I welcome Dr. Sarah Pospos to the show to discuss her interesting career path in the world of psychiatry, specifically telepsychiatry.
Dr. Sarah is a devoted B.rad listener, and in this show, you’ll learn about her highly integrative approach to psychiatry—as you’ll hear, I had to push and prod her to even talk about prescription medication! She is a strong supporter of incorporating exercise, nutrition, sleep, stress management, time management and breathing exercises, and yoga in order to handle the very common, prevailing mental health struggles that have escalated in recent years, especially in the age of quarantine and the accordant lifestyle disruptions (such as anxiety, depression, PTSD, etc). The immediate successful interventions that can concur with something like a simple breathing exercise or a quick workout will be great takeaways from this show; in fact, she cites research that proves a single workout can alleviate the acute symptoms of anxiety! You’ll also hear about imposter syndrome: why it’s become so prevalent and how to combat it without becoming overly arrogant, egoistical, and narcissistic, and learn a lot about how to achieve balance in both your brain and in your life.
Dr. Sarah Pospos is a sports and perinatal psychiatrist and former student-athlete. Her Masters in Psychopharmacology and Applied Psychology allows her to add even more insights on all things medication and human behavior—she has published quite a bit on work burnout, anxiety, and depression at UCLA, UCSD, Harbor-UCLA, and UCSB. Dr. Sarah is devoted to helping working professionals feel their best again, especially when dealing with anxiety, depression or other psychiatric challenges associated with work stress, intense workload, deadlines, no work-life balance, and others. She incorporates exercise, nutrition, sleep, stress management, effective time management (especially as a full-time psychiatrist and new mom of 2 under 2), and other sustainable lifestyle changes.
Dr. Pospos is a psychiatrist who believes exercise, nutrition, and sleep and such are preferable to medication for handling life’s struggles. [01:27]
How closely related are the more traditional treatments vs. the lifestyle focus. [09:26]
What are some of the challenges when people maybe are too depressed or anxious to adhere to the healthy lifestyle changes you are encouraging? [11:29]
What role does medication play in intervention? [14:01]
Does modern day psychiatric training include these important aspects like sleep, diet, exercise? [16:01]
Telepsychiatry is convenient for busy folks. There is no need to take commuting time away from work or errands. [18:12]
Dr. Pospos’s practice is out of network for insurance for many reasons. [20:45]
Research on burnout, anxiety, depression shows a strong connection with lifestyle changes such as yoga and meditation being implemented is beneficial. [24:23]
Anxiety relates back to our ancestors as a threat to survival. [29:16]
Is cold-water therapy a good treatment for anxiety? [32:47]
Exercise, art, and other activities can give you a sense of mastery, which, of course, helps with mental health. [35:13]
Where do medications fit in? Are they overused, over prescribed? [37:34]
There is such a continuum in diagnoses and labeling in this field. [43:29]
There is a big effect on our mental health with navigating the internet and mobile devices. [50:09]
Comparing yourself to others can lead to imposter syndrome. [52:16]
It is important, especially for kids, to try to implement the mindset in the process rather than outcomes. The emphasis needs to be on effort and personal improvement. [58:34]
How does Dr. Pospos keep her own life balanced in a healthy manner? [01:03:42]
- Brad Kearns.com
- Brad’s Shopping page
- Dopamine Nation
- The Inverse Power of Praise (How not to Talk to your Kids)
- Podcast with Ashley Merryman
- Nurture Shock
- Top Dog
- Dr. Pospos’ website
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Hey listeners, I welcome to the show, Dr. Sarah Pospos. She is a devoted listener of the B.rad podcast. She wrote me an interesting note about her unique career path, and we thought we would talk about it, get some interesting insights about the world of psychiatry, particularly telepsychiatry. So she has a private practice consulting with patients all over California, where she’s based, and she will be your go to psychiatrist on the go. On zoom convenient, easy. And what’s great about her is she has this highly integrative approach to psychiatry. I had to actually, push and prod her to talk about prescription medication, which we widely believe to be the centerpiece of psychiatric care. But she’s strongly enrolled in the approach of incorporating exercise, nutrition, sleep, stress management, effective time management, yoga, meditation, breathing to handle the very common prevailing mental health struggles that have escalated, especially in the age of quarantine and the accordant lifestyle disruptions.
And those would be anxiety, depression, PTSD, things of that nature, uh, but with a special focus to anxiety and depression, because it’s so prevalent and growing at such a fantastic rate. The immediate successful interventions that can occur with something like a simple breathing exercise or a workout will be great takeaways. In fact, she cites research that a single workout can alleviate the acute symptoms of anxiety, and she discusses exactly why using the ancestral health example of what our brains and our neurochemicals hormones, neurotransmitters are primed for the state of alertness in the fight or flight survival of the fittest circumstances of our past, which now are associated with mobile device usage. The comparison culture of social media. Uh, she talks at length about imposter syndrome and you hear that term all the time bantered about I had a vague idea of what it meant, but we’re gonna get into an interesting definition from a psychiatrist why it’s become so prevalent and what we can do to kind of combat that and get our heads in the right spot, get out of our own way, be proud of our accomplishments, but of course not trend too far over into the other direction to where we become arrogant, egotistical, narcissistic.
So, you’re gonna learn a lot about, um, a balance in the brain in life and a nice chat with Dr. Sarah Pospos at lifestyle telepsychiatry.com. And she is an official training in the specialties of sports and perinatal psychiatry. She’s a former student athlete. So she works with athletes in that, on that level. She’s published a lot of work on the topics of burnout, anxiety, and depression, and she’s worked and studied at UCLA, UC San Diego, UC Santa Barbara USC. And when I hear UCSB, where I went to school and UCLA where I was born, I’m like, okay, come on. I’m, uh, I’m in you, you got me. So here she is on the show. She’s gonna talk about some work life balance with her own personal example at the end. But at the start you heard a little shout out for some of her work life balance, and that would be her two children under the age of two. I thought I detected a little bit of shout out from some fans in the other room. And that was so cute. I’m usually listening for barking dogs in today’s era of zoom technology and remote meetings. And then I’ll ask what kind of breed and stuff. But I don’t think that was a dog this time. But here’s a very busy, enthusiastic and progressive medical practitioner, Dr. Sarah, Pospos.
Dr. Sarah Pospos. Thank you for joining me on the show.
Of course. Thank you so much, Brad, for having me. It’s Such an honor.
Yeah. Um, pretty exciting messages we’ve exchanged, especially with your training and your area of work. It seems like the cutting edge of medicine, and that’s so exciting cuz I think we’re all trying to reconcile the challenges, the problems, the narrowness of traditional medical treatment. We’re into the ancestral health scene, progressive ideas and things like that. But of course we have a lot to, um, to, to synchronize here to get optimal care. And so I think I would love for you to introduce yourself and talk about your training and how you kind of ended in this current model of practicing perinatal psychiatry and sports psychiatry and doing it from this new remote model that allows it to be accessible to more people.
Absolutely. So hi everyone. My name is Sarah Pospos. As Brad mentioned, I completed my psychiatry residency as a chief resident at UCLA current. And I’ve published, uh, quite a bit as well, uh, on the subject of burnout and depression at places like UCLA, U C S D and UC Santa Barbara as a psychiatrist, I am devoted to helping high performers optimize and balance their lives through exercise, nutrition, sleep, stress management, efficient time management techniques and other sustainable lifestyle, which is very much in line with my expertise in both perinatal psychiatry and sports psychiatrists, sports psychiatry. So currently I’m only serving patients by telehealth, uh, which just means that the visits are done virtually a hundred percent virtually in California, but, uh, for non California residents, I also do offer free resources on all things, lifestyle psychiatry on my website,:lifestyletelepsychiatry.com.
So it sounds like your patients are people looking for something different than the traditional model, the often criticized model of going to see a psychiatrist for a very short visit getting prescribed medication and then the essential role being just kind of tweaking the medications rather than bringing in all these other aspects that you mention about lifestyle, diet, sleep, all the important things that might affect your psychiatric health.
Yes. Uh, definitely. So, you know, in addition to the, like you mentioned, the traditional psychiatric care that we’re all perhaps familiar with, I also would like to emphasize the lifestyle factors of things, through things like nutrition, um, exercise, sleep, optimizing sleep, and all those good stuff, because as you probably can imagine in psychiatry, most, if not all of the conditions are chronic, right? So just like we would think of common, chronic other common chronic conditions like diabetes, for example,.Yes, medication might help. But in addition to that, what if someone doesn’t take care of their diets continue to take a lot of highly processed sugary food? What if someone’s not physically active? You know, their insulin hormone that took care of the glucose response in the body wouldn’t work as much. What if someone’s not sleeping enough or is under constant stress, their stress hormone, the cortisol would be true to roof and also affects all this thing in their body in relation to the glucose response. So similarly, like you mentioned, uh, in mental health, just adding these tweaks, lifestyle tweaks can really, um, can really, you know, improve their mental health, as a whole as well.
So what are we missing here with the traditional view of these conditions and treatments? You know, we talk about anxiety, depression at record rates. We had, COVID the quarantine, which disrupted a lot of people, young and old having to recalibrate and missing out on rich social interactions and things that improve our mental health. But where do these pieces fit together? When someone comes in with a clinical diagnosis of anxiety, depression, whatever it is, PTSD, um, how can we, uh, how, how can we intervene both from the, the medication side and the lifestyle side? What, how, how closely you related are those, you know what I mean?
Yeah. So that’s a very good question. So typically in psychiatry, our first visit is dedicated to get, get to know you, right. Uh, in terms, uh, of not only your, your current symptoms. So for instance, that would be your depression symptoms, your anxiety symptoms, or what have you, but also, your life in general. So, you know, what’s your family background for instance? What’s your occupation? How far did you go to school? And things like that, including your lifestyle. So how’s your sleep typically look like, you know, your, um, physical activity level in general, your nutrition and whatnot. So all those taken together, these data points, uh, based on that we can create, ideally and holistic integrative overlooking plan that not only address your psychiatric symptoms. So that would be the depressive anxiety symptoms at that time, but also attack the symptoms from other viewpoints, including their lifestyles as well, so that we optimize all the mental health outcomes that we’re looking for. So that would be your mood, your stress level or anxiety level, your sleep, your energy level, which all types up together in terms of what you’re experiencing in the end.
So you’re certainly gonna recommend your patient get sufficient sleep, get up with the sun, get some sun exposure, do some physical exercise, which has been proven to work better than, um, SSRIs to combat depression. But what are some of the challenges when people maybe, maybe they know what to do, um, but they’re too depressed or anxious to adhere to healthy eating strategies or exercise protocol.
Yes. Great question. So I would probably take that into two parts. So as of right now, specifically for depression, perhaps, exercise, um, specifically it’s proven to be effect as effective as medication or as effective as talk therapy, uh, you know, but not necessarily in replacement of those, if indicated of course. In psychiatry, we always try to see it on a case by case basis, uh, in terms of treatment wise, whether they need medication, whether they need talk therapy, whether they need lifestyle changes, approach, or a combination of both, which typically is the most ideal, uh, way to go. And then in terms of the second part of it is in terms of if they’re in the middle of the depression or in the middle of you know, filling down hopeless not motivated, which could be very well part of their depressive symptoms, right?
It’s definitely very hard to, um, introduce and added task like exercising, making sure that they get enough sleep and whatnot. So perhaps, uh, one or two possible solutions to that is one just start small. We don’t necessarily have to attack all this checklist, so to speak at the same time. So perhaps just try to improve their sleep first, uh, by using, you know, one tech for instance, avoiding coffee before noon. That might be a start. And then as they go up with that momentum, we could start in introducing more stuff. That way it’s less overwhelming and they’re more likely to get a buy in on that. The second tip would be, since we’re simultaneously gonna treat them, treat the depression as well, once the they’re not in the peak of the depression. So once the symptoms start to get better, then, uh, we could be in a better place to have that conversation on how to optimize their lives in other aspects as well.
What do you see are the major areas where we are going astray in modern life, you know, with your total client base?
That’s a good point. I’m glad you bring that up. I think perhaps in terms of lifestyle, in general, it has switched quite a bit right from, from before, especially perhaps with COVID too. So just on top of my head, after COVID, a lot of work has tend to be remote work, which means for instance, for parents, they have to juggle their home life with their work life simultaneously. You know, perhaps it’s a bit harder to put a separation in terms of being on call, so to speak forward 24/7 versus before when they have to go into the office. Uh, so with that, it comes with lifestyle changes, perhaps their sleep get affected, uh, because of less work life balance, their stress level continues to increase. And because of this busy lifestyle, it’s hard to pay attention, to exer to get in that exercise, the recommended amount of exercise that’s needed or to eat healthier in terms of their nutrition factor.
And what role does the medication play in the story and how, you know, what, what have you seen has been the most successful interventions from that side? Assuming that we’re also telling the, the patient to get enough sleep, get sunlight, get exercise
Mm-hmm <affirmative> so it’s, uh, very much a case by case basis. Most of it determine perhaps, uh, one, one important consideration is their symptoms, right? So the more severe the symptom is perhaps the treatment would be more complicated and that might include medications. But, having said that, I just wanted to emphasize that sometimes medication, only medication is not enough. We probably should also pay attention and, um, highlight the importance of changing this lifestyle habits in addition to medications, when indicated too, just to get that more compound effect, uh, of both interventions.
And so I wonder if that, uh, that philosophy has caused you compelled you to depart from your traditional training model where I, I don’t know, uh, what role those play when you’re, when you’re going through psychiatric residency and so forth. Maybe tell me if, if there is some increased awareness these days to the lifestyle elements or, uh, is this stuff that you have to bring in outside of your medical training certification?
Yeah, definitely. So, I think we, you know, through medical school, and medical training, we all learn about the importance of things like exercise, how it affects the brain, how it affects the body, of course, the mind, body connections and whatnot, for example, but having set that in practice, there’s a lot of limitation, perhaps one for instance, just the time, right? Sometimes the time, um, is not enough to not only get to know the patients, address the complaints, talk about the intervention, or the treatment that we wanted to, move forward with, but also to get just in depth, uh, in terms of trying to get to know their lifestyle in this case and counsel them as well in terms of what to do with those lifestyle changes. So I think the knowledge is there, it’s just sometimes in, in practice, it’s hard to implement at times because of those restrictions or those limitations.
Yeah. So what, uh, compelled you to kind of launch this new model of telepsychiatry and also include all these other elements into the, into the healing process?
Yes. So perhaps it’s the overarching teams, that I have, as I mentioned earlier, I’m devoted to helping high performers to help optimize and balance their lives, right with using this lifestyle tech sustainable, not only a one time lifestyle technique, uh, adjustments, too. So in order to do that, I’m glad you touch on the telepsych component. Most of this high performers have busy lifestyles, right? Uh, time is very, very valuable and limited. So with telepsychiatry, perhaps it could be a solution, in terms of at least those addressing those valuable time, instead of having to commute back and forth to your doctor’s office, mm-hmm <affirmative> and having to wait to be seen in the doctor’s office, you could simply just be available for your set appointment time, and instead use those time, you know, to do your work, do your errands, do everything else that you might need to do and save time that way. So the access in terms of convenience, uh, could potentially be a solution in this, um, you know, type of group, the high performers group.
Well, you’re also being able to seek out the ideal medical guide, wherever you live. I mean, California’s a big place and that’s, that’s probably the, the best factors that these progressive opportunities exist now for 39 million people or whatever are whatever the population is in California.
Absolutely. And I’m really glad you brought that topic up too, because in telepsychiatry, like you said, we just need to be in the, in the specific state. So let’s say California, for instance if you have to travel, you know, back and forth from LA , San Diego, what have you, as long as you’re still in California, you can still keep your appointment, and not miss it and not, you know, having to go through the hassle of finding a different doctor, starting from scratch and things along those lines.
Now, how does this work in the traditional insurance provider model? I know we have a lot of cutting edge physicians that are practicing outside the model. And so you’re doing cash pay for your stem cell therapy. It’s quite expensive. It’s limited to people in the high income category, but can we obtain, I mean, do, do you, do you take insurance from carriers for your practice or how does that work? People like you obviously
Yes. So currently in my practice, no, we’re out of network, meaning we don’t take any insurance, uh, it’s cash based. So what it means for, for the patients, uh, at least are three things. One it’s personalized care. And what I mean by that is, as you probably all know, sometimes insurance posts a certain restrictions that may or may not in fact, direct patient care, right? So just as an example, some insurance wouldn’t allow the psychiatrist doctor to do things like additional things like talk therapy, addressing this lifestyle and recommending a lifestyle intervention, in addition of the regular, uh, prescribing medication practice, some insurance might not cover certain medications that could be a better fit for a patient. And, uh, because of the amounts of paperworks, uh, that are needed back and forth by the insurance, those time that, you know, is dedicated for direct patient care might be deferred into doing paperwork and whatnot.
The second benefit perhaps is getting a more confidential care. And by that, I mean, um, the, as long as you’re with an insurance, of course, your medical records become permanently become parts of associated with that insurance. So when it time, when the time comes to apply for, let’s say life insurance, disability insurance, and what have you, uh, it may or may not affect your eligibility to apply for those. And then the third point is, um, in terms of telepsychiatry or telemedicine setting that we already talk about earlier, some insurance may or may not, um, reimburse or pay for that. So just give much freedom, an option in terms of, you know, how we want the psych care to be when you are considering cash based or out of network psychiatric benefits.
So we’re getting the freedom, the flexibility, the more personalized relationship. And do you see, uh, us heading in that direction smoothly in the years to come, or is this gonna be a big challenge to kind of topple the traditional model where you’re into a very more regimented system with limited options, less time with the physician one on one and all those other the less privacy sort of thing?
I believe so. Before COVID some had already started, um, telepsychiatry or telemedicine, um, visits, and of course, a lot of places had already been out of network with insurance as well. But, since COVID, as you probably can imagine, we all just have to scramble, right, the in person, healthcare settings just all have to scramble into telemedicine, at least for that, uh, part amount of time. So, yes, I definitely see this heading towards that direction in the future.
Um, right. The, the insurance carriers are gonna have to look to these solutions, especially because they are more economical in many ways. We don’t have a giant fancy office on the 11th floor for Dr. Sarah because we don’t need it and you don’t need it. And so it, it does seem more efficient, but it seems like we have some hurdles to cross over because there’s so much paperwork and all that nonsense that we’re subjected to in the, uh, in, in the, um, traditional care model,
Mm-hmm, <affirmative> definitely, definitely.
So you’ve published a lot on burnout, anxiety, depression, and I’m wondering, some of that research and commentary are you touting the success of diet nutrition, sleep, stress management in conjunction with medication, or what’s some of that what are some of the high points that you’ve discovered through your research and publishing?
Yes. Great question. So I did alluded to some of the lifestyle approaches, mainly yoga and meditation within that research, not so much in depth, of the other aspect yet <laugh> because at that time I was focusing, you know, solely on burnout and depression and those side of things in a more traditional approach, so to speak.But as you mentioned, there’s definitely connection, strong connection, with lifestyle changes, and common psychiatric, uh, conditions that we came across, including, you know, depression, anxiety, even extending to substance use ADHD and all the other common conditions in psychiatrist as well.
So where does yoga and meditation fit? What kind of results have you seen for what conditions and so forth?
Yeah, definitely. So in terms of exercise specifically the most well researched type, uh, if you will, it’s actually aerobics, but yoga and meditation does definitely have benefits, uh, as can imagine in, in depression, anxiety, and other common illnesses. And the reason for that is several fold. So first, you know, as you know, yoga has many components, right? There’s adopting a certain posture component. There’s a breathing component. There’s also mindfulness that that’s often incorporated into yoga practice as well. USo each of these have different specific roles, but in general to quote unquote oversimplify it, it affects not only the mine, but also the body, for instance, for one, it stimulates what we call BDNF or brain-derived neurotrophic factor, called a miracle growth for your brain, if you will, which just stimulates the new neuron, new nerve cells in the brain, uh, to come up and also improve their connection, you know, their functions and also, uh, just kind of their connectivity to one another in a long term basis.
And then, secondly, perhaps, uh, this is a bit more familiar with others too. Uh, it, instead of activating our fight and flight response, which is associated with what we call sympathetic response, it activates the opposite, which is parasympathetic response. And that’s, uh, the system that lower your heart rate, lower your breathing rate when you’re feeling anxious, actives, the part of your brain that enables you to think clearly instead of just living in fear and trying to escape the situations for example, and many other benefits that comes with yoga and meditation as well.
Yeah. I love that insight about boosting your brain neuron function, brain derived neurotrophic factor coming from movement activity. One of the most prominent studies from UCLA, Hey, da <laugh>. So I believe it was groups of elderly where one group walked fewer than 4,000 steps per day. So that’s kind of, uh, trending toward that sedentary lifestyle. And then the other group walked, uh, significantly more than that. And they had larger, better functioning brains into their old age, basically bringing the takeaway insight that humans are meant to move, and we need that every day activity to connect directly with improved brain function.
Yes, absolutely. And, you know, I think the most interesting part as well, specifically in mental health, the, uh, research mentioned just one hour per week for aerobic exercise can help protect you against depression and just one bout of exercise. So one episode of exercise, does appear to decrease your anxiety level as well.
A a, a single workout can go,
Yes, just a
Single blow off some steam, some energy. So what’s going on at the, you know, the biological level there,? The anxiety is sort of a, I’m guessing like, you know, an overactive brain or something where, engaging in exertion will, will turn off this faucet or what’s going on?
Yeah. So perhaps it’s, it’s helpful to look back a bit, right? So anxiety in our ancestors world back then, uh, one of its function is to, uh, let us know about, uh, threat to our survival. So for instance, in the hunting world, uh, if a bear were to come and attack us, our anxiety, uh, try to tell our brain that, Hey, there’s a threat to our survival in that way, and the brain, uh, and reaction to that turns on all the other, uh, body responses, which might include increasing your heart rate, kind of increasing your alertness, so to speak, increasing your breathing rate and whatnot, the fight or flight, um, or sympathetic response. So how exercise might help a lot of ways. One is the BDNF factors of things which just improves your brain function. Two, it activates the, you know, it activates the part of your brain that think more clearly versus the one’s associated with your fear, but perhaps specifically for anxiety and interesting part is, in case of anxiety or panic attacks, your, if you’re so used to it, your brain might perceive bodily sensations that could, uh, be similar in panic attacks and exercising.
And what I mean by that are those responses like high, um, heart rate, higher heart, heart rate, um, higher breathing rate and what that, and interpreted as a sign of anxiety. So when you exercise, you expose your body and mind to this similar set of symptoms, but in a controlled, positive way. So down the road, your body wouldn’t automatically think of this set of responses as anxiety, but is more used to that and can be less anxious if that makes sense, whenever this physical sensations come about.
Oh, that’s great. I’ve never quite heard it described that way, but it’s, I guess, you know, I’ve, I’ve heard of exposure therapy too, where you have anxiety about talking to people. And so, Dr. Craig Marker former guest on the show, psychologist in Atlanta, he takes, uh, patients to, uh, the supermarket, uh, parking lot front entrance, uh, where the solicitors are, you know, looking for money or whatever. And, he just has them greet people and say hi. And so they’re exposed to their biggest fear. And I suppose, like going out and doing a workout when you’re having, when you’re experiencing high anxiety, you’re now, simulating with the heart rate, with the cortisol, with all these things. And then, I suppose, especially when you complete the workout and return to a rested state, now you’re telling your brain, your emotions that you can handle it. It’s okay. The workout’s over, and that’s a proxy for the anxiety being over. Is that a, is that a, a relevant insight?
Yes, exactly. It’s like, exactly, like you said, um, it’s pretty much exposure, quote, unquote, but the key is it’s a systematic right exposure. We wouldn’t, you know, just have, in this case, have someone, do it from a scale of zero to a hundred. We wouldn’t just have them do a hundred immediately, but it’s systematic. And then it’s associated with a positive control environments, of course. and it’s similar to that analogy. Definitely.
Unless, you know, you go out for a jog and a bear or a pit bull actually does chase you. Then it’s gonna be ineffective anxiety treatment to go for workout work. We’re expecting a pleasant workout where you’re on a nice trail and waving high to other joggers or whatever controlled setting. We’re talking about the Peloton bike in the comfort of your living room, no honking horns, no exhaust blowing at you or buses cutting you off. I got it. Okay, great. I’ve also read that a immersion into cold water, which is something I’m a fan of, uh, this cold water immersion represents an instant cure for anxiety as well. I’m wondering if you’ve heard that, or if that’s the same mechanism that as strenuous or a vigorous workout would, would, um, offer
Good point. I I’m actually not familiar with that, but I’ll be sure to check that out. Um, in terms of cold water.
Yeah. The good thermogenesis, like the, um, therapeutic cold exposure, um, to prompt, I mean, obviously it prompts a fight or flight reaction when you jump into cold water. But then as soon as you get out, then you have that recalibration. I’m thinking of, uh, a recent guest on the show, Dr. Anna Lembke, author of Dopamine Nation, where she talks about this concept of opponent process reaction, where if you put yourself through something difficult and challenging, um, you are getting like sort of a rebound effect in the brain toward, uh, sensations of pleasure, calmness and all these things. So when we’re going and doing a vigorous workout, uh, we’re looking at that rebound effect where we have that sensation of calmness, as opposed to maybe, you know, pre-workout state of anxiety because we’ve been sitting around worrying about our, uh, problems and stressing over the future.
Right, right. Definitely. That would make perfect sense. And also to touch on that as well. Um, I’m glad you brought that up because exercise not only have, of course the biological benefit, right. But also psychological side of things too. And that could include a sense of mastery. So whenever, you know, let’s say someone completed one session and then the next day completed another session and so forth, it just builds on, on their sense of mastery, which would of course impact their self-confidence self-esteem and all the other good stuff as a whole as well.
So, uh, would other things fall into this category, like, doing an art, project, making a drawing, making a, a clay, uh, a formation, uh, in the studio or something where you’re expressing, um, artistic energy and trying to gain form of mastery. I wouldn’t call it mastery, but I do these clay dogs that are pretty good, but they’re not perfect. So I feel like I’m building, um, a semi mastery and getting a completely different, experience than a physical workout. But I’m also wondering if there’s, I mean, you mention yoga and meditation, which are, you know, quite different than, um, the, um, the, the, the lifting the weights or running down the street.
Right. Absolutely. I believe so. So, you know, anytime we put in time, uh, or energy towards one, uh, goal in this case, the, the art part, right. Um, we could just build on those momentum in terms of trying to build our sense of mastery or in relation to self esteem, self confidence in our ability to problem solve ourself and, uh, things along those lines too.
So I guess it’s really getting out of your head, getting out of your inactive state. I would assume anxiety and depression are strongly associated with inactivity rather than the rash, of bicycle rider who experience depression while they’re peddling up a hill. I, I don’t think that exists as much. I never thought about that either where, um, if you can just get moving in some way and get into some project you’re gonna be, um, in pursuit of self-confidence mastery and an ensuing improvement in your symptoms.
Yes. And, perhaps another aspect to add is the social aspect to, right? Because with exercise arts or other, um, project similar projects, you also add that social stimulation, um, to the brain too, which not only helps prevent withdrawal, which is, or isolation, which is very common in depression, let’s say, but also get more input in terms of stimulation to your brain, which goes a long way too.
Dr. Sarah, we haven’t talked much about drugs yet. I mean, come on, everyone’s excited to talk to the psychiatrist. I’m wondering, it is really, refreshing and wonderful that you’re leading with all these other concepts. But I’m wondering, you know, what are the role that these play, do you feel like they’re overused, overprescribed, as we often hear about used as a crutch? Um, what does, you know, what does a winning formula look like in the event that and I want you to talk about athletes too, because, um, sometimes athletes need, uh, prescriptions or their, uh, real people. We just saw the great Noah Lyless break, the American record last night in the 200 meters at the world championships. And he’s been public about his challenges with battling depression and so forth. Not sure if he mentioned, uh, medication as part of his, part of his battles. But you would assume so if he’s, um, been, been public about it and been under treatment, so, where do all these pieces fit in? And I, I think I’m really looking for, like, what are the best uses of these amazing breakthroughs that we have in pharmaceutical medicine today?
Yeah. That’s a very loaded question, right? <laugh> um, <laugh> right. Woo loaded. <laugh> uh, So in, in psychiatry, uh, perhaps just to give a background, like I mentioned, typically when we first see a patient, we did this thorough evaluation right on, getting to know them and their symptoms, uh, you know, everything about their symptoms and their lifestyle that could contribute to what’s happening to them right
Now does that happen in traditional framework? So if you’re taking your first visit to the psychiatrist at an HMO or a major provider mainstream, uh, are you gonna have that sit down where they’re gonna get to know you and see if your, um, your, your mother-in-law is really annoying you, or, you know, those kind of things.
Wow. That’s a very good question. I would say yes, every psychiatrist would try to, uh, but again, time is, uh, of course, uh, the session in terms of time is of sometimes, could be a limiting factor in terms of how depth can you go in, in just those first session, right. That’s why, especially in psychiatrist, I think it’s important to, um, keep your follow up if you can, with the same doctor, because it’s like piecing different pieces of the puzzle together, and along times you could, you know, just get to know each other more, more and more that way. Um, but after the psychia, what we call psychiatric evaluation, so the interview part, then we together would determine what kind of conditions do you have. Of course, again, it’s a case by case basis. So based on this information, we determine, for example, if you have depression, if you have anxiety, if you have both, if you have other conditions and based on that, and the severity of the symptoms for the most part, then we can discuss more about treatment.
So in psychiatry treatment, could consist a lot of things.There’s of course, the options of talk therapy, especially if your symptoms are on the milder side. So that includes things like C, B T cognitive behavioral therapy, um, and other types of therapy. Uh, if typically, if your symptoms is more on the severe side, uh, on a more serious side, we might also utilize medication, uh, depending on your conditions. So for example, for depression, we’ll use antidepressant. For anxiety, we’ll use anti-anxiety and so forth, or we could, if you’re open to it, we could, uh, and it’s indicated we could do combination combination of both. Lifestyle. Ideally the lifestyle part of it, lifestyle counseling, uh, would always help no matter which way we choose whether it’s medication, whether it’s talk therapy, whether it’s combination, because again, it’s just a sustainable investment in your health, both physical and mentally.
Um, with, with that regards. In terms of athletes, those sports, related me, psych medications, I would say it just have a lot of more, um, subtle nuances for several reasons. One, perhaps perhaps an athlete would be, um, would have some consideration in taking certain medications because that medications might inadvertently affect their performance. So it could go either way. If the medication happened to improve their athletic performance, let’s say, it helped reduce tremor. Like in the case of propanolol, it might be prohibited in certain sports, right? That where fine movement is of importance, like, uh, archery shooting, things like that. And, and so of course, an athlete wouldn’t wanna be taking a medication that would lead them into trouble unknowingly in that scenario or a medication might have side effects that, on the other hand, impair their performance. So let’s say medications that cost weight gain that lowers your heart rate. It might affect, uh, sports endurance related sports, for instance, uh, and therefore might impair athletic performance. So that’s why I think, uh, perhaps it’s a better fit if you’re an athlete and is concerned about that get in touch with sports psychiatrists because those specific medication concerns can be addressed in more depth.
Are you using talk therapy as one of your tools, your protocol, or are you referring that out?
Great question. So in terms of the traditional, full session of talk therapy, I refer it out,, but I do try to use some components, uh, if, and when is necessary of talk therapy within, uh, my visit.
You know, this is, this is super cutting edge it’s, it’s amazing stuff. And, um, I suppose you’re still going through you know, these, these, um, traditional protocols of how to treat a patient and you’re applying a diagnosis to them. And I’m curious about that whole world of diagnosing mental health conditions and what this continuum represents from someone who has a label, such as you have <laugh> anxiety. You have PTSD. You have, , you are bipolar. You are depressed. And then, what, at what point can we switch over to a model or belief system where you are exhibiting symptoms of depression, which you can alleviate immediately with a walk around the block. Even going to more extreme like bipolar is believed to be a pretty hardcore diagnosis. But Amber O Hern a leader in the carnivore diet space has talked publicly about being virtually free of symptoms and free of medication after having, um, you know, a very serious condition of bipolar for a long time through, she, she points to dietary intervention as her main way of essentially curing herself, curing herself from this illness by a virtue of not having any symptoms nor medication.
Yeah, I think, definitely the first step I would say would be to recognize the symptoms, meaning, let’s say depression, for example, you know, everyone feels down sometimes, right? Whenever something in our life happens. Sometimes we feel sad, we feel blue, and whatnot, but when exactly does it considered, uh, depression, uh, so typically in terms of psychia, uh, when to seek psychiatric help, when. Well, first let me back up. In terms of depression, perhaps, like you said, it’s a spectrum. No one has the exact same symptoms, you know, uh, in comparison like A to B would be exactly the same, but some common symptoms to watch out for might be feeling down for most of the days. Not enjoying things that you like to enjoy before your hobbies, for instance, having trouble concentrating, uh, sleeping, eating, uh, feeling hopeless. A lot of times beating yourself up over some mistakes, to feel excessive, guilty about something for instance, and things along those lines. And especially when this things, this symptoms have caused intense, severe distress, or if they interfere in your day to day. So that could look like it might affect your work, your relationship, your grades. If you’re a student, then it’s a good time to seek psychiatric help.
So let’s say that you meet this criteria where you’re not depressed for an hour after a disappointing phone call, but it’s really dragging you down and it’s becoming a pattern and it’s interfering with everyday life activity. So you, a diagnosis is applied and you’re suffering from depression. I’m wondering, um, at what point are these similar to your diagnosis of a cancer of the throat versus, um, something that’s a symptom and the cause is, uh, these seven things that you can correct immediately. One of ’em being in the case of anxiety, you go and conduct a workout. You no longer are in representing symptoms of anxiety, and we can build from there into just these are, behaviors or present circumstances that don’t represent a, a label on the person.
Great question. So perhaps the best way to differentiate it is to see a psychiatrist why mm-hmm <affirmative> because <laugh>, uh, those would be things that we consider during our inter psychiatric interview that initial, the first interview, uh, because like you said, uh, you know, it, it could be a lot of things, right? Depression could, for one is multifactorial, there could be many causes. We could also consider things like currently, is there any specific stressors in your life that might trigger that depression, or, you know, make yourself sad, uh, in this case, like the phone call, we might also consider more information like your history, has this ever happened in the past? How, if so, how long has that been? What other symptoms did you experienced then? We might also consider your family history. Um, if there’s depression in a family or your medical history, cause some medical conditions might look like depression.
You know, let’s say low thyroid hormone or, um, you know, low, uh, iron anemia, which may man be manifested as feeling tired all the time, for instance. So it’s a lot of different pieces of the puzzle that needs to be puzzled together, that need to be pieced together. And then in terms of intervention, which would be the next step of that. Again, it just depends on, on your particular situation. So it’s an individual basis, so to speak, uh, depending on the severity of the symptoms, your other medical conditions, it applies your current life stressors, and things along those lines are very important too.
So today, with the accelerating pace of technology and the exponential increase in technology, meaning that in the last one year, technology has advanced more than the previous 10 years combined in many ways, which has advanced more than the previous a hundred years. So we’re having to navigate and negotiate these extreme changes in our lifestyles. I’m old enough to reference the, a good chunk of my life, where I existed before the internet before mobile devices and all these things. So I have reference points of when, you know, we sit around on the porch and talk to burn a few hours of time where that doesn’t happen anymore, because we’re all connected to devices and, and so forth. So, you know, I’ve had to navigate these challenges personally, even in my career, for example, working on writing a book and in the old days, that would mean going to the library, checking out four or five hardcover books, bringing ’em home, uh, thumbing through them, bookmarking taking handwritten notes, trying to work on a manuscript.
And now you’re just cranking uh, 11 browser windows, open, getting all the information you need at your fingertips and proceeding at, you know, a break next speed to crank out more and more content. And then of course we’re consuming more and more content than ever before. So, this, it seems to have a overall detrimental effect on mental health because it’s so difficult to adjust and navigate, although there are many positive aspects to it. And so I wanna frame the conversation, uh, not coming out and saying social media is terrible, so are mobile devices because they’re pretty awesome in so many ways, but I think it’s a matter of taking control of the situation, using them to our advantage, using them to give us the life that we’re dreaming about and the pleasure and the enjoyment and the satisfaction and none of the negative stuff. So, um, in your practice and in your observation, what are some of the things that are tripping us up here with, um, technology relating to burnout and how are some of the ways that we can navigate this successfully and make them positives?
Hundred percent. That’s such an important point to discuss, I believe so. Just a couple of things, right, right off the bat, uh, in terms of notifications, whether it’s email notifications, social media notifications news in general, that pops up in our phone, it could very much be anxiety provoking, right? Like you said, we’re continued to live in that space where nothing stops, literally we’re bombarded with information. And, you know, sometimes if it’s on the news, it might not be the best information in terms of happy information, right. It’s might be, you know, disturbing information, so to speak. So that could very much impact our just mental space in general. Uh, and this notifications also is very much anxiety provoking in a sense that, like you said, we’re not in control in full control of our time of our time. If I could put it that way, let’s say, you know, we’re trying to focus on work.
But we keep our notification open and things keep popping up. We might feel this needs to respond immediately, for example, or, you know, just having that in the back of our mind, just adding things, adding clutters, if you will, to, to our brain, um, in that way. And then the other thing, the second thing is also the comparison side of things, especially with social media, it’s very hard to not, uh, intentionally or intentionally compare yourself to what’s going on out there. What other peoples are doing their achievements, you know, their lifestyle whatever’s going on in their life. So the comparison piece is definitely huge. It could very much lead to not only burnout, perhaps in a sense that, you know, you’re having to, to quote unquote compete all the time, but also might lead to what we call imposter syndrome. For those of you, who’s, uh, not familiar with the term. It typically happens to high achievers when they have this almost selective attention where they attributed all their success, even though there’s a lot to luck to things like luck, help from others, just anything outside themselves, but whenever they hit a wall, they attributed it to the fact that they’re not competent. They they’re not good enough. Um, so that could very much be triggered, uh, by this comparison, as well.
So the symptoms of imposter syndrome are going outta your way to diffuse, um, a, a credit or, or, or, you know, credit for your accomplishments, you know, effusive in your, a gratitude and, um, uh, pointing to luck and so forth is one. And then the other one is, when you struggle, you internalize it that, um, the reason you’re struggling is cuz you don’t deserve to be there.
Yes. Yeah. I mean, you hear that term bantered about all the time, but I never really reflected on deeply on the definition. Now. where does this sort of thing originate from as a prominent condition these days when, um, you know, you, you went through a heck of a lot of training to become a psychiatrist? So you went through years and years of medical school residency. You probably have a memory of those hard times and all the hard work that you put in. How could you possibly develop something like imposter syndrome when you have all this, uh, uh, you know, graphic recognition that you worked hard to get where you are?
Very, very insightful question. Very good question. So I think it probably, or one of, uh, the more common cause if I may put it that way is what we in C B T cognitive behavioral therapy called a cognitive distortion, right? Which just means, our minds sometimes are put in automatic pattern of thinking something that are not, that simply is not true. Mm-hmm <affirmative>. So in this case, the mind selectively attributed things to different things. I dunno if that makes sense, uh, the mind has selective attention, so anything that’s good. Uh, the mind just your mind just makes you believe that it’s not because of the yours. So even though you achieve a lot of things, it’s just because of luck, it’s just because of others’ people’s help, because your mind makes you believe that you’re not good enough as an overarching team, so they can diffuse, they can almost selectively differentiate what happens to you better. Good. Based on that overarching or core thoughts, core automatic thoughts.
So why would the human brain engage in this? Is it some sort of protective mechanism to, uh, protect against a sense of devastating failure? If you do struggle in your career or don’t, don’t get hired, uh, by your desired job or something?
Great question. So many believe that it, you know, know this sort of automatic core thinking pattern or you need from childhood, right. In terms of just in our lives. It, it, it has a long route, so to speak, uh, going back to our childhood because sometimes we just need to, to survive. We just need to do certain things or in this way, think of certain ways, uh, to help us get there. And then unknowingly, we keep using this thinking pattern again and again and again, throughout our adulthood. And it just becomes ingrained. Although most of the time we didn’t realize that it’s there in our brain,
Oh, I, I can see a, an athletic, um, relevance here where at some point, um, you are overmatched and intimidated when you walk out to, uh, practice for the first day at, for the UCLA football team. And you’re a, walk-on thinking, wow, these guys are big and strong and fast, and I don’t really deserve to be here. So I better work my ass off and hustle more than anyone else on the field. So I don’t get blown out the side door, never to return. And so you have this, fighter’s this battling mentality rather than stroking your own ego and coming in with too much swagger and getting it handed to you, you, you by necessity have that humbleness, but then when the humbleness is gone, overboard <laugh> years later or whatever, I think, you know, the actors and the, the fragile ego that we that they, that they seem to have, and that we get to read about in the gossip magazines, where, um, you know, that you’re only as good or bad as your, your last movie. And so the insecurity is rampant. And, that can be, you know, what was once a, uh, a powerful weapon where you were, you know, going to apply that determination and not take anything for granted at a certain point, we have to, I guess, strike a balance to be able to pat ourselves on the back at times and say, yes, I am a, world’s leading authority on telepsychiatry, and I’d love to talk about it, you know?
Right. Absolutely. A hundred percent, like you said, Brad, I think it’s, it’s all about balance, right? Everything in life I would say is a spectrum. And the key, I guess, is to find that balance right in the middle.
Now, what do we do with, I, I mean, this is, uh, I’m sure defined, uh, category of mental health, where we have, um, people on the other end of the spectrum, especially in this comparison, instant gratification, social media driven culture, where we have the little superstars, if we’re thinking of, um, the, you know, the, the youth that are growing up with helicopter and lawnmower parents telling them that they’re God’s gift and they are gonna go be president, cuz of course it’s possible and anything you dream and, um, then they don’t get accepted into the, the four preferred colleges. And so, um, they’re, and then all the way into adult life where, um, you hear that term narcissist bandied about all the time, especially in the dating scene and people in the workplace where they think their God’s gift and that their voice reigns over everything else. How do we navigate those waters where I guess that would be the opposite of imposter syndrome is the narcissistic syndrome <laugh>
Right, right. Um, and that’s why I think, uh, especially for kids, uh, it’s important to try to implement the growth mindset or focusing in the process for them. Right. So not, not the outcomes. What I mean by that is for example, instead of praising uh, the kids on, oh, Hey, you’re so smart, you’ve got anA or hey, you’re so strong. You made the team within your first tryout. Uh, but perhaps try to emphasize the fact that they’re, uh, not, you know, resilient, they’re working really hard towards their goal. They’re not giving up given the first obstacle and things along those lines. So that way, uh, they’re more focused. Uh, one on the process and two, they didn’t necessarily, um, or fully, uh, relate their self identity with just their achievement down the road.
Well said. I, I think you’re honoring the work of Carol Dweck, author of Mindset. Yes, Stanford, so popular. I’m thinking of my very favorite parenting article called the Inverse Power of Praise. How Not to Talk to Your Kids, uh, will have a link for that in the show notes. But it talks about, um, what you just expressed here, where we wanna put the emphasis on, uh, on their effort, on the process, on personal growth rather than, you know, jump over to, uh, comparison, measuring and judging and you’re the best and, and all that kind of thing. And, boy, that’s a, um, that’s something you see left and right all over the place is you know, uh, forgetting about the, um, the process and just trying to obsess with the results and the status and the consumption and all the things that go with it.
I had, uh, great talk with Ashley Merryman, a long time ago on the podcast author co-author of Nurture Shock and Top Dog. And she talks about, you know, we’ve, we’ve, um, often been told to focus on the effort, don’t attach your self-esteem to the outcome. And she wanted to offer up a little, a nuance or another level of sophistication there. And what we wanna do is emphasize the effort toward improvement. So if you’re just pounding your head against the wall and making the effort and getting congratulated for that, that could easily lead you off track and you’re doing stupid shit with your life. So, um, if you’re not destined to be an Ivy league student, and you’re trying to make more effort to bring yourself up from a C average to a B minus, um, it, it’s not gonna happen for you.
Same if in the athletic world where the poor kid who, um, doesn’t make the basketball team is now told to go put in more and more and more effort where maybe they want to, you know, cut their ties with something that’s not, uh, their destiny, um, reframe their goal to something more realistic and then be darn sure that any effort that you put into any peak performance endeavor is appropriate, well chosen, well guided so that you can reference improvement. And so when your kid goes and works on their vocabulary words for an hour and comes out, expecting a lollipop and a trip to the ice cream store for putting in all that hard work, let’s make sure they weren’t goofing around with a video game playing in the background and the effort didn’t really count for something. And I love that nuance that Ashley offered up. But again, um, the, you know, the emphasis is on the effort and on personal improvement rather than comparison culture and, and I guess leading toward imposter syndrome someday, if you are obsessed with results only.
Yes, absolutely. That’s such a great point, definitely. And, uh, to your point as well, the strong tie to that identity, right? For example, the identity of a high achiever or the athletic identity, the smart student identity, if you’re so attached to it instead of the process, so to speak, it could very, uh, much be a risk factor, uh, of getting imposter syndrome in that relationship
And depression, anxiety, I suppose.
Absolutely. Yes, definitely.
So Dr. Sarah, how do you do it? You have two, two kids under two, you’re getting this thriving practice going. What are some of your tactics and strategies for keeping a healthy, happy, balanced life and the balancing your career endeavors with your personal life and so forth?
Yes. Um, so it’s a work in progress, right? <laugh> so I, I try at least for myself, first always try to reflect, uh, on my own why. Meaning my personal, why, why am I doing all this, right. My own pros and cons that I already brainstorm myself to come into an informed decision of choosing to pursue all this. And why is that important? I think because if we’re just simply listening or looking up to others, people, uh, others, people’s why, um, you know, not ourself we’re humans, it’s very easy to get ups and downs throughout life. So when the downs come, if we don’t have a strong, personal sense of why we’re doing things in relation to what we want, not what everybody else’s want. It gets very hard. Two on a more practical level, I try to quote unquote multitask and why I put the quotes on that is because I believe if we’re doing something that’s, requires brain brain power, it’s good to singlehandedly focus on that task, but we could always combine it with quote unquote mindless task, like doing dishes, for example, doing errands, driving, what have you.
So I try to put in my exercise, whenever I can while I work, for example, uh, you know, I just get a little step from Amazon, um, a little floor desk that I put on top of my desk to help prop it up to the point where I can stand and type. Um, and then that way I could not only save time in terms of doing valuable work, but also get my steps in, get my cardios in, uh, for the day. And then I try to implement third. I try to implement simple stress management techniques, for example, one of my favorite, because it’s so easy and can be done everywhere, including in a meeting room, is breathing. A lot of you probably are familiar with this, uh, with me deep breathing, uh, ideally would include belly breathing, diaphragm breathing, And I also count while doing deep breathing. So I count as six when inhaling six when pausing six, when exhaling do it a couple of times. And that way it could just activate my parasympathetic system to take over this empathetic, the fight or flight response and, uh, enable me to think, uh, more clearly throughout the day that those would be a few practical tips that I personally use.
Right? So the breathing is I think, instant access to changing your, your blood chemistry and your autonomic nervous system state. Why is that so effective? What kind of mechanism is working there?
That’s a good question. I think mostly it, it it’s, it relates to the parasympathetic, um, nervous system that take control of so many of our body responses associated with anxiety one. And two associated with the part of our brain, uh, the earlier part or, or the reptile quote unquote site part of our brain, uh, that took over. Right? So when that part of the brain took over our higher functioning brain, the performal cortex part of the brain, which is a responsible for clear thinking for functioning and whatnot, kind of take a back seat. So in order to switch that over, we need to activate, uh, those parasympathetic, um, system as a whole, which can be done easily by deep breathing.
Love it, inhale for six, hold it for six, exhale for six, and you’re instantly calm Dr. Sarah Pospos. We love this quick look at the future of medicine. We can follow you at lifestyle telepsychiatry on Instagram and your website is also lifestyle, telepsychiatry.com. Mm-hmm <affirmative>. Any other ways we can connect with you? Those are the best things to do.
Yes. Um, and again, if you wanna get in touch, if you’re in California, uh, my next available appointment by telehealth is in September, or if you’re not in California, uh, I also do offer free resources, which you can get my website lifestyletelepsych.com slash subscribe,
Right on. Thank you, Dr. Sarah. Thanks for listening everybody. Da da, da.
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