Dr. Victor Carrión
Appearances
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
No, this is a very interesting subject. The jury is still out if genomic changes that result as a consequence of stress can be passed from one generation to the other. But certainly the genes that made one generation vulnerable are being passed to the next generation as well that we know. So it can be passed that way. But what happens is that there's also this impact of learning.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And I have treated kids that come to me with all of the symptoms of PTSD and there's no trauma. I cannot find the trauma and the parent cannot find the trauma and the kid doesn't report a trauma. But when I'm talking with the parent, the trauma becomes evident in the history of the parent.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So the parent has developed PTSD and behaves in a way that has been learned by the new generation, ways like avoidance or re-experience or hypervigilance or lack of trust, you know, things like that. So certainly there are pathways in which it can go from one generation to the other. And we know that the battle between nature and nurture is pretty much over, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We know that they both influence vulnerability and that they both interact. And I imagine that's what's happening in some of these situations.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
No, this is very interesting. Well, we're talking about the letters. Let me say that a lot of people call post-traumatic stress disorder post-traumatic stress injury, not considering it a disorder, but considering it something that where our fight or flight mechanism, the autonomic nervous system has been desensitized And we need to regulate it again. And it's going to hurt.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
It's going to be painful. It's just like when you break your arm and go to the emergency room and it hurts to be placed back in place. But it's the cure. It's what cures it. So a lot of people visualize, and sometimes I do, as an injury rather than a disorder.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And so what happens? So this autonomic system gets activated. We have our fight-or-flight reaction. But what happens to a young kid? Because they're very little and they cannot fight. They're also very dependent and they cannot flight. So they're stuck. They're stuck there. So they freeze. They freeze and that's dissociation. It's actually during development a healthy defense mechanism.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But very much like a white blood cell, that's very helpful. If you have too much of it, you develop a leukemia. You can develop dissociative disorders if that's the only thing you have. But it does help children cope with some of these situations pretending this is not real or this is not happening to me. It's the only thing they have left.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And because this arousal system is so key in the development of these children, I thought that we should look at the hormone cortisol in the kids. And when I started, when I was a fellow doing my child psychiatry fellowship, I was seeing all types of kids with all kinds of issues. Some had ADHD, some had OCD, some had PTSD symptoms.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But I was getting a lot of kids with notes from school saying, this kid has ADHD, please place on Ritalin, right? A stimulant medication. And I'm like, wow, the diagnosis has been made. There's already a treatment plan. What am I training here for? But in some instances, they were right. You know, the kids had ADHD.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But in most cases, what happened is that that hypervigilance that you're talking about was being misinterpreted as hyperactivity. And the dissociation was being misinterpreted as inattentiveness. So the kids were getting a diagnosis that was not correct. Of course, there are other very complex cases where you have both ADHD and PTSD.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Also ADHD can put you at risk to develop PTSD because you're not as attentive as to what's happening in your environment. But there's definitely two different conditions. And it was that clinical observation that made me think, well, people don't know enough about PTSD. And certainly they don't know enough about PTSD in children.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And we were having some research in adults around that time in terms of cortisol levels. David Spiegel, who you've had here, Rachel Yehuda, the Bronx VA, looking at PTSD in adults. But I said, but how does PTSD look early on? What's happening in the hypothalamic pituitary adrenal axis that is responsible for secreting cortisol and regulate cortisol when these children are young?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Because this is a new axis, you know, is it already not working or is it working right? And so, we did a number of studies that demonstrated that the normal circadian rhythmicity of cortisol was there. It was higher early in the morning, which we need to jump out of bed, and as the day progresses, it decreases.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Very helpful, it goes up when we are stressed, like when we have lunch, after we have lunch, cortisol goes up, right, so that we can help manage the insult of digestion or whatever. And these kids were having those levels, but something was happening in a number of studies, and we noted that the pre-bedtime level was higher.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We were measuring it at different times, in the morning, pre-breakfast, pre-lunch, pre-dinner, pre-bedtime. But it was the pre-bedtime level. that wouldn't come as low as the healthy controls. It would remain high. And this was also important clinically because many of the symptoms these kids were having were happening at night.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Aneurysis, bed wetting, nightmares, not sleeping deep enough, not sleeping long enough, fears. At that point, I felt, well, we don't know anything other than the cortisol-free bedtime is elevated, right? Maybe they need it to be. Who knows? But I was concerned about the work by Sapolsky, right, and Bruce McEwen, his mentor, demonstrating
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
the neurotoxicity that glucocorticoids can have in key areas of the brain, areas in the limbic system and the cortical system, which, interestingly enough, have a lot of glucocorticoid receptors. So then we decided to look at brain structure and brain function in youth with PTSD symptoms and see how this cortisol would relate to that or not.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And we did that through MRI, magnetic resonance imaging.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I thought about that when I had those high levels, but I felt that we needed to understand better. I think, yes, that there were some attempts with some medications, and I don't think that led to anything in terms of helping those kids or just helping individuals in general that had high levels of cortisol because of traumatic stress.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But nighttime, you're right, it is a time when basically we fall asleep because we let it go. And this kid's hyperarousability does not allow them to let it go. So if these levels are high, as I was finding, you know, what impact are they having in brain development? And usually the younger you are, the more universally distributed receptors are.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So glucocorticoid receptors could be anywhere at that point. But as we age, they become more localized. And the glucocorticoid receptors and cortisol is a type of glucocorticoid. are more common in areas like the hippocampus and the prefrontal cortex, which I also found interesting because these areas relate to the symptoms, right, that many individuals with PTSD have.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And even those attention issues that make them overlap with kids that have ADHD as well. So this frontal limbic pathway, the prefrontal cortex communicating with these emotional areas of the brain, including the amygdala, which is very close to the hippocampus, needed to be investigated in pediatric PTSD. And what I sometimes call pediatric PTSS, because post-traumatic stress symptoms.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Because as I mentioned, there's a group of kids that have post-traumatic symptoms to not fulfill criteria for DSM-5 PTSD, but their function continues to be impaired. Sometimes that's because of comorbidity. There's a high incidence of comorbidity with anxiety and depression.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So most of our studies that have looked at PTSD symptoms also look at the impact of the interventions that we're doing in anxiety and depression as well.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I firmly believe that ADHD does exist. I'm going to say two facts that we know in the field. One, are kids getting overmedicated? The answer is a clear yes. They are getting more medications that they need. For ADHD. For anything in general, kids. Now, in ADHD, they're getting undermedicated. So that's the second fact.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So the first one is that if we look at kids overall in the field of mental health, those that manage to receive treatment, which access is something else we should talk about, because like 50% of them do not get access to mental health services. Those that manage to get it may end up with...
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
the appropriate treatment, right, a medication or a psychotherapy, but there's another subset of them that will be medicated no matter what they present with because they need to be seen fast or it's a fast solution. So there's many reasons for that. But are kids getting over medicated? Yes.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But within those kids, those that truly have attention deficit hyperactivity disorder are getting under-medicated, and that's because of that access issue, because most of them were not identifying. And that's a pity, because the first line of intervention for ADHD is stimulant treatment. It does work, and it works very well for children that have the correct diagnosis.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But the first line of intervention for children that have a history of PTSD, be it acute or chronic, is psychosocial. It's a psychosocial intervention. So if you give a kid that has PTSD and no ADHD a stimulant medication, not only is it not taking care of ADHD because they don't have it, but it adds to that hyperarousability that is manifested there from before.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
By the way, there are clinical ways of separating hyperactivity from this hyperarousability and hypervigilance. Hyperactivity, if you see a kid that is not medicated and has ADHD and they have the hyperactive symptoms and the hyperactive type, they're going to be hyperactive for most of the time that you're with them. The kid that has hyperarousability, it will be more of an on and off phenomenon.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
The hypervigilance and hyperarousability comes more when they're presented with a cue that consciously or unconsciously reminds the body of the traumatic event or the traumatic experiences. What happens, though, is that usually we don't know what those cues are, right? So we just see a kid that sporadically becomes hypervigilant or hyperaroused.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And then the other thing is, is hypervigilance something that needs to be treated? You know, I learned this from a mother early in my career. She's like, I was giving some talk in the community and she came to me afterwards and she said, listen, we live in a street that's very dark and it's very dangerous. And my kid has to pass through that every day. I want him to be hypervigilant.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And if he has developed this trait of hypervigilance, this is something that could be helpful to him. And I said, you're right. I said, you're right. It's not only to him, to a lot of people. It could become very helpful to be hypervigilant, to assess the environment in which they are in. So the problem is not the hypervigilance. The problem is knowing when to turn it on and when to turn it off.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Having the cognitive flexibility, right, to be able to say, yes, this is a dangerous situation and I better respond this way. If I can give you an example of a kid, right? A kid that experiences domestic violence and has associated that with noise in the house, learns that running and getting into the room is a safe thing for them because they are out of the picture, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And they protect themselves in the room. But a year later, they're in the classroom. And for some reason, the classroom gets this level of noise. The body, without him knowing, right? the body reacts by the response that was helpful. This is classical conditioning, right? So he runs out of the classroom, but he's missing the context. The teacher is missing the context.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
When the teacher sends him to the principal's office, the principal doesn't have the context, right? That this response was actually adaptive at one point and helpful at one point, and the body has had a hard time letting it go. To ask that kid to give us the only response that he has is not the way to help him.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We need to help him develop new competitive responses so that the experience of the other responses then extinguishes that response that was adaptive at one point but now is maladaptive. By the way, if they are in a traumatic situation, again, we still want them to use it, right? We still want them to run and get out of there. It's part of that hypervigilance that's protecting them in a way.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I'm sorry to interrupt, but if I could add, the inattention comes and goes. Because we all know kids that have ADHD, that if you give them the right video game, all of a sudden they become attentive, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
First, a word on the Vietnam veteran, because there is a very important study that was published years ago that demonstrated that those veterans that had a history of child maltreatment and went to war had PTSD at higher prevalence than the ones that did not have a history of of child maltreatment. So... Child maltreatment. Yeah.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And maybe they did not develop PTSD, but once again, that point of the accumulation, right, of the stressors at different times. And I'm just mentioning that because you may have a veteran And you're waiting to look at the classical cues where, in fact, it might be more like a voice, like the example that you were giving that triggers them. What triggers an individual is very personal.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So cues are usually neutral. And they're usually related to our senses. And I know you like senses a lot. So what we see, what we hear, you know, all of these things. The senses are really the window to the central nervous system, right? This is how we get information the first time. So in this state of hyperarousability, when something traumatizing is happening, our senses are really...
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
acutely aware of what's going on. And they are making sense of the insult, but they also are registering everything that's related to that. So these cues usually are neutral. So they're not like a gun, for example, because a gun is not a cue, it's a threatening, it's a threat, right? But it's usually a color.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So there was a red car parked near where they were, so the color red may be a cue, may be a trigger. It was raining the day that that happened, so rain may be a cue, may be a trigger. And to answer your question, identifying those cues are important because... They let you know when your symptoms are coming. They let you know that they're not coming out of nowhere.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They let you know that you're not a problem or that you're crazy or that you're bad, which is sometimes the messages that kids get when they go to that principal's office, okay? But they let you know that they learned themselves, this is a normal response, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I've learned through my psychosocial intervention, I've learned that this is a cue that triggers a response from me, triggers a response that was helpful at one time. And through classical conditioning, and we do teach classical conditioning to the kids, those responses then become present, become conditioned, right, when the cue is there, when the trigger is there.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So, yes, to answer your question, it is important to know the cues. Now, what happens? Are we going to know all the cues to everything, to all of our behaviors and this shift in mood that sometimes we have during the day and we don't know why, right? No, the answer is no, we're not going to know all the cues.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But the beauty of this is that if we can just learn about one or two or three cues, what our response is, there's more of a forgiveness to ourselves in that when we respond inappropriately, we can think, well, maybe I was exposed to a cue, right? Because I've learned all of this about cues and classical conditioning. Maybe that's what's happening here.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yes. No, and I like the visualization of your seesaw and the example of the hinge because it reminds me of that cognitive flexibility, right? It's not there. It's kind of stuck. It's kind of tight, too tight. And in some individuals... they just experience the dissociation. They're like stuck on the bottom, right? Sitting on the bottom of the seesaw.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Whereas for the other individuals, they're hyper aroused all the time and then you have everything in between. But no, that's a very good representation of it.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And I think people have their own experiences with sleep, right? We've all felt that cold that's coming. And if we really sleep those eight hours, we may be able to fight it because we've strengthened our immune system. If we don't, we will get sick.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So in pediatric psychiatry, we have three different populations. We have the preschoolers, we have the school age, and we have the teenagers. Okay. And they are all very different. They all have responses and defenses that are very different. The projects that I'm describing happen mostly with the school-age children.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah, 15, and then the teenagers later on.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So I work mostly with the school-age kids. And like I said, when we started doing magnetic resonance imaging— to look at the impact of cortisol, we have a number of studies really demonstrating that those kids with higher levels of cortisol had less volume of the hippocampus. The first study that we did in that was cross-sectional and there was no difference.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And it gave me a lot of hope that there would be a window of opportunity there where we could intervene. because what we were seeing in chronic PTSD in adults was that there was smaller volumes of the hippocampus, which help us process memories and have strong connections with the emotional center of the brain, the amygdala, and also with the prefrontal cortex.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And what we found was that cross-sectionally there was not this difference, but we also follow a small sample longitudinally, and there we saw a correlation between that higher pre-bedtime cortisol and the smaller hippocampal volume. More impactful was a functional imaging study.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
As many of your audience members know, with magnetic resonance imaging, we not only can look at the structure, but we can also give tasks of memory, for example, or of executive function and different tasks. that tap at the areas that we are interested in looking.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So when we look, when we give a memory task and we looked at how children with post-traumatic stress symptoms were behaving compared to kids that do not have symptoms or other psychiatry diagnosis, we were seeing that the healthy kids were activating a lot of more voxels or units of the imaging of the HavoCampus.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So there was concern here that, yes, that plasticity that you talked at the beginning was really affecting the development of the brain of the kids. And then with the prefrontal cortex, we saw something similar in the ventromedial area of the prefrontal cortex. But with other tasks, right? With tasks of executive function or tasks of emotion, right? looking at faces, for example, emotional faces.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
All of this to say that they probably have a malfunctioning frontal striatal pathway and frontal limbic. So frontal limbic, I'm sorry. So if we think of the amygdala, for example, in close proximity to the hippocampus, being involved in this hypervigilance, and we have some data to show that the amygdala becomes active very quickly when you present emotional faces to young kids.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
and that that hyperactive amygdala needs a break of some sort. That break comes from the prefrontal cortex. But if you have a prefrontal cortex that's not working that well either, then your break is not working. Right? So then the issue came here, well, this is important information to know what we need to target with treatment.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And can we target this with psychosocial interventions and the way that we provide treatment? And we decided to begin with what we discussed earlier with the cues, right? And teaching and having kids understand what cues are, what classical conditioning is, talking to them about the impact of trauma, talking to them about the impact of treatment and how recovery is possible, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So an educational piece. Something that I never thought I would end up doing was developing a treatment, right? I felt I'm here to investigate and use the treatments that we have. But it became very clear to me that there were a population of kids that still needed a form of treatment that was not out there.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So most treatments out there for trauma were targeting one traumatic event and not targeting that backpack, that allostatic load. Also, and rightfully so, most treatments were requiring that the parents were involved in treatment as well.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And also when there's avoidance, right? And also when there's practicalities that if they lose one day from work, they're going to get fired. So sometimes the parents are just not available and the kids are totally ready to begin and do the work. So I wanted them to be able to do so. So how can we devise a treatment that is hybrid, and by that I mean multimodal,
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
that is not only cognitive behavioral therapy, but that it brings other elements that are important, like self-efficacy, empowerment, insight-oriented work, and give it a structure that can be tested. And that's how we created Q Center, Q being C-E-U-E, Q Center Therapy. for kids that have PTSD.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And we've had a number of trials with them and it helps decrease symptoms of anxiety, symptoms of depression, and symptoms of PTSD. And not only as scored by the student, but also scored by observers, by the parents. And in one of the trials where we measure actually how the parents were doing, parents that were not participating in treatment, their own anxiety was decreasing as well.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And that's easy to understand, right? If your kid is doing better, you're gonna do better as well. So that was very, very good to see. But then we wanted to see that plasticity too. Is this doing something to the activation of the brain? And that's when we brought functional near-infrared spectroscopy into the picture because it's cheaper than MRI and it's more portable and it's easier to do.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
It only gives you cortical information. It doesn't get into those interesting limbic structures.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And these outside areas of the brain, the cortical areas and the prefrontal area, were helping predict which kids would do better. only for those kids that were having Q-center therapy and another gold standard treatment called trauma-focused cognitive behavioral therapy when they were both compared to treatment as usual.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Thank you. Thank you so much for having me.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And can I comment on that dialogue? Because all of those are examples of positive thoughts, right? Positive thoughts that are good, but they're not automatic thoughts. They are thoughts that need to be practiced, right? Negative thoughts, unfortunately, that reside in our reptile brain are automatic. So that hyper response, I'm in danger type of situation, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
when we evolved, right, is responsible for our survival. So we learned the negative thoughts very well. I'm in danger. I have to run. I have to get on top of this tree. The lion might come, whatever. So only 50 million years ago, when we developed the frontal cortex more, positive thoughts came into the picture.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
That's a very good way of starting because in reality, my main interest was the role of stress and the role of stressors and how stressors really would activate the gene makeup and make us vulnerable to things that we might be vulnerable. But at the time when I was training, everything, psychiatry as a field was very diagnosis-based. So you needed an anchor.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And they're very helpful for all the reasons you're mentioning, but they're not automatic. Like the negative ones are. Hopefully they will become. So what I tell the kids is if they don't play guitar, if I give you a guitar right now, would you be able to play me a song?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But... If I gave you a guitar with guitar lessons and you practice, you probably will be able to play a song a year from now.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
With a lot of help.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
A support system.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So we have a slogan in my team, which is practice positive thoughts. All the thoughts you were mentioning are good ones, and we have to practice them, right? This is what I'm learning. No, I'm not bad. This is happening because of the cue.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
All the time.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Interesting. It's like it's learning a tool. So in this Q Center therapy, one of the lessons is that they have an empty toolbox. And this toolbox gets filled with tools that they learn. And practicing positive thoughts, deep breathing, mindfulness, all of this, muscle relaxations, are tools that we teach them.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But they decide, and here's where the empowerment comes in, they decide what the cues are. They decide what tools they're going to put into their toolbox or they're not going to put in the toolbox. And by far, whatever tools they develop that have not been taught by me or anybody else work better when they develop it themselves. Interesting. Yeah.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
You know, I had this case once, and it got illustrated really well. When I was in one of the sessions, you teach them breathing exercises, muscle relaxation, things that we know help, and I'll talk a little bit more about how we know that they help.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And then they have like a week to practice, and then they come the next week, and we see where they are and what's in the toolbox and things like that. And the next week when she came, she was much, much better. And I said, I was very proud. I'm like, oh, you've been practicing the tools, right, that we discussed last week. And she's like, no, I actually don't remember anything you said last time.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But I came up with this thing that when I feel bad, I'm drinking a glass of orange juice every time. And at that moment, I knew I could go both ways. I could go, no, no, you must practice my tools. Or I could say, how wonderful. You've identified a tool that helps you to drink a glass of orange juice, which obviously is what I did. And then she was able to have that in her toolbox automatically.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And we have multiple examples like this.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah. Of course. Um, But for me, and this still needs to be tested, it's nothing necessarily about the glass or even the orange or the vitamin C or anything like that. It's about the fact that she has this message. She has sent a message to herself. I can take care of myself. Because the best tool that I have is me. It's my own body.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And hence, I used PTSD to communicate what I was really referring to. But the reality is that the experience of stress, as we now know, is a spectrum from beneficial to not beneficial to traumatic. So it really, stress operates in our lives as an inverted U-shaped curve. The more stress we have, the better we perform, the better we do.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Whatever these kids go in the future, there's something that's always going to be there with them, which is themselves. So they, as themselves, is the best tool they can have. You know, their body, the way they think, all of these things.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yes, because it gives them a sense of control, right? And they have control over this. And some people may choose to leave them in the fridge, and some people may choose to put them elsewhere. But it's what they decide. It's that decision they're making that gives them a sense of control. That's important.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So this narrative is important. It's an important part of recovery. But we feel that it needs to come after the education piece. And after learning a toolbox, having defenses, because sometimes it can get very charged when you go through the narrative and you want to assess many things during the narrative. You want to assess gaps of memory. You want to assess potential cues.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
You want to assess the emotions that are present. So, and the narrative should be one that covers not only negative events, but also neutral ones and also positive events. And it sounds like a lot, right? But when you're talking about kids that have 10, 11, 12 years, it is doable. You know, you can really manage it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
By the way, with the cold showers, I think you're getting to the hinge of that CISO. I think the cold shower probably does not the cold shower. What do you want to call it? Deliberate cold.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
If we don't care about that exam that we're going to have tomorrow, we'll probably fail. So it's good to be somewhat stressed, right? Vaccines are a stress in the system. So... We'll talk about this, I hope, but I'm very concerned also about the overprotection of kids to protect them from any type of stress.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I think you need some exposure of snakes in your cold.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Correct. So the exercise of the events is a lifeline that we do separate from the toolbox. We actually work on the toolbox first to identify coping mechanisms and coping tools that help.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yes. So the first thing I would say, when you're feeling a certain way, whatever way we're talking about, right? Anxious. Agitated, anxious. Nervous. Is there anything that makes you feel better? Because the experience of having something and they bringing something is important, too. And sometimes they do.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They say, I listen to music or, you know, I play the guitar or I go to play or... My friends. Or my friends or my teammates, mostly, actually.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Teammates is pretty popular.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah, there's something about sports. And sports is something that comes up a lot when we do the toolbox. People put in their sports they're doing or talking to their coach or talking to their teammates or... or learning a new sport. Sports are big, so that's an example that they give. Talking to friends, planning a sleepover, listening to music, different things like this.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Because it is through this experience of early stress that of us develop our problem-solving abilities. And we become aware of our coping mechanisms. We become aware of our support system. How can I manage that stress? And we can. We can manage stress because in the same way that through the process of homeostasis we process, we have a range of temperatures, right, in which we can live.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So the ones I just mentioned are some ideas that the kids bring with them. What we always try to do is we teach them exercises of relaxation. We have to be very careful with this because, like you say, it's good to be personalized, right? It's good that it's adapted. to the kid. And that's why we don't tell them, put this in your toolbox.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We tell them, learn it, and if it helps you, you decide if you put it in the toolbox or not. So when I talk about the treatment being not so much about the what, because there's many components here, like education, narrative, that are common, right? Exposure, we can talk about It's not so much about the what, but it's about the how.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
It's about empowering kids to identify those cues, to say if a tool works or doesn't work, to develop their own tools. But sometimes they are very stuck, right? And they need a little bit of help. So we teach them breathing exercises, and we have a script for that. We teach them muscle relaxation. And we have something for that. We teach them the positive thinking, for example.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So that's a cognitive type of tool. And we teach them mindfulness because of our other work in prevention that we can talk about later in English. mindfulness has been helpful. And also yoga, very simple yoga exercises. So nothing too complicated. Things like the mountain pose, for example, can be quite helpful for some kids. If anything, it helps them reassess the moment and stop.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And if we're going to think about it in cognitive behavioral terms, kind of break that chain of negative thoughts that happen one after the other, which can lead to a panic attack, right? That's many times how a panic attack can start.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We're also talking about eradicating stress that causes discomfort, right? And it causes distress. Not necessarily to live a life without stress or to get rid completely of stress, because that would be impossible.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I like that you're not calling it nervous energy. Because it is just what you said. It's just energy. It's extra energy that needs to be placed somewhere. And they're trying to find out where to place it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah. And some of us, you know, choose to have meetings while walking rather than being in an office. That's certainly my preference. You know, I go for a walk sometimes when I have a meeting. So, yes, so there is increased energy, but there's increased energy that of I feel like I need to do something, and there's increased energy that causes a lot of discomfort sometimes.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
The same thing with stress. We can actually cope up to a certain point. After a certain point, it's not homeostasis anymore, and it turns into what we call allostasis, when it really starts having a physiological cost to the body.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So for these kids that experience discomfort, then they can look at their toolbox and say, which one I'm going to use. And that gives them also a choice, which goes back to that sense of control again.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yes. So we have to be careful with structured interventions because sometimes structured interventions can break a little bit the fluidity of the relationship that a therapist and a child may have or have. a therapist and a patient. So it's better to be semi-structure and to really be attentive to the temperament that the kid brings into that relationship or into that session.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And certainly with the toolbox, as you mentioned, we see an example of that. We also add that in cue center therapy by dissecting and examining a response. So, for example, a child that breaks windows or a child that screams or a child that leaves the classroom running, we try to understand what's happening at that moment. And the way that we do that is by looking at a square.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And a square is composed of four corners, and the four corners are what you're thinking, so it's a cognitive side to it, what you're feeling emotionally, what you're feeling physically, and what you are actually doing, what the action is. And this is your classical triangle of cognitive behavioral therapy in terms of what you're thinking, what you're doing, and how you're feeling.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But we felt it was important to add that somatic physiological component, because for many children, they don't have the vocabulary to talk about all of this. They just tell you, I have a headache, or I have a stomachache, and there's no other medical reason that explains it, right? So, depending on the kid that comes, you're going to start examining their response through one of those corners.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So, if the kid is really brainy and likes to think about the things they think or don't think, you start in the cognitive corner. You know, other kids are very attentive to their body and they say, I feel my heart racing when thinking. I engage in this behavior or in this response. And you start with that corner.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So in that inverted U-shaped curve, there's that optimal point where your health, your happiness, your performance, everything is better because of the stress you've been having. But after that optimal point, all of those outcomes, health, performance, start to decline. Happiness starts to decline. And it is in that second part of the curve where we find traumatic stress.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
The beauty of this is that most of the time, you don't have to work in all of the corners. By just working in one corner, all the other corners change and a new response develops. OK, so if I'm thinking that I'm not in danger, maybe I don't need to leave running. Maybe I can just tell the teacher I'm distressed by the amount of noise. All of a sudden the kid has created a new square.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
That's another square. So hopefully we take that one response as a square and build a cube, right, of many potential responses. so that when the cue happens, now there's an armamentarium of responses, and if I'm too distressed to think what response to do, I can bring myself there by using my toolbox. So it all kinds of starts tying together.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And then as I have more responses, as I understand cues, I can begin talking about this narrative that I have where I will fix some cognitive distortions, hopefully, like it was my fault I made it happen to things like No, it wasn't my fault. Somebody else was responsible and I'm just a survivor, right? I'm not a victim, I'm a survivor. That's another cognitive distortion that can't be fixed.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So all of that, we've included all of this in a manual for therapists, right? So we have a manual for therapists that is called Q Center Therapy for Youth with Post-Traumatic Symptoms published by Oxford.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But I believe that adults that want to reexamine their childhood or their history or want to think about their kids or are interested in trauma can get a lot from actually examining this manual and studying this manual. And in fact, I believe in so, so strongly that we are beginning the first steps of adapting it, not only for youth, but also for adults.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But it carries an emotion with it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And action is a really fun one because you can imagine there are some kids that are not psychologically minded at all, and they don't even want to engage in this with me. And they are like, okay, what is it that I'm doing? I'll do something different. So they'll immediately develop the next square.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So they cannot talk too much about their emotions or how they're feeling physically or look at the negative thought. But they say, oh, is the problem that I'm running out of the classroom? Well, what if I don't? And they give you another action. And so some kids start with that corner. So you can really start with any of the corners.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Traumatic stress being a type of stress that is not only something you have to cope with, but it actually puts your physical integrity in jeopardy. It's a threat. And you have to manage that. And when you experience traumatic stress, many outcomes are possible. One is that you're resilient. And we'll talk a little bit about that as well, I hope.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We usually use Wagner's emotional thermometer to measure where the kid is at. And it goes from like 0 to 10 or 1 to 10 with different levels of stress. And it's good to use something concrete because sometimes we think they're at 10 and they're at 5. or vice versa.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah, he always says that. And it's true. It's so true. And it's true. But I would say if the kid is at 10 at that moment, the best thing is to use a tool from the toolbox and not to engage on the square at that moment. until they come down a little bit and they can pay attention and they can listen to you, because then they will be letting the information come in.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They're so emotionally charged right at the moment that that may not be the right time. Which also, by the way, is the same thing as when you need to talk to kids about traumas that are happening in our society, right? Sometimes you just want to let them know that the door is open for communication. You may want to talk about it at the moment, but the kid may not be ready.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But you can let them know, well, when you're ready, we can talk about it. Here, the same. When you're ready, let's go over the square exercise or the example if the kid is already familiar with it, or I have something to show you, and pique his curiosity that way. But I would say use the thermometer to see if that's a good time. If it's 10, 9, 8, probably not.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But another one is that you may develop symptoms of post-traumatic stress disorder. And the reason that I didn't anchor on the diagnosis right away from the outset, and I was interested in studying stressors, is because many kids, we were seeing many kids that had symptoms of PTSD without having the diagnosis. that were demonstrating functional impairment. So they were not doing well in school.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Wait till it's like 5, 4, 3, and then engage in that.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah, well, our hope is that after a kid goes through Q-Center therapy that they can internalize a lot of these activities and exercises and, like I said, become their own tool, like take those for life and continue to use them.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah, by directional, right? Kind of making things worse. Once they happen, they impact the system even further.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And it's interesting that you bring that up because I often think about, we've been talking about how we experience trauma as individuals, right? But we experience trauma in our civilization. We experience trauma in our history. We experience trauma in our nation and how does a nation heal? How does a system heal? Well, the steps are not that different.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
It comes down to that space you were talking about and building that space and creating that mindfulness time that you need, which is also going to be personalized. It's going to be different for different people. This spring, I was in Morocco and I visited the Medina. I was staying at the Medina. And I was overstimulated, as you can be, and enjoying it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But I imagine this is the state that teenagers are in all the time when they are with social media, bringing them information and different tidbits and different things that are happening all over the place. And very much like I found it restful to go to my hotel for a couple of hours before dinner, people need to build that space. People need to create that space.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
What I tell parents is that it's important to remember that this was also a very helpful tool for us when we were in the pandemic, right? The kids were interacting socially, academics, school was happening through technology. So how can something so good be at times so harmful? And I remind them about when they brought hammers to their house, right? And they had little kids.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They had to teach them how to use them. This is a very important tool when you need to nail something or when you need to take a nail out. This can be dangerous, right? You don't run with scissors. You have all these rules around other tools. We have to have these rules around social media as well.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And I think that's what the Surgeon General is getting at when he talks about we need some regulations around it. But at the family level, I think parents need to say there are certain boundaries that we are going to have. So at dinner time, for example, in this basket, all the phones go into the basket. And that's what we're going to do from now on.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But it is very difficult because when you establish rules like that, kids watch you like a hawk. So you have to model the behavior you are expecting, right? The moment that you as a parent decide, oh, no, I need to go to the basket during dinner because I need to check this thing out, then it breaks. So that's what I think. I think it can be quite helpful. And I think that it can be dangerous.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They were not doing well with their relationships. They were experiencing distress. So their function was affected, yet they didn't have the diagnosis. So the diagnosis is good in that it's there, and it is a behavioral definition that we can anchor in. But there's more nuance to that. So then that shows the whole spectrum.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We've seen examples of that. And it is a tool like any other, like a knife, that we need to learn how to use it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yeah, I think if you live in a virtual world all the time, then you're not living, right? You're not in the real world. So it's like, how can you use the virtual? Are there ways that the virtual world can help you live the current world in a better way? Yes. So that's why I think it's helpful. But if you replace your life with a virtual life, then that's a pity. That's very sad.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So here we were in my program. We had created Q Center Therapy, right? We developed a training program for it. We have a Q Center Therapy training program. And I became increasingly concerned about my own staff and my own team because this is a team, as you can imagine, that are seeing trauma every day and are seeing trauma in kids, right?
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I was worried about vicarious trauma and the impact that this would have in their health. So I remember that when I was doing my residency, I took a course in hypnosis, and I was really struck by how much control one has during hypnosis. So it's nothing like anyone is doing to anybody else. It's really... kind of having the control to relax yourself. Self-directed hypnosis.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And of course, we can come out of PTSD, and we can go back to that optimal point. So we don't want to get rid of stress, but we just want to return to that optimal point. And treatment is available, and people can recover from PTSD, and especially kids can recover from PTSD.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Self-directed type of hypnosis. And I said, I would like to bring something like that. And I met a PhD, John Rutger, that was a yoga instructor and also a mindfulness instructor, and I brought him to the team. And he had other things to do, but one of the main goals was to take care of the team. And we started regularly practicing yoga and practicing mindfulness.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
as we were seeing all these cases and working with trauma and so forth. And I was able to see firsthand how helpful it was for me personally and for my team. At the time, we were doing some work in East Palo Alto in some of the schools. We were doing some pro bono counseling because this is another problem. Many of the schools have no counselors, right? But this was a while back.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
This was like 10 years ago.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And it is not now, but many years ago, it was the number one murder capital in the U.S. It's also the place where Facebook is now. So, and Ikea, and there's people that bring some employment to the area, but also bring some other resources.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And, of course, there are wonderful families there. Of course. that support the kids. There's Ravenswood, which is also the other name for East Palo Alto, family health center, that really provides a lot of good resources to the area. And there's a good school district, but at this time it was missing counselors. So we had some presence there.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We decided to bring some of the things that we were learning in terms of yoga and in terms of mindfulness to two of the classrooms. At the end of about three months, I get called to the principal's office.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
I have to go to the principal's office because the principal was interested in finding out what was going on in there because none of those kids in those classrooms had gone to her office in all that time. They hadn't gotten in trouble. They had not gotten in trouble. So I explained what it was and we decided to do, you know, a bigger scale study.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But there's one thing that really gets in the way, and that's something that in my team we call, we have a phrase that we say PTSD feeds on avoidance. If we pretend that something didn't happen, if we pretend that it will go away, if we pretend that treatment is not necessary, then that's when it gets complicated. And it gets complicated with substance abuse.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And eventually we partner with a group called Pure Power, purepowerinc.org, developing a yoga and mindfulness curriculum for students at schools.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
At that time, we started bringing yoga instructors into the classroom, but we very quickly learned that the best approach to this would be to teach the teachers and have the teachers teach the students because the yoga instructors had no training on how to control a classroom. And the teachers did.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And some of these poses were so elemental that, you know, it was okay if they were not a yoga instructor. So anyway, we tested this curriculum and there was a piece about it in the news hour. I think it might still be there. And I get this...
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
wonderful phone call by this family in New York that wants to see how they can help me spread this further into not only the classrooms that I was working, but into the whole school or the school district. And I knew at that point that two things were important, not only that they wanted and I wanted, but that the school district should want it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And also that at this time, we would need to do a very in-depth study to see what our intervention was and what the curriculum was. Because mindfulness can be the name that you give to many different things. So we wanted to make sure that our intervention of yoga and mindfulness exercises that now Pure Power carries is really what we're being tested.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So they were very, very helpful in helping sponsor not only the dissemination of this curriculum through the school district, but a randomized controlled trial where we actually had a whole other district that would also be trained, but only after the study was over. It was a demographic comparison school in San Jose, in the city of San Jose.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
near enough for us to conduct the study, but far enough that there wouldn't be too much dissemination from one district to the other. And it was good that we did a district-wide control because if we would have done it by classroom or by school, it wouldn't have worked because there was so much diffusion of what the kids were learning
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
into their friends and their family and the other classes and the other people in the community, that was beautiful to see, but it would have ruined a control study.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Exactly. So we demonstrated feasibility. You know, we were able to do it. We demonstrated acceptability. The kids liked it. The kids would do it. Some schools actually had a room specifically for them to go and do it, even if the teachers were not doing it in the classroom. in the classroom.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And it ranged, it was like twice to three times a week for 15 or 50 minutes of this curriculum in the classrooms.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
It gets complicated with self-injurious behaviors. And then at that point, it becomes harder to treat.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So they stay with the same clothes, but we had mats. They had mats. Every student had a mat. And it's interesting that you mentioned PE because the first suggestion was let's do it during PE class. And I'm like, no, that's, you know, rolling from Paul to Peter. Um... Until I learned that PE, like you said, was not happening. So sad. Which I couldn't believe.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And if anything, I think the study has helped for them to bring PE back. And the classes, which are these lessons and yoga movements and mindfulness, were really taking place in the classroom that whatever teacher learned it. So if it was the math teacher, she was taking 10 minutes aside to do it.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
If it was the PE and PE was not happening there, they may dedicate the 50 minutes to do the yoga and the mindfulness. So we have a number of assessments that we did. And like I mentioned, yes, it was acceptable and it improved mood and all of that. But I think the biggest finding that we published from that study was that it increased 73 minutes of sleep per 73. 73 minutes of sleep.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
That's extraordinarily high. On average for the students. And it increased the depth of sleep. So something that we did in this study was that we also did portable polysomnography. And it was not in a sleep center. It was in their own house. So collaborating with Ruth O'Hara from the department, we were able to assess their sleep. And deep sleep is very important.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
That's where you process the events of the day. So these kids were increasing REM, total sleep, deep sleep, doing much better. And then another thing, because of our previous studies that we've talked about in terms of brain function,
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
This hasn't been published, but we have some preliminary data demonstrating that those kids that went through the intervention before and after the intervention were able to decrease the activity of their amygdala, which was very powerful and also very helpful. So many of these kids adapted this into their daily practices after the study was over.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We went to our control group and we taught those lessons there. And now it has served to identify even more tools that we can put in the toolbox of CCT. So we utilize some of the things there and here. So Pure Power and our program have been collaborating a lot because it covers the risk group and the treatment group. So sometimes when we go to schools and we do trainings,
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
we partner with them so that we have the yoga and the mindfulness and the Q Center therapy. And I by no means mean these are the two things that everybody should be using. I'm saying these are two more tools. In fact, I think we need more development, more development of interventions, both for treatment and for intervention.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And how do we identify who needs what and how is where we're moving next.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
It's interesting that you use the word perseverate because one of the characteristics of trauma when it affects children is that it robs them from play. Play is something that's essential in development. It's how we grow socially, emotionally, physically. But when play becomes traumatic play, it becomes non-joyful. But it becomes perseverant and repetitive.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Well, we need to prioritize it, right? We need to prioritize education. For starters, right, we were talking about classes not even having physical education or arts, for example. And we need to prioritize mental health, and it needs to start early. And I think when we work our national budget, it needs to be...
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
There needs to be earmarks for these two areas that should go to the Department of Education. The Department of Education should make this a priority. Teachers are really, really overworked. They are under-resourced, and like pediatricians many times,
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
are responsible for doing somebody else's work right everybody tells them oh this will only take a minute or this will only take two minutes or if you make this assessment you know you can do that but but it the time is finite right and the space is finite so they need more space they need more time they need more support teachers um
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And then this needs to be a priority from districts to really implement programs like this.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So let me tell you what we just started doing in Puerto Rico. I'm from Puerto Rico. But Puerto Rico and Puerto Rican students have gone through a number of natural disasters that started with Hurricane Maria and continue with other hurricanes, and also with earthquakes, and this has led to violence, and there's interpersonal violence. So some of the cases in Puerto Rico have gone through a lot.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But also, the whole island of Puerto Rico is one of the largest school districts in the US. The whole island is one district, meaning that if you do something like a program like the one we're talking about, you can implement it island-wide. Currently, we are launching a project in Puerto Rico where all the teachers will be trained in the yoga and mindfulness curriculum.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
This is the attempt of the individual to try to make sense of what happened. And the reason why it's not good to be alone with it and kind of perseverate on it by oneself is that we're probably not looking at the right insult. So in our experience, usually PTSD doesn't result from that one traumatic event.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And all of the counselors will be trained in Q-Center therapy. The kids are being assessed at baseline. Then they go through their yoga and curriculum. And at time two, when they get assessed to see how they're doing after that, we also screen those that have PTSS, post-traumatic stress symptoms that cause impairment.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And then those go through the trained counselors, and then they get assessed again at the Q-Center.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
in the latter part so the the goal is for us to although we've talked about the two treatments we've never really uh have both of them happen simultaneously and we want to do it in a large scale like this because if this works if if it's sustainable if it's feasible we can actually then bring it to other large school districts like new york like la for example and and start disseminating this
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Well, I think we need to redefine success and what it means to be successful. I think that we're currently describing it with the examples that you just gave, which probably was not the way that we were describing it in the 60s or the 70s. But It is harming individuals, which is most of us, that cannot attain that level of proficiency in an area.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And in fact, the individuals that are choosing to have a broader belonging in a way, are more protected. I worry about those other individuals, too, that have that very personalized, not personalized, but very individualized, unique component in their life where they dedicate everything to that one thing.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But the idea of belonging, right, is that you belong to many different facets of life. You are a sports person. You're a community person. You're a student. You're a father. You're an aunt. You're different things. When you're only one thing and that fails, your whole identity is gone. It doesn't even have to fail. You have to perceive that it has failed. And that's enough to throw you off course.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We all carry a backpack and we can all carry all the stressors that have come our way, like we were saying before. But if you're five, six, seven years old and that backpack gets really heavy, you can fall backwards. And when you fall backwards, that's because you don't have the tools really to carry that. But what I'm saying is that it is the accumulation
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And so with the current definition of success, we're not doing a service for those that attain that definition and those that do not attain that definition. I think it needs to be broader. I think belonging needs to be included. I think the way that we care, not only for ourselves, but for the rest of our citizens, needs to be included. Citizenship is important. So it is dynamic.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So far it has been dynamic, how we define success. And hopefully it will change again.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Resilience is a physical term, right? It means you bounce, the coil bounces back to where it was originally. I like to think of the word adaptation because it means not only you bounce back, but you bounce back to a better place. Yes, we were resilient because we survived it. Some of us did, not all, right? Some of us have to deal with the grief of what happened during that time.
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Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But adaptation means that not only we go back to where we were before the pandemic, but that now we've learned from that experience to be in a better place. Now, we know very little about resilience, and we definitely know very little biology about resilience. We know that having a sense of humor is good. We know that perseverance is good.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
We know that the presence of an adult in a child's life that was there to give them opportunity or to talk to them about things they were going through, that's probably the best known, you But what if it's not the presence of that adult, but there's something in that child that makes them seek and maintain that type of relationship, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So I feel that we need to start looking at the biology of resilience. And one way that we've done that in my program is through a collaboration with Alex Urban from our department and from genetics and Carolyn Perman, who's in his lab and one of his postdocs. They work with organoids, and I don't know if you've mentioned organoids before to your audience.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Yes. So we have stem cells that can be converted to any type of cell under the appropriate nutrients and environments that we want to examine. So for a psychiatrist, of course, the interest is to turn them into neurons. And not only they can grow in a petri dish, but they grow suspended. So it's almost like a 3D. And Sergio uses the term assembloid for when he actually assembles them further.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
to build more organ-specific. Mini-brains. Mini-brains is the term that I like, yes. So these mini-brains are these neurons that are growing in a circle like the brain, and they communicate with each other, and they are active with each other, and we can study.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So in conversations with Alex, and now that you all know my previous work with cortisol and all that, I was telling him and Carolyn, well, what would happen if we expose some of these organoids to cortisol? And, of course, we needed to come up with, oh, what would be the right amount, you know, that would mimic trauma.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
of stressors, some of which may be traumatic, that cause the symptoms of PTSD. So for example, some of us went to Haiti after an earthquake, right? And I was starting my program at that time. I was very young, all ready to talk about earthquakes and know everything about earthquakes. It was the last thing they wanted to talk about.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So we also involved Robert Zavolsky to help us come up with a concentration that would be trauma-mimetic. And so we exposed a number of organoids to different levels of cortisol. For some of them, it was a trauma. For others, they were not exposed. Then half of that amount or much less of that amount was a trigger, the cue, right? So some had the trauma and the cues, some...
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
had no exposure, some only had the Q, and then we compare what was associated with really, well, the first thing that they needed to do was identify that these neurons actually had these glucocorticoid receptors. and that they were active, and they did have them, and they were active. So we looked through epigenetic analysis. We is the royal we, right? It's more Alex and Carolyn.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They look at the genes that were changed, that their activity changed because of this cortisol exposure. And through epigenetic analysis, which is this space, you know, between DNA and RNA and there's like methylation patterns and all that. And some genes activity changes. Some turn on, some turn off.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
So, interestingly, the majority of the genes that we found there were genes that have been addressed in the literature as potentially being related to post-traumatic stress disorder. Things like the glucocorticoid receptor genes and things that you would think of.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But there was another subset of genes that we identified that were novel, and I was very interested in those because of my interest in accelerated aging because of stress. And those were genes that are related to collagen formation. And we know that atherosclerosis has been related to stress, for example.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And we know that accelerated aging, not only in PTSD, but in mental health conditions overall, individuals that suffer from severe mental illness chronically in their life end up dying 25 years younger than the rest of the population. That's very significant. And so stress and accelerated aging, interesting. Okay, so these are interesting findings in organoids.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But when you have those, what you do is you move on to a population study. So these kids in Puerto Rico that are going through these interventions, besides me checking on their PTSD, their anxiety, their depression, they're giving me a vocal swab.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And in the vocal swab, those epithelial cells, we can actually take them through epigenetic analysis and see those kids at time one that, even though they've gone through all this trauma, may not be faring that much worse as their counterparts and compare them.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And not only that, we can actually also look at response, treatment response for the intervention, for the yoga and mindfulness preventive intervention, and for the treatment, for the Q Center therapy. So that's the plan. That's the plan in trying to bring more light into what is the biology of resilience and how can we understand resilience better.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
They saw the earthquake as an opportunity to talk about the violence they had been experiencing, the poverty, the lack of education. So they were talking to me about everything they were carrying that led some of them to develop symptoms of PTSD.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
And collaborations are key, right? Because the world is so complex now that there's no way that a single lab could have all this expertise. So you're right, a place like Stanford allows for these communications to happen, for these collaborations. to happen. In 28 years that I've been there, I have never heard, no, I'm not interested in that.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
The first thing that comes to mind is the importance of listening and listening to what kids and adults have to say about their experiencing and really creating a space for them where they or us don't feel isolated. that they feel supported, and that they feel that they can identify their own strengths and their own capabilities of making themselves better.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
You know, everyone knows or has heard about psychiatrists and everybody thinks, oh, what would your psychiatry say? And psychiatrists have these smart things to say to people that help them with their life. But the best psychiatrists that I know actually say very little. They listen. So I would say that listening to the experience that people have is key.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Epidemiological studies confirm your assertion. Children, we think, we usually, you know, one line that I really don't like is, children are resilient. Because children are really not. They are more vulnerable. They have the opportunity to become resilient if we help them and we tell them what tools to use and how to develop and all of that.
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
But they are more vulnerable to PTSD, and part of it might be that neuroplasticity. And this is why we care for them, right? This is why we protect them and give them safety, because they are vulnerable. By the same token, that neuroplasticity can work both ways. Because if PTSD is teaching us that the environment can have an impact on biology, that's the only lesson, right?
Huberman Lab
Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
Environment can have an impact on biology. And PTSD is a negative impact because of a negative stressor or accumulation of stressors. But that also means that if the impact is positive, as in a good supportive system or as in psychotherapy, that recovery can actually happen in an easier way.