you can do all four going to some sort of a movement class. Go to a movement class with friends and do it every week. All of a sudden, you have mastery. If you're breathing and doing yoga, it's mindfulness, right? So if you take nothing else from this conversation, I would say the four M's of mental health, put them in your phone in the note section and start scheduling them this week. So you have mentioned a worry journal in your

book. Is this something that would be helpful for that? And what is a worry journal? So the idea of a worry journal is you spend about 10 minutes and just start worrying, write all your worries on a piece of paper. And I know you're looking at me. Different than the what I was told to do of everything you're happy about. Yeah. Yeah. Yeah. So you're looking at me like you're crazy. Why? And I know. so my therapist had given me this homework, and that's how I first got onto it. I said, why would I worry? Like, who does that? I'm trying to get away from my worries. I don't need more of them. I already have enough in my head. And she was like, trust me, the idea is that you're taking all of your negative thoughts or worries and you're putting them on paper. So number one, you're getting it out.

And just that act in itself gives you a little bit of like agency. Respect it. Yeah. And it gives you a little bit of control. And then what I realized is studies show that 85% of the time, the things that we worry about, they never actually happen. And then the 15% of the time that they do, we are more in control of the situation than we actually give ourselves credit for. The other thing is that when you start to worry, you realize that there are themes, and it's the same theme over and over and over again. Oh my God, I'm going to make a fool of myself. Oh, my God, no one's going to like me. And that's not the case. And then you get to write in your worry diary what actually happens. I have my patients write it. So if you're like, oh my God, I'm going to ask a girl out

or I'm going to try to make new friends and I'm going to get rejected, I say write down. And the things that you're worrying about, vast majority of time, you don't get rejected. You are able to make a friend. Somebody does go with you on that coffee date. So worry helps you park it out of, take it out of your head and park it on paper. And then I say the next step is that's the worry part. And if you wake up at 3 a.m. and you can't go back to sleep, write a worry journal. But the best thing you can do is schedule a worry sometime in the evening when you have time and do it preemptively.

So you've already gotten right. it's like a cleanse. It's like a toxic cleanse, a free 10-minute toxic cleanse, get everything that you're worried about out on paper. And it's not your responsibility. All right, Dr. Sue Vorma, thank you so much for coming on on pause. Thank you. So great to talk to you. You can find Dr. Vorma on Instagram at Dr. Sue Vorma or through her website, Dr. Suevorma.com. Her book, Practical Optimism, is available wherever you buy books. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire

and get honest and accurate information on health, fitness, and navigating midlife at thepawslife.com. My new book, the new perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode.

While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with pod people.

I'm your host, Dr. Mary Claire Haver.