In our first video, we chatted with Dr Mike about the physical and mental health relationship, Who to reach out to for support and how you can maintain or improve your mental well being.

Stay until the end to learn practical tips on managing your body and mind, thoughts on any resources that might be useful for just the general public to read on about mental wellness for sure.

So, I have sort of like, I would say two books that I recommend quite often to my patients as one is an introduction to cognitive behavioral therapy.

It's called Feeling Good.

There's actually an updated version called Feeling Great by David Burns.

Great author.

Great book has work book within a book, so you're kind of like, not passively reading, you're actively reading and then filling stuff out and learning about yourself in the process.

I've read it, I've got tremendous benefit from it.

I was actually introduced to it by our behavioral specialist in my residency program who kind of helped teach us, who help take care of us when we were struggling as residents.

That book did wonders for me and there's some preliminary research showing that bibliotheca, p just reading that book alone from mild symptoms goes a really long way to helping alleviate them.

So, that's one that I often use as an introduction for cognitive behavioral therapy.

And then when it comes to how your physical health is impacted by your mental health.

There's an author by the name of Dr Sarno the late Dr Sarno one is called a divided mind and oftentimes if I feel a pain that's coming in with a physical manifestation of a mental health situation.

Common example of this would be low back pain or some other musculoskeletal complaint, where I'm like, look, we've ruled everything out anatomically, You're okay, there is no nerve impingement, the muscles are intact, there's no major spasms.

You have good range of motion, but you are having pain, it's not all in your head, but it's happening as a result of what's going on in your head, and that's part of life.

That's like what our bodies do, naturally.

It really stems from the side signs of pain perception.

Because I think something everyone can relate to is if you're having an ache, no matter what it is, stomachache, elbow ache, Backache, and you go to a party and you're having fun with friends, I guarantee you you're feeling that ache less, like you're on adrenaline, you're having a good time, you're feeling it less.

But if you were to receive some bad news, I guarantee you that cake becomes intensified and it's not again, just all in your head, you're making it up, It's true, the pain is true, your body is perceiving it differently, but that's because of what's going on in your mind in your mental health state, and that's what the book, the divided mind really dives into as to why our minds do this, Dr Sarno postulate some interesting theories as to why our bodies do this.

Something he talks about is repressed childhood trauma, emotions how they potentially if they're being repressed and untapped that our bodies are actually creating some of these physical manifestations to prevent us from thinking about that.

And I think there's definitely something there.

I don't think it's fully fleshed out yet.

But to me it's interesting, it's an interesting field of research.

It's an interesting part of reading because I've had patients who have come in with these manifestations physically that nothing medically I can give them a diagnosis on the M.

R.

I.

Is normal, the imaging is normal, the function of it is normal but there's pain and then we dive into the mental health side of things and all of a sudden the pain is gone.

I've actually had an interesting interaction with the patient.

I mentioned elbow pain several times because she came in after three visits with other doctors.

Elbow was bothering her M.

R.

I was normal X rays.

Normal functionally looks okay.

Had some physical therapy no improved.

I bring up this topic.

She was very reluctant to talk about her emotions but then said you know what I want to try it because the elbow is bothering, I asked her to give me a call back to give me an update in a couple of weeks, see how she's doing no call.

So I was kind of upset.

I said you know what maybe I should call and just make sure everything's okay and when I called her she said you know I'm kind of upset with you doctor, why are you upset?

What's going on?

And she says because my elbow pain is gone and like well why are you upset if your elbow pain is gone?

Because she says you know now it makes me feel like it was all in my head and we have to have that conversation about, it's not all in your head, this is part of how your body perceives pain.

If there's some kind of trauma there, your body will act differently, it will perceive pain differently.

Your experiences in the world will be subjectively different and that's normal.

It's again, it's so important to talk about because it's how the body copes part of its natural mechanisms.

And I wish we put that out there more because I feel like we would have a lot less sham medicine of miracle cures, would have a lot less imaging that is unnecessary and we have a lot less surgeries and procedures that patients don't need.

But then end up suffering from because of the side effects of these procedures.

If you're feeling good, you're releasing endorphins.

Those are natural pain relievers.

It's almost like our own opioid system within our own bodies.

So like the fact that we feel less pain when things are good, goes to show that there's something happening mentally that's affecting this really simple question, I ask patients is you know, does your back hurt or does your head hurt only on weekdays?

And if they say yes, what happens on weekends, on weekends?

I'm off.

I'm not stressed from work, I'm having a good time with my family, I'm happy.

Well, why is that if you have a broken bone, if you have pressure on your nerves, if you have a tumor, God forbid, why would it take weekends off?

Like medically, it doesn't make sense.

So, we have to start looking elsewhere and figuring out why it's happening with that pattern.

And that goes back to that cascading pathway and figuring out the diagnosis in the beginning and that's why the mental and physical health relationship is so cool.

At the same time, there's a lot of stigma around.

So patients aren't always open to having that conversation.

Some have experienced true traumas that they're not comfortable sharing.

Especially meeting me for the first time, if I'm not their primary doctor, that makes things even more trick.

That's my field of work, where I'm trying to figure out how to get patients excited, motivated and looking deeper into themselves to become more introspective, right?

Mental health and physical health as you just described.

We just chatted.

It's just so, it's almost inseparable.

I would say sometimes it's unfortunate that's quite difficult for people to reach out and I think one of the difficult is that there are so many different types of health care providers, for example, social workers, psychiatrists, psychologists, you name it that it's hard to know who reach out to first like primary care.

That's why like if you have primary care they'll help you guide this.

The system is complicated.

Like you're so right on this.

Even for me, like when I have something wrong and I need specialty care, I'm confused.

I'm like who do I go see?

Like I need to start digging into my roller decks or maybe even using our references that we use for you know medical conditions to see like who's the optimal person to refer this patient.

Is it ear, nose and throat?

Is it maxillofacial surgeon?

Like who is the best person to take care of this because sometimes things are very sub specialized and you don't know who to see.

So the fact is if you have a good primary care doctor, who cares, who understands the system, they'll be able to guide you if you need a social worker counselor and sometimes a counselor may not be enough for the severity of the case that a patient has maybe a patient needs an inpatient stay maybe after their inpatient stay.

They may need an intense outpatient program where they're going every single day to this program.

And I've had patients benefit greatly from doing these intensive outpatient programs as well as in patient programs, but unless you're aware that they're available, you may not take advantage.

And the only way you can really know outside of doing like a lot of serious digging and research is have a good primary care doctor and be plugged in.

So after someone reaches out to their primary care provider presumably would take some time to actually meet them.

So in the meantime, do you have any recommendations on what someone can do to either maintain wellness or to just feel better for the time being?

It's so hyper dependent.

It's hard to give generalized advice here.

I just think like everyone could benefit from cognitive behavioral therapy, even if you're not having a quote unquote diagnosis, you could still benefit from cognitive behavioral therapy because we're also prone to disorder thoughts where, you know, I didn't get an A.

So I'm a failure.

My partner was looking at their phone a little longer than usual.

They're cheating on me.

Like these thoughts pop into all of our minds.

They can really derail how we feel If you feel a certain whether you're feeling down angry, sad.

If someone tells you to snap out of it, they're kind of being rude because you can't really control your feelings, but you do have some control over your thoughts so we can attack some of those disordered thoughts through cognitive behavioral therapy.

Even from the knowledge of cognitive behavioral therapy, it can go a long way.

So for everyone, I recommend doing at least the initial reading of feeling good or feeling great general gist and understanding of what's going on and something that kind of a hack or a tip that I like using is some of these simple, almost gimmicky things, but they actually have evidence behind them that you can do one is like the letter of gratitude, basically in the field of positive psychology, it's been found that if you write a letter of gratitude to someone who you're grateful to, whether it's a family member, friend doesn't really matter.

You write it out, but you don't send it, you call, you meet the person and you read it to them in person and often times it's an incredibly emotional experience.

Obviously depending on who you choose, how you choose to read it and the benefit in terms of decreasing anxiety and depressive symptoms, just by reading that one letter to one person and writing it, there's weeks of relief or at least a slight decrease in symptoms that's been validated in scientific research.

The second one that's probably more well known is the three positive things at the end of the day jotting down on your phone on a piece of paper.

Three good things that happened to you.

There's slightly different variations, You could do three good things with one sentence as to why you think they happened.

There's three good things that you can write, how you earned those three good things.

Like for example, if I say, oh, they're my dog behaved well today and my reason could be because I took a lot of time to train there and that is useful for someone who may be having problems with self confidence.

So we can add those little boosters in in addition to the three good things that also has been validated for decreasing depressive and anxiety features if you do it for a period of two weeks and yet again, multiple weeks after you even discontinue doing it of relief of your symptoms.

And again, it's not a cure all.

It's just something you can do that is just a healthy exercise for your brain, almost how I can tell a patient, you know, oh, walk, healthy for you or movement is healthy for you.

This is a form of brain exercise that's good for you because our brains are so attuned to being anxious and nervous in order to survive.

And now that our worlds have become safer, we need to sort of retune them back to enjoy this and be happy and be optimistic.

And something interesting that my behavioral specialists in my office said to me the other day is therapists call optimism a form of functional delusion, which is funny because optimism is a good thing, right?

But yet it's a delusion and the reason why it's a delusion is because validated scientific research separated folks into two categories.

Those who were optimists and those who were more pessimists.

And they gave them scenarios short term, medium term and long term and they tried to have them predict how the outcomes would happen in the world and every single time, the pessimists were more accurate in their predictions.

The optimists were less accurate.

So they were almost delusional in how they thought the future would go.

But the optimists were healthier, they had a happier life during that time.

They met more of their goals and they achieved more.

So it's like maybe if you're pessimistic might be more accurate, but then you're missing out on some of the positivity that is life and that's where that balance comes into play, that you can't always be optimistic and fully happy all the time, but you can also be pessimistic because it's going to take a toll on your body and mind so much so that you won't have the longevity and the joy that you would if you were somewhere in between any other personality trait typically associated with people leading happier healthier lives apart from the things that people think of, like optimism.

Yes, like this is really interesting.

So we talked about gratitude right?

Important thing in order to have a healthy mindset and there's some recent research that I've looked into about how there's something even more powerful than gratitude in terms of keeping happiness levels up and fighting off feelings of depression or hopelessness, especially during a time, like the pandemic and that's looking forward to the future, like not predicting the future, but being excited about the future and it's something that I personally experienced And then when I was exploring it with my own psychologist that I'm seeing for myself throughout the pan, I realized that this is actually a new form of research and I'll give you my personal example, my coping mechanism that has worked very well for me, it doesn't work for everybody was looking forward to the future.

So if I had one month in an ICU that I was working and I was working seven days a week, six days a week, whatever it was, you know, people say, how do you function?

Aren't you sad?

I wasn't because I knew after that month I was going to go play basketball, I was going to be with my friends and I would look forward to that or if I had a long hospital shift, I wouldn't be sad because I would say afterwards I'm going to go away, watch a movie or netflix, whatever, hang out there.

So I would always be like thinking about the future to not feel sad about the present and that was my coping mechanism.

The pandemic took that away because the pandemic, there was no certainty there was less social communication, there was less ability to go play basketball, especially in the beginning when we didn't know what was going on and because of that, my coping mechanism was essentially taken away from me and I started suffering.

That's why I needed to get help and I realized that I started working with this therapist and she told me about some research that was being done testing whether gratitude we're looking forward towards the future.

Like I was doing it was my coping mechanism was more powerful.

They started doing this with war veterans.

They started to see that war veterans who look towards the future actually at healthier levels of satisfaction in life and less feelings of hopelessness in comparison to those who use gratitude as their strategy.

So that also is another area where, okay, if gratitude isn't working for you, the three good things isn't working for you, try looking forward to the future and that may not always be possible with the circumstances, especially in the middle pandemic, but maybe there's small wins that you can have their, for example, in order for me to have something to look forward in the future.

I bought a piano and I started I want to learn how to play the piano or I bought a new game and a video game and I was like, you know what, I want to play this video game.