Episode 431: Pathological Demand Avoidance in Coaching & Persistent Depression

Welcome to another episode of the Hardcore Self Help Podcast with Dr. Robert Duff! In this Q&A episode, Dr. Duff tackles two insightful listener questions on very different but equally important mental health topics.

Question 1: Pathological Demand Avoidance (PDA) in Coaching

A listener working as an individual sports coach seeks advice on how to best support a talented but highly resistant student who displays signs of Pathological Demand Avoidance (PDA). Dr. Duff dives into:

What PDA is and how it manifests in individuals, particularly in relation to autism, ADHD, and other neurodivergent conditions.
The importance of reframing PDA as a high drive for autonomy rather than defiance.
Practical coaching strategies to work around demand avoidance, including collaborative goal setting, offering choices, and making training sessions more engaging and playful.
The significance of open-ended questions and genuine curiosity in understanding the root of a student's resistance.

Question 2: Chronic Low-Grade Depression (Persistent Depressive Disorder)

A listener describes their struggle with long-term, low-grade depression despite attempts with medication and therapy. Dr. Duff provides insights into:

Understanding Persistent Depressive Disorder (formerly known as dysthymia) and how it differs from episodic major depression.
Behavioral activation as a treatment approach, including strategies for identifying and engaging in potentially enjoyable activities despite a lack of motivation or pleasure.
The five-minute rule to help overcome resistance to activities.
Medication considerations, including alternatives like Wellbutrin (bupropion) and the combination drug Auvelity, which may have fewer side effects.
Non-medication treatments such as Transcranial Magnetic Stimulation (TMS) and ketamine therapy.
The importance of evaluating life circumstances to identify external contributors to chronic depression, such as hidden identity struggles or unsatisfying relationships.

Chapters

[00:00] Intro and updates on Dr. Duff's upcoming bipolar book [03:00] Question 1: Pathological Demand Avoidance (PDA) in coaching [12:00] Strategies for engaging students with PDA [14:00] Question 2: Chronic low-grade depression and treatment options [19:00] Behavioral activation and the five-minute rule [23:00] Medication alternatives and non-pharmacological treatments [27:00] Life circumstances and their role in persistent depression [28:00] Outro and listener support requests

Resources & Links

Dr. Duff's website: http://duffthepsych.com
Email your questions: duffthepsych@gmail.com
Follow Dr. Duff on Instagram: https://instagram.com/duffthepsych
Dr. Duff's book "Hardcore Self Help: F**k Depression": https://www.amazon.com/Hardcore-Self-Help-Depression/dp/B01J4H5A40
Previous episodes on TMS and ketamine treatments: http://duffthepsych.com/podcast
More on ketamine treatments: https://duffthepsych.com/ect-and-ketamine/

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431: Pathological Demand Avoidance & Persistent Low-Grade Depression