Ep#219 Hope for Youth Depression
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[00:00:00] Dex: Hi everyone. My name's Dex Randall, and this is the Burnout to Leadership Podcast where I teach professionals to recover from burnout and get back to passion and reward at work.

[00:00:23] Hello my friends, this is Dex. And before we start this episode today, just a quick warning. We will be speaking about youth mental health, depression and suicide prevention. If you find you need urgent support from something that comes up, please call a crisis hotline near you. In Australia, that will be Lifeline on 1 3 1 1 1 4.

[00:00:46] So, okay. That said, I'm very pleased today to welcome our special guest, Dr. Tim Strauman, who is Professor of Psychology and Neuroscience, and Professor of Psychiatry and Behavioral Sciences at Duke University. Dr. Strauman is a clinical psychologist who translates behavioral science and brain science research into treatments and preventive interventions for mental disorders.

[00:01:12] His recent research includes: development of a self-system therapy, translational psychotherapy for depression, which combines psychotherapy with transcranial magnetic stimulation or TMS; Creating and testing multidisciplinary interventions to reduce risky behavior and increase academic engagement among adolescents; and a risk phenotype model for vulnerability to depression. An interesting trifecta.

[00:01:43] Anyhow, we're going to hear from Dr Strauman today about a potential breakthrough working with adolescent depression.

[00:01:51] So, hi Tim, how are you today? 

[00:01:53] Dr Tim Strauman: I'm fine, thank you. Thanks for having me on. 

[00:01:56] Dex: My pleasure. And I think it would be helpful to start, because people might be wondering straight off the bat, what's going on, is:

[00:02:04] Please tell us what is your mission right now? 

[00:02:07] Dr Tim Strauman: Oh what we are focusing on and by we, I want to refer to my research partner, collaborator and spouse, Dr. Ann Brewster. We are interested in helping United States, the world, do a better job of identifying adolescents who are at risk for depression and at risk for suicide, before things get to the point where a crisis has occurred.

[00:02:33] So we've taken everything we can find that's the best available work out there and tried to systematize it. And we're in the process now of working on ways to bring it to scale so that every youth who needs something like this will have access to it, won't have to pay for it.

[00:02:52] Will get the care that they need and ideally will not only save lives, but will prevent people from even heading down that trajectory in the first place.

[00:03:02] Dex: That is amazing. More power to you. And the immediate thought that springs to my mind is, why are you doing this?

[00:03:10] Dr Tim Strauman: My career has been about taking the best science that we know, how people's minds work. And I'm a psychologist, so I'm fascinated by the mind and the interaction between the mind and the body, taking what we've learned and bringing it outside of the laboratory to situations where we suspect it might be helpful.

[00:03:31] In, in some endeavors there's a product development pipeline and, a new pharmaceutical comes through or a new medical device or a new diagnostic device. But there really isn't such a thing for breakthroughs in psychotherapy, in counseling and behavioral intervention.

[00:03:50] So we've really taken it upon ourselves for years to be spokespeople for, Hey, here's a model that we think will really make a difference in people's lives. We think people deserve to have access to it. We don't think it's something that should be only for the elite or only for people who have expensive health insurance.

[00:04:12] And then the question is, how do we do it? How do we bring it out? How do we make it available through schools, through communities, through individual mental health practitioners, regular old doctors and health practitioners and nurse practitioners? How do we make it available to people? How do we make their lives better?

[00:04:30] Dex: Yeah. I read your outline document that you kindly sent me, and it's fascinating to me, and I do know some of the science behind it. I'm familiar with some of the terms and some of the problems there, but for people who are listening who don't know, can you just give us a little nutshell view of what your proposed solution or remedy is for this?

[00:04:51] Dr Tim Strauman: Sure. So what makes many of us adults, teenagers, what makes us vulnerable to stress and over time that stress wearing us down, making us vulnerable to depression and maybe even vulnerable to suicidal ideation and suicidal behavior. What often is at the center of that is that we hold ourselves to a set of standards.

[00:05:16] There are particular kinds of people that we grew up believing we're supposed to be, and we'd ideally like to be. And that's a great thing. There's absolutely nothing bad about it. It's a real human capacity. It obviously makes for incredible excitement in people's lives, but it's a real double-edged sword, because when we see ourselves as not being the kind of people that we believe we're supposed to be, or not being the kind of people we really ideally like to be, that triggers negative emotion. That triggers a sense of, Hey, I'm not being who I'm supposed to be. What's going on here? What's the problem?

[00:05:56] Now, in a reasonable dose, that's obviously a really adaptive thing, right? Because you want to have the capacity to say, this isn't quite cutting it, this is not living up to what it is that I want. You want to notice it. And emotions make us notice things and say, okay, what shall I do differently here? So, in measured doses, in reasonable amounts, this is what actually helps us become the kind of people that we want to become.

[00:06:24] Where the problem really kicks in is when it's happening again and again and nothing's changing. Then it starts to feel more like, gee, maybe this is just who I am. Maybe this is as good as it gets. Maybe I'll never be that person. Maybe I'll never attain that accomplishment that it is I want. Maybe I'll never be the person I think I'm supposed to be.

[00:06:46] Now what? That's not a happy place to be. And there's a lot of evidence that, thinking that way can make people depressed. And that being depressed makes people think that way. So again, once you get caught in it, it can be really difficult to get out of it. So a lot of our work has been first to help people who are caught in it.

[00:07:06] And then most recently, the work I'm doing with Ann Brewster is how can we actually teach people a set of skills so that they don't get there in the first place, so that they know that kind of thing can happen. They know how it can go wrong. They can keep it from ever really bringing them to the point where they're incapacitated in pursuing their own goals.

[00:07:26] Dex: Yeah, and that same kind of crippling dynamic also afflicts people in burnout that I work with, and maybe that's why we have some crossover interests. Obviously you've had a career long interest in this. I've had a passing acquaintance, but the dynamic, where they want to be a particular person, but they can't quite arrive at being that person and they can't be this mythical, best self, is chronically painful to the point of debility for many people. 

[00:07:53] Dr Tim Strauman: Yeah. And what becomes especially difficult is when it's primarily due to circumstance. Our nervous systems are really good at helping us protect ourselves, at helping us grow, at helping us when we see the possibility of something rewarding happening and helping us go after it. They're not particularly good at taking a step back, strategizing, saying, okay, I need to try another strategy because I'm hitting a dead end here. I'm banging my head against the wall and my lay person's understanding of what the experience of burnout might be like is a little bit like that. I'm part of an organization, I'm part of a setting, and what used to work is just not working anymore.

[00:08:38] And, I'll perseverate with it, I'll keep trying it, again and again, and it just and it ends up creating more problems. So that's a very familiar dynamic in people who are vulnerable to depression, and I'm guessing from having seen, some of your excellent work. I know that's what people are often experiencing in the process of reckoning, I think I'm burned out.

[00:09:01] Dex: I do see it as having a lot of similarities with depression, whether people are clinically depressed or not.

[00:09:07] So let's just switch for a minute then. So you have a project running. Tell us a little bit about the structure of that project. What is it trying to do? How is it trying to do it? 

[00:09:18] Dr Tim Strauman: Sure. We see schools as a terrific entry point to do large scale health prevention studies. Everybody needs to be in school. Communities have the wherewithal already set up. So from the point of view of , if you wanted to reach millions of teenagers, how would you do it? The obvious places you would do it through schools. And that's not always that easy to do because certainly in the USA schools are very busy and there's a lot of demands for, every minute of time is taken up by the curriculum.

[00:09:54] But what we are doing, and I think it's really a fun idea, is taking some principles that help people what you call self-regulate better. So basically understand what it is that they want, how they're feeling when they think they're getting it and not getting it. What kinds of obstacles might occur?

[00:10:13] What problems people have had in the past, and what kinds of things do they tend to get hung up on? What we do is actually deliver information about that in the context of an introductory psychology mini course. Everything we want people to learn. We want people to learn about, you have a fight or flight response and while that's a really nice adaptive thing to have, sometimes it gets kicked off at the wrong times, and it ends up creating more problems than it solves.

[00:10:39] We teach that skill in the context of people learning about fight or flight to begin with. We teach the impact of how our environments and the social world can sometimes make us feel bad about ourselves by teaching about the social psychology of prejudice and discrimination and how that operates.

[00:11:00] It's really fascinating because it often operates completely automatically. Like it's in the water almost, and we don't even know it's happening to us until it's really affected us. So we teach people about that and we give them skills to evaluate, Hey, how is my environment affecting me?

[00:11:16] How is it making me feel about myself? By doing it through what is essentially a session of introductory psychology. Then one of the things that I think is most exciting and this is something that I really value Ann's perspective on, we encourage everybody to be their own scientists.

[00:11:34] So you don't just read the book, you don't just learn about this stuff. You figure out how can I test this in my own life? So I've got a cell phone, I've got a wearable, I've got the ability to monitor myself. How can I learn about my own strengths and vulnerabilities? How can I learn about my own tendencies?

[00:11:54] How can I get my hands on data about me? And then when I have those data, what can I do to, take a step back and say, alright, it looks like I'm doing all right with this one, with fight or flight. I'm not having panic attacks and I'm not coming apart at the seams, but I'm having a really hard time with how I think about myself and I'm evaluating myself negative, but what can I do about that?

[00:12:16] We want to do what Ann says, pull back the curtain, let people see it. This is what science is, this is what behavioral science is. This is what good intervention work is. This is what good counseling and coaching work is, and we want people to engage in it, get a sense of agency about it, a sense of efficacy about it.

[00:12:35] Hey, I really can do this. And it's remarkably exciting to watch. Some of the kids we've worked with who come from some very difficult backgrounds, who've had some very difficult experiences in school already. You almost see the light bulb go on when they realize: No, I can get this, I can do this. I can make sense of this. There's something here for me.

[00:12:58] You asked before about, why are we doing this? That's part of it. It's invigorating to see somebody for the first time be able to say, I'm not going to let that happen to me anymore. Yeah. I've been stuck in that pattern and yeah, when I'm in that situation, I respond a particular way, but now I know.

[00:13:18] Here's what I'm going to do to reduce the likelihood that happens next time, and here's how I'm going to figure out whether it's working or not.

[00:13:24] So we really ask everybody to be their own scientist. And in doing that, by the way, people share experiences and techniques and encouragement with each other.

[00:13:35] So it's not a solo operation. It's done with a group of people, with a trained teacher and a trained interventionist. And people learn an awful lot from each other's experiences so that you don't have to actually have everything bad happen in your life to be able to anticipate how you might want to prevent it, you can hear somebody else's experience with it.

[00:13:53] Dex: Sounds very powerful. And I really love wearables for the exact same reason, that people can develop more agency over their experience because they can track it and see what's affecting it. I did briefly wonder though, whether underprivileged populations would be able to afford a tracker. What's your experience there?

[00:14:15] Dr Tim Strauman: I think that's a really good question. We know that 98 or 99% of teenagers in the US have a cell phone. The system that we're building doesn't require any more than that. If you have a tracker, an Oura ring or something else, it can certainly supplement the kinds of things that you can learn about yourself.

[00:14:36] But we're beginning with the assumption that this is a zero cost proposition. Which is why we're going to deliver it through schools, which is why the apps that are being developed will be low cost, they'll be for the systems that already exist, that people already have their cell phones about.

[00:14:54] There's an incredible wealth of data that a cell phone can collect. Oh, and I should mention this is all opt-in. This is all only happens when people give permission to do it. When parents, family members say, this is absolutely okay. And the system we're developing has the kinds of privacy safeguards that mean that, you will never have to worry about the wrong person getting their hands on anything that you've said or thought about yourself or any of the work that you've done. We've taken privacy concerns and ethical issues very seriously, especially because we want this to be available to everybody, and that technically is challenging but we think that's absolutely essential.

[00:15:37] Dex: I can imagine. So I'm glad you're taking the ethics and privacy seriously. I think that's a given these days., But let's move on just now, because in your outline that you sent, you're talking about the interventions that you then use with people in your process, mentioning things like self system therapy, TMS.

[00:15:59] Can you explain for people who don't know, just give us an outline of that. Let us know what they are and why did you choose them and how that works. 

[00:16:07] Dr Tim Strauman: Sure. So Self System Therapy is a way to help people understand how they are evaluating themselves, and it boils down to four questions:

[00:16:20] What do you want?

[00:16:21] What are you doing to try to get it?

[00:16:24] What's going wrong?

[00:16:26] And what can you do differently?

[00:16:28] So everything in intervention is related to one of those four questions. And we have learned over the years that people, for example, who are depressed tend to have particular patterns of problems within that general framework.

[00:16:43] People who are anxious tend to have a different pattern of problems, but, in each case, what we try to do is to get people to look closely at who is the person you're trying to be and what's getting in your way. And sometimes that's circumstantial. Sometimes it's opportunities are not present for you at that moment.

[00:17:03] Sometimes it's needing to develop a skill set that makes it a little bit easier to relate effectively to other people. Sometimes it's you've been grieving, there's been a loss in your life, or there's been some involuntary change. You got fired or you lost a spouse, or you got a chronic illness or something.

[00:17:21] So there's so many things that can interfere with people being able to pursue what it is that really is meaningful to them. And that's what self system therapy is designed to do. One of my colleagues here at Duke, Catherine Ramos, has taken self system therapy and translated it into a brief intervention for people who have end stage lung cancer, and it's an absolutely marvelous process to watch.

[00:17:47] These are people who do not have a lot of time left on this planet, but they still want to live a meaningful life. They, it still matters to them to be a certain kind of person. And Dr. Ramos had a real insight that this something was going to work. It would never have occurred to me. And it's such a pleasure to watch it happen.

[00:18:05] So that's a big part of what we do. Another part of what we do is we've learned a lot over the years about what happens in your brain when you are thinking about yourself. And we can tell from using certain kinds of brain scans, like functional MRI, that sometimes people are in a state where they start thinking about something they really want, or kind of person they really want to be.

[00:18:29] But the brain is just not mustering a very effective motivational response. For some reason or other it's tamped down. It's like the thermostat has been reset, 60 degrees Fahrenheit rather than 75 degrees Fahrenheit. And it's stuck there. And sometimes part of what can be helpful, getting the brain unstuck so that it's free to respond in a really vigorous way is to actually stimulate the parts of the brain that we know are engaged when you're thinking about yourself.

[00:19:00] And that's what things like transcranial magnetic stimulation do. It's literally a magnetic field that's aimed at a particular point under your scalp, that when you're thinking about yourself, tend to get activated. So we interview people and ask them all kinds of questions about what kind of person would you ideally like to be?

[00:19:21] What kind of person do you believe you're supposed to be? And then we'll bring them in for an MRI scan, and measure what's happening in their brain while we're simply reminding them of the things that they told us were important to them. And we can actually find triggering points to reengage these processes, here's the right locus to do it for you as opposed to for somebody else.

[00:19:46] And one of the real problems with TMS, which is commercially available, is it hasn't really been a good logic for, how did you aim it? There's some average, if you're depressed, it's probably around here somewhere and that's great. Everybody understands that it really needs to be more precise and individualized.

[00:20:01] And that's part of what our studies are doing. My colleagues and I figured out pretty early on that the brain circuits that I was interested in as a psychologist with self system therapy, they were interested in the very same circuits as biological psychiatrists and treatment of depression. And we said, why don't we put them together?

[00:20:21] Target them toward the same thing. What we do is while people are getting the brain stimulation, literally at that moment, they're also doing the psychotherapy. So it's completely simultaneous treatment. And we've got some really interesting pilot data. There's a study going on at the National Institutes of Health here in Bethesda, where we're trying to take that into a larger scale.

[00:20:44] But that's the kind of work that we've been doing. I think you can see how it is intended to translate the science into something that can actually lead to better treatments, which is where the term translational research comes from. 

[00:20:58] Dex: Yeah. That's the magic, right? 

[00:21:00] Dr Tim Strauman: Ideally. 

[00:21:01] Dex: Let's backtrack a minute.

[00:21:02] So you're talking about a new way of predicting and working with teen depression. What do you think about the way teen depression has been treated, the methodology up until now? The traditional or existing way? 

[00:21:16] Dr Tim Strauman: First of all, I think it's a very difficult problem to take on and I have the greatest respect for people who are willing to do it.

[00:21:24] We know that the average age of onset for a first episode of depression has gotten successively younger, and it looks like now for many people it's around age 14 or 15, which if you think about it, is frightening. That did not used to be the case. Back when I trained as a young psychologist, the average age of onset of depression was 30.

[00:21:46] Now we don't know exactly why that's happening, and our mental health systems are not built for that. What we're built for is adults to get individual treatment. See a psychiatrist, see a therapist, see a counselor once a week. And that seems to be what works. That's not sufficient to help get younger people out of depression.

[00:22:08] And it's certainly not sufficient to help prevent it from happening. So the biggest challenge has been how do we make this available to everybody who needs it, in a dose that's big enough that they're going to get the benefit that they need, in a way that they can afford in a way that preserves their privacy, which of course we all really want to see happening.

[00:22:29] Ideally before they even realized that they need it. That's the challenge, and it isn't so much that there haven't been really good insights into what makes people depressed. The challenge has been how do we get those insights into somebody's life? How do we make it so that they learn that about themselves and they say, oh, okay, yeah, I notice every time I'm in that situation, I think a certain way.

[00:22:55] And when I think that way, I get really sad. If I think that way too much, I stay really sad.

[00:23:01] Okay. Now that I know that, what can I do about it? To a certain extent, that knowledge has been there for a long time, and I've been the beneficiary of wonderful mentors over the years who are real experts in that kind of work.

[00:23:12] And what we're trying to do is take it to the next step of, okay, we know that. Now how are we going to get it out to everybody who needs it? And the current system is just not built for it.

[00:23:22] There will never be enough therapists to do one-on-one individual therapy with every teenager on this planet who needs it.

[00:23:29] But there are schools where we can intervene with hundreds or thousands of people at a time and identify people who maybe need more individualized care. And identify the majority of people who don't and use those resources much more efficiently and much more effectively than we're able to do now.

[00:23:49] Dex: Interesting. I, on the social media landscape, I hear from a lot of psychotherapists who are having a real difficult time, quite a lot of 'em are burning out right now and losing a bit of faith about things like wait times, maybe over prescription of drugs, low therapy success rates. There seems to be a growing body of them that don't think therapy is enough, that might maybe agree with you that perhaps the intervention comes earlier.

[00:24:13] Dr Tim Strauman: Yeah I think that's becoming increasingly clear. And you mentioned social media, which, for me, and for many of us in this line of work, is a real mixed blessing. Because you can find anything you want. If you wanna find evidence that you are a marvelous human being and everybody loves you, you can find that on social media.

[00:24:36] If you want to find evidence that the sky is falling, the world is coming to an end, forget it. It's not worth it. Don't even bother. You can find that on social media. Social media creates a kind of a hot house effect that I think it helps to explain why the onset of depression has gotten younger.

[00:24:55] It's because people are having to deal with more and more challenging information, contrary information, before we've really given them the set of skills that they need to be discerning consumers of what they hear.

[00:25:11] I like to look at social media, but I won't look at the individual comments that people make about, say, a particular Facebook posting. I know what's going to happen to me when I do. It's going to drag me down, it's going to make me feel bad. I'm dosing myself with an additional stress that frankly none of us really need. Whereas I do think social media is a big part of the problem, I also think social media is potentially a big part of the solution, but it has to be done so much more effectively than it's happening right now.

[00:25:39] And, part of what we're trying to do with developing apps that will coordinate with the skills that we're teaching in schools is to make that synergy work better. So the skills can be available 24 7 anytime anybody needs it. They can go to their phone, say, Hey, I think this thing is happening again. Can you help me with it?

[00:25:58] And the phone will know exactly what the thing is they're talking about. It'll know what skills works for this person and it'll help 'em do it right then and there. And if they want, it'll report back to their therapist that the whole thing happened. And the next time they talk to their therapist, there's a record of it.

[00:26:14] Dex: I'm with you on social media. I do think it has mixed blessings, but on the balance of it, when we see the rate of mental health problems in young people escalating and the curve steepening, it concerns me very much that they won't have the discernment that maybe you and I have that we'll just cherry pick the things that we look at, and we won't look at the stream of comments and hype and anxiety provoking content.

[00:26:38] Fear inducing content, addictive content. Personally, I really mostly follow academics, for their research because it helps me in my work. But it's quite an ambitious concept to think that we can reform social media because what we would be then asking them to do is take away the addictive element, and that's not going to be a very appealing prospect.

[00:27:01] Dr Tim Strauman: Yeah. Where we come down on that is we know there are things that social media can make available to people by virtue of the fact that they're so widespread, that has to potential to do a lot of good. So we're not about taking on content providers or trying to, create an alternative sort of online universe that only has positive things about it and every day is a sunny day. We're trying to say, this technology has the ability to really help people stay on top of what's happening in their lives and to actually be empowered to make choices. Social media is meant to be enticing, seductive. It's meant to draw us in, but the kind of social media use we're talking about is: you're setting this up for yourself. What do you want your day to be like? Who is the person you want to be? How are you going to do that today?

[00:28:00] What do you anticipate's going to go well today. What do you anticipate might be challenging? Great. Let's talk about it right now. And there are lots of resources available for mental health and there are wonderful testimonials by all kinds of people who've had life experience and be able to say, this is what helped me and I'm going to be here for you.

[00:28:20] But our stance is I don't think we're going to be able to do much about the content provided, but I think we can do a lot about making better use of what that technology can do for an individual person when it's under their control. 

[00:28:35] Dex: I would very much agree that when you bring somebody to higher levels of mental and emotional health, to more self-advocacy, to more agency, to more power internally, they have less need for that side of social media anyway, that does harm.

[00:28:49] Dr Tim Strauman: Yeah I think that's true. I think we will find that out. There's some terrific work already being done around the world, including a couple of universities in Australia, trying to identify how, with the right skillset, people do learn to effectively titrate input they're getting from social media. So that they're wise consumers, rather than passive almost victims you might say. 

[00:29:14] Dex: Yeah. All of this makes me wonder. So we've talked a little bit about your program, how it's laid out, why it's laid out that way. But the question I'm asking myself now is.

[00:29:25] You've had a long time to think about this in your academic career, what took you into academia in the first place? Was it this or is this something you've developed as you've gone through? 

[00:29:36] Dr Tim Strauman: I would say it's both. It's always been how do we take what we learn about the mind and help people have healthier lives.

[00:29:45] I've been interested in psychology since I was about 15. I had a friend whose mother had taken a college course and had a Principles of psychology textbook there, and we got into a conversation. She said I'm done with class. Why don't you take this book?

[00:30:01] It just blew me away. It had such interesting questions, like, how do we know what's happening in somebody's head when it's automatic and unconscious and they can't report on it? It turns out there are a lot of ways you can learn that. It's just takes a little bit more experimental cleverness. I was smitten by that right away.

[00:30:21] The other thing was what people used to call psychosomatic illnesses. High blood pressure, cardiovascular disease, gastrointestinal problems, that clearly are exacerbated, if not caused primarily by the stress people are experiencing.

[00:30:38] And when I got to graduate school, my mentor at the time who was a distinguished social psychologist, his expertise was on how do we help people learn the way they're thinking about themselves so that they get a chance to say, Hey, that's not working so well for me. But he wasn't a clinical psychologist, so he bequeathed that to me.

[00:30:57] Throughout my entire career, that's been the thing. We know a lot about how people think about themselves. It's solid science. How do we get it out there so that people can have better lives. And, I've benefited from it myself.

[00:31:09] Who hasn't been in therapy? I've been in therapy. I believe very much that there are skills people can use, insights people can learn about themselves that really do make a difference. That you feel it differently, you experience it differently, you behave differently.

[00:31:24] Our work, your work with me has been very much focused on identifying the mental components that are getting in the way. So I'm a big believer in it, always have been. What I find appealing about what you and I work on too, because that's the principle. It's no, there's something happening in your head and if you were thinking differently, you would feel different.

[00:31:47] An example that I give a lot when I'm giving lectures or even in classes. Back in the day before we believed in privacy, American universities would post on the wall of the classroom everybody's name and the grade they got in the course. But you could watch two people who had exactly the same grade.

[00:32:06] They both got, 88 out of a hundred, and one of them is elated and one of them is devastated. So it can't be the grade. It's not the number. It's one of those people probably exceeded their expectations and one of them probably failed to meet them. Accurate, inaccurate, who knows?

[00:32:27] That's the demonstration that there's an awful lot about what we experience emotionally that we influence, based on how we're thinking about ourselves. And a lot of that is habitual, it's implicit, it's things we've been doing all our lives and a lot of the work of a good therapy or a good coaching session is we're just going to unearth that.

[00:32:49] So you can take a close look and say, how do you really feel about that? That worked for you 20 years ago, Is it still working for you? Maybe you want to do things differently. I like working with people, because you get to see the liberating power of that, and I'm sure you have that experience all the time.

[00:33:06] Dex: Absolutely. Yeah. Using very similar methods actually. To me it seems at this stage intuitively obvious, but I know that your ideas are actually fairly revolutionary within your world. So what's it like, trying to break through with an idea that some might regard as too big a leap? How has it been received? What's happening?

[00:33:30] Dr Tim Strauman: I'll be honest with you. When we do talk to people about it, it tends to be received positively. But immediately things get back to yes, but. Where's the money going to come from? What's the institution that's going to help you do that? And gee, our funding agency doesn't do that. Sorry, we'd love to help you, but we do this other thing.

[00:33:50] And here's this idea that everybody says, why are we not doing this yesterday? And we all end up getting hung up in the pragmatics and it takes two years to publish those findings. It takes another year to apply for a grant, and then you don't get it the first time, and then you gotta apply again. And before you know it, you're retired and it's too late.

[00:34:10] We're not going to let that happen. I'm very motivated. But that's what we're up against, academia. It's a very conservative, it moves very slowly. It's like trying to turn a battleship around, there's the received wisdom.

[00:34:23] At first glance, people are like yeah, bring us some new ideas. But when you try to find the dollars, find the new ideas, people are not as willing to give up those dollars from the old ideas to help make the new ones go. But as you have pointed out in our conversations, that's the journey and that's the excitement of the journey and the uncertainty of it and the commitment that it requires is part of what really makes it worthwhile for me on a daily basis.

[00:34:50] Dex: Yes. My observation is that it is very difficult to push anything through. There's a "there be dragons" mentality that you are not encouraged to cross the edge of. But how's it going across with your students? I know you're still teaching.

[00:35:04] Dr Tim Strauman: Students are wonderful because they haven't yet become cynical about how the system works. If they're undergraduate students, they're smart, motivated, excited, idealistic. And I'm providing an opportunity to say, no, you can come do cutting edge science. You can come being part of our lab and you're doing it, and when we publish it, your name's going to be on it. Being able to do that is great. Graduate students they haven't yet got to the point where they have to find a job. So they haven't had to go out into the academic world and, toe the line and make sure you look the right way and sound the right way so they can still get excited about their own ideas.

[00:35:42] I feel very fortunate being able to teach, like I said I had outstanding mentors and teachers and I like being able to give some of that energy back. But it's really important too, because for me it's a source of energy. It reminds me, no, I'm not going to let the jaded side of this academic world keep me from pursuing this. This is something that I know is good science and I know is likely to help people, and I'm not going to take no for an answer.

[00:36:07] Dex: I imagine you're a really wonderful teacher. I wish I'd had more teachers like you when I was in my e ducation. But I'm wondering then, if your students know all these principles that you're working with, do you test it out on them?

[00:36:18] Dr Tim Strauman: We invite people if they're interested to explore things obviously. There are some pretty hard and faster rules. You can't collect data on people without their permission, and they have to understand everything as you're doing.

[00:36:33] But in the spirit of like Ann says pulling back the curtain, we do that anyway and we make available to our students and to our colleagues, anything and everything that we have. Here's how we ask the questions. Here are the questionnaires we use. Here's the brain scanning protocol that we use. Here's what the intervention looks like. We just make it available. We're not the only people who do that. Those are really good principles of science, so anybody who wants to can get ahold of our data and say, you know what, I'm not sure I agree with your conclusion.

[00:37:04] Great. Take the data. Test to your conclusion, maybe you're right, and even better yet, maybe we're both right, but neither one of us is completely right and if we work together we'll come up with something that would be better than what either of us would've hit on left to our own devices. 

[00:37:21] Dex: What would you say, if there's a teen listening to this podcast, what would you want them to know?

[00:37:25] Dr Tim Strauman: Life is tough. Don't let anybody tell you that it's not, but you have the ability to successfully navigate it. It's not rocket science. It's a very straightforward set of skills you can practice, and things you can learn that go a remarkably long way toward keeping a good day good and keeping a bad day from becoming a terrible day.

[00:37:54] You can do this. We know this works. And so yes, life is tough, but don't be discouraged. This is technology you can count on. We and many other people around here would be more than happy to help educate you about how you can do that for yourself.

[00:38:09] Dex: What would you say to parents who are listening who have themselves a teenager in distress?

[00:38:15] Dr Tim Strauman: You mean have a teenager?

[00:38:16] That was a evil attempt at a joke. We would say really the same thing, that there are ways to help people. Just as, for adults who are struggling with those kinds of issues and situations.

[00:38:29] We know what works. We know there are things you can learn. We know you can practice them, you can get good at them. You can anticipate problems before they arise. The exact same thing is going to be true for teenagers. We just haven't made it available yet, and we're just beginning the process of figuring out how to do that in a way that, we're literally re making it available to everybody.

[00:38:51] But it will work. It does work. The earlier in life people learn the skills, the better off they are. It predicts all kinds of excellent long-term outcomes. Academic success, career success, mental health, physical health, longevity. It predicts so many good outcomes and the earlier you get into that pipeline, the greater the likelihood that you'll get your share of all of those good outcomes.

[00:39:17] So that's what I would say to the parents. 

[00:39:19] Dex: And I concur. It's in principle, the same thing I do with people in burnout is I help them have access to a set of skills that will support them much better in their life, whatever their life looks like. Same thing. This is partly why I'm so encouraged that this is becoming more accessible for teenagers who are struggling.

[00:39:38] Dr Tim Strauman: Yeah, that's our mission. 

[00:39:40] Dex: How, is there any way that listeners here can support your mission?

[00:39:44] Dr Tim Strauman: I think the most important thing right now is to encourage schools to make sure to leave time and opportunity and resources not just for people who are really struggling, but for people who just seem like they may be having a bad day. There may be things have become difficult. We know a lot about the course of how people go through school.

[00:40:09] So here in the US for example, the transition from eighth grade, which is typically in middle school to ninth grade, which is the first year in high school is enormously difficult. It's one of the most difficult life transitions people have to face. And we know that in some respects, high schools are really good at right away identifying people who are most likely to have trouble with that transition and providing for them things that will maybe make it a little bit easier, but that can be done on a much broader scale. And it needs to be done on a broader scale. 

[00:40:44] Dex: Okay. For those people outside the US what ages are you referring to then? 

[00:40:48] Dr Tim Strauman: 13 and 14. 

[00:40:50] Dex: Okay, thanks. So in terms of this, what we've been talking about today, maybe in those ideas, what's your prediction for how we're going to support resilience in future?

[00:41:01] Dr Tim Strauman: We're going to do it by teaching it more effectively through schools. We're going to do it by allowing healthcare providers and mental health professors to have access to information that they need about individual people in real time. So if you think about it, somebody can go to school tomorrow, have a really bad day, get suspended for a week, and go to the hospital, the emergency room, two weeks after that because they made a suicide attempt.

[00:41:35] And the school never talked to the healthcare provider. If that information had been available, that attempt never would've happened. So we are going to be able to do that. That's a technological problem that can be solved.. And what it requires is big vision.

[00:41:51] People being able to say no, the status quo is just not acceptable. We're not doing right by enough kids. In the US about 8,000 people between ages of 10 and 24 commit suicide every year and hundreds of thousands or more make attempts. That's not acceptable. And we as a society have to wrap our heads around that is not acceptable and it's not inevitable. There are things we can do and we can start them today. Working with schools, healthcare providers, community agencies, local governments. There are so many stakeholders here who really want to be part of the solution.

[00:42:30] Which to me is another exciting feeling about, where we're at right now. 'cause it seems like things are beginning to gel, that everybody understands, no, we actually can make this better. 

[00:42:39] Dex: It's certainly gut wrenching to think about that disconnect. But it is only quite recently that we've had the technology that would empower us to connect the systems together, help that system work as a more coherent whole, and I too would very much look forward to the day where that support is able to be much, much better.

[00:42:59] If people are listening today and they want to take immediate action, do you have a particular resource that they can study and start to do this: Where do I wanna go? Why aren't I getting there? Have you got a specific one in mind? I can propose my own in the show notes if you don't.

[00:43:15] Dr Tim Strauman: Why don't you propose one? There are a bunch out there that are really good. I'm a big believer in what is known as Cognitive Behavioral Therapy, which is obviously a basis for what you do as well.

[00:43:26] I'm going to refrain from being self-promoting here and just say that there are wonderful resources out there.

[00:43:31] What I'm hesitant about is we're not really at the point where we can disseminate things as effectively as we would like to. If we were, I'd have a book sitting here behind me and I'd be encouraging everybody to buy it.

[00:43:44] Dex: I was just going to ask you where the book was. 

[00:43:47] Dr Tim Strauman: The book is here, but it's coming we've been working on this for 30 years and we've produced a lot of good science. Now we're taking it out of the scientific world into the larger world, and it's frightening and it's exciting all at the same time.

[00:44:02] Dex: And what would success look like for you on your mission? 

[00:44:05] Dr Tim Strauman: Lives saved, very simple lives saved. That's the thing that matters. It's not how many people read the book. It's not how many people take the course. It's can you show that because people have learned this set of skills that you told them are going to be helpful, that their lives are better.

[00:44:26] So fewer people are making attempts, fewer people are feeling despondent enough to even consider making attempts. Fewer people are engaging in self-harm, in substance use having difficulty with eating related behaviors. That's, to me, the definition of success.

[00:44:46] And we'll know. We're making some pretty strong predictions, that we can help people improve their lives, and that the onus is on us to show that it's true. It's a strong prediction, but those are our indicators of success. We've made people's lives better, or I should say we've given them the wherewithal to make their lives better.

[00:45:04] Dex: Yeah, and I can't wait to see that happen. We're running out of time, but before we close, is there anything else you'd like to add? Anything you wish I'd asked you? 

[00:45:10] Dr Tim Strauman: No, it's been a lot of fun talking. I do enjoy the fact that the work that you do and the work that I do have such common elements and I'm grateful to you for the opportunity to just come here and talk about it and for the encouragement that I get when you and I talk.

[00:45:25] This is a real turning point in my career, moving away from being a traditional academic toward being something that's more like an architect. Trying to build something bigger in cooperation with all of the different stakeholders and we all want the same thing.

[00:45:41] We just haven't been able to make it happen yet. If I can be a part of that, making this big thing happen at scale that can really affect hundreds of thousands of people's lives. It doesn't get any better than that. 

[00:45:53] Dex: The wheels are already in motion, so we look forward to hearing more later.

[00:45:58] Dr Tim Strauman: Thank you. I would be happy to report back and yes, the wheels are in motion for sure. 

[00:46:03] Dex: Thank you Dr. Tim Strauman for sharing your passion, your dream in support of teens with depression. You've always impressed me with the warmth, dedication, and perseverance you bring to your work against clear headwinds. And it would certainly fill a gap if you bring this project to the Youth of America and hopefully beyond.

[00:46:25] Dr Tim Strauman: Thanks for having me, and thanks for the encouragement. 

[00:46:27] Dex: Pleasure! Listeners, I'll come back to you with more next week examining what you can do to relieve suffering and maximize your success in this world, but also looking at how we can work together to create a better future.

[00:46:42] Thank you for listening, and please do share this podcast episode with others who may benefit.