Dr. Jessica Eastman, a naturopathic doctor and psychedelic-assisted therapist, shares her integrative approach to trauma recovery and mental health. She emphasizes the significance of preparation and integration in psychedelic therapy, highlighting that healing occurs during the integration of insights gained.
Dr. Eastman discusses the need for emotional readiness and a curious mindset, addressing the risks of poorly guided experiences. Advocating for a holistic, patient-centered approach, she stresses the importance of foundational health and patient autonomy. She also announces her upcoming online trauma recovery program and offers resources for ongoing support and education.
Chapters
Introduction to Psychedelics and Mental Health
Niche of Trauma Recovery Coaching
Exploring Safe Psychedelic Practices
The Importance of Preparation
Understanding Psychedelic Experiences
The Power of Perspective Shifts
Emotions and Connection
The Healing Process
Risks of Untrained Guidance
Managing Post-Psychedelic Dysregulation
The Complexity of Memory and Trauma
Navigating Expectations in Therapy
Organizing the Mental Closet
Gaining Control Over Emotions
Foundations of Healing
Integration of Psychedelic Experiences
Balancing Medication and Self-Care
Building a Therapeutic Relationship
The Role of Nutrition in Mental Health
Empowering Patient Agency
The Dynamics of Patient-Provider Relationships
Understanding Resistance in Healing
The Importance of Curiosity
Medication Misconceptions
The Art of Prescribing
The Role of SSRIs in Treatment
The Process of Learning
Alternatives to Medication
The Evolution of Medical Practice
Humility in Healthcare
Accessibility in Mental Health Services
Transcript
[0:01] All right welcome dr jessica eastman a fellow ccnm colleague and so we recently connected over um yeah well i guess like topics around psychedelics and mental health and uh some cult psychology and spiritual bypassing and um but i think what we want to talk about today is like mental health and maybe some psychedelics and trauma and because that’s a big part of what you do and what your practice is in BC.
[0:34] And yeah, maybe you could introduce yourself and tell me a little and tell the audience a little bit about your practice. Yeah, for sure. Yeah. So I am a naturopathic doctor licensed in British Columbia. I’ve been practicing there for almost 10 years.
[0:49] And I also am a psychedelic assisted therapist and as I call it, a trauma recovery coach. Um, so I kind of mashed together, uh, integrative psychiatry and, um, integrative mental health work with trauma-informed primary care and, uh, some psychedelic, um, assisted therapy, like prep and integration work. I don’t do the actual medicine sessions because it’s not in my scope of practice, um, but. I could do that if I was like working
[1:19] under another like field trip or a numinous or something like that. But I get a ton of value in doing like harm reduction discussion and prep and integration. And I have a little niche of people who come to see me when they’ve gone to do psychedelic assisted therapy, usually with an underground therapist who wasn’t super well trained and they had a bad experience.
[1:38] And then they are looking for somebody to like help them sort that out. Also because a lot of psychiatrists and psychotherapists and psychologists and medical doctors don’t have a whole lot of training or understanding about psychedelics and so these people sometimes come to me they’re like in inpatient psych and their psychiatrist is saying like you’ve broken your brain and there’s nothing we can do to help you and then they call me kind of like as a last-ditch effort to be like hey is my brain really broken and I get to say like no it isn’t actually we can heal this and we can work through this so that’s a really fun little niche that um is is developing there’s like more and more need for that um and then i do some trauma recovery coaching specifically both in my practice and separately um so i get to kind of weave a whole lot of mental stuff together that’s really cool that’s really really really interesting i know bc has a more expanded scope than ontario when it comes to um like i think i Dr.
[2:37] Ray St. Arnall about ketamine therapy and like that’s in scope or like legal for therapeutic use. But yeah, how did you get into the and what maybe you can describe some really interested kind of like what the prep would be like in a in a responsibly administered sort of psychedelic session, like what kind of prep is usually involved and what’s the integration like afterwards if someone’s really going about it in like a.
[3:04] Yeah, totally. Yeah, safe way. Yeah, so the prep work is actually done from, you know, anywhere from one to multiple, like three or four, you know, up to like six months worth of sessions before you do the actual medicine sessions.
[3:25] And what’s involved in prep work is really variable from person to person. The kind of universal things that are involved in prep work is having a discussion with the client or the patient about what they are expecting. And a big part of the prep work is helping them to get clear on what their goals are and helping to work away from a bunch of expectations and toward like intentions and an opening to the possibility of whatever the medicine is going to take you into. Um as a lot of people go into these sessions understandably like hoping that they’re gonna you know be a cure-all because they’ve been struggling with you know depression or PTSD or OCD or whatever it is for a long time and um, psychedelic medicine is a unpredictable in certain ways and so it doesn’t it’s not linear in the way that like when you give this dose of a of an ssri we generally have this response and when we increase the dose we have an increased response and so psychedelics are a more unpredictable, world they kind of um work often by teaching you how to surrender and and exposing you to, feelings and or stuff that you want to work through or that you maybe need to work through.
[4:47] But going in the most likely things that are going to create a bad time or a bad trip is if you go in with a whole bunch of expectations or you go in with the expectation that you’re going to be able to control the experience. And so like a classic example is like people who come And they say, OK, I want to go into this session to heal my relationship with my father. And that sets you up for a challenging session, potentially, because there’s a whole bunch of expectations built into that concept. And so what we often work that into is something more open ended is like I my intention for this session is to be curious and to understand more about my relationship with my father because we don’t put expectations on like healing or outcome necessarily because a the medicine doesn’t do that for you. It illuminates things and helps you to do that work on your own and be surrendering or being able to like relinquish control to the experience is a big part of how the medicine works and how it helps you to allow for neuroplastic change and perspective updating.
[6:01] So, yeah, that’s a big part of kind of like universal prep work with anybody who’s doing it well. And then there are some other things that some people need more support in than others. Like some of the things that I personally would, you know, like more or less require would say like this is a prerequisite to being able to do this work is… Decent amount of experience and tools in being able to manage uncomfortable emotion and knowing that you understand like how to know where your edge is in terms of like I can handle this and this is where my overwhelmed edge is and when I need to ask for help and then also having the skill set of being able to ask for help when you need it because like I said sometimes these sessions are unpredictable and sometimes they’re very chill and gentle and like lovely and warm and you you know feel love for the whole time and other times they like you know open doors to old emotions
[6:51] or memories or stuff that like can be a flood of discomfort. And it’s important that people are not going to be super dysregulated after and not then know how to handle that or get the support that they need.
[7:06] So that’s a component of it. And so, you know, if people come with years of psychotherapy experience, then they’re probably full up on all of those tools. And if they’ve never done any of that work before, then we do some of that work first. Yeah, that’s really useful. It’s like, what are your intentions that are kind of reasonable? And then, yeah, maybe looking at, because one of the things it does, it kind of drops defenses. And sometimes those defenses are there for very important reasons that once they’re gone, you know, what do you, you know, how might you respond or, you know, how might you find stability?
[7:50] Yeah. Like, you know, if there’s some things that have been compartmentalized for good reason and now they’re blasting open or you’re in touch with them or, you know. Yeah. Yeah, exactly. Exactly. And I think that’s probably the most misunderstood part of psychedelic-assisted therapy and all that kind of work is that people think that the medicine is the thing that heals them or is that the thing that fixes their brain, so to speak. And it’s actually like it reveals a bunch of stuff to you and it puts your brain into a particularly like flexible and malleable state where you have the potential to have neuroplastic change and build new neural
[8:34] connections in the like, you know, a few days and weeks right after your session. So you are more changeable in that period, but the change comes from you and the work that you do a little bit during the session, but in large part after in the integration work where you’re being exposed to or choosing to expose yourself to the feelings that it illuminated and the memories and the awarenesses and the connections and then how you process and integrate all of that into the rest of your life. That’s where the change and the growth and the healing really happens. Yeah, in that integration period of like, kind of, yeah, it’s like this, like this kind of like ego dissolution. It’s like your ego dissolves and you’re this raw kind of.
[9:20] Bare soul but that’s not how we operate through the world like we we need to kind of reconstruct the ego the persona to like be able to work your job and be in relationship and parent your kids and like all that stuff right like you can’t just be connected to the trees um or like in a dissociated state so it’s like how do we kind of repair and and like carve new pathways around well traumas or metabolize and reintegrate the traumas that may have been yeah yeah exposed yeah yeah exactly what do you find like when people are so i know you’re not administering the medicine but like what is because a few patients have asked me like especially with treatment resistant depression that’s often like a category where these medicines are really like looked at and studied um a lot of people who have had kind of lifelong depression lots of treatment not really a lot of resolution uh maybe some trauma they’re like maybe i should do an ayahuasca retreat or what do you know about you know psilocybin assisted psychotherapy and like what do you find when someone’s been in years and years of psychotherapy and maybe they’ve got some they’ve built some skills they’ve learned some things about themselves but what what are you seeing with people when they do psychedelic assisted therapy like is it like what kind of changes or what, you know.
[10:42] What’s that like? Because it is framed like a miracle a lot of the time. Yeah, totally. And sometimes it is. Like, sometimes people’s experiences of that are like, this is actually a miracle. And so it does, like, that rhetoric exists for a reason.
[10:55] It’s just, it doesn’t happen every single time. It doesn’t happen in every patient. It’s also really about where you are at in your journey and, like, if the medicine was chosen correctly in alignment with where you’re at. And so, yeah, there’s a lot of parts. But excuse me, I think that.
[11:13] So, a big thing that often people take away from psychedelic experiences is new perspectives, looking at the same things they’ve been talking about or working through or feeling for, you know, months, years, decades, but they get to look at them from a new lens.
[11:34] So it allows you to see things from different angles that also often allows you to develop or unlock compassion for yourself in the past or for the other people in the story in a way that allows you to, as you said, like metabolize the trauma a little bit.
[11:50] Feel, process, and release is the language that I use a lot of the time. Um and as you said earlier it it really also as some medicines more than others but there’s a lot of like dialing down of the amygdala activity during while you’re under the influence of the medicine this is especially true for mdma um but true in you know ketamine psilocybin etc and the amygdala is responsible for our fear response and therefore our protection responses and that is the thing that is often preventing us from being able to really look at and feel the emotions or feel the memory or whatever um and that is there for a reason as you said but also when we dial down how intense the amygdala is active uh is activated in that moment sometimes we can often we can have the memory or feel the feelings without the associated fear and intensity of like a need to protect and so you’re able to just feel.
[12:50] It as opposed to it being buffered by your nervous system saying like it’s too dangerous for you to feel this and so there’s often container too of safety so it’s like yeah it’s appropriate to have that like reduced defense like yeah yeah yeah for sure if if the psychedelic assisted therapy is done well and you’ve got a safe container with a therapist that you trust and it’s yeah so uh it often so it gives people often new perspectives it also gives them an opportunity to have a big release of feelings like i’ve heard many people talk about how this is my experience also like it helped you it helped me and and many others to feel the feelings separate from the story that your brain is telling it for the first time ever just like a thing we work so hard at in psychotherapy to try and like allow for and validate and make space for the feeling without your brain pulling you into like but that shouldn’t have happened or I shouldn’t have done that or if it was different and so to be able to just feel the raw feeling and feel the sad or the anger or the fear, maybe not even connected to a story, but that has been kind of stored in your body. And to be able to release that…
[13:58] And being able to experience that and then know that your brain is capable of
[14:02] that often translates into you being able to retain that ability in your sober life. And then kind of on that same track, another common experience is like being able to feel love or feel cared for or feel cared for others or feel connected to others in a way that people haven’t been. And because that protection that keeps you, you know, from not being drowned by your feelings also prevents you from being able to connect with other people fully, connects you from being or prevents you from being able to feel the love and the vulnerability and all that stuff. And so letting down those defenses also lets that in. And that can be a really powerful experience for people to be like, oh, I am capable of feeling love. This is what it feels like. Now I want to look for that in my regular life. Now I want to strive for that or create a safer container in my regular life so that I can feel that more regularly. Yeah, that’s cool. Yeah, that’s a great way of saying it. Like this, like you feel you release the emotion separate from the story. It’s just the raw experience of the emotion without the like fear of experiencing it, you know. Like, yeah, it’s kind of like this grief dumping that you get.
[15:11] Yes. you clean out your house and you put it all in in donation bins and you’re just yeah you know.
[15:17] Yes yeah yeah exactly yeah that’s beautiful yeah I know too like research has shown it increases like the personality metric of openness to experience like permanently yeah kind of this yeah which is kind of connected to like intelligence creativity but also connection like there’s less inhibition and and store you’re less trapped in the story and those like well-worn paths yep you know yeah which then very linearly um connects to an increase in empathy which then allows you to have more compassion for yourself for others to be able to connect more to people that like understand other people’s struggles you’re like less, intolerant this is that’s the um the facet of psychedelics that people reference when they say like if you know if like all the world leaders took psychedelics the world would be a way happier place because it like helps you to see things from other people’s perspectives and helps you to remember or realize maybe for the first time that we’re all just humans out here like struggling and doing our best and having feelings and loved and being hurt and all of that and like we’re all if we if you can.
[16:29] Remember or remain connected into the fact that like there’s more similarities than there are differences then suddenly a lot of the like world problems feel silly oh we’re all just out here hurting and loving and trying to take care of ourselves and each other yeah like that raw human emotion like when you feel it you recognize it in others and maybe our stories like there’s an infinite amount of stories so maybe that keeps us separate yeah it’s like well i’m different from you because of this particular detail even though maybe it’s kind of the same, which kind of keeps us siloed but if we when you really understand sadness or happiness or joy in your body and you.
[17:10] Can recognize it in others like oh this is just yeah that’s one of the elements of self-compassion is the common humanity idea of like this is just this is something that all humans feel no matter how rich or privileged you know we have these emotions that run through us yeah yeah and that’s like that’s a big part of what is not talked about in our regular society because it’s not productive or it’s not encouraged or it’s like weak or whatever but it’s it’s a big part of it and i think that that contributes to us all feeling like we are alone in these experiences if we all felt more capable more comfortable more confident more safe to be able to say like oh i’m a person and i’m having these feelings then we would all probably feel less alone in that experience yeah and if you say that to somebody who is comfortable or can provide a container for their own feelings they can provide a container for yours like a lot of the time empathy like moments of empathy can be missed when somebody like doesn’t really want to feel it because empathy is ultimately kind of feeling or letting in another’s experience so if I don’t really want to feel that because I’m uncomfortable with it I may invalidate you or dismiss you or you know yes and yeah create like a chasm between us which isn’t helpful yeah yeah totally yeah what happens when okay so now like the negative like what when you when you see people who are worried that their brain is broken or maybe.
[18:39] They had kind of an irresponsible journey or somebody that wasn’t trained like.
[18:43] What kind of things like what are the risks that you’ve seen.
[18:47] Yeah, so there’s a few different facets there. The biggest risk, I think, is the emotional-mental dysregulation piece, and that’s often what the, like, my brain is broken piece is, right?
[19:02] And that, I think, comes from a combination of things that in the patients that I’ve worked with that have been through that experience, it’s often that they were not in a safe or regulated or grounded or nourished state to begin the treatment. And so like the patients that I’m thinking of were like, they had been burnt out for decades and they were like, you know, had recently gotten over like really significant illness and were feeling fairly dysregulated in their day to day. And then a poorly trained or untrained therapist, in quotations, says like, oh, yeah, well, this will solve all your problems. And so they encourage the patient to come in before they’re ready, before they’re like physiologically ready, before they’re mentally ready, and then also sets them up with a whole bunch of unrealistic expectations. Sessions and that then puts their nervous systems and their physical bodies in a position to be very depleted, to be very dysregulated.
[20:07] Like these experiences are taxing. I think that’s a thing to recall. And especially the longer sessions, like ketamine is a shorter session. It usually is like two hours in entirety, but it’s a draining experience for your body.
[20:21] Psilocybin is like six hours ayahuasca is like eight or ten or twelve depending on where you’re doing it and how long you’re doing it for and so these are not it’s like you’re like, running a marathon that whole time. And so if you think about, is this patient fit and ready and has the capacity to like go and do a really hard, laborious task for 12 straight hours, that kind of gives you some idea of like, is the foundation laid for this to go well or not? And then I think the other big mental emotional risk is that, like we’ve talked about already, often psychedelics can open doors to big feelings or big memories or like realizations about traumatic pasts that you’ve had like traumatic experiences that you’ve had in your past and I think that there’s a handful of well-intentioned underground therapists who haven’t been properly trained in trauma or in what happens when people get really dysregulated or their sense of identity gets really disconnected or threatened.
[21:31] And then those people have the really scary experience of being hit with all of this awareness that they didn’t know about, like memories of stuff that happened or connections about like, oh, I’ve been avoiding thinking about this because it was too scary and now I’m being faced with thinking about it.
[21:51] Paired with a therapist who doesn’t know how to meet them there and hold space for them or how to carry that back into their regular life.
[21:58] So then they feel this compounding like, I’m really overwhelmed. I don’t know how to handle this. And I’m alone in that experience. And then the nervous system understandably responds with like big fear responses in those moments. So then you are flooded with all of the hormones that try to keep you safe. And you’re just like on a crazy high alert and you end up in a like perpetual state of hypervigilance. Um so that that’s like a common outcome you know you’re not sleeping and then that’s all compounded that you’re not sleeping you’re not eating your hormones are dysregulated and then everything just kind of snowballs um and i think so that’s like um yeah i’ve worked with a handful of people who’ve been in that position it just takes time for us to help them return to and like rebuild safety in their body and then also understand the patterns that they were living in before they did the session that maybe perpetuate or contributed to this that they didn’t even realize. And so it’s like a process of healing from the experience itself, but then also like rebuilding new patterns because we don’t necessarily even want to go back to what they were like before we want a healthier version of that.
[23:08] And I think I would be remiss to not mention also like some of these, some people have more risks than others for these things to trigger like other things. Psychological disorders. And so certainly a properly trained psychedelic assisted therapy program is going to really assess like your medical history, your psychological history, your family medical history. Not all of these things are safe to take depending on the medications you’re taking. And so there’s definitely some risks there.
[23:38] And then there are some physical capacity risks like you have to have controlled blood pressure. You could be on medication or you have regular blood pressure, but if you have uncontrolled hypertension, all of these medications temporarily increase your blood pressure like they would if you were doing strenuous exercise and so that needs to be a thing that we are cautious of so there’s some like purely medical side um precautions that need to be taken as well to make sure we’re not hurting you in any way or interacting with medications you’re on or putting you at risk for you know bipolar mania or anything like that yeah that makes sense yeah it’s like an underlying predisposition or like you know risk factors or family histories even um and then yeah this kind of like physical stability and how you know what are the structures that are in place in your life like yes it’s like you know all of a sudden you’re you discover like my job is intolerable my life is intolerable my relationship but I have nowhere now to go no safe place to land like how do I cope with my daily life as I figure out how to transition or like all of these things you know yes exactly yeah yeah and then you mentioned too yeah I know we talked about kind of like, maybe traumatic experiences that people don’t really remember and sometimes people have the experience of like.
[25:04] I know with some ayahuasca stories, I’ve heard people have talked about, like, I was kind of in my childhood watching it like a movie.
[25:12] That could be amazingly therapeutic, but, and we’ll probably talk about this when we talk about trauma, but not, it’s not always that. There’s a time and a place to kind of revisit memories, you know, and maybe don’t want to revisit memories at all. And so there’s a lot. Yeah, there’s a lot there for.
[25:33] Yeah and that’s a good example like I would say like if a person came to me and they said okay I want to do psychedelic assisted therapy but I want to make sure I don’t revisit any memories from this one time in my childhood I would say like okay you’re not ready yet like this is maybe not the right tool for you at least right now because we can’t control what happens in that experience just like we can’t control what happens in life and so a lot of the the work is like making sure like you said you’ve got support systems and mechanisms in place to help you manage whatever comes up yeah it’s like okay like yeah we don’t know what will happen but we can’t necessarily yeah like you said have an expectation of what will happen but also have kind of a boundary of what i don’t want to experience it doesn’t exactly work like that yeah and and And there’s like, there’s a lot of variability with dosing and with medicine. And so it’s, I know people talk about ego dissolution and psychedelics a lot. And that, you have to like work hard to get to the ego dissolution place. And so I would say most psychedelic experiences don’t involve like true ego dissolution. And so you do retain some, you like, you know who you are, you know where you are, You have some connection to like, you know.
[26:54] And everybody’s got a different experience and the medicines are all different, but there are definitely a lot of opportunities in there for you to be like, I’m not sure I want to go there. And so you do have some influence, but we can’t guarantee it.
[27:05] And also there is some…
[27:08] It’s worth discussing, like, the things that you explicitly don’t want to look at are, you know, it’s like, don’t think about white elephants. Like, that’s where your brain is going to take you a lot of the time, probably for good reason, because there’s stuff there that’s worth looking at and then metabolizing and moving through.
[27:25] Yeah, if you’re consciously, like, suppressing. Yes. Like, a closet overflowing, but, like, I know it’s there. I know I got to deal with that. Yeah. That’s exactly the analogy that I use. Yeah. It’s almost like, though, I think the gravitation towards psychedelics is kind of like the person’s like, okay, I kind of do want to open that closet. Like, I’m ready. I’m scared, but I’m ready. You know, otherwise I, you know, probably don’t want to take ayahuasca, you know? Yes. Agreed. Yeah. And most people, very rarely does somebody come to me and say like, I want to do this, but I don’t want to look at any of this stuff. Yeah, it’s very much like, okay, I don’t know how to look at that stuff, but I know that there’s probably something in there for me. And so I’m ready to explore whatever that is. Hire like a closet organizer.
[28:17] Yeah, exactly. You still watch. No, no, don’t throw that away. Okay, actually, fine. you can yeah and that’s that’s the that’s the analogy for trauma recovery that i use all the time is like hey you’ve got a closet in your basement that you’ve been shoving stuff into, no judgment but like that’s your that’s been your coping mechanism you’re like i can’t deal with this right now it’s going in the closet you know and that’s been happening for you know five ten twenty thirty years and now you the closet is so full that you have to spend all day leaning on the closet to keep the door closed and so you’re living your life with like one hand and maybe one leg so because you’re just like using a lot of your energy to keep the door closed and so the the process is like okay we open the door we let six things tumble out we close it again and then you and I together work through and learn how to deal with the six things that tumbled out you know and for each one you’re like Marie Kondo-ing your brain sort of you’re like picking each thing up and holding it to the light and saying like, okay, is this mine? Do I want to keep it?
[29:21] If not, do I want to get rid of it? Do I want to give it back to the person that it came from? Do I want to burn it? And then also you have the question of, well, is there a hole that is left behind by that belief or that paradigm? And what do I want to replace it with? And just like go through that process slowly over time until one day you can open that closet and look in and walk in and like it’s all organized and there’s a bin and every now and then you’re like, okay, I’m going to take down this childhood relationship with my father bin and like figure out what’s in there, you know, but it’s it’s, more organized, you have more say over when it happens and how it happens.
[29:57] And that’s where people start to gain the experience of being in control of
[30:03] their emotions and of their life. It’s like it doesn’t make the past go away, but it teaches us how to work with it in a way that feels like we get to be in charge. Yeah, that’s an amazing analogy, actually, because, you know, like I can picture the person kind of like one arm and a leg leaning on the closet, And then the other arm is your job and your kids and your daily life. Why am I so exhausted? Why am I sober? Why am I so overwhelmed? Exactly. And then when you sit down with someone like you, like a therapist, a naturopath, and you’re like, okay, now with my free hand, though, I’m going to sort the six pieces that we let out. So now, so this kind of describes the type of context to enter into trauma work with, where it’s like, can you use that hand or are you using it to like keep things afloat in your life, right? Like, can you take, is there a container that you can, yeah, you have, you know, therapists and support to help, but your free limbs are kind of engaged now in like doing this work. But eventually, you don’t have to be pressing on the closet because stuff kind of stays in there so you can walk away and now you have your full capacity to, you know, enjoy and engage with your life. But in the meantime, yeah, there is kind of this.
[31:21] Like not checking out from life but like you’re you’re there’s time and energy that needs to be kind of uh allotted to tend to it yep yeah you’re not able to be fully present in your life because you’re spending a decent chunk of your energy either keeping that door closed or dealing with the mess that happens every time you step away from the door oh yeah it is a thing that i say often in the early days of trauma recovery work is like this is unfortunately and through no fault of your own your next full-time job you know and now you have to figure out how to balance your actual full-time job and your responsibilities as a parent or a partner or of whatever and also doing this work and that determines the pace of recovery a lot of the time because we can’t always do all of that and so that’s where a support person or multiple support people therapist coach naturopathic doctor come in that’s also where medication and supplements and optimal diet and nutrition come in to help like give you the most capacity that you have potential
[32:27] for in that moment so that you can put more effort into that.
[32:30] If you want to but this is also why i don’t have any judgment or anything but like respect and compassion for people that don’t want to do this work because it’s really hard sometimes and it takes energy and capacity and not everybody like it’s a privilege to be able to do this work if you are drowning in like you know food insecurity or paying your bills or keeping a roof over your head or being a single parent that might not be the right chapter in your life for you to be able to do this because more important stuff is taking your attention and your effort and your capacity. Yeah. Like if that free hand is like keeping you alive, essentially. Yes. Yeah. Then yeah, you need it. It’s not the appropriate time right now. And it’s interesting because as we’re talking, like I think of many psychotherapy clients often don’t.
[33:24] With who are kind of neurodivergent and they’re like they come in they’re like I’m burnt out and I’m just.
[33:30] Kind of in this um treadmill with work like.
[33:33] I’m I’m behind I’m overwhelmed you know and so when we do kind of just like almost like solution focused stuff and we help like build skills and manage the day-to-day overwhelm you know systems stuff like that that’s often when now we go down and it’s like okay actually no it’s my father it’s my mother it’s my you know traumatic past or it’s uh my core beliefs there’s like it goes deeper it’s like once we’ve kind of addressed that initial layer that was sucking all the energy now there’s room to address.
[34:10] The contents of the closet um yeah but yeah when you’re managing things with one hand again like it’s a great analogy because it there’s a lot of compassion it’s like well no wonder you’re overwhelmed and it’s so hard for you to like have your inbox like at zero and not be kind of flooded all the time and like not have not be behind in all these deadlines because you only have one hand to manage everything yeah yeah exactly and then what’s the integration like so after someone’s doing psychedelic therapy like you know how many sessions is it usually i know that can obviously vary but super variable yeah so in the literature like in the research that we have currently usually it’s and you have an integration session that day or the next day right after the medicine session and then one or two weeks later and then kind of ongoing with your own therapist.
[35:04] Um and so there’s a there’s a various various things that happen in an integration session like and it also it depends a lot on how new you were to the experience like in early days for people have never done psychedelics before often a lot of the integration is just talking with somebody and sharing your experience to be like well that was a crazy experience like I’ve never had an experience like that before um the the to be able to like be validated and seen with somebody that also has been there and understands what it feels like to be in that um The terminology that we use in the literature and in the academic world is a non-ordinary state of consciousness, NOSC, which can be also accessed via breathwork and some forms of meditation and that kind of stuff. But it is an altered state and it is a wild experience. And so it’s difficult to talk about if you haven’t experienced it before.
[36:00] So that’s often a little bit of what happens. And then there is sharing about the revelations or the awareness that you have, you know, come to realize or come to experience. Or sometimes you take the medicine and like nothing really happens. And then you are like, at least in your perception.
[36:19] And so then you are processing and metabolizing the feelings of like frustration and disappointment and curiosity and like did something in my brain change but even though I didn’t feel the medicine and all of those things people that have been doing this work for a while talk about how like the integration session is like six to twelve months long so it’s it’s kind of like laughable to say like oh yeah it’s one to three sessions because what actually happens in the integration happens over time as you you know you’ve adopted a new perspective about yourself or the world or belief or whatever and now you have to go through slowly the experience of living your life through this new lens and be like oh wait well how does this change the way I handle conflict with my partner how does this change the way I handle uh feeling underappreciated in my job how does this handle you know like and and it’s it’s that same kind of like Marie Kondo effect of like well I I have to pick up every piece of my life and figure out, well, how does this change that? And that takes time.
[37:22] And the cool thing about all of the work that I do is like it doesn’t require you don’t have to sit down and do that consciously. Like you don’t have to journal about every single part of your life in this new belief system. A lot of it happens in the background, like in the default mode network controlled stuff that just is like happening as you’re living your life. Yeah. As long as you’re committed to curiosity and like paying attention to what is changing and noticing what’s happening in your body and in your mind, you’ll be able to see the changes that happen over time.
[37:53] That’s really cool. Yeah. Yeah. Like it’s, it takes a while to like kind of encounter the moments that you’re maybe watching for or like, you know, okay, the next conflict with my partner, what changed and to kind of be aware of how these changes happen. Yeah, like it’s and like making meaning of the experience can take time to write like what does it mean? How does that weave into my narrative? Yeah yeah exactly yeah yeah and like maybe you have a you know a perspective of like oh i um i am worthy of love you know or i am deserving of being cared for and so then you have this new belief but now you have to go through each part of your life to be like well how would that change all of the ways in which i interact with this life and how can i ask for more and so then you have like okay well you have a sit-down conversation with your partner and be like Actually, these are the things that I would like to be receiving from you in order to feel more cared for. And then you go through that many-step process with your partner to update the systems and the ways you’re caring for each other. It’s a big ripple effect, and it takes time. I think I’ve told this story before, but I remember my own experience where after an experience with a medicine, I was walking in the forest, actually, and I passed somebody. And I saw this kind of like.
[39:18] Judgmental or kind of contemptuous expression on the person’s face. And I remember distinctly feeling like, oh, they made an expression on their face. And it was this first time, like really embodying this feeling of, oh, people’s crap doesn’t always have to do with me, you know, or my, but how does that then, how do I act that out in my life now? Like, how do I bring that awareness to, you know, I mean, that’s a clear interaction. I don’t know that person they’re just walking by what did I do like there’s you know so cognitively I know that it doesn’t have anything to do with me even if that little schema is running yeah but when somebody is unhappy with me or I am in a conflict with someone how can I bring that into the you know how do I how do I work with that or what replaces that schema or you know how does it become modified because sometimes it is about me sometimes I did screw up you know so yeah yeah so What’s the more balanced thought, I guess, in CBT language? And so that can take a lot of time. Yeah, for sure.
[40:23] It is a process. And I think that it is a gift to be able to give yourself time to process all of that.
[40:31] And it’s a recognition of that the medicine isn’t doing the work, you are doing the work. The medicine just kind of like showed you a door that you didn’t know existed. You get to choose if you want to continue to keep that door open or walk through that door in your your waking regular life it’s so cool yeah it’s a really fascinating, area like I’ve always been kind of interested in it because of the.
[40:58] The kind of pivotal way that it can really like accelerate like it’s, It’s very hard to, like, build those different neural pathways when you’re stuck in this same groove and you just, you know, like, you know, often there’s a lot of intellectualizing and a lot of like the cognitive changes that can be really, really sticky. But there’s something about embodying the feelings and just seeing that as a truth that kind of hits you that can be really powerful. Yeah. Yeah. For sure. Like you said, seeing another possibility or another perspective and really seeing it, not just like, oh, yeah, I can use my imagination and kind of see how, yeah, like I know it on a level that’s deeper than just, like, I wish I knew this. I wish I believed this, but I don’t know. It’s hard for me, you know? Totally. And for that reason, the primary modalities that are used in psychedelic therapy and psychedelic integration are generally somatic work and like internal family systems parts work and like mindfulness and where those three all overlap, which is like polyvagal theory and all of that stuff.
[42:09] Because it’s not really about the cognitive understanding. It’s about the somatic felt sense of like, oh, I know that I’m deserving of being respected or cared for, but I feel it now. And being able to feel that is the thing that’s going to enable you to like enact a boundary, you know, or ask for more or decide that you want to make a different choice. It’s not the cognitive knowing that drives behavior a lot of the time.
[42:35] Much as we want it to. Yeah. And I think that’s a good approach to trauma work, too, for most people. I know that CBT-informed trauma therapy is the gold standard because it’s easy to study it. Yeah, exactly. but mostly when you talk to people they’re like uh you know the real movement that i experienced was ifs internal system somatic therapy where i really like you know emdr like where i really was able to kind of locate these parts in my body and metabolize them because a lot of it’s not verbal and not cognitive and not a conscious decision you know yeah exactly and also the like analytical conscious brain often gets in the way and so there’s that’s like a thing i’ve seen in cbt many times both as a patient and um like when i was the patient i mean and in in my patients now who’ve come to me from cbt is like the talking about the trauma or about the patterns or about the belief systems like reinforce them or keep you stuck in those patterns and.
[43:42] There’s like no way to talk your way into something you’ve never felt before. You have to experience your way into something you’ve never felt before. And that’s just not a framework that CBT holds. So it’s a useful set of tools. And I don’t think it is an all-encompassing trauma treatment because it doesn’t really get anything like below the head, so to speak.
[44:06] Yeah, that’s a good way of describing it. Like you know write out your beliefs why do you believe this is there another way of thinking about this that’s a good skill sometimes it’s the first layer like to introduce therapy like oh wow my thoughts like awareness of self-talk is really useful challenging self-talk but yeah it’s a lot of um people who’ve experienced trauma are caught up in ruminate ruminative cycles you know so it’s like all in the head um yeah i guess that brings us to like how can an nd support someone who’s experienced trauma because yeah yeah so there’s a few layers to that the place where i always start is an assessment and a shoring up or a stabilization of the foundations of health so like what what nds are you know functionally good at across the board because Like, are you sleeping? Are you eating enough of the right nutrients at the right times? Is your blood sugar regulated? Are your stress levels even remotely manageable, sustainable?
[45:14] Do you have the ability to move your body? Do you have a support system? Those are the like five foundations of health from my perspective and also they are like the you know the bottom of your maslow’s hierarchy in terms of health like we can’t do higher order healing whether it’s like regulating your reproductive hormones or healing your trauma if you’re not sleeping or eating enough or if your blood sugar is super dysregulated or if you can’t leave your house or can’t move your body in any way um.
[45:45] And it’s a common thing that also comes up with medication because psych meds are notorious for being mediocre in their efficacy. And I think a decent amount of that is because they’re not going to do very
[46:00] much if you’re not sleeping and eating. And that’s such a brutal catch-22 because mental health stuff, especially when you are in the throes of PTSD or complex PTSD, make it really hard for you to sleep and eat. And then people are like, take these drugs, and the drugs aren’t working, or you’re doing your CBT, and you just feel worse and worse because you’re taking the meds and you’re going to therapy, but you still don’t feel good. Yeah. Or you feel like your functioning is even decreasing even further. And so I always start with sleep and nutrition, and that’s different for every person. Sometimes it’s like we run labs and we make sure you’ve got adequate vitamin D and iron and B12s, common deficiencies that are going to contribute to mental health and your ability to be regulated in any regard. Sometimes it looks like, you know, sleep hygiene and sometimes it looks like medication to help you sleep better. Because if you are so, so sleep deprived and your sleep is so interrupted, we’re not going to be able to do any of the trauma work. You’re not going to be able, you have no chance at regulating if you’re getting three hours of interrupted sleep at night. So we start at the bottom, and we work there.
[47:10] Sometimes that’s, there’s like a lot of education involved there because often people come to me and then they are like, okay, I’m drowning in trauma or I’m stuck in complex PTSD. Like, how do I get out of this? And I’m like talking about sleeping and what you’re eating for breakfast. And it’s important for me as the practitioner to make sure that they understand why that stuff is important and how it’s going to help them to feel better.
[47:33] And I love starting there for, in addition to that, like it is the prerequisite to everything else we want to do. I love starting there for two reasons. One is that so often when we start there, a lot of the symptoms that people are struggling with correct themselves on their own because the body has the innate capacity to heal when we give it the building blocks that it needs and we remove the obstacles in the way. And so I think it’s a very useful way for us to get out of the trap of like a supplement for every symptom or a drug for every symptom. It’s like, well, when you sleep and eat and give the body its basic building blocks, you know, half your symptoms are going to get better. And then the other half, okay, those are what we build a treatment plan for. And the other thing that I think is really important about that step of the trauma recovery work is that most people who have been drowning in trauma and struggling for long enough to come and see me have lost a lot of faith in their body and a lot of trust. And a lot of trust is broken between their body and their ability to interpret what their body needs. And I think rebuilding that trust or maybe building it for the first time that like your body is sending you messages and you can learn to interpret them in a way that allows you to take care of yourself and get to a place of happy, healthy well-being.
[48:53] That’s a really important part of, important part of healing and of trauma recovery. And so if we help people to see, like, I don’t give supplements or medications in a lot of cases on visit one, because people are so quick to attribute improvement to those things. But if all we did was we helped you to eat breakfast and go to sleep a little bit earlier, and then you feel, you know, a 50% reduction in your anxiety, which I hear all the time. Yeah people are like oh damn like okay this is real and when I take care of my body it actually does feel better and you start to like build your we get to start to build a blueprint for people of like what are their baseline needs this is the thing that you want to do every day for the rest of your life to take care of yourself so we’re empowering them it’s the you know teach a person to fish thing like I want them to not need me anymore and this is part of how we do that to be able to help them to understand, okay, what does my sleep and my diet and my supplements and my social support and my movement need to look like in order to set me up to be able to do that stuff? And how do we make that sustainable for people? I love that. That’s where we start. Yeah. Yeah. It’s like, yeah. I know we said before we recorded, I’m like, let’s talk about mental health and what NDs do because it is my focus. But you lose yourself in the weeds as you’re talking about the specifics and the extra things and the cool new therapies or the angles.
[50:21] And what is really beautiful about natural health medicine this is like the topic of a new sub stack i’m working on but like the but we’re really the biopsychosocial yeah you know um that model like you know because, And a lot of people will kind of get that biopsychosocial from various practitioners, but an ND is really true. Like, that’s what holistic means, ultimately.
[50:48] And, yeah, like, so many, like, in my psychotherapy practice, a lot of people who, like, there’s probably a blood sugar dysregulation here. And all the talk therapy in the world or somatic work is not going to fix that, you know? It might help you understand you need to eat. Yeah, yeah, yeah. Yeah. But a lot of the time with that, like being tired and needing to regulate your blood sugar, like you were saying, there’s sometimes a disconnect in that biofeedback of really even understanding what those signals mean or what those cues mean. Especially if that hasn’t been built in when you were a baby like the inner child kind of needs that safety and that reconnection with like talking about like ifs like the different parts and how do we take care of ourselves recognize what it feels like to be tired it’s time to go to bed even if you might also be kind of wired or um procrastinating when it comes to sleep like revenge bedtime procrastination or yeah you know you’re so um hungry that you don’t really feel hungry anymore. You just feel anxious and almost nauseous. You don’t really think that food would help, but then you develop this relationship with yourself where it’s like, oh, actually, that’s when I should eat, you know? So there’s a lot of these pieces of like, how do we learn how to take care of ourselves?
[52:08] Yeah, so it’s all of that. And it’s all of that through a trauma-informed lens, which means that we’re approaching all of this without judgment. And we’re building a plan to help those pieces get accessible for the patient at whatever pace works for them. The understanding that a lot of people will come to this point like they know that they’re not eating well and they know that they’re not sleeping well and if this you know like if all they needed to do was to have somebody tell them to do it better they would have done it already right so there are there are things that are blocking them from being able to make those changes and so that’s why i really like having to getting to wear multiple hats under one license because I you know my my coaching clients are also my patients and so we can like jump back and forth for me to say like okay like let’s maybe do a coaching session here where we talk about the parts of you that are resistant to taking care of yourself or to explore why it doesn’t feel safe or even accessible to listen to the signals that your body is giving you.
[53:19] And then we can jump back in to the naturopathic work and be like okay now that it feels a little bit safer for us to even talk about what you’re eating or to be able to even give any attention into how you’re making food for yourself because it no longer is like going to trigger a full disordered eating flare or whatever okay now we can talk about yes you need 30 grams of protein at breakfast and you need to have that before caffeine and you know all of those things so it’s like a back and forth of that um and then also compounded by an awareness of how many people come here for this work with a history of being really mistreated or dismissed by other medical professionals like the medical trauma layer it’s really common in women especially and in mental health um patients and in like you know people in bigger bodies or people that aren’t straight or that aren’t monogamous or that aren’t you know like that don’t fit the standard you know, white straight norm basically skinny you know all of those things yeah and so it’s like building a therapeutic relationship and a relationship with themselves to be able to make those changes.
[54:28] To make them accessible and to make them sustainable and like yes you and I could talk forever about like the herbs and the supplements and I’ll give you my 10 cents on on psych meds because I think that’s a really cool layer but so much of it is the foundational piece, but just really like taking our time in the foundations to be able to make it feel possible for people. Yeah, that’s a great point, right? Because there’s sort of the…
[54:56] I’m very resistant to the idea of protocols, even though it’s, but sometimes these courses or packages, they can be accessible to people, right? When you do your own research and go to Chachi PT and here’s, but there’s a lot to the art of like, okay, yeah, sleep, breakfast, but how does that look like? Like what does that look like for the particular person right and how much time do we need to just spend on psychoeducation and like letting them like kind of helping match the symptoms to that or letting someone talk and you know express what they already know about their sleep or what their obstacles are what their difficulty is or um yeah like looking at yeah like the ifs like there’s a lot of um stuff that comes out around lifestyle changes around like the the inner rebel and then the inner critic and their dance. And sometimes people will describe, like, I know I need to exercise. I really want to exercise. I have so many values that are connected to getting stronger, longevity, but I just can’t do it. And then we often discover that there’s a rebel that’s trying to stand up to the critic who is like.
[56:12] Yes, you have these values, but the critic is also kind of shaming you. Why aren’t you living up to your values? What’s wrong with you? And then there’s a rebel that’s like, no, I don’t want to live this way. I don’t want to live under your rule. And so looking at that, you might not see any change on the surface. You might not be lifting a weight for many months as we kind of tease that apart and understand it. You know yeah another one I see often there in that realm is people that have all those values but are really resistant to doing the work because they didn’t get cared for in the way that they deserve to as a kid and so there’s a lot of resistance to being like I’ve been caring for myself my whole life I it’s like not fair that I have to do even more to get myself out of this hole that got dug for me by trauma that I experienced as a kid. So there’s like a lot of grief work often to be able to sit with like how shitty and unfair it is. Like, yeah, that sucks. And it’s okay that you really don’t want to do this work right now, you know, and how can we make space for that and allow you to feel and metabolize and process those feelings of like, Like, yeah, this, it’s not fair that you have to do all of this work on top of all the work you’ve been doing already
[57:27] to, you know, to get yourself here. That you’re still, yeah, you’re still having to do this. Like, you’ve been adulting since you were five.
[57:36] And, yeah, I can see, like, there’s a, you know, without kind of really understanding or unpacking that layer, sitting in front of someone who even compassionately or, you know.
[57:51] Benevolently is like, okay, like, let’s eat protein at breakfast. It’s like, here’s another thing I’m doing wrong. Here’s another thing I have to do. Like, feeling that.
[58:00] Burden of like okay so I’m already I’ve already been feeding myself cooking for myself planning my own meals my whole life but now you’re telling me that I have to fix it even more there’s something that I wasn’t like yeah totally yeah exactly yeah and so like my stance on that is like there are no such things there’s no such thing as a non-compliant patient only a practitioner who is missing a piece that’s education or compassion or the trauma layer or the resistance or whatever But yeah, it’s all of that. Yeah. For patients listening, you can come back if you haven’t done anything. Yeah. A lot of the time people will say like, I’ve been wanting to come back. I haven’t been feeling better, but I’m just worried because I didn’t do the thing you said. But that’s an amazing opportunity because especially when we’re getting to know somebody, you can say like, okay, like sleep, let’s work on getting to bed 30 minutes earlier. Let’s come back. And then we often don’t know what the obstacles are until we try. Yep. So that’s a good opportunity to come back and be like, hey, look, I didn’t do it. And we can work together to understand why, you know. Yeah. Yeah. And that’s the thing that I now like build into my patient communication, especially after our first visit. I’m saying, okay, here’s what we’re going to do in the second visit. We’re going to check in on all these things that I’ve suggested for you. And if they’re going well, this is what we’ll do. And if you didn’t, none of them, this is what we’ll do. And so that they can know like there is space here. It is safe here. I’m not going to be like chastising them.
[59:29] And that’s part of a trauma-informed practice is to like really be very transparent with your patients and with your clients about what’s happening so that they are not going to be scared or not going to be surprised or not going to be blindsided, because trauma is like ultimately about, having your agency removed yeah so if you give people back their agency it’s a big part of the healing process yeah and i’m glad that you brought up the medical trauma piece because i think that’s huge right like i remember talking to a friend about this and she was like i just can’t take a like i can’t take a supplement or an herb that’s recommended there’s something about just.
[1:00:10] Like having you be like we should try like melissa the herb that just feels like i don’t want to just take advice when it’s given to me like there’s an immediate kind of um defense that comes up like i need to maintain my own agency so i can’t you know i’m so used to just being told what’s good for me or what’s going to happen and and i thought that was really interesting and very self-aware of her and you know we don’t always have that kind of like, awareness of when it’s happening but yeah that’s yeah like yeah but if you have yeah if you’ve got a patient that comes back and they say like okay well I didn’t do any of the stuff that you said like you can either approach that from like okay well what now or you can get curious like hey let’s explore why that felt inaccessible for you and let’s get let’s spend time like working through that so that we can figure out how to make it accessible for you yeah yeah the nice thing too about natural medicine is there’s so many herbs, supplements, angles, ways to approach something that, And something, I’m not an expert on this, but something that’s always been interesting to me is when someone kind of has an intuitive sense around an herb or supplement, like one person was like, I had a dream about this herb last night for some reason, like Hawthorne or, you know, and that’s great. Let’s go with that.
[1:01:33] Um but sometimes people like i just don’t want to take iron i don’t know why like i know it’s good for me i know and so to be able to trust that and allow that can also really help build someone’s self-trust and agency and then the therapeutic relationship okay don’t let’s not take iron let’s go somewhere else with this um as opposed to like yeah fighting or doubling down like there’s a million other ways to yeah maybe get iron or maybe there’s something else that needs to happen first and our body is so complicated that it isn’t so linear like low iron take iron you know yeah um yeah yeah totally the number one rule in my practice is no forcing like i am not going to force you to do anything i don’t want you to force yourself to do anything even if it’s a thing i’ve told you you should be doing because if if you have to force it it’s a it’s a cue to us that there’s resistance there that we should get curious about and at the very least if you’re able to force it, it’s not going to bring about sustainable change.
[1:02:34] Because most of my patients come to me with a background of trauma and either come to me directly for trauma work or for the physical manifestations of trauma. I think the no forcing rule is a very foreign concept for a lot of them because they’ve had to force themselves to do things for a long time. And also that rhetoric is really reinforced by society. Be like, oh, you’ve got a headache, take an Advil, go back to work. Oh, you’re tired? Have caffeine. Go back to work. Oh, you have your period? Suck it up. You know, like forcing is like a part of our life because of capitalism and the patriarchy and all of that stuff. And so if we can start to.
[1:03:11] And what it does is it really reinforces that you shouldn’t be listening to
[1:03:16] the messages your body is sending you. And then over time, that just dilutes your ability to even interpret them at all. So if we can really work back into a flow and a reciprocal, safe relationship with your body and its messages, and maybe it’s no iron right now, and maybe three months from now, they’ll be ready to take iron, but willingly. And and I would much rather us wait three months and then work into a plan that feels accessible to them because we’re building these plans for life and so like three months on the scale of doing being able to take care of yourself for the rest of your life is a drop in the bucket yeah but the alternative is that I like you know force you or you force yourself to do this thing in spite of what your body is saying in this moment that’s going to fracture our therapeutic relationship, likely, it’s also going to further break the trust between you and your body, and it’s not going to help you get better long term.
[1:04:10] Yeah. And a lot of this is like a patience and an immense amount of trust in the inner wisdom of the person’s nervous system. And that doesn’t always mean that their dreams are right or their intuitive sense is, you know, like, yes, that’s exactly what you need. But it’s coming from somewhere. and to honor that and to work with that and to meet the patient where they’re at I think is really the the key yeah yeah like I think you know you really want to like honor someone’s intuition and like how they’re building that trust with themselves and their gut instinct and um you know it’s not I know better or this is the way because you’re yeah um I love that yeah Yeah.
[1:04:59] And I’m also thinking, you know, how sad it would be if someone, because it takes a lot to finally reach out, right? Like many patients will say like, I’m thinking about this for eight months, a year, multiple years, like I’ve been following you, listening to your podcast. And now I’m finally booking an appointment and you know how sad it would be if there’s a rupture that you know yep, where the person’s like okay like I I need to be at a certain level of like readiness or I need to like.
[1:05:31] Take this on wholesale if I am going to get this kind of help, as opposed to being met where I’m at. Yeah. Wherever that is. Yeah. Yeah, I agree. Yeah. Yeah. You said you had something to say about psychiatric medication. Oh, that’s like that. Yeah. Yeah. Okay. This is my own personal little soapbox. So in British Columbia, natural medical doctors have a pretty broad prescribing scope. And so we prescribe most of the things that a GP can prescribe or an NP, like a primary care provider, because we are primary care providers here. We can’t prescribe anything scheduled. So like no opiates, no benzos, that kind of stuff. But all the psych meds are in our prescribing scope. And not that many of our colleagues out here are trained in them. So not that many people use them. But SSRIs are a common drug that lots of people use, especially GPs.
[1:06:25] And I think they are a really, really useful drug and potentially life-saving
[1:06:31] in a lot of cases, and they are often not well understood. And so then they are misprescribed or misused in a way that perpetuates the stereotype of them. And so I think, so the way that I use SSRIs and the way that I think they are best served or best serving the patient is to use them to support the expansion of the patient’s window of tolerance like it’s like you know you are leaning your whole body against that closet and you’ve only got one arm and an ssri like gives you a longer reach no or it gives you a second arm and it like doesn’t um it doesn’t so i think a common error that people make is prescribing too high yeah and it results in just like a numbing out like a disconnection from the feelings and for some people that is what they want because they have no skill set or understanding of like why feeling their feelings is important or how that can be productive or valuable for them.
[1:07:31] And it’s not a criticism of GPs. They aren’t properly trained in a lot of ways as well. And so they just have their patients coming back saying, I’m drowning in my anxiety, and they don’t know what else to do but to increase the dose.
[1:07:45] But I think the best and most effective dose is the lowest dose that you can get that gives you more capacity, that makes you feel like you’ve got a little bit.
[1:07:57] More room to handle what life throws at you that doesn’t numb you out that doesn’t disconnect you from your feelings and also doesn’t you know give you bad or uncomfortable side effects yeah um but with my patients um like escitalopram or lexapro is a is the most common one of the most common SSRIs that we use now and the research as done by the drug companies suggests that the starting dose is 10 milligrams. And I start a lot of my patients, most of my patients, I would say at two and a half milligrams. It’s like a literal 25% of the starting dose of what’s recommended. And most of my patients see benefit, you know, and we get up to like five milligrams or seven and a half milligrams and some they’re at 10 and that’s great. And I’m not at all opposed to people taking a higher dose when they need it. But I have a lot of patients that have a history of being on SSRIs and they came off of them because they didn’t like how disconnected they felt because they started at 10 or, you know, an equivalent starting dose of another drug. And, you know, it’s just, you know, the analogy I always make here is like, you know, it would be about equivalent of somebody saying like, oh, I’ve got a really brutal headache. And somebody say like, oh, take ibuprofen 20 milligrams. Like the minimum effective dose of ibuprofen is 200 milligrams in most people. And so if you don’t, if you’re not familiar with that, you’d take 20 milligrams of ibuprofen, you’d be like, oh, that drug is stupid. It doesn’t work.
[1:09:24] And it was actually just not the right dose. And the same thing is true in a lot of drugs, but especially in SSRIs, which have just such a really bad rap. Yeah. Because I think they’re often dosed too high. Yeah, I agree. Like, yeah, I think I’m really happy that you mentioned that because I think a lot of the way that studies are designed, you want to see an outcome, you want to see an effect. You don’t want to do a really, really long study because that’s very expensive. And you’re also going to get like a placebo response in the placebo group that’s pretty robust, especially with subjective symptoms like mental health. You know, you’re not measuring blood pressure. You’re not looking at like an MRI. not like you’re just how are you feeling are you eating like so yeah but what i i totally agree like i think um what i see very often it’s interesting that it’s usually like i see this so much with zoloft or sertraline for ocd which can be extremely crippling for a lot of people that’s not a good word but like destabilizing for a lot of people like caught up in like rumination and unable to function and just really trapped in those sort of thought loops.
[1:10:37] And very often, like, okay, I’m trying Zoloft, you know, first, I think it’s 25. And they’re like, and that’s great. That works really well. And then their GP is very often like, okay, so you’re tolerating it. Okay, so we’re going to 50.
[1:10:53] And then they don’t feel as great. And the benefit isn’t really there. And we often have a conversation where I’m like, let’s just stay at 25. But maybe even better to start even lower and just see what’s the minimum effective dose because there’s yeah you know often a trade-off like the more the higher the dose the more the side effects you know yeah yeah exactly yeah and i think um i end up starting with lexapro often because it’s a tablet so you can cut it in half but my patients uh who prefer serotonin will just get it compounded and then we do drop dosing to figure out whatever less than 25 milligrams is a good place for them to start. I think it’s a common misconception that the.
[1:11:32] Instructions that are determined in a study are exactly how you’re supposed to do it in in your clinical community practice and having you know interacted with researchers that are running these studies like they are out there saying like no no this is not what this is to determine safety and efficacy this is not to determine best practices yeah and I think that’s a thing that’s often overlooked and like we could talk about how like you only have five minutes with the patient and so you don’t have time to think about like what’s the best practice you’re just trying to do the best that you can in a really limited amount of time in the conventional system at least so I understand the contributing factors but I think there’s a lot of art to prescribing yeah and I think it’s worth it to talk about it because these drugs I have so many patients that it took them like five plus years to get comfortable with taking this drug because there’s so much negative rhetoric around taking SSRIs or taking any medication for your mental health stuff. And so many of these patients are like, oh my God, I have a life now. I wish I started taking this drug five years ago. Yeah. It’s a good point too, to point out how that might perpetuate a stigma.
[1:12:47] Also, it’s held up as like, this is the first line treatment. If you have depression or anxiety, then you get one of these medications and that’s kind of it. Yeah. Versus the, and that is kind of how it’s studied, right? It’s like, we just want to see what’s the effect on like the GAD score for your anxiety, you know, like, is there going to be an effect? And you’d probably have to prescribe pretty high to see something change. But I love that you talk about the window of tolerance. It’s like, we don’t want to numb your feelings. We just want to create a bit of softness around and expand. And for listening, window of tolerance is sort of like.
[1:13:23] You know, where you’re regulated and connected to yourself and above the window you’re hyper aroused and below you’re in a dissociative state or under aroused.
[1:13:33] And like the work is kind of done within that window. So if you can kind of soften the edges and like open it up a little bit, then work is done inside of that, whether it’s like lifestyle stuff or therapy. Be but that also implies that there’s like other things that you’re going to receive, in terms of treatment not just the substance you know yeah and like a one of the there are kind of a few main questions that i use to help people decide if starting medication is the right choice for them and like we already said earlier like it’s it’s almost never the place that i start like we start with all the foundational stuff but one of the big questions is do you feel like you have the capacity to add more things into your life in terms of supplements or therapy or practices or meditation or exercise or whatever in order to continue to work on improving your mental health right now and um or do you not have capacity for that right now and in which case sometimes medication is the right answer because it very quickly gives you more capacity like it expands your window of tolerance which like allows you to.
[1:14:39] Takes the intensity down off of the like high highs and the low lows. That’s what the drug does. And then expanding your window of tolerance gives you more capacity to handle feelings and stress and tasks without getting super dysregulated. And then another question that I use to help people make this decision is like, do you have, based on how you’re feeling right now, do you feel like you could hang out here for another like two or three months while we build these practices and like get you to eat regularly and get you to take your meds and or take your supplements and do your workouts and do your journaling and go to therapy? Or do you feel like, no, I need to feel better yesterday or else something bad is going to happen? Then, okay, that also helps us to decide what is the first treatment. And like you said, if I’m prescribing a medication, that’s by no means the only thing I’m doing. It’s just the beginning or like a step in giving us more capacity to be able to implement all the other things. And for some people, it’s this is a drug they want to be on for the rest of their lives. And for some people, it’s more capacity temporarily so they can learn how to do all this other.
[1:15:43] Tools and like ways of managing their mental health so that they don’t need the drug down the road and like i’ve got no attachment to one one outcome or the other it’s just how can we help you to feel better and get to the place you want to be yeah so it’s like yeah true holistic kind of biopsychosocial prescribing of like yeah do you need to do you need immediate relief and And, you know, I mean, our style of medicine is quite active, you know, so if that and that’s not always accessible for people like, you know, we’re asking you to, okay, like, add some things and take some things and that’s adding more to your plate. So, you know, if you’re already squeezed, then it may not be possible to add more things. Those are great questions. Yeah.
[1:16:30] And then a low dose is easier to wean off of. Yeah. Yeah.
[1:16:36] Yeah. And it’s also like the slower we build, even if we end up working up to 10 milligrams, if we do it slowly, then we’re also in the process giving you more opportunity to get to know what your body is saying and to feel the changes and to as opposed to just like barreling through and like placing you in this new mindset of like, oh, I’m not drowning in depression anymore. Like, well, actually, let’s give you the opportunity to be present in that process so that you can really understand what it feels like as you start to feel lighter or feel things less intensely or feel more capacity, which is a part of, you know, like learning how to.
[1:17:14] Like, the process of healing, especially in trauma, mental health, nervous system recovery stuff, is learning to have a relationship with your nervous system. And you can’t have a healthier relationship with anything if you don’t speak its language. Yeah. And this is the part like we have and learning language takes time. Yeah. And and and it also takes exposure. And so if we build that up more slowly, then we have a greater capacity for exposure to the signals that your body is giving you that you can then learn to interpret and that strengthens your ability to speak to and engage with your nervous system and with your body in a healing, sustainable way.
[1:17:51] Yeah that’s a great point right when you’re like kind of titrating up very slowly you can like watch the change like what do i feel as opposed to oh my gosh i’m at 25 milligrams this is like maybe too high for me yeah and it’s like too big of a jump and yeah are there oh go ahead yeah go ahead like you said like some people are in such an acute state that they like that’s not the time where we learn the language like that’s the time where we get immediate relief and so we we don’t have to do it slowly we can do the slow on the other end as we taper down as well so it’s just it’s really it’s about meeting the patient where they’re on as opposed to just like applying a protocol to every patient universally yeah it’s like if someone’s screaming at you in a language you don’t speak you’re like i’m not gonna get my like book out i don’t know yes yeah like do i need to get off the road am i like stepping on something you know yeah yeah Yeah.
[1:18:48] So like I need to calm down or have like a more regulated state to be able to like start to interpret and learn the vocabulary and hear the syllables.
[1:18:59] I was going to ask, though, if there are other, so for people who are very against medication or for us Ontario practitioners that don’t have prescribing and can’t kind of titrate doses, do you use other stuff that works in the serotonin pathway? Like have you find that that’s effective or yeah yeah I it works a little bit differently than medication but for a lot of people it’s the right choice for for various reasons um,
[1:19:25] I use a combination of supplemental nutrients and botanical medicine. Lots of magnesium and higher dose EPA omega-3s and St. John’s Word in really high doses, but like concentrated doses.
[1:19:42] Saffron, ashwagandha, theanine, inositol. There’s lots of nutrients and a handful of plants. Um hawthorne is a nice one for like the the panic palpitations that people feel so yeah there’s there’s a combination of things that i will use for sure and lots of my patients don’t want to be on meds or can’t be on meds or you know were and had a bad time and so there’s like many many tools that we can use and a lot of it is also about getting really curious about so like once we’ve established the foundations what are the underlying drivers that are contributing to the anxiety or the depression and like in some people yes it is just like pure you know neurotransmitter biochemical imbalance we think but there are a lot of people for whom it’s like you know a histamine thing or a reproductive hormones thing or a menopause thing or a gut health microbiome thing or an inflammatory thing and so it’s also really a lot about like what getting curious about what or the root causes that we can influence from a more broad perspective.
[1:20:52] And that just generally also tends to work better, more sustainably, and gets us away from just like symptomatic management and like the, you know, they call in school, they call it green allopathy, like prescribing a supplement for a symptom, which is like sometimes the trap that GPs or MDs can fall into as well. Yeah. So, yeah, it’s so easy to kind of Yeah, I get wrapped up into like, I just want to help. I just want someone to feel better. And you, um, the fixing part or the performance part wants to kind of like, you know, um, yeah, one of my most popular, like I made this YouTube video, I don’t even know, 10 years ago, I don’t know about, uh, about, uh, amino acids. I don’t even know. It’s not even a good video, but it’s so popular compared to my other YouTube. And it’s just very interesting because like I always think I’m like what is so attractive about the idea but I think I mean this idea of like you’re right my medication stigmatized so people looking for kind of an alternative based on that neurotransmitter idea but also this I just want relief I just want to feel better you know so I did a follow-up video saying like yeah they can be helpful, but I, you know, kind of like a pyramid. I mean, you know, by the time that we’re working on neurotransmitters.
[1:22:16] Maybe we find that’s not really the thing that’s out of balance, you know, but I like that. I like the frame that you created of like, well, you know, when do we start with foundations and when do we start kind of at the top of the pyramid to provide relief? You know yeah exactly yeah yeah which is like functionally it’s are your symptoms the thing that is impairing you from being able to sleep or eat or take care of yourself yeah okay well then we treat your symptoms first so that we can then down the road or three weeks or it’s free you know a month from now start working on the foundations but it’s it’s the same thing we were saying before like if you just shout louder at somebody that they need to sleep more and eat more and that It doesn’t address the reason why they’re struggling to do so. Right. Yeah. Yeah. We talk a lot about like vicious cycles, right? So where do you address it? And where do like chicken and egg kind of cycles? Like where do you start with the chicken or the egg? And sometimes it doesn’t matter. It’s just about patient preference and what, you know, they intuitively feel because, you know, if you take a neurotransmitter to help with sleep and then you sleep better, well, then now you’re sleeping better. And then that’s addressing the underlying thing or if you’re able to work on sleep then might regulate your neurotransmitters so it’s kind of just about where it makes sense to start and yeah yeah i love that collaborative aspect i think um.
[1:23:39] It can feel a little bit foreign for a lot of people that has a practitioner that’s like, you know, woody, like kind of turning it over to you and not just telling you what to do. I think a lot of people are like, oh, my gosh, wait, I have to make the decision. I don’t know what I need to do. You’re the doctor.
[1:23:53] Yeah. Yeah. And I ask my patient that question all the time. Like, hey, here are some options.
[1:23:58] Which path do you think feels the most accessible or the most aligned with you? And, yeah, often people are caught off guard. And so, like, sometimes I will walk them through, like, here are my thoughts. Like, here are the pros and cons. Here’s how I would make that decision but I think it’s actually really important for us to.
[1:24:14] Give the power back to the patient like a lot of the values that I operate from in my practice is that to like minimize the power differential as much as possible like I’m not the boss I also don’t know what’s best for your body more than you do yeah and so but but the the world, and the medical system and especially if you’re a woman especially if you’ve got any mental health challenges has just told you over and over and over that like you have to outsource everything to somebody smarter than you or with more letters after your name or with more power than you and like that is part of the problem yeah totally yeah i just had this conversation with a friend it’s a little bit of a non-sequitur but we were talking about societal pressure to like for women to have children and i’m like you know it’s like if somebody’s like don’t you have kids and it’s like okay let’s like unpack this for a second like I would have to be the one to be pregnant to deliver a baby to care for a baby so you know you’re you’re telling somebody you need to take iron but you’re not the one going to buy the iron taking the iron swallowing iron maybe feeling nauseous from the iron so it’s all well and good to give someone advice but to actually have the burden of having to follow through and do it and be in the body.
[1:25:32] Is, yeah, that’s, you know, that’s something else. So, yeah, to be able to, like… Allow someone to embody their health experience again.
[1:25:42] And information is so accessible that I think maybe that is helpful for the power differential a little bit too. Like a lot of patients are coming in with a lot of, like kind of a massive confusa of information that, you know. As long as we are receiving it with grace and being like, yeah, bring me your questions. I would love to, you know, like dispel your Reddit myths or show you the data on why I think this is true but conversely if we’re if we’re receiving that as an attack or a threat to our ego or you know like you know shut up about your doctor google like that’s just going to perpetuate the problem but yeah yeah yeah but i that’s one of my favorite things to do is like yeah bring me all the nonsense you find out on tiktok and we’ll parse it apart here’s the evidence that i know here’s the evidence that disproves that here’s the question mark or the gray area that like maybe that’s true but here are the risks here’s how you make that choice because i i think it’s you know our jobs are evolving as the world around us evolves and i think part of you know like, docere is the root, you know, Latin word for doctor, which means teacher. And I think that’s a big part of our job is to give people the opportunity to learn how to take care of themselves in the world that we are living in in 2025, which now means how do you interpret.
[1:27:00] Media and social media and all of the nonsense that’s out there? And how do you figure out what’s right for you? Yeah, exactly. Like the common, I’m sure you get questions. I get question all the time and the answer is always it depends because there’s a reason that the intakes are an hour and a half like we got to sit with everything and go through it and but another thing i really love is the the broad spectrum of of being an nd is that i don’t feel beholden to any or in love with any particular therapy of course i have my biases like we all do but, I’m okay with killing off darlings like you know I’m there’s I don’t want to make myself sound amazing I’m sure there’s lots of resistance that my parents have encountered sometimes but um you know like because we there’s a big toolbox yeah like okay supplement like one person came in um a few people actually have been like it’s not good to take vitamin d and so I kind of went down a rabbit hole and unpacked it and came in and out of the cave. And I think my point that I’m sitting at now is that maybe we should probably take vitamin D in the winter because we don’t make it. But, you know, our bodies are complicated and the thing like there really isn’t an answer. Like even the best study with the best outcome is not going to be 100% effective.
[1:28:25] You know, whatever it is, even exercise, even all the things that we know are amazing, like exercise, like the you know um there’s tons and tons of nuance and uh so much individuality and everyone’s different so it’s nice to kind of be a little bit you know like on our toes like a little bit um flexible with how you know yeah it’s that like open-minded um like personality trait that we it earlier i think there’s a make somebody a really good physician because i think the analogy i are the example i always use here is like the doctors in the early 1900s were making fun of and laughing at the guy who suggested that we start washing our hands between autopsies and deliveries because he they were like yeah you right yeah right there’s like imaginary invisible little poisonous dudes in the air you know and it turns out germ theory is real yeah we didn’t have the right tools to study at back then. And so those guys that thought he was.
[1:29:28] Making stuff up, didn’t have any evidence for germ theory. And, like, it’s hard to fault them for that. And I think it’s really worthwhile for us to remember that, like, we are not by any means at the pinnacle of our understanding of the body or science or of medicine. Like, we know way more than we did five years ago and, you know, a ton more than we did 100 years ago, but we do not know everything.
[1:29:51] And it is really complicated. And I think it’s really important to, as a care provider to not get trapped in the like belief that we have all the answers because it’s it’s an ego trap it’s going to result in you know like making an unsafe space for your patients but also.
[1:30:12] Closing like prematurely closing your mind to what the possible solutions are, yeah i love yeah and the that story with saml weiss saml weiss yeah yeah yeah wasn’t he um He had his license removed. Yeah. That’s for being like, oh, you know, maybe we shouldn’t deliver babies after we handle cadavers without washing our hands in between. And they were like, you’re a quack. Yeah.
[1:30:40] Yeah, totally. Yeah. A lot of humility in that, you know. It’s funny, though, like you hear that story of when you’re like, oh, yeah, we would never. They were idiots back then. But then, you know, you can really humble yourself by thinking like, well, what are we doing now that we’re going to be disgusted by in like 50 years or 100 years, you know? Yeah. So tread kind of carefully, you know? Yeah. Yeah. Yeah. Absolutely. Yeah. Live with that uncertainty a little bit, I think. Yeah, I think you’re right. I think, you know, kind of flexibility, open-mindedness, humility, curiosity is important to be a practitioner and give the power back to patients because there has been an era in medicine where people have been disempowered and there’s like authoritarian structures in medicine. It’s like a very authoritarian system that I think is being dismantled. Like my GP feels very different. I know like the new generation of doctors feels a bit different. Agreed. Yeah. All of my peers that are like our age that are MDs are very different than the doctors that I grew up knowing. So, yeah, it is changing.
[1:31:47] And patients are different, too. Like people are encountering like a doctor who’s like, you know, not really working with them. And they’re pushing back or looking for a different practitioner, kind of not just accepting that answer. So, yeah, really encouraging and good. Yeah, agreed. I don’t think we’re mistaken about that in 100 years. They’re like, no, no, the authoritarian systems were right. Yeah, we’ll see, but I don’t think we’re mistaken about that. Yeah, I think we’re good. Yeah, I think it’s important for people to be empowered. I think that’s universally a good thing. I agree. Yeah. Any last thoughts, Jessica? Anything you’re offering? Anything you want people to know?
[1:32:30] Yeah, my private practice is in Vancouver, BC. I can see patients anywhere in British Columbia. So I do lots of virtual work as well as in-person work.
[1:32:39] I do have a little bit of private trauma recovery coaching, like separate from my medical practice for people that are outside of BC, if that’s of interest to you, if you’ve got specific like psychedelic integration stuff that you want to talk to me about um and hopefully by the end of this year i’ll have a trauma recovery um online program it’s like with my guidance um but again like more available for people at like a lower cost than seeing me in person and also not restricted to british columbia um but yeah i’m on instagram and the internet dr jess eastman that’s pretty Yeah, I think there’s a huge place for programs like psychoeducation programs and teaching people skills and having some guidance and can drop the burden of cost down a lot. Yeah. I’m glad you’re offering that. Yeah. Even for practitioners to take to learn, you know. Yeah, totally. It’s for everybody. But yeah, it feels important.
[1:33:35] Like I, you know, Vancouver is an expensive city and our work is expensive. And so I am very aware that the cost of seeing you or I is not accessible to everybody. And I hate that. And I also have to pay my bills. And but it’s important to me to make an offering that makes it more accessible to more people.
[1:33:57] Yeah. Amazing. OK, so people I’ll have links for people to find you and yeah, hopefully they can join in. And thank you so much for talking with me. Yeah, thank you. It was really lovely.
