WEBVTT

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Welcome today . We're going to talk

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about mental health conditions and well

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being . My name is Dr Patel and I'm dr

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german . It's no secret that life is

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complicated . On the one hand , this

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complexity can make our life experience

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rich and meaningful . At the same time ,

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it can present challenges that may

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develop into mental health problems .

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Stress is a universal human experience

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and sometimes it can make us feel stuck .

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Stress impacts how we feel physically

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and emotionally and influences the way

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we think , How we think and feel can

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affect the choices we make and how we

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behave , including how we interact with

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other people and with our environment .

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At times it can seem like these

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physical , emotional , intellectual

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behavioral and environmental factors

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are conspiring against us and the

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harder we try to get unstuck , the more

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difficult and uncomfortable life

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becomes . Fortunately , humans are

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remarkably adaptive and it's in our

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nature to quickly develop coping

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strategies to deal with the

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complexities of life . Often these

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coping strategies are helpful and

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effective , but some strategies are not

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so helpful and may in fact be harmful .

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These are called maladaptive coping

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behaviors . Fortunately we can make

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changes in how we think feel and behave .

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To eliminate the unhelpful strategies

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and establish new methods that work

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well effective coping strategies can

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reverse the downward spiral of

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suffering and build long term

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resilience . This means that there is

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hope for positive change even if

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someone has been coping in unhelpful

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ways for a long time . In this program ,

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you can learn about a number of common

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challenges and mental health conditions ,

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including depressive disorders ,

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anxiety disorders , trauma related

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disorders , life and family stress ,

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attention deficit hyperactivity

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disorder , sleep disorders , addictions

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and personality disorders . We also

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cover mental health issues that are

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specific to military life , such as

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career adjustment transitions ,

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profiles and fitness issues demanding

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work in combat environments and

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military sexual assault . Our

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specialists dr phillips dr Mansfield

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and Mr Willis provide their expertise

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throughout the program . Keep in mind

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there maybe terms that you're not

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familiar with . So please visit our

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glossary at any time and be sure to

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check out the other resources included

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in this program . Thank you for joining

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us .

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Challenging life experiences can evoke

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uncomfortable emotions such as sadness ,

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fear , shame , guilt and anger and

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themselves . These emotions aren't

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usually a problem . In fact , all of

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our emotions can help us recognize

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what's truly important in life .

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However , because these emotions

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involved pain or discomfort , it's not

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uncommon to behave in ways aimed at

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avoiding escaping or numbing these

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experiences . While such behaviors may

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provide short term relief , they

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ultimately tend to deepen suffering ,

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avoidant behaviors often result in

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reduced engagement in life , including

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engagement with those things that make

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life worth living . For this reason ,

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avoidant behaviors tend to worsen the

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very experiences their intended to ease

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the good news is that these challenges

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are absolutely manageable and can be

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overcome with varying degrees of self

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community and medical or psychological

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help . In this section , you can find

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information on the bio psycho social

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model which is a framework for

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understanding well being , the

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development of problems of living and

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the treatment of those problems . We

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also talk about how to seek

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professional help when self help

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strategies are not enough . We discuss

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what to expect if you seek help from a

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mental health professional , and we

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also address how to recognize and

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overcome barriers to seeking care .

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The bio psycho social model is a

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framework for understanding well being ,

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as well as the development and

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treatment of medical and mental health

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conditions . Dr phillips . Can you tell

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us more about this approach ? Of course .

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Dr Patel . The bio psycho social

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approach refers broadly to the many

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biological factors , psychological

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factors and social factors that

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interact to influence our health and

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well being . However many mental health

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professionals use an expanded

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definition to cover five domains

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including physical , cognitive ,

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emotional behavioral and environmental .

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Physical factors have to do with the

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physical state of the body . They can

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include things like genetics and

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internal biochemical processes as well

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as the way illness and injury affect

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the body , the body's response to

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quality of sleep , diet , exercise

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medications , substance use and

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physical abilities and disabilities are

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also physical factors . When we talk

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about cognitive factors were referring

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to thoughts , our minds are constantly

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remembering , judging , interpreting ,

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predicting and filling in the gaps to

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help us understand and respond to

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experiences . Emotional factors have to

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do with feelings or mood behavioral

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factors refer to actions , particularly

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habits or patterns of behavior as well

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as the way we respond to thoughts ,

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emotions , physical sensations and

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events that happen in the world .

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Environmental factors are external to

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our thoughts , feelings and behavior .

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They include interpersonal

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relationships such as friendships ,

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romantic relationships , family

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relationships and relationships with

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coworkers and neighbors . Environmental

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factors also include things like

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culture , finances , access to care ,

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socioeconomic status and situational

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stress . The bio psycho social model

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considers the influence of all these

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factors as well as how these factors

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interact with one another . Well being

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results from the ability to make

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strategic changes in each of the five

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domains to maximize health and

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happiness because a problem in one

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domain can negatively affect each of

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the others . Understanding the factors

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at play and how they interact . Can

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help providers identify the most

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effective treatment for a particular

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problem or condition .

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It's not always easy to know when to

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seek help and where to turn when you're

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ready for help . Dr Mansfield , can you

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give us some advice on when and how to

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seek help for problems of living ? Sure ,

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Dr german , there are a number of

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different reasons A person might seek

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help from a mental health professional .

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Some of those reasons include severe or

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long term stress from a job or family

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situation , the loss of a loved one or

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relationship or other family issues ,

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symptoms with no physical explanation ,

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such as changes in sleep or appetite ,

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low energy , a lack of interest or

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pleasure in activities once enjoyed

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persistent irritability or a sense of

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discouragement or hopelessness that

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won't go away , persistent thoughts of

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self harm or referral by a health care

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provider who suspects a mental health

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condition . It's often a good idea to

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start with a primary care provider who

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can do an initial exam to ensure that

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nothing in a person's overall health

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would explain their symptoms . Primary

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care providers are an excellent first

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step in approaching issues from a bio

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psychosocial perspective , they are

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also able to refer patients to a mental

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health professional they trust if they

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do suspect a serious mental health

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concern , if you haven't been referred

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to a particular kind of mental health

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professional , but believe you might

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benefit from such help , sifting

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through all the available options to

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find the right resource can fill

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overwhelming . There are various types

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of mental health professionals and each

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type has different specialty specific

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training . It's important to look for a

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professional who has the credentials to

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treat your specific condition . Unlike

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medications , which are vetted and

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approved by the US Food and Drug

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Administration psycho therapies aren't

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subject to a formal approval process .

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Instead , those therapies that are

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supported by rigorous research studies

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are designated as evidence based

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therapies because these therapies are

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grounded in the best available science ,

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it's important to find a mental health

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professional who utilizes evidence

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based therapies . Finally , once you've

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identified a mental health professional ,

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you may want to have a preliminary

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conversation to get an idea of how

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treatment will proceed and whether you

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feel comfortable with that provider .

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Many of the topics discussed in therapy

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are quite personal . For this reason ,

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Rapport and trust with your provider

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are extremely important and can have a

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direct impact on how well you respond

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to treatment .

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Mental health professionals provide a

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variety of options for care . Mr .

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Willis . Can you tell us what to expect

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when working with a mental health

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professional ? Absolutely , Doctor

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Patel . Most mental health

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professionals offer a variety of

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counseling approaches , including

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individual therapy , group therapy ,

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and couples or family therapy . Some

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mental health professionals even offer

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virtual or remote interventions . Of

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course , choosing an appropriate

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therapy option depends on the nature of

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the problem , the experience of the

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therapist and the unique needs of the

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individual client or patient . Patients

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should feel assured that whatever they

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discuss with the mental health

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professional is confidential . The only

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exceptions to this rule or when there's

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a serious threat of harm , either to

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the individual or to another identified

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person providers will review the limits

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of confidentiality with their patients

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before beginning any assessment or

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treatment , knowing what questions to

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ask the provider before and during an

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appointment can help patients feel like

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they're starting off on the right foot .

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Things to consider asking a provider

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include , what are their credentials

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and experience ? Do they have a

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specialty ? Do they practice a

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particular type of psychotherapy ? One

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of the reasons or evidence supporting

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that type of therapy ? Do they have

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experience in diagnosing and treating

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the age group and specific condition

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for which treatment is being sought ?

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What are the goals of therapy ? Do they

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recommend a specific time frame or

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number of sessions ? How will progress

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be determined ? And what happens if you

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or the provider feel like you aren't

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improving ? Will there be assignments

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to be completed between appointments

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and our medications ? An option ? If so ?

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How will medications be prescribed if

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the provider is not a position or

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prescribing provider ? Mhm . Yeah .

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Sometimes we recognize that we need

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help but there's something stopping us

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from seeking it dr phillips . How can

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we recognize and overcome these

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barriers to care ? Well , dr german for

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some people , the barrier to care is

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simply not knowing what the appropriate

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resources for their specific problem .

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And some are afraid that even asking

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about resources will cause others to

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see them differently in the military ,

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many people are unsure how seeking help

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will affect their career and how much

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of their conversations with the

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military provider will remain

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confidential . These are common

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concerns , but they should never stop

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someone from seeking the care they need .

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If you recognize that you need help , a

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good place to start is your primary

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care provider . They may be all the

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help you need , but if they're not ,

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they can refer you to the right

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resource . You can also contact the

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mental health clinic directly to make

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an appointment or ask questions . It's

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extremely important to seek immediate

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help in the event of a life threatening

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emergency . If someone you know is

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having thoughts of self harm or harm to

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another individual , take them to the

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nearest emergency room or call 911 .

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Yeah ,

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I was 24 . I was just promoted to

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staff sergeant . But I was also going

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through a really rough divorce . I was

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preoccupied with life things . But then

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I had all of these new responsibilities

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at work . I kind of felt like like I

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was losing control of my life . My

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friend noticed that I was constantly

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stressed and he recommended a counselor

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he'd been seeing , I thought about

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going , but I waited

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and waited . It wasn't because I didn't

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want help or didn't think I needed it .

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I did . I was afraid of what

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they might tell me . I was terrified .

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They diagnosed me with something and I

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felt that as long as I didn't go in , I

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wouldn't be labeled mm hmm . I felt

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like they weren't gonna tell me

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something . I don't already know . You

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might be able to tell . I'm the kind of

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guy who thinks I'll fix it myself .

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Which frankly for me can work most of

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the time . But then sometimes that

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attitude can keep you from getting

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healthy . I was embarrassed , proud ,

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afraid of what my friends or parents

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might think that they think I was , you

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know , week or not man

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enough on top of that . I'm security

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forces . I kind of thought it would

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affect that too . Like maybe I wouldn't

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have been allowed to carry a firearm or

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they could have made me switch career

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fields , something like that ,

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definitely embarrassed . But mainly I

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was worried about the perception and

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how it might impact me professionally .

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I have a . T . S . Clearance and I

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often have to brief colonels and

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generals , people from senior executive

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service legislators . I thought maybe I

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wouldn't go as far or worse yet , maybe

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I'd lose my clearance or my job . I

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just didn't have time to see a doctor .

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It sounds crazy now . But between my

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family and my job , I felt like I was

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constantly putting out fires all the

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while , My mental health was just

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spiraling . I'm old school ,

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my parents brought me up , you know ,

15:16.370 --> 15:19.750
boys don't cry and always be strong and

15:19.750 --> 15:21.694
intellectually . I know that's not

15:21.694 --> 15:24.530
healthy to bottle your emotions , but

15:24.530 --> 15:26.697
when you're brought up a certain way ,

15:26.697 --> 15:28.880
it becomes instinctual to revert to

15:28.880 --> 15:31.980
those original lessons half the time .

15:31.980 --> 15:33.924
I don't even realize that's what's

15:33.924 --> 15:37.490
happening . I'm stubborn . I've always

15:37.490 --> 15:40.670
been stubborn . So I think for me , the

15:40.670 --> 15:42.781
biggest hurdle was acknowledging that

15:42.781 --> 15:44.892
the best thing for me at the time was

15:44.892 --> 15:47.114
to go talk to somebody you don't really

15:47.114 --> 15:48.948
think to take care of yourself ,

15:48.948 --> 15:51.170
especially if you're physically healthy

15:51.170 --> 15:53.281
when you have kids , baseball games ,

15:53.281 --> 15:55.392
birthday parties , sleepovers , dance

15:55.392 --> 15:57.614
recitals , parent teacher conferences ,

15:57.614 --> 15:59.781
homework . It doesn't end , especially

15:59.781 --> 16:02.560
when he's deployed and by the time you

16:02.560 --> 16:05.210
finally have a chance to reflect you

16:05.210 --> 16:07.310
fall asleep , I thought it would be

16:07.310 --> 16:09.820
difficult to be effective at my job .

16:09.830 --> 16:12.660
If my authority , if my expertise were

16:12.660 --> 16:15.100
to come into question , I was just

16:15.100 --> 16:17.800
trying to it up and pretend everything

16:17.800 --> 16:20.260
was fine . And of course that didn't

16:20.260 --> 16:24.230
work . But it took a lot

16:24.240 --> 16:26.407
of courage to finally get myself to go

16:26.407 --> 16:30.030
in . Yeah , I'm glad I did .

16:30.740 --> 16:34.060
It's just not worth it .

16:34.940 --> 16:37.520
I would say in the end , it's not worth

16:37.520 --> 16:39.409
the trouble . You could be saving

16:39.409 --> 16:42.160
yourself by getting help if you need it ,

16:42.540 --> 16:45.020
you just have to prioritize your sanity .

16:45.030 --> 16:47.600
I mean , people don't walk around on

16:47.600 --> 16:49.830
broken ankles . Why should it be any

16:49.830 --> 16:52.470
different for your mental health , no

16:52.470 --> 16:54.748
matter where you come from , Sometimes ,

16:54.748 --> 16:56.970
because of where you come from , you're

16:56.970 --> 16:59.192
gonna have issues you need to deal with

16:59.192 --> 17:01.359
in life for a lot of people they might

17:01.359 --> 17:03.192
not ever have to see a doctor or

17:03.192 --> 17:06.750
counsellor or psychologists , but a

17:06.750 --> 17:09.028
health condition is a health condition ,

17:09.028 --> 17:11.250
no matter how much you try to ignore it

17:11.250 --> 17:14.480
or explain it away . I guess what

17:14.480 --> 17:18.210
surprised me most is once I talked to a

17:18.210 --> 17:20.470
couple of my buddies , I realize I'm

17:20.470 --> 17:24.430
not alone and everyone is dealing

17:24.430 --> 17:26.890
with something . What should have been

17:26.890 --> 17:29.168
obvious to me was I can perform better ,

17:29.168 --> 17:31.057
give better insights and pay more

17:31.057 --> 17:33.112
attention to detail Now that I don't

17:33.112 --> 17:35.223
have to manage some invisible monster

17:35.223 --> 17:37.560
on a daily basis . Just don't wait .

17:38.440 --> 17:40.496
There's a treatment that's right for

17:40.496 --> 17:42.384
everyone , even if it's something

17:42.384 --> 17:44.496
simple like taking a walk , calling a

17:44.496 --> 17:47.310
friend or whatever . But talking to a

17:47.310 --> 17:49.421
professional can really help identify

17:49.421 --> 17:52.350
what you need to do and develop a plan

17:52.360 --> 17:55.050
for making sure you do it . I would say

17:55.050 --> 17:58.290
don't let life get in the way this is

17:58.290 --> 18:01.110
your life . If I could offer advice .

18:01.840 --> 18:04.510
If something is not right , it won't

18:04.510 --> 18:06.621
get any better if you just sit around

18:06.621 --> 18:10.170
not doing anything about it . Get help .

18:18.540 --> 18:20.707
Depressive disorders are mental health

18:20.707 --> 18:23.120
conditions characterized by sad , empty

18:23.130 --> 18:25.730
or irritable mood as well as physical

18:25.740 --> 18:28.130
and cognitive changes . These changes

18:28.130 --> 18:30.352
have a significant impact on a person's

18:30.352 --> 18:32.490
ability to function in daily life .

18:32.500 --> 18:34.660
Depression , sometimes called major

18:34.660 --> 18:36.470
depressive disorder or clinical

18:36.470 --> 18:38.510
depression , is the most common

18:38.520 --> 18:40.850
depressive disorder . It can result

18:40.850 --> 18:43.270
from and be affected by a number of bio

18:43.270 --> 18:44.950
psychosocial factors .

18:52.840 --> 18:54.896
Depression is one of the most common

18:54.896 --> 18:57.062
mental health conditions in the United

18:57.062 --> 18:59.360
States and it most often results from a

18:59.360 --> 19:02.260
combination of bio psychosocial factors .

19:02.640 --> 19:04.584
Doctor Mansfield . Can you tell us

19:04.584 --> 19:06.570
about some common risk factors for

19:06.570 --> 19:08.550
depression ? Of course , dr Patel

19:09.140 --> 19:11.307
depression can happen at any age , but

19:11.307 --> 19:14.070
often begins in adulthood . For many

19:14.070 --> 19:16.060
middle aged and older adults ,

19:16.070 --> 19:17.959
depression co occurs with another

19:17.959 --> 19:20.120
serious medical illness , such as

19:20.120 --> 19:22.670
diabetes , cancer or heart disease .

19:23.240 --> 19:25.351
Some medications prescribed for these

19:25.351 --> 19:27.462
illnesses can cause side effects that

19:27.462 --> 19:29.630
contribute to depression . Other

19:29.630 --> 19:31.686
physical risk factors for depression

19:31.686 --> 19:33.519
includes sleeping difficulties ,

19:33.519 --> 19:35.463
chronic pain , vitamin and mineral

19:35.463 --> 19:37.800
deficiencies , poor diet and genetics .

19:37.880 --> 19:40.250
Additionally , some people with a

19:40.250 --> 19:42.250
family history of depression may be

19:42.250 --> 19:44.430
predisposed to experience depression

19:44.440 --> 19:47.360
themselves . Cognitive factors include

19:47.370 --> 19:49.481
tendencies toward negative thoughts ,

19:49.481 --> 19:52.590
judgments , predictions or comparisons

19:52.590 --> 19:55.680
about oneself , the world , the future

19:55.690 --> 19:58.400
and other people . Emotions like

19:58.400 --> 20:00.740
sadness , Irritability and emptiness

20:00.740 --> 20:02.962
are typical experiences for someone who

20:02.962 --> 20:05.390
is depressed . These emotions can

20:05.390 --> 20:07.168
negatively impact cognitive and

20:07.168 --> 20:09.440
behavioral factors , which in turn

20:09.450 --> 20:12.090
intensify the negative emotions in a

20:12.090 --> 20:14.270
similar way . Other mental disorders ,

20:14.270 --> 20:16.350
such as an anxiety disorder or

20:16.350 --> 20:18.600
borderline personality disorder can

20:18.600 --> 20:20.822
also increase the risk for depression ,

20:21.340 --> 20:23.860
behavioral factors such as isolation or

20:23.860 --> 20:26.400
withdraw from others . Dietary changes ,

20:26.480 --> 20:28.820
increased alcohol consumption and

20:28.820 --> 20:30.598
reduced engagement with healthy

20:30.598 --> 20:32.930
activities , increase the likelihood of

20:32.930 --> 20:35.600
experiencing depression . They also

20:35.600 --> 20:37.544
tend to amplify negative emotional

20:37.544 --> 20:40.090
experiences . Environmental risk

20:40.090 --> 20:42.368
factors such as interpersonal problems ,

20:42.368 --> 20:45.080
major life changes , trauma and stress

20:45.090 --> 20:48.050
can also contribute to depression . For

20:48.050 --> 20:50.250
instance , the loss of a loved one , a

20:50.250 --> 20:52.361
difficult relationship or a stressful

20:52.361 --> 20:54.460
situation with a co worker can be

20:54.460 --> 20:56.060
triggers for depression .

21:03.840 --> 21:06.150
Generally , if a person has five or

21:06.150 --> 21:08.317
more symptoms most of the day , nearly

21:08.317 --> 21:10.680
every day for at least two weeks , they

21:10.680 --> 21:12.902
will be diagnosed with major depressive

21:12.902 --> 21:15.120
disorder . Mr Willis . Can you tell us

21:15.120 --> 21:17.231
more about symptoms of depression and

21:17.231 --> 21:19.176
how depression is diagnosed ? Sure

21:19.176 --> 21:21.480
thing . Dr german not everyone who has

21:21.480 --> 21:23.680
clinical depression experiences every

21:23.680 --> 21:26.610
symptom , but in order to be diagnosed ,

21:26.620 --> 21:28.780
one of the symptoms must be depressed

21:28.780 --> 21:31.250
mood or loss of interest or pleasure .

21:31.260 --> 21:33.530
In most activities that were previously

21:33.530 --> 21:35.820
enjoyed . Depressed mood may be

21:35.820 --> 21:38.570
described as feeling sad or empty .

21:38.580 --> 21:40.580
Other common symptoms that may

21:40.580 --> 21:43.050
accompany a depressed mood or loss of

21:43.050 --> 21:45.500
interest include feelings of guilt ,

21:45.510 --> 21:47.560
worthlessness or helplessness ,

21:47.940 --> 21:50.850
decreased energy or fatigue moving or

21:50.850 --> 21:54.150
talking more slowly feeling restless or

21:54.150 --> 21:55.983
having trouble sitting , still ,

21:55.983 --> 21:58.690
difficulty concentrating , remembering

21:58.700 --> 22:01.080
or making decisions , difficulty

22:01.080 --> 22:03.430
sleeping early morning awakening or

22:03.440 --> 22:06.680
oversleeping appetite and or weight

22:06.680 --> 22:08.950
changes and thoughts of death or

22:08.950 --> 22:11.910
suicide or suicide attempts . While the

22:11.910 --> 22:14.400
severity , frequency and duration of

22:14.400 --> 22:17.330
symptoms may vary , all symptoms tend

22:17.330 --> 22:19.660
to create significant distress or

22:19.660 --> 22:21.827
impairment in day to day , functioning

22:22.240 --> 22:24.630
distress and functional impairment

22:24.630 --> 22:27.580
negatively affect relationships , work

22:27.590 --> 22:30.120
and recreational activities . It's

22:30.120 --> 22:32.180
important to keep in mind that it's

22:32.180 --> 22:34.410
common to experience one or more of

22:34.410 --> 22:36.243
these symptoms from time to time

22:36.440 --> 22:38.329
feeling sad after a breakup , for

22:38.329 --> 22:41.630
instance , is an expected reaction when

22:41.630 --> 22:43.574
symptoms persist for more than two

22:43.574 --> 22:45.630
weeks . However , or if they have a

22:45.630 --> 22:47.741
significant effect on your ability to

22:47.741 --> 22:50.880
function , it's time to seek help . If

22:50.880 --> 22:52.991
you're having thoughts of self harm ,

22:52.991 --> 22:55.102
you should seek help immediately . If

22:55.102 --> 22:57.324
you don't know where to turn for help ,

22:57.324 --> 22:59.870
call 911 or go to the nearest emergency

22:59.870 --> 23:01.170
room .

23:08.740 --> 23:10.796
There are a number of strategies you

23:10.796 --> 23:12.851
can implement on your own to prevent

23:12.851 --> 23:14.684
symptoms of mild depression from

23:14.684 --> 23:16.629
becoming worse or interfering with

23:16.629 --> 23:18.900
daily functioning dr phillips . Can you

23:18.900 --> 23:21.067
give us some of these self help tips ?

23:21.130 --> 23:23.890
Absolutely , Doctor Patel . Some tips

23:23.890 --> 23:25.723
that may help you or a loved one

23:25.723 --> 23:27.820
experiencing depression include be

23:27.820 --> 23:30.310
active in exercise , set specific

23:30.310 --> 23:32.580
realistic goals for yourself , spend

23:32.580 --> 23:34.820
time with other people and confide in a

23:34.820 --> 23:37.760
trusted friend or relative . Be mindful

23:37.760 --> 23:40.160
of the natural tendency to isolate and

23:40.160 --> 23:42.271
whenever possible , do the opposite ,

23:42.540 --> 23:45.020
expect your mood to improve gradually .

23:45.040 --> 23:48.060
Not immediately and postpone important

23:48.060 --> 23:50.227
life decisions until you feel better ,

23:50.640 --> 23:52.990
discuss decisions with others who know

23:52.990 --> 23:55.290
you well and have a more objective view

23:55.290 --> 23:56.460
of your situation .

24:04.540 --> 24:06.318
Medications prescribed to treat

24:06.318 --> 24:08.540
depression are called antidepressants .

24:08.540 --> 24:10.596
Dr Mansfield . Can you tell us about

24:10.596 --> 24:12.596
some common antidepressants and how

24:12.596 --> 24:14.707
they work ? Certainly doctor German ,

24:14.707 --> 24:16.596
some common antidepressants often

24:16.596 --> 24:18.762
prescribed to treat depression include

24:18.810 --> 24:20.700
selective serotonin re uptake

24:20.700 --> 24:23.990
inhibitors or ssris , serotonin ,

24:23.990 --> 24:26.101
norepinephrine reuptake inhibitors or

24:26.101 --> 24:29.470
SnR is Murtaza pin and buPROPion .

24:30.240 --> 24:31.907
It's believed that one of the

24:31.907 --> 24:34.018
contributing factors of depression is

24:34.018 --> 24:36.129
an imbalance of a neurotransmitter or

24:36.129 --> 24:38.296
chemical messenger in the brain called

24:38.296 --> 24:40.650
serotonin . The nerves in the brain

24:40.650 --> 24:42.372
communicate with each other by

24:42.372 --> 24:44.860
releasing and absorbing serotonin , the

24:44.860 --> 24:47.027
nerve cell that releases the serotonin

24:47.027 --> 24:50.010
re uptake or gathers back up any extra

24:50.010 --> 24:52.860
serotonin left over after the release .

24:53.440 --> 24:56.460
SSR eyes stop the releasing nerve cell

24:56.460 --> 24:58.850
from re up taking the serotonin so that

24:58.850 --> 25:00.970
there's more serotonin available for

25:00.970 --> 25:03.570
the second nerve to absorb . With an

25:03.580 --> 25:05.580
increase in the amount of serotonin

25:05.580 --> 25:07.802
traveling between the nerves , messages

25:07.802 --> 25:09.858
can be sent and delivered throughout

25:09.858 --> 25:13.090
the brain more effectively . SnR is

25:13.090 --> 25:14.868
work much the same way . But in

25:14.868 --> 25:16.979
addition to blocking the re uptake of

25:16.979 --> 25:19.490
serotonin , they also block or delay

25:19.490 --> 25:20.879
the re uptake of another

25:20.879 --> 25:23.270
neurotransmitter called norepinephrine .

25:24.140 --> 25:26.460
The net result of an increase in levels

25:26.460 --> 25:28.800
of serotonin and norepinephrine tends

25:28.800 --> 25:31.380
to elevate mood Murtaza , pin and

25:31.380 --> 25:33.680
buPROPion . Both work to increase

25:33.680 --> 25:35.847
certain types of activity in the brain

25:35.847 --> 25:38.670
to restore chemical balance . Yeah ,

25:46.040 --> 25:49.850
I guess I started noticing it after I

25:49.850 --> 25:52.470
first joined and moved to my first duty

25:52.470 --> 25:55.760
station . I mean I always felt

25:55.760 --> 25:58.990
different from other people and my

25:58.990 --> 26:01.890
friends would tell me I'm grumpy but I

26:01.890 --> 26:03.668
never really connected the dots

26:05.340 --> 26:07.930
sometimes hard to separate a

26:07.930 --> 26:10.350
personality type from a mental disorder .

26:12.440 --> 26:15.870
It wasn't until I really was on my own

26:15.880 --> 26:18.600
in a new part of the country that I

26:18.600 --> 26:21.750
started to reflect on what might be

26:21.750 --> 26:25.710
going on with me . I was tired all

26:25.710 --> 26:29.200
the time and wanted to be on my own a

26:29.200 --> 26:32.520
lot , even though there were a bunch of

26:32.520 --> 26:35.920
people from my unit who hung out . I

26:35.920 --> 26:39.790
never really wanted to be involved . I

26:39.790 --> 26:41.670
had this feeling that it was

26:42.740 --> 26:46.290
interfering with my life . Like I had

26:46.290 --> 26:49.960
something better to do , but I didn't

26:51.840 --> 26:55.450
half the time I just watch tv or waste

26:55.460 --> 26:57.890
time online , which made me feel worse .

27:01.440 --> 27:03.662
I'm proud to say I still did well at my

27:03.662 --> 27:06.270
job . It was very good

27:06.840 --> 27:09.570
technically , but I was still

27:09.570 --> 27:12.050
struggling when it came to the sort of

27:12.060 --> 27:14.870
extra curricular stuff that everybody

27:14.870 --> 27:18.090
else was doing . I just had no

27:18.090 --> 27:20.670
motivation to go above and beyond like

27:20.670 --> 27:24.440
that . Still , I didn't

27:24.450 --> 27:28.350
actually have anything clearly telling

27:28.350 --> 27:31.170
me that something was really wrong .

27:32.340 --> 27:34.260
I just felt like I always did .

27:37.340 --> 27:39.470
I wrote off some of the feelings to

27:39.480 --> 27:41.560
being in a new place .

27:43.340 --> 27:45.850
But I felt like I was living a double

27:45.850 --> 27:49.460
life here . I was

27:49.940 --> 27:52.060
progressing at my job ,

27:53.340 --> 27:55.690
coasting on small talk with my

27:55.690 --> 27:59.460
coworkers , whatever . But then

28:00.140 --> 28:03.090
in my dorm , I was just a shut in .

28:05.200 --> 28:08.210
It was so far in my own head

28:09.440 --> 28:12.770
and I couldn't break out . And I felt

28:12.770 --> 28:16.410
like , mm I couldn't talk to anybody .

28:20.140 --> 28:22.650
I started to become self conscious the

28:22.650 --> 28:25.450
way I came off to other people . So I

28:25.450 --> 28:27.960
just started avoiding everything .

28:29.840 --> 28:33.810
It was like a vicious cycle . So it was

28:33.810 --> 28:37.160
actually my brother on the phone who

28:37.160 --> 28:40.130
pulled it out of me , who went beyond

28:40.130 --> 28:43.800
the surface level of how you doing when

28:43.800 --> 28:45.967
I heard myself talking about all these

28:45.967 --> 28:48.300
issues , it was a serious reality check .

28:49.140 --> 28:52.160
I went wait a second . I'm seriously

28:52.160 --> 28:55.770
sad right now . It's

28:55.770 --> 28:57.881
amazing how much of a difference just

28:57.881 --> 28:59.659
talking about something makes .

29:01.940 --> 29:05.540
So I kept doing it . I actually went

29:05.550 --> 29:07.420
into mental health and had a few

29:07.420 --> 29:10.460
regular sessions where I just unload

29:10.460 --> 29:14.290
about anything and everything , which

29:14.290 --> 29:16.012
really helped me gain a better

29:16.012 --> 29:18.710
perspective on my issues . The most

29:18.710 --> 29:20.654
helpful part of those sessions was

29:20.654 --> 29:22.870
something called Mindfulness based

29:22.870 --> 29:25.900
cognitive therapy , which is just a way

29:25.900 --> 29:27.956
of recognizing your negative thought

29:27.956 --> 29:30.620
patterns and becoming aware of how they

29:30.620 --> 29:33.910
affect your life in different ways . In

29:33.910 --> 29:37.510
a lot of ways I was more comfortable

29:37.510 --> 29:41.060
talking about my issues . Um but

29:41.060 --> 29:44.630
they didn't completely go away . It was

29:44.630 --> 29:47.850
a slow process , but I did end up

29:47.850 --> 29:49.683
talking to the shirt who told me

29:49.683 --> 29:53.160
something I'll never forget . He said

29:53.640 --> 29:55.751
if you break your arm , people run to

29:55.751 --> 29:59.360
you to help you . If you say you're

29:59.360 --> 30:02.270
depressed people run away .

30:03.870 --> 30:05.926
I think that saying is important for

30:05.926 --> 30:08.710
two reasons . First , just because

30:08.710 --> 30:11.220
mental health issues aren't obvious ,

30:11.230 --> 30:13.452
doesn't mean they don't deserve as much

30:13.452 --> 30:15.786
medical attention as a physical problem .

30:17.140 --> 30:19.196
Second , I think a lot of people are

30:19.196 --> 30:21.140
uncomfortable talking about mental

30:21.140 --> 30:23.740
health . Just still a shock to me

30:23.750 --> 30:25.806
considering how common it is to deal

30:25.806 --> 30:28.560
with depression or anxiety , even when

30:28.560 --> 30:31.990
it's just for a little while , I think

30:31.990 --> 30:33.990
most people do and would understand

30:33.990 --> 30:36.157
each other and be able to support each

30:36.157 --> 30:37.990
other . If we just talked more ,

30:40.720 --> 30:43.540
ask your airmen , ask your family , ask

30:43.540 --> 30:45.818
your friends or your significant other ,

30:45.840 --> 30:48.920
are you really fine ? Are you really

30:48.920 --> 30:52.360
okay ? Wait a minute . Pay attention to

30:52.360 --> 30:55.700
each other . I know it can be

30:55.700 --> 30:59.660
hard , it's tough ,

31:00.040 --> 31:03.910
it's uncomfortable but we're

31:03.910 --> 31:07.350
all here on earth mm We all put on our

31:07.350 --> 31:11.310
pants one leg at a time . If

31:11.310 --> 31:13.477
we all took the time to listen I think

31:13.477 --> 31:16.700
we'd all be better for it by no means

31:16.700 --> 31:20.490
am I living a perfect life ? I

31:20.490 --> 31:24.320
still have tough times but at

31:24.320 --> 31:26.431
least now it doesn't feel like I have

31:26.431 --> 31:28.040
to go it alone . Yeah .

31:31.840 --> 31:32.840
Mhm .

31:39.240 --> 31:41.730
Anxiety or a feeling of worry or

31:41.730 --> 31:44.040
apprehension is not only a normal part

31:44.040 --> 31:46.530
of life but also a natural and often

31:46.530 --> 31:48.280
helpful response to stressful

31:48.280 --> 31:50.750
situations . This is called adaptive

31:50.750 --> 31:53.010
anxiety and it's indispensable for

31:53.010 --> 31:55.050
managing many of life's problems .

31:55.340 --> 31:57.800
While anxiety is necessary for survival ,

31:57.810 --> 31:59.810
it's not always comfortable . So we

31:59.810 --> 32:01.977
might be inclined to avoid things that

32:01.977 --> 32:04.180
make us anxious . However , avoiding

32:04.180 --> 32:06.402
situations , thoughts and emotions that

32:06.402 --> 32:08.291
make us anxious can actually make

32:08.291 --> 32:11.040
anxiety more powerful over time life

32:11.040 --> 32:12.984
starts to revolve around avoidance

32:12.984 --> 32:15.220
rather than the experiences people and

32:15.220 --> 32:17.770
values that matter most . When anxiety

32:17.770 --> 32:20.200
doesn't go away gets worse over time or

32:20.200 --> 32:21.922
starts to interfere with daily

32:21.922 --> 32:24.010
activities . A person may have an

32:24.010 --> 32:26.300
anxiety disorder . There are several

32:26.300 --> 32:28.467
different types of anxiety disorders ,

32:28.467 --> 32:31.080
including generalized anxiety disorder ,

32:31.090 --> 32:33.960
panic disorder and social anxiety

32:33.960 --> 32:35.170
disorder .

32:42.440 --> 32:44.551
Research suggests that there are many

32:44.551 --> 32:46.680
bio psychosocial factors that

32:46.690 --> 32:49.630
contribute to anxiety disorders . Mr

32:49.630 --> 32:51.797
Willis . Can you tell us about some of

32:51.797 --> 32:53.630
these risk factors for anxiety ?

32:53.630 --> 32:56.590
Definitely Doctor Patel . Some specific

32:56.600 --> 32:58.660
physical factors that are associated

32:58.660 --> 33:00.970
with anxiety disorders include genetics

33:00.980 --> 33:03.450
or family history of anxiety or other

33:03.450 --> 33:06.500
mental disorders being female , some

33:06.500 --> 33:09.140
thyroid conditions , serious illness ,

33:09.740 --> 33:12.680
respiratory disorders such as asthma of

33:12.680 --> 33:14.624
the medical conditions and certain

33:14.624 --> 33:17.500
medications . Cognitive factors that

33:17.500 --> 33:19.222
can increase the likelihood of

33:19.230 --> 33:21.440
developing an anxiety disorder include

33:21.560 --> 33:24.380
excessive worry , a tendency towards

33:24.390 --> 33:26.790
anxious alarming and negative thoughts

33:27.340 --> 33:29.960
and a belief or feeling that anxiety is

33:29.960 --> 33:33.320
harmful and tolerable motions that can

33:33.320 --> 33:35.140
contribute to anxiety include a

33:35.150 --> 33:37.261
tendency towards negative feelings or

33:37.261 --> 33:40.160
mood , a fear of rejection or negative

33:40.160 --> 33:42.770
perception . Certain patterns of

33:42.780 --> 33:44.680
behavior can be risk factors for

33:44.680 --> 33:46.990
anxiety disorders as well . These

33:46.990 --> 33:49.157
include the use of products containing

33:49.157 --> 33:50.930
nicotine such as cigarettes or

33:50.930 --> 33:53.980
smokeless tobacco , A tendency to avoid

33:53.980 --> 33:56.270
certain situations , places people

33:56.280 --> 33:58.950
emotions or thoughts over seeking

33:58.950 --> 34:01.590
reassurance and a tendency towards

34:01.590 --> 34:03.270
social isolation or shyness .

34:04.140 --> 34:06.370
Environmental risk factors for anxiety

34:06.370 --> 34:08.530
include unpredictable , chaotic or

34:08.530 --> 34:11.290
abusive relationships , having few

34:11.290 --> 34:14.000
economic resources being divorced or

34:14.000 --> 34:17.700
widowed . Mm exposure to stressful life

34:17.700 --> 34:20.040
events such as the death or illness of

34:20.040 --> 34:22.140
a relative or a change of job or

34:22.140 --> 34:24.910
location . Childhood experiences of

34:24.910 --> 34:27.150
abuse or maltreatment and having

34:27.150 --> 34:29.372
overprotective parents during childhood

34:29.740 --> 34:30.740
Yeah ,

34:37.730 --> 34:39.786
some amount of stress and anxiety is

34:39.786 --> 34:41.952
normal in many situations , but when a

34:41.952 --> 34:43.786
person is excessively anxious or

34:43.786 --> 34:45.619
worried more days than not . For

34:45.619 --> 34:47.730
several months it may be a sign of an

34:47.730 --> 34:49.786
anxiety disorder . Dr phillips . Can

34:49.786 --> 34:51.674
you tell us more about diagnosing

34:51.674 --> 34:53.674
anxiety disorders ? Sure thing . Dr

34:53.674 --> 34:56.270
german one important thing to remember

34:56.280 --> 34:58.440
is that in order to be diagnosed with

34:58.440 --> 35:00.970
an anxiety disorder , symptoms must

35:00.970 --> 35:03.520
persist for a period of time and they

35:03.520 --> 35:05.880
also must have a significant impact on

35:05.880 --> 35:08.740
day to day functioning generalized

35:08.740 --> 35:11.070
anxiety disorder is one of the more

35:11.070 --> 35:13.570
commonly diagnosed anxiety disorders .

35:14.040 --> 35:15.990
The most prominent symptom of

35:15.990 --> 35:18.320
generalized anxiety disorder is

35:18.320 --> 35:20.700
excessive and uncontrollable worry

35:20.710 --> 35:23.460
about a number of activities and events .

35:24.040 --> 35:26.640
Other symptoms can include restlessness

35:26.650 --> 35:29.610
or feeling wound up or on edge , being

35:29.610 --> 35:31.980
easily fatigued , difficulty

35:31.980 --> 35:34.740
concentrating or the mind going blank ,

35:34.750 --> 35:37.880
irritability , muscle tension ,

35:38.340 --> 35:40.860
difficulty controlling worries and

35:40.860 --> 35:43.820
sleep problems . Another anxiety

35:43.820 --> 35:46.530
disorder is panic disorder . This

35:46.530 --> 35:48.752
condition is characterized by recurrent

35:48.752 --> 35:51.560
unexpected panic attacks , as well as a

35:51.560 --> 35:53.504
persistent worry about having such

35:53.504 --> 35:55.950
attacks or maladaptive changes to

35:55.950 --> 35:57.890
routine . In order to avoid these

35:57.890 --> 36:00.820
attacks , panic attacks are sudden

36:00.820 --> 36:03.030
periods of intense fear that may

36:03.030 --> 36:05.360
include palpitations or pounding ,

36:05.360 --> 36:09.170
heart , sweating , trembling or shaking

36:09.290 --> 36:11.710
sensations of shortness of breath

36:11.720 --> 36:14.780
smothering or choking and a feeling of

36:14.790 --> 36:17.910
impending doom . Social anxiety ,

36:17.910 --> 36:20.050
sometimes called social phobia is

36:20.050 --> 36:22.600
another example of an anxiety disorder .

36:22.610 --> 36:24.780
People with social anxiety have a

36:24.780 --> 36:27.050
marked fear of social or performance

36:27.050 --> 36:29.690
situations in which they expect to feel

36:29.700 --> 36:32.570
embarrassed , judged , rejected or

36:32.570 --> 36:35.640
fearful of offending others when these

36:35.640 --> 36:37.807
fears impair day to day functioning or

36:37.807 --> 36:40.160
cause significant distress , a person

36:40.160 --> 36:43.340
may have social anxiety disorder .

36:50.330 --> 36:52.441
There are a number of things a person

36:52.441 --> 36:54.386
with an anxiety disorder can do on

36:54.386 --> 36:56.820
their own without formal therapy to

36:56.820 --> 36:59.560
manage their anxiety effectively . Mr

36:59.560 --> 37:01.727
Willis , can you tell us about some of

37:01.727 --> 37:03.782
these self help techniques ? Yes , I

37:03.782 --> 37:06.510
can dr Patel . It's important for those

37:06.510 --> 37:08.677
with anxiety to try to maintain a good

37:08.677 --> 37:11.100
life balance . One strategy that can

37:11.100 --> 37:12.990
help is writing down worries and

37:12.990 --> 37:14.960
identifying what's in the person's

37:14.960 --> 37:18.170
control to do or change . Breaking down

37:18.170 --> 37:20.870
necessary task into smaller steps can

37:20.870 --> 37:22.814
make them feel less overwhelming .

37:23.130 --> 37:25.241
Another strategy for maintaining life

37:25.241 --> 37:27.660
balance is to place a priority on self

37:27.670 --> 37:30.310
care , getting adequate sleep , a

37:30.310 --> 37:32.620
nutritious diet and plenty of exercise

37:32.630 --> 37:34.930
are very important . People with

37:34.930 --> 37:36.763
anxiety should consider avoiding

37:36.763 --> 37:38.986
caffeine and some over the counter cold

37:38.986 --> 37:40.920
medications that can make anxiety

37:40.920 --> 37:43.400
symptoms worse . Other self care

37:43.400 --> 37:45.180
practices to consider include

37:45.630 --> 37:47.930
intentional relaxation , guided

37:47.930 --> 37:51.290
meditation or prayer . Finally , it's

37:51.290 --> 37:53.512
important to spend time with loved ones

37:53.512 --> 37:55.734
who are supportive sharing problems and

37:55.734 --> 37:57.846
achievements with a trusted friend or

37:57.846 --> 38:00.150
family member . canI's apprehension and

38:00.150 --> 38:01.483
build self confidence .

38:09.520 --> 38:11.450
Medication does not cure anxiety

38:11.450 --> 38:13.672
disorders but often provides short term

38:13.672 --> 38:15.960
relief from symptoms . Dr Mansfield ,

38:15.970 --> 38:17.859
can you tell us about some of the

38:17.859 --> 38:20.026
medications prescribed for anxiety and

38:20.026 --> 38:22.026
how they work ? Of course Dr german

38:22.026 --> 38:24.260
antidepressants are commonly prescribed

38:24.260 --> 38:26.149
for people with panic disorder or

38:26.149 --> 38:27.593
social anxiety disorder .

38:28.020 --> 38:30.187
Antidepressants can take several weeks

38:30.187 --> 38:32.187
to start working and may cause side

38:32.187 --> 38:34.630
effects such as headache , nausea or

38:34.630 --> 38:37.080
difficulty sleeping . For people with

38:37.080 --> 38:39.120
generalized anxiety disorder of

38:39.120 --> 38:41.080
benzodiazepine may be prescribed .

38:41.370 --> 38:44.160
Benzodiazepines are sometimes used to

38:44.160 --> 38:46.360
treat short term symptoms of anxiety .

38:47.120 --> 38:50.210
Gamma amino butyric acid or gaba is a

38:50.210 --> 38:52.770
neurotransmitter or chemical messenger

38:52.780 --> 38:55.350
in the brain that inhibits or reduces

38:55.350 --> 38:57.517
the activity of nerve cells within the

38:57.517 --> 39:00.180
brain . Benzodiazepines open gabba

39:00.180 --> 39:02.400
activated channels in the brain which

39:02.400 --> 39:04.540
makes the nerve cells resistant to

39:04.540 --> 39:06.590
excitation . In other words ,

39:06.600 --> 39:09.120
benzodiazepines force the brain to

39:09.120 --> 39:12.340
relax . Although benzodiazepines can be

39:12.340 --> 39:14.120
helpful in relieving short term

39:14.120 --> 39:15.980
symptoms of anxiety , there's a

39:15.980 --> 39:18.147
potential for a number of serious side

39:18.147 --> 39:20.091
effects , including depression and

39:20.091 --> 39:22.091
drowsiness , that can affect speech

39:22.091 --> 39:24.670
coordination and cognitive function .

39:24.740 --> 39:27.680
In addition , some benzodiazepines can

39:27.680 --> 39:30.020
be habit forming and misuse of habit

39:30.020 --> 39:31.798
forming medications can lead to

39:31.798 --> 39:35.330
addiction overdose or death . Beta

39:35.330 --> 39:37.552
blockers are another form of medication

39:37.552 --> 39:39.497
prescribed to treat the short term

39:39.497 --> 39:41.970
physical symptoms of anxiety . Beta

39:41.970 --> 39:43.526
blockers work by preventing

39:43.526 --> 39:45.526
norepinephrine and epinephrine from

39:45.526 --> 39:47.526
binding to certain receptors in the

39:47.526 --> 39:49.630
vascular system . This reduces heart

39:49.630 --> 39:51.630
rate , which can ease other anxiety

39:51.630 --> 39:53.463
symptoms , such as trembling and

39:53.463 --> 39:54.463
sweating .

40:02.110 --> 40:08.570
I

40:08.580 --> 40:11.210
would characterize myself as

40:11.220 --> 40:15.120
ambitious ever since I was

40:15.120 --> 40:18.150
little . I always wanted to be the best

40:18.220 --> 40:21.700
at everything I did . I originally

40:21.700 --> 40:23.756
joined the military to get money for

40:23.756 --> 40:26.240
school so as soon as I could , I got a

40:26.240 --> 40:30.140
degree , but I realized I really liked

40:30.150 --> 40:32.960
what I was doing . The speed and

40:32.970 --> 40:35.520
intensity of it was perfect for me .

40:35.530 --> 40:39.190
And I had more responsibilities as a 23

40:39.190 --> 40:41.357
year old than anyone I knew outside of

40:41.357 --> 40:45.210
the air force . So I kept on , I

40:45.210 --> 40:46.932
was involved with professional

40:46.932 --> 40:49.940
organizations . I was all over

40:49.940 --> 40:52.030
intramurals . I was highly involved

40:52.030 --> 40:55.760
with my unit but I was also developing

40:55.760 --> 40:58.910
myself professionally . I made tech my

40:58.910 --> 41:02.530
first time testing . Not long after I

41:02.530 --> 41:05.910
found myself volunteering to be acting

41:05.910 --> 41:08.570
first sergeant . That might have been

41:08.570 --> 41:11.530
enough for any sane person . But

41:12.210 --> 41:15.380
I'm me . So I decided to get my masters

41:15.380 --> 41:18.830
degree to back up a little bit .

41:19.210 --> 41:22.630
Uh keeping busy is what makes me happy .

41:23.010 --> 41:26.380
I like the pressure and I thrive under

41:26.380 --> 41:29.020
stress . I thought

41:29.910 --> 41:33.880
I had it under control because I always

41:33.880 --> 41:37.530
do , but it's a fine line .

41:37.910 --> 41:40.320
Mhm . The next thing I know these ,

41:41.410 --> 41:44.050
these stressors start building up

41:44.050 --> 41:46.430
around me And of course I don't even

41:46.430 --> 41:48.880
notice . At first I was doing homework

41:48.890 --> 41:50.946
and writing papers in the evenings ,

41:51.210 --> 41:53.543
taking calls in the middle of the night ,

41:53.710 --> 41:56.700
putting out fires at work and then my

41:56.700 --> 42:00.680
dad um my

42:00.680 --> 42:03.320
dad got really sick

42:05.600 --> 42:09.140
and I am the closest child . So then I

42:09.140 --> 42:13.000
was a caregiver . Yeah . I

42:13.000 --> 42:16.520
felt like I was on a boat

42:17.000 --> 42:19.520
that kept springing . New leaks .

42:21.500 --> 42:25.430
Didn't take long after that until I was

42:26.400 --> 42:28.660
waking up in the middle of the night

42:28.670 --> 42:32.300
consistently with my heart racing which

42:32.310 --> 42:35.840
I had never experienced before . My

42:35.840 --> 42:39.730
life turned into all of

42:39.740 --> 42:43.620
these interconnected stressors where

42:44.100 --> 42:47.340
the shifting or nagging of any one

42:47.340 --> 42:50.520
thing would exacerbate the others . So

42:51.900 --> 42:54.800
I started trying to avoid the things

42:54.800 --> 42:56.920
that were bothering me 1x1 . Which is

42:56.920 --> 42:59.540
crazy . I've never avoided a problem

42:59.540 --> 43:03.360
before . But of course that made things

43:03.360 --> 43:07.210
worse . After a couple of weeks of that

43:07.220 --> 43:10.370
I started getting these heart

43:10.380 --> 43:13.100
palpitations almost always at night

43:13.110 --> 43:16.290
when I was lying in bed and I was

43:16.300 --> 43:19.710
really scared mm . Now it's my

43:19.720 --> 43:22.280
physical health on top of everything

43:22.280 --> 43:25.580
else . So I would psych myself

43:25.580 --> 43:28.110
out by thinking about my problems which

43:28.600 --> 43:30.600
could make it hard to breathe . And

43:30.600 --> 43:32.656
then I was concerned about my health

43:32.656 --> 43:34.656
which made all the symptoms worse .

43:36.600 --> 43:40.390
It's so obvious looking back

43:40.400 --> 43:44.040
what was going on . But four in that

43:44.040 --> 43:47.000
moment it took this physiological

43:47.000 --> 43:50.720
problem to finally stop and

43:51.400 --> 43:53.710
I think that maybe I should go to a

43:53.710 --> 43:57.440
doctor . So on one

43:57.440 --> 43:59.980
hand I was relieved to hear that there

43:59.980 --> 44:02.147
was really nothing wrong with my heart

44:02.147 --> 44:06.140
that it was just stress . But it was a

44:06.140 --> 44:10.000
little harder to except

44:10.010 --> 44:14.010
that for the first time in my life

44:14.490 --> 44:18.120
I wasn't able to manage this juggling

44:18.120 --> 44:21.420
act . So

44:22.090 --> 44:24.970
anyway , my doctor referred me to

44:24.970 --> 44:28.320
mental health and I can hardly admit

44:28.330 --> 44:31.610
how scared I was to go to that first

44:31.610 --> 44:35.300
appointment to address my physical

44:35.300 --> 44:37.220
symptoms . My therapist had me

44:38.090 --> 44:41.320
replicate a racing heart by basically

44:41.320 --> 44:43.320
hyperventilating on purpose , which

44:43.320 --> 44:46.920
sounds weird , but over

44:46.920 --> 44:50.550
time it it let me disconnect

44:50.560 --> 44:53.320
that physical feeling from an anxiety

44:53.320 --> 44:56.380
attack . So I was less afraid of what

44:56.380 --> 44:59.530
my stress would do to me . And then it

44:59.530 --> 45:03.020
was onto exposure therapy , which is

45:03.020 --> 45:06.640
basically facing your fears little by

45:06.640 --> 45:10.570
little they might , it seems

45:10.580 --> 45:14.010
obvious to some people , but I found it

45:14.390 --> 45:18.310
really helpful to understand

45:18.320 --> 45:21.990
how exposure to certain stressors would

45:22.000 --> 45:24.870
affect me and changed my thinking from

45:24.870 --> 45:26.600
a psychological perspective .

45:28.090 --> 45:31.620
Eventually , I I realized that

45:31.630 --> 45:34.260
no one thing in my life was truly

45:34.260 --> 45:37.780
insurmountable and I was

45:37.790 --> 45:41.110
really frustrated with myself for a

45:41.110 --> 45:45.080
while , for not being able

45:45.260 --> 45:48.000
to do it on my own , which I can't

45:48.000 --> 45:51.310
imagine helped at all . But

45:51.990 --> 45:54.720
yeah , I soon began to realize that

45:56.190 --> 45:59.340
I can't be my best self . If I'm

45:59.340 --> 46:03.040
overextended like that , I can't be

46:03.040 --> 46:06.100
there 100% for my dad ,

46:07.680 --> 46:10.340
uh huh or for an airman who's in

46:10.340 --> 46:12.710
trouble if I'm not well ,

46:14.430 --> 46:17.310
it's like on flights

46:18.080 --> 46:20.420
when they tell you to put on your own

46:20.420 --> 46:23.650
oxygen mask before assisting others . I

46:23.660 --> 46:26.020
was holding my breath trying to save

46:26.030 --> 46:29.520
everyone around me . I needed to take

46:29.530 --> 46:33.210
care of myself at times to have the

46:33.210 --> 46:35.700
energy to balance everything .

46:45.180 --> 46:47.360
A traumatic event is a shocking

46:47.370 --> 46:49.500
distressing or dangerous experience

46:49.500 --> 46:51.444
that affects someone emotionally .

46:51.444 --> 46:53.800
Examples of traumatic events include a

46:53.800 --> 46:56.480
natural disaster such as a tornado or

46:56.480 --> 46:58.930
earthquake , a car accident , an

46:58.930 --> 47:01.390
assault crime or violent attack and

47:01.390 --> 47:05.140
combat individuals may respond to

47:05.140 --> 47:07.307
traumatic events in a number of ways ,

47:07.380 --> 47:09.720
Most people have intense emotional

47:09.720 --> 47:12.070
responses immediately following the

47:12.070 --> 47:14.630
event . While these emotions may last

47:14.630 --> 47:17.180
for several weeks , they usually lessen

47:17.180 --> 47:20.110
over time and eventually disappear

47:20.110 --> 47:22.970
entirely . For some people , however ,

47:22.970 --> 47:25.026
the stress and anxiety caused by the

47:25.026 --> 47:27.192
trauma continue for an extended period

47:27.192 --> 47:29.192
of time and begin to interfere with

47:29.192 --> 47:31.303
everyday life . In some cases , these

47:31.303 --> 47:33.210
responses affect the body and can

47:33.210 --> 47:35.100
manifest as physical symptoms .

47:42.980 --> 47:45.400
By definition , a trauma related

47:45.400 --> 47:48.120
disorder is caused by a traumatic event .

47:48.130 --> 47:50.130
It is one of the few disorders for

47:50.130 --> 47:53.470
which we know the exact cause . However ,

47:53.470 --> 47:55.359
there are other factors sometimes

47:55.359 --> 47:58.300
called predisposing , precipitating and

47:58.300 --> 48:01.060
perpetuating factors that influence the

48:01.060 --> 48:03.020
likelihood of developing a trauma

48:03.020 --> 48:05.910
related disorder , its severity and its

48:05.910 --> 48:08.630
duration dr phillips . Can you tell us

48:08.630 --> 48:10.900
about some of these factors ? Sure

48:10.900 --> 48:13.320
Doctor Patel , there are several bio

48:13.320 --> 48:14.987
psychosocial factors that are

48:14.987 --> 48:17.390
considered to be predisposing . This

48:17.390 --> 48:19.760
means they exist prior to any trauma

48:19.760 --> 48:21.860
exposure and make a person more

48:21.860 --> 48:23.693
vulnerable to suffering a trauma

48:23.693 --> 48:25.582
related disorder should they ever

48:25.582 --> 48:28.720
experience a traumatic event ? Common

48:28.720 --> 48:31.410
predisposing factors include childhood

48:31.410 --> 48:33.354
emotional problems or prior mental

48:33.354 --> 48:36.420
disorders , exposure to prior trauma ,

48:36.430 --> 48:39.160
especially during childhood childhood

48:39.160 --> 48:41.580
adversity , such as family dysfunction

48:41.590 --> 48:44.980
or economic deprivation , minority ,

48:44.980 --> 48:47.800
racial or ethnic status , cultural

48:47.800 --> 48:50.150
characteristics such as self blaming

48:50.150 --> 48:53.540
coping strategies being female and

48:53.540 --> 48:55.596
being a younger adult at the time of

48:55.596 --> 48:58.970
trauma exposure , precipitating factors

48:58.980 --> 49:01.147
are those factors that have to do with

49:01.147 --> 49:03.369
specific aspects of the traumatic event

49:03.369 --> 49:06.890
itself . These include severity of the

49:06.890 --> 49:09.400
trauma , perceived life threat ,

49:09.770 --> 49:12.080
personal injury , interpersonal

49:12.080 --> 49:13.870
violence , especially trauma

49:13.880 --> 49:16.810
perpetrated by a caregiver for military

49:16.810 --> 49:19.500
personnel , witnessing atrocities or

49:19.500 --> 49:23.040
killing the enemy and dissociation that

49:23.040 --> 49:26.230
occurs during the trauma perpetuating

49:26.230 --> 49:28.610
factors are factors that come into play

49:28.620 --> 49:31.230
after the trauma has occurred . These

49:31.230 --> 49:33.550
factors deepen and prolonged trauma

49:33.550 --> 49:36.630
related to stress . Common perpetuating

49:36.630 --> 49:39.240
factors include negative appraisals of

49:39.240 --> 49:42.090
the event , the use of maladaptive

49:42.090 --> 49:44.510
coping strategies such as avoidance ,

49:44.550 --> 49:47.240
substance use and isolation , or

49:47.240 --> 49:50.110
withdrawal , subsequent exposure to

49:50.110 --> 49:52.300
repeated upsetting reminders ,

49:52.310 --> 49:55.360
subsequent adverse life events and

49:55.360 --> 49:57.450
financial and other trauma related

49:57.450 --> 49:59.200
losses .

50:07.160 --> 50:08.938
The experience of psychological

50:08.938 --> 50:10.993
distress following a traumatic event

50:10.993 --> 50:12.993
varies from person to person . Dr .

50:12.993 --> 50:15.160
Mansfield . Can you tell us about some

50:15.160 --> 50:17.216
symptoms of trauma related disorders

50:17.216 --> 50:19.271
and how they are diagnosed ? Well dr

50:19.271 --> 50:21.382
german traumatic events are naturally

50:21.382 --> 50:23.604
upsetting and a wide range of responses

50:23.604 --> 50:25.604
or symptoms immediately following a

50:25.604 --> 50:28.070
traumatic event are normal and natural .

50:28.560 --> 50:30.616
These symptoms are generally grouped

50:30.616 --> 50:32.449
into five categories , including

50:32.490 --> 50:34.980
intrusion symptoms , negative mood ,

50:35.460 --> 50:37.850
dissociative symptoms , avoidance

50:37.850 --> 50:40.490
symptoms and arousal symptoms .

50:40.860 --> 50:43.410
Intrusion symptoms include recurrent

50:43.420 --> 50:45.750
involuntary and intrusive , distressing

50:45.750 --> 50:47.639
memories of the traumatic event ,

50:48.060 --> 50:50.440
recurrent distressing dreams related to

50:50.440 --> 50:53.250
the event , flashbacks in which the

50:53.250 --> 50:55.194
individual feels or acts as if the

50:55.194 --> 50:58.230
event were recurring and intense or

50:58.230 --> 51:00.230
prolonged distress . In response to

51:00.230 --> 51:03.400
reminders of the event , negative mood

51:03.400 --> 51:05.590
refers to a persistent inability to

51:05.590 --> 51:07.646
experience positive emotions such as

51:07.646 --> 51:09.880
happiness , satisfaction or affection .

51:10.960 --> 51:12.860
Dissociative symptoms include an

51:12.870 --> 51:15.410
altered sense of reality and an

51:15.420 --> 51:17.364
inability to remember an important

51:17.364 --> 51:19.476
aspect of the traumatic event that is

51:19.476 --> 51:21.670
not related to other factors such as

51:21.680 --> 51:24.280
head injury , alcohol or drugs

51:25.160 --> 51:27.710
avoidance symptoms include efforts to

51:27.710 --> 51:30.060
avoid distressing memories , thoughts

51:30.060 --> 51:32.420
or feelings about the event , and

51:32.630 --> 51:34.963
efforts to avoid reminders of the event .

51:35.560 --> 51:38.140
Finally , arousal symptoms include

51:38.200 --> 51:40.690
sleep disturbance , irritable behavior

51:40.690 --> 51:43.230
and angry outbursts . Hypervigilance

51:43.330 --> 51:45.830
problems with concentration and

51:45.850 --> 51:48.980
exaggerated startle response . When

51:48.980 --> 51:50.924
nine or more of these symptoms are

51:50.924 --> 51:52.980
present for more than three days but

51:52.980 --> 51:54.980
less than a month , a person may be

51:54.980 --> 51:57.147
diagnosed with acute stress disorder .

51:57.660 --> 51:59.660
If symptoms persist for more than a

51:59.660 --> 52:01.882
month , they may be diagnosed with post

52:01.882 --> 52:04.770
traumatic stress disorder or PTSD .

52:12.450 --> 52:14.339
There are several things a person

52:14.339 --> 52:16.506
experiencing a trauma related disorder

52:16.506 --> 52:19.380
can do to help themselves . Mr Willis .

52:19.380 --> 52:21.380
Can you tell us about some of these

52:21.380 --> 52:23.436
self help tips ? Absolutely . Doctor

52:23.436 --> 52:26.050
Patel , A few simple steps that may

52:26.050 --> 52:28.272
help someone suffering a trauma related

52:28.272 --> 52:30.930
disorder include engage in mild

52:30.940 --> 52:33.250
physical activity or exercise to help

52:33.250 --> 52:36.670
reduce stress , set realistic goals .

52:37.050 --> 52:39.960
Break up large task into small ones and

52:39.960 --> 52:42.800
set priorities . Try to spend time with

52:42.800 --> 52:45.460
other people . Confide in a trusted

52:45.460 --> 52:48.210
friend or relative , tell others about

52:48.210 --> 52:50.154
things that may trigger symptoms ,

52:50.550 --> 52:53.010
expect symptoms to improve gradually ,

52:53.020 --> 52:56.250
not immediately and identify and seek

52:56.260 --> 52:58.920
out comforting situations . Places and

52:58.920 --> 52:59.980
people . Yeah ,

53:07.350 --> 53:09.350
the first line treatment for people

53:09.350 --> 53:11.572
with trauma related disorders is trauma

53:11.572 --> 53:13.683
focused psychotherapy . Dr phillips .

53:13.683 --> 53:15.183
Can you tell us more about

53:15.183 --> 53:17.406
psychotherapy treatments ? Sure thing .

53:17.406 --> 53:20.140
Dr german psychotherapy for a trauma

53:20.140 --> 53:22.370
related distress typically takes place

53:22.370 --> 53:24.680
in an individual setting but may be

53:24.680 --> 53:26.840
done in a group setting as well .

53:26.910 --> 53:28.830
Support from family and friends .

53:28.830 --> 53:30.910
During psychotherapy treatment is an

53:30.910 --> 53:33.960
important part of recovery . In fact ,

53:33.970 --> 53:36.350
research suggests that the involvement

53:36.360 --> 53:39.060
of key support persons such as a spouse

53:39.070 --> 53:41.420
or partner may lead to much better

53:41.420 --> 53:44.490
outcomes . While some therapies focus

53:44.490 --> 53:46.840
on social family or job related

53:46.840 --> 53:48.850
problems that are peripheral to the

53:48.850 --> 53:51.690
disorder , the most effective therapies

53:51.700 --> 53:53.770
tend to focus directly on the trauma

53:53.770 --> 53:55.920
related memories and symptoms of

53:55.920 --> 53:59.140
avoidance . These therapies also

53:59.140 --> 54:01.560
emphasize education regarding triggers

54:01.640 --> 54:04.000
of symptoms and skills to better manage

54:04.000 --> 54:07.150
those symptoms . Two forms of cognitive

54:07.150 --> 54:10.150
behavioral therapy , or CBT , have

54:10.150 --> 54:12.400
proven especially effective in treating

54:12.400 --> 54:14.600
post traumatic stress disorder , or

54:14.600 --> 54:17.860
PTSD . The first is called prolonged

54:17.860 --> 54:20.790
exposure therapy , prolonged exposure

54:20.790 --> 54:22.840
therapy helps reduce problematic

54:22.850 --> 54:25.290
avoidant behaviors by repeatedly

54:25.290 --> 54:27.530
exposing the patient to memories of the

54:27.530 --> 54:30.250
traumatic event in a safe environment .

54:30.260 --> 54:33.380
Over time the anxiety and distress

54:33.380 --> 54:35.760
associated with the memories decrease .

54:36.340 --> 54:38.890
The second form of CBT used to treat

54:38.900 --> 54:41.980
PTSD is called cognitive processing

54:41.980 --> 54:44.910
therapy . It's similar to prolonged

54:44.910 --> 54:48.000
exposure but places special emphasis on

54:48.000 --> 54:50.420
changing unhelpful or inaccurate

54:50.430 --> 54:52.780
thoughts associated with the traumatic

54:52.780 --> 54:56.020
event . Both treatments help patients

54:56.030 --> 54:58.450
overcome negative memories and thoughts

54:58.680 --> 55:00.624
that might be preventing them from

55:00.624 --> 55:03.040
participating in meaningful activities

55:03.050 --> 55:06.140
and relationships . In many cases ,

55:06.150 --> 55:08.720
patients no longer meet the criteria

55:08.730 --> 55:11.680
for a PTSD diagnosis after they've

55:11.680 --> 55:14.760
completed a full course of treatment .

55:21.140 --> 55:22.560
Mhm . Mark .

55:29.140 --> 55:32.600
No . This would have been three , 3.5

55:32.600 --> 55:34.711
years ago now it was a normal day . I

55:34.711 --> 55:36.878
pick my kids up from daycare was on my

55:36.878 --> 55:39.230
way home , it was november , so it had

55:39.230 --> 55:41.286
already started getting dark early .

55:41.286 --> 55:43.840
The roads were a little bit slick on a

55:43.840 --> 55:46.007
particularly curvy stretch of road . I

55:46.007 --> 55:48.490
remember I came around the corner and

55:48.490 --> 55:50.768
by the time I saw them it was too late .

55:51.340 --> 55:53.562
A silver suv was getting broadside . In

55:53.562 --> 55:55.618
the middle of the road . I could see

55:55.618 --> 55:58.690
people inside scared . two adults , 2

55:58.690 --> 56:02.480
kids , a family . I

56:02.490 --> 56:04.601
slammed on my brakes but it didn't do

56:04.601 --> 56:07.480
much . We were pretty banged up but we

56:07.480 --> 56:10.350
were all wearing our seatbelts . I

56:10.350 --> 56:12.572
could tell immediately the situation in

56:12.572 --> 56:14.572
the other car was bad . I mean , so

56:14.572 --> 56:16.572
what do you do ? I had to make sure

56:16.572 --> 56:18.794
that my kids were okay . I mean we were

56:18.794 --> 56:21.017
shaken up but I was also thinking about

56:21.017 --> 56:23.350
that other family . I'm not a paramedic ,

56:23.350 --> 56:25.360
I'm a calm guy but I remember abc

56:25.360 --> 56:28.140
airway , breathing circulation . I was

56:28.140 --> 56:30.196
approaching the vehicle and the lady

56:30.196 --> 56:32.362
inside started to come to . The others

56:32.362 --> 56:34.690
were dazed or unconscious . I'm working

56:34.690 --> 56:36.801
to get these people out stop bleeding

56:36.801 --> 56:40.790
things like that . But that kid , he

56:40.790 --> 56:42.901
wasn't wearing a seat belt and he was

56:42.901 --> 56:45.234
thrown through the window onto the road .

56:46.830 --> 56:48.830
There was nothing that I could have

56:48.830 --> 56:51.290
done for that kid . But yeah , he could

56:51.290 --> 56:53.650
have been the same age as my boy . Mhm .

56:54.330 --> 56:57.800
So fast forward to three months later .

56:57.800 --> 56:59.856
And I can't get this image out of my

56:59.856 --> 57:03.390
head . This poor little boy's face . I

57:03.390 --> 57:05.279
never really remembered my dreams

57:05.279 --> 57:08.750
before . But this face was in my dreams

57:08.760 --> 57:12.450
every single night . Every night .

57:12.830 --> 57:16.070
Yeah , I had to stop driving that route

57:16.070 --> 57:18.070
home from work because every time I

57:18.070 --> 57:19.959
came around that bend , I started

57:19.959 --> 57:21.848
sweating , shaking . My heart was

57:21.848 --> 57:24.590
pounding . Like I was afraid I couldn't

57:24.590 --> 57:27.980
control the vehicle . Mm hmm . I've

57:27.980 --> 57:30.147
never had anything happened to me like

57:30.147 --> 57:32.369
this before . I mean obviously not like

57:32.369 --> 57:34.720
the accident . But then this this

57:34.720 --> 57:37.890
repeating , haunting image . My sleep

57:37.890 --> 57:41.110
was bad . I was short with people for

57:41.110 --> 57:43.960
no reason and when I would come home ,

57:43.960 --> 57:46.182
it was almost like I was trying to stop

57:46.182 --> 57:48.349
my kids from going out or playing with

57:48.349 --> 57:50.460
their friends . Later I realized that

57:50.460 --> 57:52.571
this boy's death must have given me a

57:52.571 --> 57:55.040
total fear of loss of my own family .

57:56.530 --> 57:59.170
My irrational way of protecting them

57:59.170 --> 58:01.620
was to suffocate them . I became

58:01.620 --> 58:04.280
someone that I didn't want to be and I

58:04.280 --> 58:06.447
didn't know how to be normal anymore .

58:06.820 --> 58:09.420
And I feel like this stories and your

58:09.430 --> 58:11.430
typical story . I mean , I know

58:11.430 --> 58:13.652
different types of trauma affect people

58:13.652 --> 58:15.819
differently , but the way this altered

58:15.819 --> 58:18.600
my life was unexpected ,

58:20.220 --> 58:24.180
shattering . Actually combined

58:24.180 --> 58:27.170
with this new fear of loss was my guilt

58:27.170 --> 58:29.760
for what had happened . I began

58:29.760 --> 58:32.700
thinking I could have done something

58:32.700 --> 58:36.450
should have done more again . I

58:36.450 --> 58:38.617
know it's irrational because the crash

58:38.617 --> 58:41.270
was out of my control , but it was

58:41.270 --> 58:44.300
tearing me apart . I started to think

58:44.300 --> 58:46.880
that I was going crazy . Like I wasn't

58:46.890 --> 58:48.612
ever gonna be the same again .

58:50.920 --> 58:53.031
I even got a prescription for anxiety

58:53.031 --> 58:55.760
meds , which sort of worked but never

58:55.760 --> 58:57.649
really addressed the heart of the

58:57.649 --> 58:59.649
problem . It wasn't until I started

58:59.649 --> 59:01.538
talking about all of this with my

59:01.538 --> 59:03.538
chaplain that things started to get

59:03.538 --> 59:06.130
back to normal . A couple of talks we

59:06.130 --> 59:09.190
had were helpful , but ultimately he

59:09.190 --> 59:11.301
encouraged me to see a psychologist .

59:13.020 --> 59:15.076
I never thought I'd see myself doing

59:15.076 --> 59:18.750
that , but I knew something had to give .

59:19.220 --> 59:21.109
I ended up doing a combination of

59:21.109 --> 59:23.120
what's called exposure therapy and

59:23.120 --> 59:25.400
cognitive processing therapy . Over

59:25.400 --> 59:27.622
time , I would expose myself to certain

59:27.622 --> 59:29.733
triggers that would cause my heart to

59:29.733 --> 59:31.511
race or have all these negative

59:31.511 --> 59:34.380
thoughts . I had already talked about a

59:34.380 --> 59:36.324
little bit of the accident with my

59:36.324 --> 59:38.491
chaplain . So the psychologist thought

59:38.491 --> 59:40.658
I was at the right point to really dig

59:40.658 --> 59:42.713
into the details . I talked about it

59:42.713 --> 59:44.824
during my sessions and listen back to

59:44.824 --> 59:46.936
the recordings of those sessions . At

59:46.936 --> 59:50.790
home from week to week ,

59:50.800 --> 59:53.710
I felt my perspective shifting in a

59:53.710 --> 59:57.140
good way . Over time I was able to go

59:57.140 --> 01:00:00.830
back and uh dr that stretch of road

01:00:01.520 --> 01:00:04.620
first during the day , and then at

01:00:04.620 --> 01:00:07.280
night , once I was more comfortable , I

01:00:07.280 --> 01:00:09.058
would just say that if you feel

01:00:09.058 --> 01:00:11.660
different or off , you need to reflect

01:00:11.660 --> 01:00:13.827
on what might be able to help you deal

01:00:13.827 --> 01:00:15.882
with whatever it is that's eating at

01:00:15.882 --> 01:00:17.993
you , ignoring . It doesn't work , it

01:00:17.993 --> 01:00:20.160
didn't work for me and it only made me

01:00:20.160 --> 01:00:20.150
withdraw from the people . I love