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Raising Good Humans
Cognitive Behavioral Therapy At Home get home (CBT): Practical Tools for Families with Dr. David Anderson
01:00:33
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- [00:01]
Dr. Dave Anderson
The following podcast is a Dear media production.
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Lisa
I'm surprise attacking you. Dr. Dave Anderson of the Child Mind Institute.
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Dr. Dave Anderson
Yes.
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Lisa
On Raising Good Humans podcast with. I'm thinking of this as. Are you excited? Because you have no idea what we're talking about.
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Dr. Dave Anderson
I really am not aware of what you're about to throw at me.
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Lisa
That's how good you are.
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Dr. Dave Anderson
Right. But I feel excited rather than nervous, which I'm wondering what that says about me.
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Lisa
But yeah, maybe now I feel worried that you're gonna be like, that's so boring. But I want to give access to the parents. Listening to a. As almost like a session on cognitive behavioral therapy. What it is, and the concrete tools that you can kind of give to kids who aren't even going through anything clinically.
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Dr. Dave Anderson
Sure.
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Lisa
And also some who might be, but they just haven't had access. Because I think cognitive behavioral therapy, which you will define for us, I'm sure.
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Dr. Dave Anderson
Absolutely. Yeah.
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Lisa
Is the kind of thing where if you. I think it's unpopular right now because it's not like digging into the feelings beneath.
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Dr. Dave Anderson
Yeah.
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Lisa
And I think that it's a real loss.
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Dr. Dave Anderson
Yeah.
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Lisa
Because it can be so helpful.
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Dr. Dave Anderson
I think the popularity thing you. What you capture is just more that, like, you know, people tend to define any sort of new trend by how it is different from the old.
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Lisa
Yes.
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Dr. Dave Anderson
And at some level involves devaluing the old as a way of propping up the new. So I think that what we generally see, I mean, you know, anytime that I hear therapists talking about new treatment techniques, you know, the most common and I think just cheap way of selling a therapy technique is to be like, look, you don't fit in a box. This therapy technique fits you into a box instead. This is where you get to expand and do something that's counterculture and not do something that big pharma wants you to do and instead, like explore yourself in kind of this way when in reality, you know, I'm not arguing with that because in my own view of kind of second and third wave psychology, I reject a lot of what was the early history of psychology, which was rife with misogyny and, you know, all kinds of weird theories about different things and psychotherapists using cocaine as a way to fuel, you know, their writing and stuff like that. And I think that, like, while we had these very odd and kind of also wrong direction beginnings of field, like also categorizing, for example, certain things as disorders that were not. That were completely normal variants of the human condition.
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Lisa
People being people.
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Dr. Dave Anderson
Exactly. People Being people. So it's like, I get the mistrust totally. But at the same time, if we're talking about what's come up from CBT through now, it's people trying to figure out how to give people constructs of healing, and then not really saying, like, you must adhere to this with great orthodoxy, but instead saying, like, if you use these, I hope they're useful to you and they're better than, you know. Part of the reason why there's a scientific basis to them is that we'll study them when they're given in orthodoxy, like through a binder, doing it in kind of sequence. But at the same time, if someone comes into the office and says, look, this would work for me. This might work better. We're flexible like that as therapists. We want to match what the patient needs.
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Lisa
So I loved everything that you just said, and I think it's so helpful because it's so true. I don't want to, you know, you don't wanna throw the baby out with the bathwater completely. So let's talk through what is cognitive behavioral therapy and what do we know about it?
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Dr. Dave Anderson
Sure. So it's in the name. So when we say cognitive behavior.
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Lisa
So you're saying you don't have to define it?
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Dr. Dave Anderson
No, no, I think we do, because it's really about the visual you give somebody in the first session where you say, look. What does cognitive behavioral therapy mean? Cognitive means thoughts. Behavioral means behaviors, even more blunt. And then just the only word that's not part of the cognitive behavioral TR that's not in the name is emotions. So we're really talking about this interplay between thoughts, emotions, and behaviors. And there's a wide variety of ways that we can kind of give people a history of cbt. We can go back and we can kind of talk about Beck and how Beck's ideas arose and how they built upon the shoulders of giants and all that kind of stuff. We can talk about how Beck also may have utilized, you know, these ideas in therapy about what kinds of schemas we have, what. How our early relationships define our sort of core beliefs about who we are and about the world, all kinds of things that, you know, helped Beck to merge concepts of the self with the tools of cbt. But at the end of the day, you know, for me, for someone like me, who specializes with children and adolescents, and especially with populations that also may have ADHD or anxiety, the longer I talk, the more anxious my patients get, or the longer I talk, the more unfocused My patients get, oh, my God.
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Lisa
That'S such a good point. So you're an even better person to have on the podcast.
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Dr. Dave Anderson
So the. So the whole thing is, I like talking for a long time. It's just that they don't. So I'm going to have to cut out the therapy lesson and instead talk about what those skills look like.
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Lisa
Ugh, amazing. Let's just get concrete.
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Dr. Dave Anderson
Sure. So what I'll lay out for folks is like, you know, and this also happens a lot with kid therapy. It's like you get a kid in the room and like, what you really hope is that a kid said to their parent, hey, listen, I'm struggling, I'm sad, or I can't seem to focus in class, or I'm anxious and I really want to go in and see the therapist. And that is a minority of cases where a kid really expresses subjective distress and says, please, you know, bring me this mental health professional. More often than not, because the stigma associated with mental health, what we hope is stigma, is low enough that a parent decides to bring their kid into the office. But it very rarely is that low for the kid. Usually the kid is coming in saying, I don't want to be the identified patient. I don't want my family to think that I'm the one that has something wrong with me. It's really my parents or my sister or just my school and my teachers are mean, and I don't understand why I have to be in the office with you when I. When really it's the people in my life that should be fixing themselves or they're sitting there saying, I mean, that's not.
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Lisa
Not true.
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Dr. Dave Anderson
Right, Exactly. It's not not true in the sense that, like, when we look at evidence based practice for anxiety and ADHD and behavior, you know, more often than not, especially with young kids, we're working more with the adults than we are with the child.
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Lisa
Right.
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Dr. Dave Anderson
But all this to say, that doesn't mean we can't teach the kid something. And the kid will say, well, I'm not, I'm not depressed right now. You know, I had a patient in my office a few months back who was just like, no, I was depressed in the winter. I'm not depressed now. Now's the spring. My friends have, like, reconnected with me, I'm feeling good, I don't need you. And this is my sales pitch. So I said, look, give me a few sessions to just go over with you and engage on some of these tools of cognitive behavioral therapy. And it just becomes part of your toolbox, you know, going forward. And so the kid was like, what are those tools? And so what I say to him and the attention soundbite is I say, look, I want you to better understand your feelings and be able to kind of notice when your feelings are getting more intense, less intense, and what those feelings are. And he's like, so that's three skills. And I was like, that's one. And then I was like, then I want to teach you some relaxation skills. Take it or leave it. You can kind of look at that. I want to teach you some skills for when you have really big feelings. I want us to really take a look at, like, the concept of mindfulness and how it's different than what relaxation skills. And then I also want us to take a look at, say, problem solving skills. And kid said, okay. And he's looking at the triangle on the wall, and he's like, what does that have to do with thoughts, feelings, and behaviors? And I said, well, what we're really going to look at in all of these things, it's like a lot of what I just listed is the behavior side. It's the B's. So that relaxation skills, the practice of mindfulness, behavioral activation, activity scheduling, all those different skills are the B's. I'm also going to teach you about cognitive restructuring. I just hadn't used that word yet, because that's where we take a look at your thoughts, and we realize that they're actually fairly changeable. They're not a permanent way of interpreting the world. And we kind of tweak that, and then we look at what effect that has on your emotions. And the kid was like, all right. So, you know, at some level, it's like, for I think most kids, what we're doing is a mix of kind of cognitive behavioral therapy and motivational interviewing. At the beginning, where we ask them their goals, we say, what do you want out of this? I want my mom off my back. I want my teachers to stop paying as much attention to me. I want to feel less nervous with my friends. And if we can then kind of show how these tools can help accomplish their goals, they're more likely to maybe engage with us in some exercises that have to be experiential. They can't be all didactic.
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C
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Lisa
Okay, yeah, so give us those exercises.
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Dr. Dave Anderson
Yeah, sure. So first exercise is, you know, everything about good child and adolescent therapy is that we're practicing something in the office before we ask the person to do it in the real world. And you know, we try to move away from words like homework, but the reality is that like therapy is going to be more effective if you're practicing it the other six days and 23 hours of the week, which effectively we're hoping that people sleep for a portion of that time, but you know, you're practicing it for that, that time and that within the office, the office is really the opportunity to introduce, do the initial practice exercise and then set goals about how we're going to practice this outside the office with the understanding, and this is the pact that we make with our patients, is that if you're feeling not so hot when you come in here, if I'm going to engage in evidence based practice with you, I should be able to say to you that I'm pretty confident that if we do this work together and we really apply ourselves, within two or three months, you might not feel like, oh my gosh, everything's improved on a day to day basis. But when you look back on a two or three month timeline, you can be like, oh yeah, yeah, things are, things are better right now.
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Lisa
That's so motivating by the way. You're sharing a goal and there's like evidence that it's going to come out better.
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Dr. Dave Anderson
Well, and I think a lot of the messaging, especially for senior clinicians in the field, has to be us talking about what we can be somewhat confident in. You know, therapists are bad at predicting the future, but we want to be like at least providing some hope based off of our experience with patients. So like I'll say to depressed patients, like, you know, I know you're in a depressive episode right now. I can tell you that if you just give me time and some buy in on this stuff, you will absolutely feel better with time and some buy in on this, you know, after two weeks. Now, more often than not, my depressed patients will say that they believe time played a larger factor than some of the practice exercises that they were doing, which irks me and my ego as a therapist. But it also is like, you know, helpful if we can give them Kind of that time horizon.
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Lisa
Okay, so the first session, first session. We're in the first session.
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Dr. Dave Anderson
So if you're here, the first session is that, you know, we're starting off and we're usually introducing some sort of emotion wheel or emotion chart or something like that. And we're, you know, talking about all the different names for feelings. And we're asking somebody to just kind of identify for us like, some of the feelings they feel. We'll usually lead an exercise where we're asking them to think of a situation where they felt that feeling recently. And then, you know, we'll ask them to start rating the intensity of the feeling in that situation. So as we're talking about different times, they felt it. So, like, you know, some kids will be very resistant. They'll kind of be like, no, I'm not, I'm not sad. I'm not sad ever. Now can I leave? And I'm like, no, no, that's not. The whole point is just we're having a discussion about feelings. They're like, I don't want to share my feelings with you. I'm like, totally fine. I have anecdotes, I have other patient stories that I can share in a de identified way. I can share these different kids in situations and hope that they're relevant. And all you gotta do is get through the next 15 minutes. And so kids will say, all right, so we'll get through kind of a discussion of the stories and then we'll highlight the fact that the skill, the skill is predictive of being able to use any therapy technique, whether it's drawn from cbt, dbt, ACT or anything else in the future, is the ability to be in touch with your emotional experience, to know what you're feeling and to know the intensity at which you might be feeling it at an evidence based level. If we just break down that simple component. And so the homework or the practice after that session is trying to get someone to create some sort of emotion log in a way they feel is manageable. That just lets them check in with themselves in a way that most humans don't do in the hustle and bustle of their lives.
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Lisa
And what does an emotion log look like?
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Dr. Dave Anderson
Right, so it looks all kinds of different ways. Classic CBT is like, you know, you give the patient a printout. That printout has each day of the week, it has four time intervals during the day. And we have the patient write down the emotion they're feeling at a certain time. They're checking in with themselves what situation they were in how intense that emotion was. And we just start with that with a lot of kids and teens, you know, with a younger kid. I'm trying to just say like, let's try three times during the week that we'll agree to practice. And can I engage your parent in helping us practice this? With an adolescent? It's gonna be more like their phone or something like that, where I might say, like, look, you know, you've got, we're gonna have notifications that we set in your calendar and we'll have a notes app and you're gonna bring me back kind of the notes app piece. And if they're worried cause like their parent has full access to their phone or something like that, then, you know, we'll figure out some other way that we can collect this data that feels secure to them.
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Lisa
Okay, so this part of the exercise is really for them to now get to know what their feelings are and sort of what the intensity of that feeling is.
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Dr. Dave Anderson
Right. Because it gives us the opportunity to then take a look at what their emotions look like, of course of the day or in certain challenging situations and then say, what techniques are we going to bring to bear in decreasing your overall stress? And then at the same time, what techniques are we going to bring to bear in certain situations where either our, our focus is on trying to modify the situation in some way for an outcome that the person finds more helpful, or we're just trying to ride it out because this is a big thing. That's also, I think, what third wave added to cbt. Okay, What I mean by that is these are the waves of evolution in psychology for our listeners. But it's really that like one of the big criticisms early on of CBT is that it takes this kind of active approach that seems like it's about, you know, defining certain ways of thinking. Like initially it's like thought of as like cognitive distortions. And then like we use a more gentle term with kids, like thinking traps, where people are like, that's pejorative. That's a negative way of talking about my thoughts. And later forms of therapy might take a more non judgmental view in saying like, your thoughts are your thoughts. Like, you need to take some distance from your thoughts in not thinking that they're the truth, but your thoughts are your thoughts. We don't need to call them bad.
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Lisa
Right?
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Dr. Dave Anderson
And everybody who's done CBT for a little while is like, yeah, like, you know, we weren't trying to call them bad. We were just trying to separate for the Patient, you know, what is perhaps increasing the feelings of distress or misery that they were feeling and the ways that we can kind of question those things and maybe change how they think, and that. That's really where we're, like, kind of moving in understanding that, like, we might change those things. You might feel better, you might not. And at the end of the day, you know, some of these strategies might help you to feel better. Some of them might be just about riding the wave. Like, I always tell my patients that I. I'm particularly phobic of flying on.
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Lisa
Planes, like you and I have discussed.
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Dr. Dave Anderson
Exactly.
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Lisa
It's a very unpleasant thing where we both travel a lot for work and also hate it.
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Dr. Dave Anderson
Right. And early 20s. I was having panic attacks on planes. You have interviewed my wife for another of your podcast episodes. She was with me on some of those flights. We had plane staff come over and ask my wife if she could get me to stop chanting, we're gonna die. We're gonna die.
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Lisa
Oh, my God, stop. He married a psychologist, just so you know.
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Dr. Dave Anderson
Yeah, exactly. And also. And at this point, neither of us were psychologists. This is just us as young kids.
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Lisa
Oh, my God, you're right. Okay.
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Dr. Dave Anderson
So, you know, we're. We're just kind of dealing with this as it comes and trying to, like, you know, think about how we treat our phobias. And so obviously, in grad school, when. When they said, you know, can you in grad school, they recommended that we all get therapists so that we could understand the process. And I was, like, done.
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Lisa
Yeah.
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Dr. Dave Anderson
Like, I have anxiety. I have this plane thing. Like, I got stuff to work on. I don't just need to understand the experience. And so much of planes for me is that, like, before the plane, I'm often using some of these more active, like, CBT strategies, like relaxation techniques, or, you know, really focusing on restructuring my thoughts. Like, I'll have a thought about how, you know, I'm worried about the plane that day, and I'll think to myself, how do I talk back to this thought? I'm more safe in plane than I am in the car on the way to the airport.
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Lisa
Okay.
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Dr. Dave Anderson
And yet I am assigning risk to the plane and not to the car. And so, you know, that's it.
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Lisa
May I interrupt that one?
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Dr. Dave Anderson
Yeah, yeah. Are we going to restructure? We're going to do plain phobia treatment as we demonstrate ct.
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Lisa
This was all just for you to work on plain phobia treatment. So as a person who understands this thought process.
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Dr. Dave Anderson
Totally.
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Lisa
Are you telling me that you haven't then said, well, now I'm going to worry about the cars.
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Dr. Dave Anderson
Absolutely. I mean, that's the nature of anxiety. Then at that point, I take a look at the Uber driver and say like, okay, like, so this is gonna be the one that kills me. But the reality is it's not felt as viscerally for me. Like, it's more like a humorous thing. But I'll find that I can restructure myself more effectively when I'm on the ground, when I'm in the air. It's, as my current therapist would say, it's radical acceptance. It's the notion that, you know, I'm up there, I'm in the plane, I'm not flying it. For me, it's loss control is really the whole thing. They're not going to let me in the cockpit and make sure this is going okay. Don't they understand I'm a therapist? I could probably talk with the pilots, consulting their kids, like, let's, let's just have a chat, it'll be great. But no, since they're not going to allow me to be in the cockpit understanding what's going on with the plane. And there's more than enough stimuli that like what I found was when I try to use CBT techniques like talking back to my thoughts in the plane, my thoughts were too fast to talk back to. I would sit there and I would say, oh, you know, the flight attendant looks distressed. And then I'd be like, okay, the flight attendant's face could just be because that passenger up there is rude. It doesn't necessarily mean there's anything wrong with a plane.
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Lisa
But then you already have a new thought.
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Dr. Dave Anderson
Oh my God, there was a sound. It sounded like I'm on the wing and perhaps a bird has flown into the engine at 30,000ft. That would mean that there's a problem with the plane.
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Lisa
This is so fun to find out I'm not the only crazy person here.
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Dr. Dave Anderson
Exactly. So I'm sitting there thinking, like, how do I stay in a space where, you know, I can't get ahead of my cognitions. I don't want to cope in a way that is perhaps maladaptive or would be less helpful to be using a less pejorative word. Because like, my, my next thought is like, I could pound three glasses of wine and that would be maladaptive and probably care less about the bird, you know, and that kind of stuff. But also like, I gotta land and be ready to talk.
- [22:27]
Lisa
Right?
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Dr. Dave Anderson
And you know, I'm in my 40s. So three glasses of wine. I'm hungover by the time we land.
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Lisa
Yeah.
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Dr. Dave Anderson
So it's not gonna be great. So instead I'm just thinking to myself, okay, how do you just look at this situation? And this is where, like, I'm more looking at kind of an intervention, like act acceptance and commitment therapy and saying, like, you know, how do I kind of accept what this is, distance myself a little bit from where these thoughts are and perhaps commit to the value that I'm living with at that moment, which is that I really value the work that I get to do and how this plane gets me to it quicker so that I can work on behalf of youth mental health across the United States. So why don't I focus on the fact that I'm doing that and watch an episode of the Office and, you know, just accept the fact that I'm in this plane now doing something of value to me while also watching a show I deeply value, like, anything that's a situational sitcom with an ensemble cast that includes like, maybe April Ludgate from Parks and Recreation, that kind of stuff. That's where I am.
- [23:33]
C
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Lisa
So now you've had, you've talked back to yourself.
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Dr. Dave Anderson
Yes.
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Lisa
En route.
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Dr. Dave Anderson
Yes.
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Lisa
When you're not in the heat of it, but you're like, right. Anticipating.
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Dr. Dave Anderson
Yeah.
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Lisa
Then radical acceptance during.
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Dr. Dave Anderson
Absolutely.
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Lisa
Now. And then you're just like, I'll just keep working this muscle until. But you're never, I'm assuming one of the things that you're coming to terms with is I'm never gonna love this.
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Dr. Dave Anderson
This is the emotion monitoring piece.
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Lisa
Yeah.
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Dr. Dave Anderson
Is that we tell people, like, when they start doing that first, you know, session of CBT where we're like, I want you to keep this emotion log. And they say they come back in and they're like, so you can make it so, like, I don't feel sad anymore or like, I'm gonna not feel angry anymore at my ex or at my brother or at my mom. Or they're saying like, so, you know, you can make me feel happy all the time. And our answer is no, Sorry. Like, you know, what we can do is we can give you a greater appreciation of the fact those emotions exist. And at the same time, we can give you tools that might decrease your stress in certain moments and at the same time, other tools that if you can't decrease your stress, give you at least a little bit, you know, of an ability to kind of ride it out better than you currently Are, well.
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Lisa
And I love that because I think just knowing that this is temporary is a great tool.
- [28:02]
Dr. Dave Anderson
Yes, yes. And that's kind of the nature of it. Where I think what unites almost all of evidence based practice is this notion that our experience is constantly changing. So this idea, it's universal to human experience that when we're suffering, we think suffering is probably not going to end. Like there's just this feeling that's inescapable. Now, I'm not saying there aren't situations in life that lead to significantly more suffering than others, but frequently that thought that this emotional state, this suffering isn't gonna end can be countered with, well, actually a lot of this is temporary or it waxes and wanes or I won't feel this pain, at least at this level all the time. Maybe there are ways to reduce in this moment, maybe there aren't. Maybe there's just ways that I can do things for myself that care for me and that keep me healthy in this moment as much as I can, and that just kind of wait for these emotions to pass.
- [28:55]
Lisa
And for parents, like, we never look at our kids and think the positive feelings are gonna be all the time. Like they're never like laughing and playing and we're just like, I guess we finished, we're now just happy.
- [29:09]
Dr. Dave Anderson
I think that lots of parents, before they become parents will think that and they'll be like, oh, I'm clearly gonna look upon my children with joy and love at all times. And there will never be any other em mixed in with that because that is all I'm, you know, gonna give them. And you know, then you get into it and you get all the other emotions.
- [29:28]
Lisa
Right?
- [29:28]
Dr. Dave Anderson
And hopefully, you know, love is an undercurrent of all of them. But, you know, we also don't want parents to feel bad if sometimes they're like, I don't love my kids as much today as I did the other days.
- [29:38]
Lisa
Right.
- [29:39]
Dr. Dave Anderson
Oh, and if my children are listening, Parker and Olivia, it's always been that we love.
- [29:43]
Lisa
Do you think they're listening?
- [29:44]
Dr. Dave Anderson
I mean, who knows? I don't know. The power of the Internet and whether or not there won't be some AI module when Parker's 20 where he says, give me all the quotes where I was mentioned by my parents in any of their media appearances.
- [29:55]
Lisa
That is really fun.
- [29:56]
Dr. Dave Anderson
And then all of a sudden he gets every statement we ever made about him, you know?
- [29:59]
Lisa
Cause I've really counted on, I mean, I really, if I mention my girls, I ask them before I put it out there. However, I have thought also, they're just not gonna comb through this. But it didn't occur to me that, of course, AI at some point will be able to do that for them.
- [30:18]
Dr. Dave Anderson
Oops. I like to think that most of the stuff that either Dylan or I have said about our children is gonna be something they look upon with, like, a bemused appreciation.
- [30:26]
Lisa
Yes.
- [30:26]
Dr. Dave Anderson
Like that they see themselves through our eyes at those ages. And that truly, even stories of their mishaps or their interesting and challenging moments were said through a lens where we're still kind of smiling as we said it.
- [30:41]
Lisa
Yeah.
- [30:41]
Dr. Dave Anderson
And I think they can be okay with that.
- [30:42]
Lisa
I think so, too.
- [30:43]
Dr. Dave Anderson
Oh, yeah? Yeah. So back to cbt.
- [30:46]
Lisa
Back to cbt.
- [30:46]
Dr. Dave Anderson
Yes. Okay. So I guess if we're on the arc of the CBT sessions.
- [30:52]
Lisa
Thank you.
- [30:53]
Dr. Dave Anderson
So you've emotion monitored now you come back in and really, like, there's not. You don't have to do all the skills in a particular sequence. A lot of times you're trying to read the room and figure out what a person says has worked for them in the past in some way around their emotions. So, like, if you were the person coming back in after you've done the emotion log, totally rookie to cbt, what might you say had worked for you in the past?
- [31:23]
Lisa
This is a long pause.
- [31:24]
Dr. Dave Anderson
Yeah, exactly.
- [31:27]
Lisa
Probably taking a walk.
- [31:29]
Dr. Dave Anderson
Yeah. So I'd then categorize that. Where I'd say to somebody, like, okay, so if we're thinking about now that you're in touch with your emotions, their intensity kind of when they occur, you're saying to me that something that you might value, and we just kind of have to break down what a walk is? It's like, is it the physical activity of the walk? Is it the fact that a walk is separate from perhaps people who might be associated with some of the feelings that you're having? Is it because a walk allows you to be in contact with nature or. Heck, we live in the concrete jungle, a lot of us. So maybe it's just that you like looking at new shops that are opening up and figuring out what bakery you might want to try later that week. And then is. Is the walk, you know, something where it's just associated with being able to think through your thoughts or process a conversation before you come back to a person. And so depending on what you said, what might you say about why a walk is interesting to you?
- [32:24]
Lisa
Because I'm getting outside in nature and seeing, like, how tiny we are.
- [32:29]
Dr. Dave Anderson
Yeah. So the next thing that I Perspective, maybe. Absolutely. So the next thing that I go to is that I. I would think to myself, if I take a person like you, who seems like some of their coping is about doing and communing and also kind of like getting some perspective, it might seem too eggheady to you if I immediately go into the cognitive part of cognitive behavioral therapy, where I say, let me show you all these different ways that our thoughts work and how we can talk back to them, I might instead just want to ride the wave of what works for you. So I might start with kids, we might call it activity scheduling. With adolescents and adults, we call it behavioral activation. I'd say, look, frontline treatment for somebody who's depressed or somebody who's feeling sad or down is gonna be trying to schedule activities that provide small mood boosts and small bursts or larger mood boosts when you get to do them. Obviously, if you have a job or you're going to school or other things, we cannot just be walking all day. But when can we put this in there? When can we intentionally do that kind of thing? Either when you're already feeling distressed or when you're not. And we start to build out kind of little way stations across the week of coping for yourself where we can look at the function of those way stations, those walks that you're taking, as either we are emptying your bucket when there aren't situational stressors that are there for you. Like, we're just saying we're going to decrease your level of overall stress preemptively.
- [33:53]
Lisa
Like, we're just going to know that you need to do this for a certain amount of time every day or whatever.
- [33:58]
Dr. Dave Anderson
Your math teacher hasn't been mean this week. Your brother hasn't been hitting on you. You know, your, your mom hasn't been terribly critical, but we're going to just decrease your overall stress so that when those situations happen, you know, or when you get disappointed or when you feel like you're having a conflicted relationship with somebody, your overall stress level is already low, just so you're not already kind of running into this. And a lot of kids will be like, I don't understand this. And I'll say, let's talk about hanger. You know, when you are hungry.
- [34:24]
Lisa
Great example. That is a great example.
- [34:27]
Dr. Dave Anderson
So we'll, we'll say, like, when you're hungry and, you know, you're sitting there, do you sometimes notice that you're more quick to react or that you might get angrier or something like that. Whereas, like, if you Just like, I don't know, have a string cheese or, like a yogurt or something.
- [34:40]
Lisa
You have children talking about kids favorite.
- [34:42]
Dr. Dave Anderson
Snacks, then you suddenly notice that you're less reactive. Like our son last night who lost his dang mind because my daughter was putting puzzle pieces on the part of the puzzle that he hadn't cared about five minutes before, but believed now was his spot.
- [34:58]
Lisa
Sure.
- [34:58]
Dr. Dave Anderson
And it was just. Cause it was the two minutes while my wife and I for the black beans and rice to cool off enough in our dinner that it wouldn't burn their dang mouths. And so he lost his mind, and five minutes later, his belly was full of black beans and rice. And all of a sudden, the puzzle came into perspective.
- [35:14]
Lisa
Totally.
- [35:14]
Dr. Dave Anderson
Right? So we give those examples, and somebody says, oh, yeah, my cup runneth over a lot. And we say, how do we schedule activities? And some of these can be stuff like a walk. Some of them is just bringing people's basic attention to basic wellness habits where we'll say, like, how much do you move your body, eat regularly, hydrate, or sleep? And then if we can work on a few of those, we also see their wellness improve. And so a lot of that is the B part of cognitive behavioral therapy. We're really helping somebody look at their wellness practices, how they behave around sleep, eating, physical exercise, moving their body, and hydration, how they schedule activities that they find helpful. Like, I was talking to a patient just before coming over here, and she was. You know, I got a. It was like I had a belly laugh because I asked her how she was getting through a moment of intense emotional turmoil over the past week. And her answer was Deep cuts of Fiona Apple, which was amazing to me because this patient is college age, and Fiona Apple, like the title album in 96, like Criminal, was like a jam of mine. And I was like, oh, my God. Like, you're really, like, getting into this. And she was like, it's her and only her. Like, I just get into that.
- [36:22]
Lisa
And you felt cooler.
- [36:24]
Dr. Dave Anderson
Well, what I realized is I hadn't actually, you know, really kept up with Fiona's oeuvre since, you know, the 1996 days. And it's actually quite different. But it's like I was. You know, what I'm astounded by is how idiosyncratic people are about what does de stress them, how much is based on past experiences or, you know, what was soothing them at a certain time in their life. But you know what that gets back to?
- [36:47]
Lisa
Well, it's interesting because I was thinking when I said, take a walk. It's because my mother always would if I was grumpy. Say, take a walk.
- [36:53]
Dr. Dave Anderson
Yeah.
- [36:54]
Lisa
However, I would also just binge watch a television show completely. That's another thing that maybe is not as, like, wellness oriented.
- [37:03]
Dr. Dave Anderson
I mean, again, it depends on what you're watching. And television shows don't necessarily hurt anybody. So they were good.
- [37:09]
Lisa
Yeah. I think that that's when I'm like, I want to stop thinking and ruminating. So I'm just going to, like, dive into something.
- [37:17]
Dr. Dave Anderson
So for me, I'm going to give you a good picture of my adolescence. I lived about an hour from my high school. And yeah, yeah, it was, it was. But I had the privilege of going to a high school that was an hour away that I got to go to because my parents had decided that they wanted to send me to a school that was more academically challenging than the school in my home area. So I was privileged in that way. Like, I was privileged to drive that hour. But when I got my driver's license, it was also coinciding with hitting puberty and beginning to sweat profusely in the heat of Atlanta, Georgia. So I needed to focus on not sweating on the way to high school. Cause I was so nervous that I would sweat around the girl that I liked when I got to high school. So I would drive shirt off in my family's Plymouth Voyager minivan, listening to Metallica's S and M album, like, on full blast. Just like, feeling it and letting it wash over me as a way as, like, I had windows open because the air conditioning was not so great on the Plymouth Voyager. Windows open. Just making sure that I could arrive at school with minimal amounts of sweat to put on my shirt and then, you know, go into class. And to this day, Metallica's S and M album, I can put on that album because it was. It was a two CD set. And I mean, I'd invested like, you know, I can put on that album. And that is massively soothing to me.
- [38:32]
Lisa
That is amazing.
- [38:33]
Dr. Dave Anderson
Yeah.
- [38:34]
Lisa
Also, not for nothing, it should make all parents feel better because look at you today.
- [38:41]
Dr. Dave Anderson
That's it exactly. If you can picture me driving on 25 in Atlanta, Georgia, in a red Plymouth Voyager minivan, trying not to be nervous about girls and shirtless listening to Metallica. Now, granted, if someone had seen me, I really do believe there would have been like a welfare check of some sort that folks would have worried about and they wouldn't have been terribly wrong. Unless it's a rough time.
- [39:01]
Lisa
It's a ridiculous image. Yeah, exactly. It's also so heartening because here you are.
- [39:06]
Dr. Dave Anderson
That's it.
- [39:07]
Lisa
And also how effective music is. Side note.
- [39:11]
Dr. Dave Anderson
Absolutely. I mean, well, and that's also, I think, something that we focus on kind of especially in distress tolerance, is that when we're teaching people distress tolerance skills, one of the main things we start with is a sensory kind of inventory where we'll say to somebody, when you're stressed, what do you like to look at? What do you like to listen to? What do you like to taste? What do you like to feel? You know, what do you like to. Wait, I'm forgetting a sense. Smell.
- [39:35]
Lisa
See? Did you say see? I think I said smell.
- [39:38]
Dr. Dave Anderson
Yeah, smell. I think it was a smell. Smell is my like, fifth rated sense. Like, I'm definitely not a foodie. I'm more about quantity than quality. I don't really care about smells.
- [39:46]
Lisa
I kind of agree.
- [39:47]
Dr. Dave Anderson
Yeah, so that's my issue is that I always forget smell, I feel like, because that's the one that matters the least to me. But in my office, I have a picture of like the beach in the world that I love the most. Because in my, like, sensory toolkit, if I can put myself on ka beach on the north shore of Kauai, like, I'm. I'm feeling it like, I'm in a good place.
- [40:07]
Lisa
So you take an inventory of all of those things that might kind of get you there. And for you, you could think about listening to Metallica or you could think about sitting on that beach.
- [40:15]
Dr. Dave Anderson
Right.
- [40:16]
Lisa
And is that a tool that you can give to, like, are these things? Because basically I want parents to be able to say, I can sprinkle these into our every day because it's not like you need to have to your point about the hangry, there's not a person in the world that wouldn't benefit from this completely. So.
- [40:37]
Dr. Dave Anderson
And with the distress tolerance piece, you know, what I'll come back to with parents is like, kids discover distress tolerance and these kinds of sensory toolkits long before we coded it as psychological. There's a reason why the trope in like movies is like, kid gets annoyed at parent goes into room, cranks stereo. Exactly. And listen to music. Like that is a distress tolerance strategy. You are literally riding the wave of anger at the, you know, chains that your parents have placed upon you by listening to something.
- [41:08]
Lisa
So it's so adaptive.
- [41:10]
Dr. Dave Anderson
Absolutely. And it's much better than screaming at your parents and making it perhaps worse or getting a larger fight or something like that. So we're just trying to tell people, like, look, if there's a moment where like, you can't fix this, like your parents have decided, that is their decision. Like, however unjust you might feel this is, however much you scream that as soon as you get your own apartment and your own job and get out, you're going to do differently, you're going to raise your kids differently. I said that a lot. No, all you're doing is trying to kind of get through it. And these are the moments where we can say to a person like, you might have done all that behavioral activation early in the week, where you might have really tried to pay attention on wellness and self care. You might have tried to keep your cup less than full. You might have, you know, tried to pepper in de stressing activities. And still, if you get to this place, how do you ride it out?
- [42:00]
Lisa
Love that. And you know, we don't often really sit and think through that. And so to just have that awareness is so. It's like, these are very easy, low hanging fruit. Is that grammatically correct?
- [42:15]
Dr. Dave Anderson
Very easy.
- [42:16]
Lisa
These are, this is the R was.
- [42:18]
Dr. Dave Anderson
Agreeing with the fruit, which is plural. I think that was fine. Yeah.
- [42:22]
Lisa
Okay. And we won't cut it.
- [42:23]
Dr. Dave Anderson
Yeah, exactly. I think, I think we should keep it in. But no, I mean, like, what I'll often kind of like, you know, think about with people is if the sole function of these skills is to give you a chance to take a pause in your life before you say or do the next thing. Are there moments you can think of.
- [42:40]
Lisa
That would have been better you wish you could have?
- [42:42]
Dr. Dave Anderson
Exactly. If you just had taken a pause before you said or did the next thing.
- [42:46]
Lisa
I mean, thank you for saying that. Because pause is the most effective way to solve the world's problems.
- [42:53]
Dr. Dave Anderson
I absolutely agree.
- [42:54]
Lisa
And these are tools that help you pause.
- [42:56]
Dr. Dave Anderson
Absolutely.
- [42:57]
Lisa
So how many of us think back to every single moment where it's just like, if I had just, just a pause.
- [43:04]
Dr. Dave Anderson
Yes, that's it.
- [43:05]
Lisa
Things would be very different.
- [43:07]
C
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- [46:18]
Dr. Dave Anderson
And this is where I'm now gonna circle back to the other domain of cognitive behavioral therapy where it's like, you know, when we think about thoughts, it's another form of A pause instead of a behavioral pause. It's this notion that like our thoughts are flowing and we'll try to, you know, the thought piece is, we'll try to generate from folks, we'll ask them for like what their thought process is in a particular moment. So like, you know, if it's in couples therapy, it's like they're having fights with their spouse. If it's like, you know, an adult talking about like a work situation and what they're thinking about their own performance. And we're looking for these patterns of like people really having negative forecasts about the future or labeling themselves really negatively or rigidly thinking about kind of like what the outcomes of the situation are over kind of focusing on negative feedback or things like that. Like, we'll get somebody. The example that I often use in educator lectures, which PS for those of you listening, you will not see the fact that Lisa just caught a fly out of the air, which was really impressive. But no, like the gnat. A gnat, yes. I'm sorry, a gnat. We have to be clear in a nomenclature during this scientific session. But no. So like, I'll give the example with a parent where I'll say. Or sorry, with an educator audience where I'll say like, imagine you walk into school and another educator walks by you and they've got kind of like a dark look on their face and you say a cheery hello that morning. And they do not respond. Keep looking down and keep walking past you. And I'll say to the group, give me your automatic thoughts. And they'll say, she doesn't like me. And I'll say, okay. And then somebody else is like, she's mad at me. I probably did something wrong yesterday. I should probably figure out what I did wrong yesterday. Then it's like, you know, she's mad because we didn't, you know, there's a student that's been unruly that I've been treating differently than she has and like that kind of stuff. Or like, you know, then somebody will say like, oh, well, they're, they're mad from a meeting they just had or oh, you know, their kid is sick. And I'll say, so all of these are possible, but usually it's a little bit later in the discussion when people get to situational factors that aren't self focused. Like their first thought is, it's me. Yeah, I messed up. They're clearly mad at me. They don't want to be friends anymore. I shouldn't say hi to them later. Like, this is what it is. And then we can get a group to a place where they'll say like, oh, well, maybe it's actually that, like, you know, she was up all night and you know, I know she has a six year old like, kid and the six year old kid had like a stomach bug and just like nobody's gotten any sleep and she feels like she's totally running from behind, like that kind of stuff. And it's like when we get to that place, it goes from what did I do wrong that I'm ruminating about for the rest of the morning to what can I do for her? Like, maybe I can check in and see if, like, she's okay and see if, like, maybe she needs any help today. Because I know I wouldn't be functioning or firing on all cylinders if I was this person. And it's examples like that we can say to a person, how do you take a little bit of distance from your own internal monologue and say, hold on, like, is this correct? And the example that we'll use with kids a lot is, I'll say, you get a bad test grade. Do you think I suck at math? I'm always gonna suck at math. There's no use in trying. Which is kind of depressogenic way of thinking. Or do you think, well, I didn't study unit 3. Next time I'll kind of study that and also clarify with the teacher what this is. Maybe put in a little bit more extra effort and not focus on English paper so much.
- [49:28]
Lisa
Yeah.
- [49:29]
Dr. Dave Anderson
The latter way of thinking is much more predictive of problem solving and not causing yourself misery. It's present focused, it's situational, it's problem solving, it's saying it isn't me. It's not a global label, it's not predicting negative future. But far too few people take enough distance to realize when they're in that mode and seek to change it or practice.
- [49:50]
Lisa
What is a quick message to yourself to cue yourself to do that. Distancing.
- [49:59]
Dr. Dave Anderson
Yeah. So I like to think of like two questions. And it depends on like, the, the person in the sense that like, one question can just be like it. Like just a sort of like, way of getting distance by just saying, like, are my thoughts running like? And it's just a moment to pause and be like, oh my God, like we are on a runaway train. Yeah, I'm just gonna step off for a second at the next station, watch it for a moment and say like, let me pick out some things about this that I can like, Kind of pull apart. Or I like to ask the question, like, just like, what evidence do I have for this? Which is a very CBT question.
- [50:33]
Lisa
Yes.
- [50:34]
Dr. Dave Anderson
And so it's like, if you're sitting there going, I suck at math. I'm like, huh? And I'll go with a kid, and I'll be like, you got a B plus in math last term. Also last year, they moved you up a math level in your high school because you were doing so well in the math before. So what it seems like right now is you've reached a certain level of challenge in math that is really challenging for you, and that if you don't study, you know, unit three or these kinds of things. Yeah. You're gonna get a C minus. That's what's gonna happen. And it's like. But the notion.
- [51:07]
Lisa
That's a different story.
- [51:08]
Dr. Dave Anderson
Yeah. It's moving it more towards, like, a sort of, you know, growth mindset type way of thinking.
- [51:12]
Lisa
Yeah.
- [51:13]
Dr. Dave Anderson
And most kids will be like, oh, yeah. Like, that makes sense. Now, what I usually get as a question from either patients or audiences at that moment is sort of like, what if it's accurate? Like, somebody will be like, I notice that no other teachers want to collaborate with me. Is it possibly me? And my answer is, it could possibly be you. Like, CBT isn't about blowing smoke for people. It isn't necessarily about saying that everybody else is wrong. And anytime you have a negative thought about yourself, you should probably just, like, let go of that and consider the evidence that you're amazing. Like, yeah, sometimes we really do mess up. But then the question becomes, like, you take the thoughts that you're having. How do you let go of the thoughts that just keep piling on yourself and maybe get to the thoughts that either help to repair that relationship or help to, like, kind of move that relationship forward or mourn that relationship. If what you did was unforgivable in the sense that, like, you know, I had an adolescent patient recently who cheated on his girlfriend. I was not interested in letting him know that it was everybody else's problem. It wasn't. He messed up. He knew it. I knew it. And, you know, then the next, you know, thought was like, he was like, can I get her back? We could entertain that for a little while, but his. His ex girlfriend was pretty sure that this was, like, cardinal sin. She was done, by the way.
- [52:31]
Lisa
Good for her, having those boundaries.
- [52:33]
C
Right.
- [52:34]
Dr. Dave Anderson
Even though relationships we. We both know as therapists can recover.
- [52:37]
Lisa
Yeah.
- [52:37]
Dr. Dave Anderson
You know, as, you know, doctors, that relationships can recover. But I mean, I think the, the whole focus for him was like, okay, you're gonna do what you can to repair that relationship. If there's a chance you'll ever get back together, you're gonna do what you can just to let her know you're sorry, that you hurt her. And then at the same time, what do you wanna do for yourself? That maybe. What thoughts do you wanna cultivate that perhaps make it so that it's less likely you might do this again or that you might be kind of in.
- [53:06]
Lisa
This space or then fall into the trap of this is, I guess who I am.
- [53:12]
Dr. Dave Anderson
Absolutely. And this is to say, some folks might conclude that I think in many situations that they can't change, that this is kind of just who they are. I always tell people that the nature of all of these tools is, again, as we said earlier, in this change is a constant. You can change, people change. People change and grow throughout their lives. Do you want to have a more conscious role in your growth?
- [53:36]
Lisa
What a great way to put it.
- [53:39]
Dr. Dave Anderson
And you know, we get a few of our stock phrases once we do this for a little while.
- [53:43]
Lisa
Yeah, that's a good one. You always have good ones.
- [53:46]
Dr. Dave Anderson
I mean, I'm not gonna lie. Like, folks watching Lisa and I also just recorded a masterclass that is going to be released, I was gonna say, in August of 2025, which is gonna be really great. And you know, in that I'll just say they keep showing me rough cuts and I keep watching what you say and being like, oh, man, oh my.
- [54:05]
Lisa
God, I haven't seen anything.
- [54:06]
Dr. Dave Anderson
What?
- [54:07]
Lisa
Well, they sent me one thing.
- [54:08]
Dr. Dave Anderson
Yeah.
- [54:09]
Lisa
And just to make sure that it was okay. And, and I was, I felt the same way. I was like, oh, man, you sounded amazing. Lisa sounded amazing.
- [54:16]
Dr. Dave Anderson
Yeah. Crawley sounded amazing. Everybody, Everybody sounded amazing.
- [54:19]
Lisa
Everybody sounded amazing.
- [54:20]
Dr. Dave Anderson
Absolutely.
- [54:21]
Lisa
But that was just the one thing. And also I was like, great. I had no feedback.
- [54:25]
Dr. Dave Anderson
That's it. Well, so they sent me a few things and if, if it was like the social media teasers that we're gonna have.
- [54:32]
Lisa
Yeah.
- [54:32]
Dr. Dave Anderson
I would sit there and I'd have a good bit of self criticism, but also a letting go that like, I really can't make it any better. Like, you know, I didn't love exactly what I said. I had issues, I had notes for myself, but also like, like, I can't really do anything. Like I'm not going to re record.
- [54:49]
Lisa
Right.
- [54:50]
Dr. Dave Anderson
And then I would see what everyone else said and be like, oh man, that is hilarious.
- [54:55]
Lisa
So everybody should watch it. I mean, I'M so glad you mentioned it because it's going to come out in a few weeks.
- [55:01]
Dr. Dave Anderson
Well, I think we can be proud of it in the sense that, like. Yeah, exactly. Right. I think we can be proud of it because from what I've seen so far, and granted, we have not seen the rough cut of the whole class. You know what a class like this does is it functions to give similar to even our discussion during this podcast, enough nuggets to be practical, like just from listening to it, while at the same time, like easily googleable or chatgptable terms that you can then go deeper on. Yeah, like we're going to either give people a practical step or a rabbit hole, and they can then choose their own adventure.
- [55:39]
Lisa
But like a great rabbit hole.
- [55:40]
Dr. Dave Anderson
A great rabbit hole. Exactly. A very wellness, focused rabbit hole. One that helps you to.
- [55:45]
Lisa
It's inspiring.
- [55:46]
Dr. Dave Anderson
Right, Exactly. Find your values as a parent, if I may say. Exactly.
- [55:51]
Lisa
So I'm gonna. Well, no, I can't put a link to that in the show notes because it won't be out yet, but everybody will know and we'll post about it.
- [55:59]
Dr. Dave Anderson
There we go.
- [55:59]
Lisa
So I'm glad you said that.
- [56:00]
Dr. Dave Anderson
Yes. The show notes can go live when the link goes live.
- [56:04]
Lisa
And that makes sense. Right, Right, right. I can always change them. Oh, my God. Technology.
- [56:07]
Dr. Dave Anderson
Yeah, that's it. I also just learned the term show notes, so that's good.
- [56:11]
Lisa
Just from me.
- [56:12]
Dr. Dave Anderson
Oh, yeah. I'm always like, our Markovs team makes fun of me for this because I'm always like, oh, yeah. The website links around this podcast. And you know that that's totally it. It's show notes.
- [56:22]
Lisa
Oh, you have a new podcast. You want to mention it while we're talking about Masterclass?
- [56:27]
Dr. Dave Anderson
We absolutely can. Yes. So the Child Mind Institute has started a new podcast called Thriving Kids, which I hope to have you as a guest on at some point. But yeah, our focus is really just kind of, you know, we're. We're starting off with many of the kind of topics in mental health and I think similar. A lot of the podcast in this space, we just want to give parents more content around the issues of 21st century parenting and things that they can take away that are practical. And, you know, between Masterclass, Raising Good.
- [56:55]
Lisa
Humans and Thriving Kids, you're taking care of.
- [56:59]
Dr. Dave Anderson
That's exactly it. Like, you can be a master of raising thriving good kids. That's if we just, you know, put that all together.
- [57:06]
Lisa
So, yeah, I love that. I want everybody to know that. Also, do we finish on cognitive behavioral therapy? Not that there's a rabbit hole to go down, but is there anything else that that needs to be said?
- [57:19]
Dr. Dave Anderson
Right. So I mean, if we're talking about kind of what we haven't really talked about, like what a session of. It looks like it's more about like what the arc.
- [57:26]
Lisa
No, but I think the arc of it is more important because for, for most people listening, it's what can they incorporate into their parenting interactions?
- [57:35]
Dr. Dave Anderson
Completely. Yeah.
- [57:36]
Lisa
And I think these are tools to use. Not in the heat of the moment. I think we should probably mention. Yeah, probably don't give these tools while you have a kid who's in something.
- [57:46]
Dr. Dave Anderson
Right. And also to teach, like, the reality is you can find ways to get your kids contact with these skills. So, like, one thing we've done for parents around these skills is create the thriving kids video series, which is the way that we named our podcast, but it is kid facing videos for pre K age range, elementary age range and middle school age range and high school age range where like the middle and high schoolers are listening to middle and high school kids their age, narrating the skills with comedian narrator also giving talking points that we, the therapists have given him. And that's Hari Kandaboulou, who's great. But like, you know, then with the kid, the pre K in the elementary concept, we're teaching it through Whimsical World of Hedgehogs. That was Emmy nominated, by the way.
- [58:29]
Lisa
Oh my God, that's so cool.
- [58:30]
Dr. Dave Anderson
Which is really great.
- [58:31]
Lisa
Okay, well, I can put that in the show notes.
- [58:33]
Dr. Dave Anderson
Yes, you absolutely can.
- [58:34]
Lisa
And those are free tools.
- [58:35]
Dr. Dave Anderson
Those are free tools. All on our website, chamind.org, and the whole, the whole focus of them was like, you know, a parent may like go back to their kid and be like, from this, like, hey, I want to teach you about emotion monitoring. We're going to keep a log and we're going to keep it in our notes and we're going to like, do, you know, emotions and intensity and like, if your kid listens to you around that, that's great. I'm not even sure my kids would listen to me around that. But there's also the opportunity to like, say, here's a video that you can watch on it. It's six minutes. Like you watch it on your own time. And then we can engage in this activity maybe together.
- [59:07]
Lisa
And I wonder if we can also do this ourselves. Yeah, and that, that also gets in the water.
- [59:14]
Dr. Dave Anderson
These tools, every time we do parent coaching or you know, behavioral parent coaching, or we do, you know, parent consultation. It's like if we have parents look at their emotions throughout the week, there's a large number of things outside of even their children that might cause certain emotional states. And if we then look at their cognitions around self care, like, many parents will come back and be like, I don't deserve it, or like, you know, I don't feel like I have time for it, or it seems like it's one of those indulgent things that other parents can do who have disposable income and time and I don't. And then we'll say, like, okay, let's look at the smallest pocket of time you actually have, you know, yourself. And then they might say, well, there's no way of changing my thoughts. My reality is my reality. And we'll say, let's just take a look at that. And so again, we're just trying to help people realize that even the smallest nooks and crannies of life, we can apply these types of things.
- [60:07]
Lisa
I love it all and I really. It's so helpful.
- [60:23]
Dr. Dave Anderson
Please note that this episode may contain paid endorsements and advertisements for products and services.
- [60:28]
C
Individuals on the show may have a.
- [60:30]
Dr. Dave Anderson
Direct or indirect financial interest in products or services referred to in this episode.