Psychiatry & Psychotherapy Podcast

Can strength training help alleviate depression? In this episode, Dr. David Puder is joined by Trent Jones, a Starting Strength athlete, to discuss how systematic strength training can significantly impact mental health. From boosting confidence and assertiveness to reducing symptoms of depression, we explore the science and personal stories behind this powerful intervention. Key topics include: The transformative mental health benefits of resistance training. Insights from research studies showing the link between strength training and reduced depressive symptoms. How strength training fosters assertiveness, confidence, and resilience. Practical tips to start your own strength training journey, even if you're a beginner. Whether you're a clinician looking for holistic treatments for depression or someone seeking new tools for personal growth, this episode offers actionable insights and inspiration. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In the third and final installment on microexpressions, Ariana Cunningham and Dr. David Puder talk about how learning microexpressions can help you build empathy and connect with other people. As Paul Eckman demonstrated in his research, they can be potent glimpses into someone's emotional experience. In this episode we talk about: How emotions come into play in our dreams and other unconscious ways. How to use what we learn from them carefully and with curiosity, rather than with a know-it-all attitude. How we create psychological defense to cope with reality How we might experience problematic relationship patterns through a theory called object relations. How our emotions happen out of our awareness. Preventing emotional overload and empathic exhaustion. Emotional transference and how to stop it. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join Ariana on Instagram: @joyspotting Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face. In this episode, we describe the science of the microexpressions of fear, disgust, and surprise and how to use it to connect with others. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources Join Ariana on Instagram: @joyspotting Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face. In this episode we describe the science of microexpressions, emotion and how to use it to connect with others. For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join Ariana on Instagram: @joyspotting Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

New research on hormonal contraceptives, "the pill", and how it influences mental health. Dr. David Puder and Dr. Mona Mojtahedzadeh explore: Claims about the mental health consequences of hormonal contraception Unique Influences of progesterone and estrogen on the brain How ovulation changes attraction and desire Discuss the controversy around recent studies that show that hormonal contraception increases the risk of depression Critique of those studies and counters to those critiques Kelly Brogan and other contrasting views and their influence on this field By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Overcoming Postpartum Depression Link to show on: iTunes, Google Play, Stitcher, Overcast, PlayerFM, PodBean, TuneIn, Podtail, Blubrry, Podfanatic This week on the podcast, I joined with Dr. Pereau to talk about postpartum depression, both from a personal level and as those who treat it in our patients. Dr. Pereau is incredibly honest and vulnerable in this emotional episode as she shares her story. Throughout it, she talks about the symptoms of her postpartum depression, including: Intrusive thoughts Emotional disconnection from her baby Sleep deprivation Hopelessness Problems with concentration Disconnection from passion and joy Panic attacks and anxiety Poor self care It had never occurred to Dr. Pereau that she would struggle with postpartum depression, though she had treated many people with it, and could easily recognize symptoms in others. Often, when we are experiencing these kinds of things, it's hard to identify the symptoms within ourselves. We understand the need for someone with a recognizable disorder, such as bipolar or schizophrenia, to get help. But depression can be a slippery, indefinable problem when it comes to labeling ourselves. If you are dealing with postpartum depression, know that it can be treated, and there absolutely hope to work through it. Here are some things that can help: Breastfeeding to stimulate connection and positive hormone production SSRI treatment (medications prescribed by a doctor) Talk therapy A good support system If you've been experiencing the symptoms we discuss in this podcast, there are plenty of resources, plenty of people who can help you during this time. The Edinburgh Postnatal Depression Scale is a simple questionnaire that can tell you if you are experiencing postpartum depression. For a list of local support groups in the region, www.postpartumprogress.com is a wonderful resource. Postpartum Support International is another great resource for online support groups and educational materials. www.postpartum.org 2020 Mom is an online advocacy group for maternal mental health. It includes blogs, educational materials and legal support. www.2020mom.org Below is a touching excerpt from her story: "My mother always said that when I had a child, I would know true love in a way I could never conceptualize. It had been a very long path to finally getting the child, and when he finally came I felt nothing. Actually, I felt worse than nothing. For the first couple months, all I can remember is darkness. I felt alone to my core. I felt like I was drifting, disconnected and lost. In my mind, my life was over. It was forfeit. The child wasn't a beaming ray of sunshine, filling me with hope and life and love. When I looked at him I felt nothing. The guilt of this overwhelmed me. I found myself wrestling through the options, fantasizing about packing a bag and running away in the middle of the night, or giving the baby up for adoption, or crashing my car off the edge of the mountain on my way home from work, or throwing myself off our cabin's third floor balcony. The images whirled through my mind and I would clench my teeth and force them away. It was all so dark. I didn't want him. I didn't want my life. I believed I knew these things for certain. I believed these were my thoughts. I mentioned to my husband Bryan about having a dream where I jumped off the balcony, but then I quickly minimized it. I filled out the Edinburgh Scale in the OBGYN office with just enough depression items to be flagged but not enough to get hospitalized. We use the term, "A cry for help," and generally refer to something gamey or indicative of less severe illness. I can see how it looks that way. But I now know without any doubt what a cry for help really is. It was the weak, thready voice of the last piece of me left in my mind, the last flicker of light not darkened by postpartum depression. It was the last bit of me that was not pinned down under the weight of illness. Those weak cries were the best I was capable of. The illness was too great. My mind did not belong to me. My thoughts did not belong to me. I just didn't realize it. As a society, we believe that depression is something that can be willed away if a person is strong enough. If they just try hard enough. And yet nobody tells a schizophrenic to just try to not hallucinate. We don't tell a person with bipolar disorder to just try to not cash out their retirement to finish that half built bomb shelter in their back yard they've been building the last few weeks. Even conditions like alcoholism have been embraced within a medical model. We don't tell the alcoholic to just try to stop drinking anymore. We recognize this to be a medical illness deserving of care and treatment. And yet we tell the depressed person to try to be positive. Try to be happy. And I think I know why. As humans on the planet, each of us suffer, faces grief, loss, and even hopelessness. And we find ways to survive, often becoming stronger because of it.

Our bodies are "wired" to perform. Learning how to consciously modulate your internal sympathetic state is the key to unlocking optimal performance. The autonomic nervous system (ANS) facilitates survival by generating the fight-or-flight response and promotes recovery following activation (the ability to relax). The ANS achieves this by balancing two complementary systems: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). For example, your ANS is currently adjusting your pupillary diameter, respiratory rate, blood pressure, heart rate, skin conductance, sweat production, sphincter tone and postural muscles (just to name a few) to allow you to focus your eyes to read this information without passing out, falling over, overheating or urinating on yourself. For PDF with full notes on our discussion and breathing: https://psychiatrypodcast.com/resources By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join Dr. Eller on: Facebook: @PhysicalTherapyRX Instagram: rxpt_ Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Learn: Why to optimize medical issues like hypertension and diabetes Change psychiatric and non-psychiatric medications to optimize brain function Optimize sleep to obtain rest and increase brain function How drugs influence the brain short and long term to change sensorium How viewing yourself without "free will" influences brain function By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. For PDF with citations and full notes go to: https://psychiatrypodcast.com/resources Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Western society faces is the most unhealthy we've ever been. It's reached epidemic proportions: depression, anxiety, poor focus and sensorium issues, chronic stress, and diseases of chronic stress (like diabetes). The solution is simple—exercise and healthy eating. In this episode, I will be going through 17 studies on how exercise influences and improves these factors. I will cover how it works, and how to develop an exercise program from the perspective of a doctor, not just for body sculpting. Some things I am covering: Strength training decreases depression Strength training increases cognitive function Fitness decreases risk of dementia Exercise increases BDNF Strength training and exercise in treatment for diabetes By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. For PDF with citations: https://psychiatrypodcast.com/my-resources Post questions and comments on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Starting Strength Online Coaching

What are the best diets for the brain and cognitive function? How much does diet influence our sensorium? What particular foods are important? How do we change our genes to optimize our brain? By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. For PDF with citations and detailed notes go to: My Resource Page Ask David questions on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

In this episode, Dr. Puder addresses the fascinating realm of schizophrenia with Dr. Cummings, a previous guest in the show. Dr. Cummings is a psychiatrist with a wealth of experience from working at Patton State Hospital in California, one of the biggest forensic hospitals in the world. -Defining Schizophrenia -Living with Schizophrenia and Perception of Reality -Are Negative Symptoms in Schizophrenia Precipitated by Medications? -Emil Kraepelin, and the Early Studies on Schizophrenia -The Pathology, Biology, and Genetics of Schizophrenia -Cannabis Use and Risk For Schizophrenia -The Loss of Brain in Schizophrenia -Counter-arguments Against Robert Whitaker's "Anatomy of an Epidemic" -Schizophrenia Prevention in High Risk Population -Australian Study on Children of Schizophrenic Parents -Crime, Violence, Mass Shootings and Schizophrenia -Medical Management of Schizophrenia -1st Break Psychosis -Long-acting Injectable Antipsychotics in Early Illness -Medication Adherence -Exercise, Lifestyle, Diet Optimization By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder CV of Dr. Michael A. Cummings Assistant Producer: Arvy Wuysang Editor: Trent Jones

This week I had a discussion with Dr. Darcy Trenkle on the difficulty of providers to get psychiatric treatment, using ourselves as the examples. In a recent article nearly 40% of physicians surveyed said they would be reluctant to seek formal medical care for treatment of a mental health problem because of concern that this may put their medical license in jeopardy. Physicians have three times the national average for suicide and have unique stressors and often a culture not conducive to seeking help. We discussed difficulties we had in contemplating getting care for different issues we faced. Hopefully, this will open a discussion regarding the conflicts providers have in engaging needed help. Dr. Trenkle is a psychiatrist in Southern California and is affiliated with Loma Linda University Health. She received her Medical Degree from Loma Linda University School of Medicine. She completed her residency training at Loma Linda University in 2015. She is the Medical Director for Electroconvulsive Therapy as well as Program Development for the Behavioral Medical Center at Loma Linda University. If you are a Medical Student, Resident or Attending listening to this and need help, please reach out to a local provider. We are open to receive emails if you are local, our names are searchable in the Loma Linda email system. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Sensorium is the total brain capacity for focusing, processing, and interpreting. It is not a static state—it can fluctuate throughout the day. It can be influenced by sleep, food, stress, exercise, drugs, medications, and long term, through epigenetic phenomenon. If there is damage to the structure of the brain, it can permanently lowered. It is a slope, which we all move up and down on, based on our baseline, but then also influenced by many factors. In your 20s and 30s you are very far on the left side of the line. If you get stressed, sleep deprived, starving, maybe have a small infection, you may still be able to think, but just less clearly. If you did those same things to an elderly person, they would be sent into a full delirium, hallucinating, throwing things, yelling, seeing spiders on the wall, and looking psychotic. In this way it is common for an elderly person with dementia, they can be more confused in the evening then in the morning, they call this "sundowning". We all have a baseline level of brain function, and this can be optimized by several factors like good sleep, good amounts of exercise, good mental functions (like reading), meaningful relationships, good spiritual practice, and meaningful work. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Personal Website: www.DavidPuder.com

This week David Puder, M.D., has a discussion with Randy Stinnett, Psy.D, regarding his journey to become an excellent therapist. Randy shares aspects of his journey and insights. His enthusiasm is contagious. He discusses formative influences including Habib Davanloo, Donald Kalsched, and Todd Burley. Please follow the link to the website for Randy Stinnett's list of 5 recommendations for someone aspiring to be an excellent therapist. By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Link to Randy Stinnett, Psy.D Short CV

In this episode I will be interviewing William Britt, PhD level clinical psychologist, an expert in cognitive behavioral therapy, object relations therapy, EMDR and a board certified neuropsychologist. He runs cognitive rehabilitation groups and neuropsychological assessments, and supervises neuropsychological fellows and interns. He also works closely with the psychiatric residents teaching about suicide. In this episode, Dr. William Britt explores his experiences running an inpatient psychiatric group for 5 to 13 year olds who are being treated for violence or attempted suicide, using uses a method based on Irving Yalom's inpatient group psychotherapy technique. We discuss how the trend of teen suicide has increased over the years and the typical causes of depression. We also cover common bullying tactics and how cyber bullying has changed society. We then discuss how to use the group's support to help each other move away from being suicidal. We explore how the Netflix TV series "Thirteen Reasons Why" has influenced young minds and the new terms the patients are using. In the end, Dr. Britt and Dr. Puder answers how we adapt and recover from trauma, and how we find meaning and value within stress. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder CV of Dr. Britt

In this episode, Dr. Cummings and I discuss psychopathy: the fearless, empathyless people, who see others as objects, and have the inability to attach within relationships. Dr. Michael Cummings recently contributed to a book called "Violence in Psychiatry," detailing the biological aspects of psychopathy, edited by Stephen Stahl. Dr. Cummings works at Patton State Hospital, one of the biggest forensic hospitals in the world. He is the Yoda of the psychiatric world, with many other psychiatrists bringing him their most complex and difficult cases. In this episode we cover: History of psychopathy Influence of early life traumas Prosocial careers of psychopaths Biological components in psychopathy The emotion psychopaths fail to see BDNF (brain-derived neurotrophic factor) Prefrontal area (the parent of the brain that warns us "that is not a good idea") Amygdala Why psychopathy has not been bred out of existence Advice when you are in a relationship with a psychopath What drugs make someone look psychopathic Effect of alcohol andmethamphetamines on the brain Influence of cocaine on the brain Why more men are violent psychopaths And treatment of this group of people (clozapine's influence on glutamate) The Story of Phineas Gage We also wrestle with how to increase the percentage of psychopaths that end up helping society vs percentage that become criminals. Warburton, K and Stahl S (Editors). Violence in Psychiatry. The Neurobiology of Psychopathy. Cambridge University Press 2016), pp. 200-05 CV of Dr. Michael A. Cummings By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Editor: Trent Jones *This podcast is for informational purposes only and is the opinions of the people on this episode. For full disclaimer go here.

This week we discussed cognitive distortions with Adam Borechy. Usually cognitive behavioral therapists deal with cognitive distortions by helping their clients identify habitual negative thoughts and and putting those thoughts on trial. We don't have to accept every thought that passes through our brains as truth. When we have distressing thoughts, it can be helpful to consider if we might be telling ourselves the full truth about a situation. We refer to common cognitive distortions—depression, anxiety, feelings of failure, negative thoughts when interacting with people, social anxiety—and we see how they are applying to our thought process. For a PDF of the cognitive distortions and a 8 days journal task towards better identifying them in your life, please see my resource page. In this 8 day journey you will better identify your own troubling thoughts and move towards gratitude. Here are a list of the cognitive distortions: All or nothing thinking: things are black and white, completely without shades of gray. For example, you may think, "If I am not perfect, I should not try at all, because then I would fail completely." Or you might think, "My significant other is completely evil." And then the next day, "My significant other is perfect." Overgeneralization: generalizations are made without context, experience or evidence. "I am always alone." Or "Everyone hates me." "I never win." Always? Never? Everyone? It happens absolutely all the time, without exceptions? In the moment, it can feel like that, but those statements are actually rarely true. Speaking truth to yourself in this case might look like: I am sometimes alone, several people are upset at me, I win sometimes, even if I didn't this time. Mental Filter: focusing on the negative rather than the whole picture. After receiving multiple positive statements and one negative statement, all you focus on is the negative statement. Disqualifying the positive: When you do something good like get a compliment or award, you instantly find ways to make less of it! For example, if someone says, "You are looking good today," but instantly you assume that person is giving you a false compliment. Jumping to conclusions (without evidence): reaching conclusions (usually negative) without little evidence. ind reading: assuming you know what the person is thinking about you. Connection occurs from accurately knowing another, and with mindreading you blind yourself without evidence. Fortune telling: predicting negative things in the future. For example you think "I am going to fail this test even if I study," so you don't try, don't study, and don't even show up. Magnification or Minimization: you make some weakness of yours much larger than it is or a strength much less than it really is. For example you see your friends as beautiful whereas you see your own beauty as very average. Emotional Reasoning: believe that your feelings reflect reality. For example, "I feel stupid, therefore I am." or "I feel fearful of flying in planes therefore they must be dangerous," or "I feel ugly therefore I am ugly despite what others tell me." Shoulding: a thing that you believe you should or should not do, often created to try to maintain an image of yourself which is more in line with social pressures. For example, "I should be perfect," "I should never cry," "I should always win," "I should be able to do this on the first try." Personalization: blaming oneself for a bad event without looking at external factors that contributed to the bad event. Attributing personal responsibility to things that you have no control over, or when you do not see all the things that caused something. For example, a friend is upset so you think it is something you caused or are responsible for. Error Messages: thoughts that are like obsessive compulsive disorder due to having thoughts that are repetitive, intrusive and not meaningful. By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Co-host: Adam Borecky Editor: Trent Jones *This podcast is for informational purposes only and is the opinions of the people on this episode. For full disclaimer go here.

In this first episode, I talk about my approach to seeing a new patient for the first time. I go over the importance of empathy and psychological safety in the first interview. I then go into how to do some of the components of a psychiatric history. I go into details on what parts are important and why. Please see my resource page for a full PDF of my notes and also the PDF of the document I give to patients prior to their first appointment with me. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David and post your comments for this episode on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Editor: Arvy Wuysang *This podcast is for informational purposes only and is the opinions of the people on this episode. For full disclaimer go here.