← The Neuro Experience
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- [00:00]
A
Habit is a behavior that's automated that really bypasses conscious control. And that's the key step. And in order to make something a habit, not only does it have to be routine, but after a while it becomes innate, where it's no longer left up to choice. In fact, I always say that choice is the enemy of habit. We make almost 30,000 choices a day. 200 of them are about food alone. And at the end of the day we're subject to decision fatigue. So the last thing you want is to have to make a good choice at the end of the night. What you want instead is for there to be a habit.
- [00:37]
B
Hi everyone, welcome back to the show. It's Louisa Nicola. I'm a neurophysiologist and human performance coach. I'm the founder of Neuro Athletics where our mission is to democratize brain health education so you can perform better, think faster and live longer. Today's guest is Dr. Sue Varma, a board certified psychiatrist in private practice in Manhattan. Dr. Varma was the first medical director treating first responders and civilians for ptsd, depression and anxiety at the World Trade Center Mental Health Program. She believes that physicians have a duty to not only take their patients from a state of dysfunction to function, but also from functional to optimal. So in today's episode we look at habits, what they are, what makes them, what breaks them, and then we take a wide lens and look into trauma. And I was super fascinated by Dr. Varma's eight pillars of practical optimism, which she details in her book that launches in stores worldwide on the 20th of February 2024. So this episode is really about self development and how understanding your brain can trick you into and also out of circumstances. Yes, that's right. I actually learned a lot during this episode. So if you're going through anything or have gone through any type of trauma in your past, then this is the episode that will teach you what, what that trauma means, how to process emotions and how to problem solve your way out of that trauma so you can create optimistic habits that last a lifetime. Dr. Varma is all about optimism and she teaches us how to become more optimistic. So if you haven't smashed the follow button on itunes, please go through and do so. If you're feeling super kind today, go through and also leave us a review. Feel free for now. Let's get into the episode. Sue, Dr. Varma, welcome to the show.
- [02:34]
A
Thank you. Thank you so much for having me. Great to see you.
- [02:37]
B
You're a Manhattan based psychiatrist, you work with everybody but you really specialize in Telling the world about habits. And I believe you've said that 80% of our health is built upon our habits.
- [02:52]
A
Yes. And, you know, that was so. Can be so freeing in a lot of ways in that a lot of times patients will say, or, you know, in general, people will say, there's nothing I can do. For example, I'm from a South Asian background, and something I hear a lot is people are like, oh, diabetes runs in my family, or, you know, insert here. Cholesterol lives in my family. Cancer is in my family. And while that might be true, and you might be not always at a higher risk of getting something at the end of the day, to realize that you have so much more agency than you think and that habits do not have to be super complicated and that there's also a mental health component to your habits, that your attitudes, your beliefs, behavior, your belief system, your emotions all affect your habits, and your habits impact your health. So if you really want to change your health, you really have to look upstream and be like, what's going on in my mind? What kind of thoughts am I carrying? What are the things that are bringing me down that are getting me in the way of executing on my habits?
- [03:48]
B
It's interesting because you, you're, you referred to something that I refer to, which is genetics versus epigenetics. I'm in the Alzheimer's disease space. And we know that we do have some, you know, there's around 30 genes involved in Alzheimer's disease, but really a lot of them are risk genes. There's probably three that are like 100 penetrant, but the rest are just risk genes like the Apoe 4. If you've, you know, you possess one copy or even two, it still doesn't mean you'll get Alzheimer's disease. It's really if you switch them on or off. And I guess it comes down to your habits which create your lifestyle. But I want to understand from your standpoint, now you're a medical doctor, you're a psychiatrist. Probably when you graduated, you probably didn't think. Or when you were going through residency, you probably didn't think that you'd be looking too much at habits and lifestyle, right?
- [04:41]
A
Yes. It's not really a big part. I mean, at least then I think things are changing. But for sure, nutrition, exercise, it was like a drop in the bucket, if it was a mention at all. And now I feel like there's so much more of appreciation about it. And yet, look, on one hand, we never want to dismiss how complicated somebody's Life is and the choices that they're making and how hard it is. So I don't want to be dismissive, because when you say to somebody, it's all about your habits, they feel invalidated, they feel dismissed, and they're like, oh, yeah, yeah, I know what I need to do, right? But even habits, there's. It's a behavioral science, right? So to understand what. Why is a person not able to execute on them so that they don't blame themselves, so that there's no shame or stigma or, like, morality, because even depression initially was like, oh, okay, you failed. It was like a character flaw. And now we're understanding, for example, like obesity as a disease, multifactorial. There's a lot that goes into it. There's a behavioral health component to it. There's a genetic component. There's epigenetic social variables and factors and your upbringing and access and, you know, poverty. And there's so many. You can't. It's so hard to tease apart the psycho and the social and the biological. But it's important to keep that entire framework in mind. And I love what you said about these genes might confer certain risk, but they don't determine your destiny. And we really need to keep that in mind.
- [06:08]
B
So then what is a habit? We've heard about the 10,000 hour rule, and we can talk about, evidently, neuroplasticity. But what, what, what is a habit?
- [06:18]
A
So habit is a behavior that's automated that really bypasses conscious control. And that's the key step. And in order to make something a habit, not only does it have to be routine, but after a while it becomes innate, where it's no longer left up to choice. In fact, I always say that choice is the enemy of habit. We make almost 30,000 choices a day. 200 of them are about food alone. And at the end of the day, we're subject to decision fatigue. So the last thing you want is to have to make a good choice at the end of the night. What you want instead is for there to be a habit. And when people say that there's something called bad habits, really, it's not about bad habits. It's about not having a habit in place really at all. It's about subjecting yourself to whim. I wake up in the morning, do I feel like working out? Do I feel. No, you have to bypass rational thought and subject it to habits. So habits are automated behaviors that kind of bypass conscious control.
- [07:22]
B
And do they control physiologically how we think and how we feel?
- [07:30]
A
Yeah, it's like, it's almost to a point where you don't allow yourself to think or feel. And that sounds so weird because in every other aspect of the work that I do, I say please think, please feel. We want you to feel, we want you to feel emotions. Except when there is something like we know that optimists, for example, have better habits from dental hygiene to mental hygiene and physical health. They're more likely to follow up with visits, they're more likely to invest in self care, they're less likely to smoke, more likely to exercise, they're more likely to wear their seatbelt when they're driving. So a lot of that goes outside of conscious control when you get into a car. For those that do wear seatbelts, that's the first thing they do. They're not thinking about how they feel. There's no rational thought or feeling involved. It's almost robotic. And I don't want you to be a robot in any aspect of your life except where the habits matter and where they're going to impact your health.
- [08:26]
B
So in creating habits, we kind of have to reverse engineer what we want, really, whether it's okay, are you optimizing for 20 pounds of fat loss, for example. So what do we, what are the habits that we have to put in place in order to get there? Is that what you're saying? So we have to just, we can't just wake up and just start to think about habits. We have to actually, it's got to become like a task, right? You have to sit down, you have to think about, yes, what habits do I need in order to achieve X, Y, Z goal? And they have to reverse engineer it. And then you just have to be deliberate at about these habits until they become, you know, you said against our conscious control, is that correct?
- [09:09]
A
Yes. And also like it's really helpful when you are developing a habit, plan to sit with someone and if you do have someone that you can do this with, but if not even on a piece of paper and, and do that reverse engineering and say, what is the goal and the outcome? Okay, if it's to lose 20 pounds of fat, for example, there's a million small things that are going to build up that are going to lead to that. And I know for most people the reason why they give up on their New Year's resolutions so quickly, the vast majority within the month of January, most by the second week of January, because it seems so overwhelming and so daunting and they haven't really thought through all of the steps as well as anticipating the obstacles and the challenges and the barriers. So let's say you're a mom, you have to look into is do I have child care? What would I do if I don't have it? For example? That's just one of many obstacles. Am I, is my boss going to keep me later at work and am I missing that 6pm yoga class? Or even better yet, I've signed up for a 6am yoga class so that I can meet with friends. Except I'm not a morning person and so if my weight loss is going to depend on me changing multiple habits, which is going to bed on time, waking up earlier, being chipper in the morning, that's not happening. So in order to be have a good habit or to develop a new one, you have to be extremely realistic and self aware.
- [10:33]
B
Oh yeah, it's a deliberate practice which is really, it's a really annoying because I've tried to develop new habits. So I was a, I was a triathlete and we, I used to wake up every morning. I never missed a day, seven days a week at 5am so now, wow. I'm just naturally the first thing I do in the morning. Gym gear on, off, whether I'm going for a run and still it's just a habit. I can't get out of it and I, well I feel like I can't but that's the only time that I train and I wouldn't have it any other way but a lot of people wake up and they, they prefer to just get to work and then work out in the afternoon. But for me it's so unconscious and if I don't do it it almost feels as if like I, like I'm sick or I haven't, it's. Something is missing from my life.
- [11:18]
A
Yes, yes, yes. And you know, it almost has to become non negotiable and I love that you're staring, sharing that because that is what a habit is at the end of the day it's non negotiable to the point where you feel very, very, very unsettled and it comes down to like a huge commitment that you're keeping to yourself. I know that for me if I don't get a workout in I feel really bad and this is something I have to work on in terms of self compassion and I talk about this, the importance of it so that you don't beat yourself up because let's say somebody, what is creating a new habit of let's say going to the, to work out Every day and they miss a day, they're going to feel there's going to be a lot of self loathing. It depends on the person, but often that self loathing, then also you, you fell off the horse and then you're so guilty, you just keep yourself down there instead of picking yourself back up. So for those people who are in the beginning of stages of developing the habit, that's another key component is what do you do when you have a setback and how do you deal with it? Because I know exactly what you're saying. That feeling of unsettled. I'm no triathlete, but for me, even a basic workout feels like I've done, I've accomplished something. I feel like I've productive. And that's what's the beauty of exercise and doing exercise in the morning or really anytime is you feel like you've won the day. Like there's that whole thing about making your bed in the morning. And for me, exercise fits in that. Because if I've done that, I feel like I've won and anything else is a bonus the rest of the day that I'm able to do so.
- [12:40]
B
Okay, so once we understand now, so you've mentioned habits are those behaviors beyond our conscious control. Now that we know that, then it sounds super simple, right? Okay. Get up, Jim. Like we, we put our habits down, but what, what stops us from actually doing the work each day? I'm sure you're going to bring in and we can talk about neurochemistry, we can talk about dopamine, because I'm sure dopamine and motivation play a role in this aspect. But what is it that's like stopping us? Is it procrastination or is it rumination or is it just laziness?
- [13:16]
A
Yes, yes.
- [13:17]
B
No.
- [13:17]
A
You know, lazy is such a loaded word. And you know, for some people, I did a show on a segment on the Today show about laziness. And there's like happy National Laziness Day. And I was like, I didn't know this was a thing. I didn't know this was a good thing. Right? To be celebrated. And I think what they meant is like, you know, for me, I call it leisure time. And I talk about this in the book where you're intentional about taking time off. That's different. That's not laziness to me, me like the definition, like the way we grew up understanding it is the negative connotation that you don't want to do the work, you don't have a good work. Ethic, that's kind of what's associated. So let's separate and say the definition of laziness. Let's say there's that the negative and then there's intentional leisure time of carving out for rest. But for a habit to happen, there has to be key conditions. And this is really important because, you know, in my undergraduate studies, I studied psychology and there was a lot of classes in like classical conditioning. And we look at how do you shape behavior? And positive reinforcement is such a big part of it. So the small wins along the way. Are you celebrating them? Are you patting yourself on the back? Are you giving yourself a small little prize? So if you're trying to lose weight, it's not going to be, you know, a scrumptious, like, you know, big ice cream gallon. But you might get a manicure, you might get a massage, you might buy yourself some new gym equipment or like really cute gear or whatever it is, golf clubs down the line if you lost the 20 pounds of the fat that you were aiming to, whatever it might be. But you have to have positive reinforcement along the way. You also have to be cued in to the, the, the high that you get and journal about it. If you have even on your phone, a notes app. And to write down what your mood was on a 1 to 10 scale. I always ask my patients, like, what's your mood today? And it's a very quick and dirty way to assess. But it's important if 10 is the best, one is the worst. That habit that you want to engage in, it could be workout. It could be simply like, maybe you want to write a book or you want to have a blog or a newsletter. How do you feel after 20 minutes of doing it? If you can just take a minute or whenever you finish to write down, I feel accomplished. And when you start to populate your spreadsheet or notes, 7 out of 10, 10 out of 10, you're like, oh my God, like you're giving yourself data points. Not just the weight loss, which is important too, to have accountability and kind of keep a track record, but the positive reinforcement and the dopamine and the mood boosted. And if you can do it with friends, even better because you'll have an association of like, oh my God, what a ball. And the time goes by and we know a very interesting study looked at, they took people and they're like, look at this incline, right? So you have to walk up, let's say it's 45 degrees or something that seems somewhat steep. And maybe you have to carry a bag. A person who's looking at it that they have to complete an arduous task by themselves is more likely to perceive that incline as steeper, as longer, as harder, and maybe even less likely to do it. Versus, hey, you and your buddy are going to approach this together, this complicated task. And that incline appeared less steep and less complicated and people are more likely to do it. We also know that when you go into addiction treatment, which many, many, many people keep falling and trying again, when you enter substance abuse treatment with a buddy, you're more likely to complete it and there's less relapse. So just maximizing and optimizing on basic things that we know about human behavior to leverage them to give you the best possible outcome and chances of winning and continue to stay winning.
- [16:41]
B
Yeah, I completely agree. I actually use this app called Day one. It's a journal app. And you know, you just open it and it's really great. And I do journal as well, like you know, with a pen and paper. But this is an app. If I'm just out, you know, you can just do this each day. I found it really effective. Now I know that, Yeah, I know that you were dealing as well with 911 post trauma patients and the word trauma ever since Even, you know, 911 and also 2020 Covid seems to be coming up a lot. I've been seeing it everywhere. I've been seeing it. You know, more books are being published on this word. I read a, a great book which is, I'm pretty sure you've, you've looked into it. The body keeps the score. Which to me, you know, in my humble opinion, I think the, the brain keeps the score because everything to, you know, it is mural first. It's not, it's not body first. But you know, the concept was really great. So can we just talk a bit about trauma? Because I think that that also plays into habits. I know that if I've been through anything and I've not been through 9 11, but you know, small, like trauma is different for everybody. Right? And.
- [17:54]
A
Yes, yes. And the level. Yeah, yes, exactly. And you know, I, I, this is just one way that I sort of look at it. And other people may have different ways, but you know, I, I like to sometimes break it down and somebody may say this is not helpful or I, I feel dismissed. But you know what, there's always going to be people who feel dismissed and not seen by something. And I'm trying to be more inclusive when I say this and that. There's the big T of trauma. The way that in psychiatry we write down a person who has experienced or witnessed a life threatening event and then they are met with fear, helplessness and horror. When they talk about in the dsm, which is just one way of conceptualizing mental health disorders. And some people have their issues with it and I do too. But let's just have it's, it's sometimes in, in any kind of medicine or science you need a shared language and you need to have a set of established criteria. So this is one criteria. And what they're talking about is usually life threatening events. Someone is held at gunpoint, you're burglarized, rape, assault, a variety of things. Now you can expand the definition to have sort of more chronic, longer standing conditions. Abuse, neglect, for sure. So there's the T of trauma, which the capital T I call, which is these life threatening events that are outside the realm of everyday human experience. And then there's the little T's. And this is just a terminology that I'm using, the everyday hassles in life and what determines little T and big T. I'm not going to ever argue with someone if they said, Dr. Varma, yeah, I lost my job, but that was big T for me. You know, that was, that was catastrophic. 100%. I'm not going to disagree. And I can understand why if, let's say someone is the breadwinner of the family, they're in debt, they needed that money to pay for surgery, whatever it might be, or that they were really struggling with a very difficult boss. I've had patients come to me to say like, I'm trying really hard, I've made the company tons of money, they will give me no accolades. I didn't get a bonus, I didn't get a raise. I'm having ptsd, post traumatic stress disorder related to my work environment. So it really is a very subjective definition. But the essence of trauma to me is where the word trauma, if I'm not mistaken, has a Greek root which means wound. And a lot of patients after 911 came to me and said, I feel broken, that there's a rupture. And what does that rupture in? It could be a rupture in your sense of self, your self efficacy, your agency, your ability to take care of yourself, your ability to be productive, member of society, to execute. It could be your self efficacy in the sense that your mental health feels broken or you feel as if you don't trust in the world and your morale is chipped. And I Can see that. Because a lot of times after a, let's say man made disasters, man made, you know, which 911 falls under terrorism. That's what it does. It's meant to really undermine your morale as a community that feels safe. Because after 9 11, people kept saying, how do I know this will never happen again? I don't feel safe. I don't want to leave my house. And I 100% get that. And when you're working with someone like that, sometimes you cannot disagree with them because no one expected it to happen. It happened. I can't tell them you're making it up. Just leave the house. Because a lot of people develop panic disorder and they didn't want to go on subways and buses. They were avoiding coming, coming downtown. So then the question chains. As a therapist, helping someone is, you're right, this can happen again tomorrow. But what's the utility in feeling this way? And that's the only best thing that I could come up with or heard, which is the utility in continuing to feel unsafe is that you don't leave your house. And then you're weighing the risks and the benefits. Because yes, the there can be a crane in New York City that falls on us, but does that mean we're gonna stay home for the rest of our lives? Right, so you're always balancing cost benefit of this. But at the end of the day, to me, trauma is a wound. It ruptures your faith and your belief in yourself, in your community and in the world.
- [21:57]
B
Yeah. And you, you mentioned big T, little T. So 911 is a definitely a big T. But what about a. I don't know, this may be a big T as well. Separation in a, you know, oh yeah, three, four, five year relationship or 20 year marriage. It can be very traumat to some people. Can be, you know, completely debilitating, can knock you off your knees, can make you, you know, not go to work, not go to the gym. Habits completely thrown out the window. But then you have to start to create habits. And this is obviously what my question is like. How do you start to create habits around that. Which is, okay, that happened. Now I need to move on. You know, how do you stop the ruminating thoughts and the obsession that comes right after a separation?
- [22:42]
A
Yes. And you know, Luis, I want to say that big T and little T, like they sometimes are on a continuum and on a spectrum and what might be small for one, it can be hugely devastating and debilitating for another person. So I really leave that up to the individual to decide. And tell me where that, what, what it felt like to them. And really that's what it comes down to is the level of impairment in functioning. So even if it's little or it's subjective or, you know, people could argue, is that little? Is it big? T, it doesn't matter. It's what ended up happening to the person. How did they perceive it? And if they were even in a two year relationship and somebody would be like, all right, well, I was in a 20 year relationship. Like, we're not doing grief comparison. We're not like, you know, that's not real. So I want to validate and normalize everyone's experience, even if it is to society small. So it really comes down to how it affected you and how it destabilized you. But you're 100% right that when the carpet is kind of pulled from underneath you, that's what it feels like, that something was taken away before it's time. Maybe you knew the relationship was going to end. Maybe you yourself were proactively thinking ways to fix it or maybe even to leave. But when something happens to you unexpectedly that you are not prepared for, that adds to the sense of trauma. When your worldview, and if your worldview was, we are a couple or I'm in a relationship and I'm not married.
- [24:06]
B
We'Re going to have kids, and then out of nowhere he's like, okay, we're done. Yeah.
- [24:11]
A
Yes. Yes. That is when, when something is kind of like when you love someone and you know they're ill and you know they're sick and you know they're dying and you're thinking, they've got two years to go, you know, and then next thing you know, three hours later, six hours later, it's like. And people will always minimize and diminish and be like, well, you know, there were red flags in the relationship. You know it wasn't going to last, or you knew the person was going to die. I mean, they were sick. Come on. Those signs were there. And it's like, it doesn't matter. Like, you're ready. You're. You're never ready to lo choose the things that you love and the people that you love. You're just not. It doesn't matter how prepared you should be. The reality is all of us engage in some level of healthy denial. And that healthy denial is necessary. If that means this person I love who is sick, I'm just going to put it out of my mind. They're going to live this troubled relationship. It'll work out. So healthy denial is necessary for us to move on with our lives, and it also is what keeps us from recognizing red flags. But I.
- [25:10]
B
Healthy denial, I've never heard of that word. And it's my new phrase, healthy denial. It can be input literally anywhere in life. Healthy denial, that I am not lifting heavy enough at the gym, but I'm, you know, saying to myself, it's okay, you're still doing the lifts. Healthy denial is my, my February word phrase.
- [25:32]
A
Please go for it, you know, and, and we need people to sometimes to push us. Like, like it keeps us going. And like, I, I've, like, worked long enough to say with people that, like, yes, we want to push them to change, and at the same time, we just want to get them to get out of bed in the morning. You know, it's like when you see the full spectrum and range of people really thriving. Like, the way that you're talking about, like, to be a triathlete, like, such discipline and, like, it's just next level what's involved. And I have so much admiration for the work that you do. And, and as being a scientist, you know, so personal and professional, I think it's amazing. And I also understand that there are people who are like, yeah, Doc, that's great. And, you know, I actually use this example, like, of triathlon. Like, for example, somebody's like, why do I need therapy? Why do I need medication? And that's a whole other conversation, you know, but it's. It's like teaching someone how to swim. Let's say they don't know the swimming component of. And they can't even keep their head above water to be able to appreciate the lessons that they're learning. So, you know, all of us might be at a different place in our journey, and that's when, you know you need more help than, you know, than just something you can do by yourself. But, yeah, healthy denial and getting relationships can absolutely. Relationship losses can absolutely be super traumatizing. And to your question about how do we get over them? You have to give yourself space, number one, to grieve the loss. And grieving is not just things that were taken away from you, things that you lost, but things you never had. So if you imagined a future with this person and you imagined that you were going to have kids or a family or you bet they were going to meet your family or any number of things, that's a loss. You have to give yourself space and time and be able to talk about it. And if it's not Going to be your friends. Because maybe your friends are like, listen, I didn't like that person for you to begin with. And, like, I don't. I don't. I don't want to give you space and time and energy for you to mourn the loss of someone who treated you so poorly, for example, that's when therapy comes in, because this is a neutral person who's like, I don't know. Go ahead, talk. And then they can also give you feedback and be like, you know what? I hear what you're saying. I'm sorry for your loss. And also, do you want to be able to look at the situation from a different light? And it's hard because I have helped countless women through breakups, and, you know, they will still hold on to the two or three positive aspects of the relationship, even though there were 90 other things that indicated that this person is not interested in changing. Let's say they didn't want to go to their own therapy. Let's say they didn't want to be able to learn how to communicate better. They weren't able to meet their needs. And I have, and I sometimes will ask, all right, tell me about the best parts of the relationship. And then they struggle. They're like, you know what? You're right. And at the same time, they're still devastated. So all of this can be true, that we can mourn the loss of someone who wasn't good for us. Yeah.
- [28:18]
B
You seem like the eternal optimist with everything that you've seen, though.
- [28:22]
A
What's.
- [28:23]
B
So your book is pretty much based on optimism. So I'm. I'm guessing that, you know, there is a part of you, after everything that you've seen, whether it's working with couples, whether it's going through relationship breakups or even trauma, and then creating new habits. There is an aspect of just being optimist. You know, what if. Because we all walk around in this what if zone, but I think most of us are what if? And then we turn to the negative. I mean, I know I do. I think, yes, maybe that's the brain's natural way. You know, our brain is built for one purpose, and that's to survive and reproduce as well. But we're always looking for the negative. Right? You know, but what if. And then we don't go to, what if my life can be like this? What if I can get a better job? Or just. We always go to. But what if I end up alone and I die alone? Or what if I do go out and the building blows up. Or what if I never get a job and I'm homeless? So you're an eternal optimist.
- [29:21]
A
And I would say I had to train myself to be that way. And it's, and it's, that's why it's called Practical Optimism, the book, because it's something you practice and it's also practical in the sense that it's tangible. So like there's multiple meanings and it's not something that comes to everybody naturally. Like there are, you know, a subset of people, maybe 25% of those optimists who are naturally, you know, very cheerful, glass half full types, we call these dispositional optimists. But what was so fascinating to me looking at the science, is that even these people, what optimism, the oxytocin receptor gene that might be associated with optimism, is really about skills and psychological resources and coping mechanisms. And as a cognitive behavioral therapist and psychiatrist, I was already doing a lot of this in my practice already and I was like, oh my God. I help patients who are going through difficult, challenging times in their lives. But the same tools and techniques and science based skills that I'm giving them to get out of the big T, right, can be applied to the little T, the everyday hassles, but also used to optimize people who are just feeling slightly stagnant or slightly bored. So optimism science shows these folks are healthier. They live on average 15 to 20% longer than the average population. Optimists have less heart disease, less strokes, less death. By all causes. Optimists make more money. They are more likely to get a promotion in the next year. They're more productive, they're five times more engaged at work. They're five times less likely to have burnout. I mean, the list goes on longer, stronger, healthier friendships, marriages, you name it. And so optimism, I feel like I came across a gold mine. It's like I was like, I cannot believe the science and I cannot believe that no one is talking about it. And I cannot believe that nobody has codified it. And that's what this book does. Practical Optimism gives you eight pillars and then under each pillar, boom, boom, boom. Yes, there's science, there's story and theories, but it immediately gives you, this is what you can do today. And so don't worry if optimism doesn't come to you naturally. And look, if you need treatment, you need to be in mental health therapy. The book is not going to replace that. Right? You still need to do that. And I can say that. And I feel proud that I can say that, because I know a lot of times people will say, this will cure you. And I'm like, no, if you have intergenerational trauma, you have a family history of depression, like, and you need to change. And I'm not going to say that diet is not a part of it. We know that there's a huge inflammatory, inflammatory component. But it really comes down to also building skills, no matter what your upbringing, no matter what your natural outlook is.
- [31:56]
B
Are you saying that eternal optimism is pretty much preventative medicine?
- [32:01]
A
Yes, absolutely. Optimism is preventative medicine. It's preventative, it's a treatment, it's a maintenance. So if there's one thing that you can do if you want to live longer, healthier, happier, wealthier, more productive life, practice optimism.
- [32:17]
B
So you mentioned, and you're doing this in your book, you've got eight pillars. Can we just give me the first three? Because I'm really, really interested and fascinated. And your book comes out on the 20th of February, right?
- [32:29]
A
Yes.
- [32:29]
B
Okay. Well, yes, we're not there yet because we're recording. It's the seventh, so I'm excited. I want to know the first three.
- [32:36]
A
Okay, so the first three. And there's no particular order. I mean, I've just put them in order because I think of it as starting with having a purpose. And it. It's. Think of it as an arc, the eight pillars. Starting with having a purpose and having an intention and being very deliberate about what you want to achieve. And sometimes this is about putting the cart before the horse. I know a lot of people who might be listening are saying, like, I don't know what my purpose is. And you know what? It's okay, your purpose 10 years ago may not be your purpose tomorrow. And if you can't find your purpose, it's your job to create it. So I give you hacks. Exercise science shows boosts a sense of purpose, whether it's the bdnf, the dopamine, all sorts of things that are increased, or just a sense of productivity. But there is a very direct link between exercise and purpose. So purpose can be big P, capital P, like, what's my purpose in life? Or it can be small. What's my purpose in this conversation, in this relationship, in this job? And then it talks about things like burnout in the workforce, like if you feel like you're stagnant, how to create a role remake or job crafting so that your 9 to 5 boring corporate job can suddenly have meaning and spice and excitement all over again. And if that doesn't work for you. How to pivot, how to become an entrepreneur. Like I go on in later chapters to give you very tangible tool sets to ask yourself, if you're looking for a pivot, how do you do that? And that's in the problem solving chapter. There's like 25 questions. So purpose is.
- [33:56]
B
The first pillar is number one. Okay, what's pillar number two?
- [33:59]
A
So pillar number two is processing emotions. And this is really important because I give people without medication, without medication. This whole book is written as if, you know people who need it, they're going to need it and it's going to be life saving and life changing for them. But like, this is when, when I meet patients I like, I want to maximally equip you because even medications, they take time to work, eight to 12 weeks. And then when you're off of them, either you can experience discontinuation and withdrawal or that your symptoms return. So not to say that they're not needed when they are, careful observation and conversation about risks and benefits and alternatives, all of that. But everything in this book is free for you to do and it's tangible and you can use it immediately. And there's no medications involved in the book. Like the book says, if you need it, you do it.
- [34:48]
B
You know, you say you and so many psychiatrists and therapists say, you know, you got to process your emotions. And to me, that is like, okay, what is, what does that mean? Do I have to write them out? Do I have to accept them? Do I like, I'm like an emotion? Like, I am sad, I am frustrated, I am mad. Like, what is actual processing emotions mean?
- [35:08]
A
Yeah. So I give people like very concrete steps on how to do that. Like, everything in this book is like, I'm not going to give you jargon, I'm going to walk you through it. So there's a quick exercise and I call this. Name it, claim it, tame it, and reframe it. And the naming part is whether it's like, what's the trigger? Right. Like a lot of times what I see is people are very busy and they're going throughout their whole day and they're like, I'm fine, I don't have any problem. Then their head hits the pillow and they cannot sleep. And I always say sleep is a window into your mental health because it'll tell you so much about yourself. So if that is when you start to ruminate, you're having racing thoughts, you're starting to think about your list for tomorrow, you're beating yourself Up. It really tells you, like, when your head hits, the head hits the pillow, you have unprocessed emotions from the day. Your dreams also say a lot, right? Like, if there's a lot of anger, if you're being chased, there's anxiety, unfulfilled needs. So, like, there's so many ways. Medical issues, autoimmune problems, headaches, irritable bowel, all of this can often be related to unprocessed emotions. So this is where I will say, like, the body communicates and speaks and expresses things that your mind cannot. And that's why if you feel like I've gone to tons of doctors and nobody knows what's going on with me, my stress levels are very high. I don't know how to manage it. Naming the trigger. What happened to you today? It's very simple. Keep 15 minutes. So journaling can be. Journaling is very effective. And we know that journaling people who do it on a regular basis have less common colds, infections, their immune system is boosted, they have less heart disease, lower blood pressure rates, like people who do this on the regular. So whether you want to just write about your day and how shitty it was great, or how great it was, who you're grateful for, I mean, you can do any number of things. But in this exercise, naming it, you write the trigger. You claim where you are feeling the emotions in your body. Is it clenched jaw? Is it tight shoulders, Is it tight fists? And then you're taming it. And then I give you any number of things you can do, whether it's mindful breathing, whether it is the journaling and then reframing. This is what I took away from my 911 work with trauma survivors is. And. And I had to go undergo a lot of training myself and. And bring in. We brought in experts from the. The VA who would work with military and past traumas. And we learned a lot. And then reframing was the biggest thing you can do is can you look at the same situation from a different position, from a different angle? And I'm not saying try to find the silver lining, because you're like, yeah, I was abused as a kid. I'm like, there is no silver lining in that. Like, not at all. And I never want to take that away from someone who's gone through something really dark and deep. And at the same time, talk about a situation where with some distance, are you able to have that compassion? I mean, that is the hardest thing to have compassion for someone who has wronged you. And I learned this from sort of like my eastern upbringing is someone. One of my older psychiatry mentor colleagues, she was like, I'm praying for my nasty asshole boss. I'm praying for him to get better so that he has more compassion in his heart so he can be a better person to me and all the people that work together. So there's so many ways to look at this same situation differently. It could be forgiveness, it could be writing a letter to someone that you never give them, but it's creating distance, Asking yourself, what would I tell a friend in this situation? What is another way of looking at it? How am I going to feel about this five years from now? So there's like, boom, boom, boom. I'm just lists upon lists and interactive exercises of, you don't have to be the helpless victim in your narrative. Like, if you want main character energy, this is what you need to do to bring yourself back front and center as the star of the show, not the person that bad things happen to them always. And that's what pessimism is about. Right. Pessimism is about feeling helpless, the victim, and then feeling paralyzed.
- [39:00]
B
Yeah. And powerless. Oh, God, that's amazing. Being the star of your own show. I. I remember. So one of the things that we do at Neuro athletics when we work with elite athletes is some of them, you would, you know, you wouldn't look at this from the outside, but some of our most elite NBA players still have performance anxiety on the court. And not being a psychiatrist, but, you know, one of the methods that we put in place is just write down what's the worst thing that can happen? You know, I don't make the jump shot. I. I make the team lose. And I keep making them go until I'm like, so death is not on there. They're like, no, I can't. You know, I don't think I can. You know, I'm like, okay, then we need to just, you know. So I don't know if that's, you know, board certified in any way, but that's. That's kind of. It reminds me of the same type of thing.
- [39:49]
A
Absolutely. And, you know, using humor is such a great way to, like, create a rapport and a bond with someone in that moment. And also I do the. I do something similar where when you make the person laugh and then not. You're not laughing at them, they're laughing. Right. But they're laughing at their anxiety and they're like, my God, this anxiety is really ridiculous. And if I gave it its way, it would take over My life and anxiety. I want to put you back in your corner. You are ridiculous. You are being irrational right now. And I heard this great video last night that I wanted to say with my kids because they're very big into basketball and they're doing quite well in it. And one of my. My son, older son, had a game and he really just was doing phenomenal. But. And he turned a corner in his. In his game and took it to the next level. And I saw this maturity of, you know, making a decision and wanting to really be the best and then proactively going out of his way. And I feel like that's important as a par. Let your kid kind of. You can't force it upon them. And I think that's the mistake that sometimes we make is that we want good things for them and we want to make them do things, but it really has to come from within. And I saved this Michael Jordan video where I thought it was so interesting. He's like, when I'm looking at the basket, I'm not thinking like you said about death. I'm thinking there's only one of two outcomes. I'm either going to get it and. Or I'm not. And if I don't, I'm going to be back here tomorrow. So I love that very simple logic of there's only two possible outcomes and death is not on them, like you said. So I love that.
- [41:17]
B
And so, okay, so wait, wait, that's. The first is so processing emotions. What's the third one?
- [41:22]
A
Yes, so the third one in the list in that chronological order is problem solving. But. And that's where if you're pivoting, but like, you know, that's very concrete in the sense that what I love about that chapter is. And that pillar is it tells you that at any given moment we are contending with a battle on two fronts. There is a battle in the outside world, and that's when we were talking about practicing healthy habits. That's actually the last pillar. So I'm glad that we knocked that one out of the way. But when you're practicing healthy habits or anything you want to execute in your life that requires an action plan, you have to recognize that there's obstacles that have to be accounted for in the outside world. And that pillar helps you do that and also that there's obstacles going on in your own mind of the rumination. I can't do this. I'm a failure. So in this chapter, we talk about how to manage your emotions one step further. So emotional Processing was like, okay, I'm going to name it, I'm going to claim it, I'm going to be aware of it, I'm going to be mindful. And problem solving is like, how do I manage my emotions on a regular basis? And gives you a variety of techniques to do that. But then Also I have 25 questions you ask yourself. So I was, I often get people in my practice who are like, I'm doing this, but this job is boring the heck out of me. Or I'm a mom and I've taken five or 10 years or 15 years off from my career and now I want to go back into the workforce. But I need a flexible lifestyle. I can't be beholden to other people, like corporate culture. Like, I want to work from home, I want to be my own boss. So I give you those questions to ask yourself. Okay, if money wasn't a factor, what would you do? If not saying that people shouldn't get paid what they deserve, but what would you do for free? What lightens you up? So it gives you a series of, of, okay, how would you do that? So just very practical, tangible. Like if you had a life coach working with you, how would you implement a plan today? Because I feel like it's so easy to, to make excuses and for things to put off. I don't have this, I'm not this. So then it builds on there. And just to tell you real quick, you know, self efficacy is one of the pillars. It tells you how to do that. Self compassion is one of them. I give you an exercise. I talk about the science of how after failure, if you can do this one five minute quick exercise based on the work of Dr. Kristin Neff. Boom, boom, boom. This is what you do to change the outcome when you try again. How to be present in the digital age and all the factors that are stripping us of our energy. And it's not just our phones, it's also our comparisons to other people. The list goes on. Then I talk about people. That's one of the pillars, how to form and maintain meaningful relationships. So there's the superficial social snacking, which believe it or not, I am a huge fan of for its own benefit.
- [44:05]
B
Social snacking. Sss.
- [44:10]
A
What's that? You're like me. Yeah, so I love my acronym. Yes, me too. I mean it's how you get through like with science. I remember in medical school learning. So the micro connections are all these built in layers of connection that we had throughout the day that got lost during the pandemic. So the barista, the dog walker, the grocery store clerk, assuming you do your shopping or anything outside in the world, and all of this is getting lost because we are just clicking and you can order a person to your apartment, you can order food to your apartment. Amazon, right? Like, no one ever needs to leave their house. The downside of that is that you're then losing momentary opportunities for connection that, and I say really try to build them back in. So if you're someone who works, works from home, and maybe you shop and do everything online. If you are leaving your house and you're in your elevator, if you live in a building, make eye contact with the neighbor, say hello. Ask them how their day went. And I know that sounds so weird to people especially. I feel like younger generations, they're like, even my kids, they'll be like, mom, stop being a stalker. Like, I'm like, I'm not being a stalker. I'm just, like, talking. I'm saying hello.
- [45:16]
B
That is so profound and so many people discourage it. But let me tell you before, you know, in 2020, prior to shutdown, I was working in neurology. I was working in a. Seeing patients. I was. It was just. I was seeing people day to day, getting on the subway. And then I, you know, took 2020 off, obviously during the pandemic. And then I'm now just started working for myself as a 2021. And I realized that, like, I would go days without having human contact. So then I started going, you know, right now I go to a coffee shop. And then I've met two, like, income, incredible friends who are now my friends. But I make it a habit every day. I'm like, if I don't have human contact today, like, I will cry. Like, it's absolutely ridiculous. Like, I need. Like, I just can't believe I have to actually say to myself, okay, I have to go. And, you know, sometimes my mom, who lives in Australia, she'll call me. She's like. She's like, are you, like, working? Like, what do you do with your life? You're always at a coffee shop. I'm like, no, I'm. It's actually called human contact. Because if I don't, I will just. Just be crazy.
- [46:20]
A
Oh, my God, 100. I so love that you value and appreciate that, because a lot of people don't. Or that they're so afraid. Like, you know, it's. I talk about loneliness and I'm a big proponent. Like, we know all about the helps.
- [46:31]
B
Yeah.
- [46:32]
A
And the risks associated with them. Morbidity mortality. It's like smoking 15 cigarettes a day. It's worse than sedentary living. I mean it's horrible. And nobody wants to admit that they're lonely. And I feel like we, I mean we know right from the numbers that we are going through as a society a loneliness crisis. You have the, you know, Gen Z and the greatest generation are most at risk for it, but so are like middle aged moms in their 40s because they've, they don't have that built in connection through their young children's school anymore. Their kids are older, they're not necessarily communicating with the parents. A lot of these women have lost their childhood friendships because they've lost touch. They prioritized family and raising their kids and having a job. So it's, there's a hundred. We don't live in the same communities. You've moved from Australia like every think we've lost those like natural neighborhood connections and being a digital nomad. I mean there's a variety of reasons. And you know, I talk about this in the four M's of mental health. If, if people want to take take away nothing else from our conversation today, these are four science backed habits that you should incorporate in your schedule every day, five to 10 minutes and meaningful engagement is one of them. So I love that you have this, this, these coffee shop friendships and like that's, that's, that's it. Could, it could have started from the social snacking where you're just turning to a person, anyone sitting next to you and making small talk. It's going to your yoga class or your exercise class and talking. I talk to everybody everywhere. Like not 100. I talked to my Uber drivers. I know people think I'm crazy. Actually when I was on Max's, that's.
- [48:01]
B
My worst fear actually talking to Uber drivers.
- [48:05]
A
Yeah, I mean look, safety first, right? So like I'm not at all like as a woman, you have to. In New York, if you're in a new city and you're traveling people, people will think I'm crazy. But the joke was when I was sharing this, he was like, oh, do you. What is your Uber driver rating? And I was like that's so funny. Like how, how high do they rate you? And I mean they often will talk and now you can actually put it. I, I'm realizing the settings where you can choose a quiet car. And I was like, yes you can. Oh my God. So I love that. Yeah, so that means no music and also no talking. So you know, I was recently in la And I was like, I can't talk. Like, I have a million emails in this, going from podcast to podcast. I have 30 minutes in between and I need to respond to my phone. So then in those moments, I had to say to the Uber driver, like, I'm so sorry, do you mind? Like, I can't really respond to you because I feel like people are just like, hey, where you from? What are you in town for? What's going on? And I have to, you know, I hate to do that, but I feel like you do need to have your. Sometimes your boundaries, but wherever possible, when it's safe, when you don't feel like it's compromising your safety, your integrity to make conversation. And going to that exercise class 10 or 15 minutes before and looking at the people next to you, and if you recognize a face, face, smiling. And people don't realize it's not that complicated to build friendship. Like, let's say you've moved to a new city and you see the same people before your yoga class asking them a simple question. As you know, do you. Who is your favorite instructor in this studio? Do you always come to this class? What do you think the differences are? I'm naturally a curious person, so, like, a lot of questions will come to my mind and I'm not recognizing that some of it might be facilitating a friendship. Then you can, if you feel comfortable, share something personal. Oh, my God, I've just moved here. I've never come to this yoga studio before. I saw this woman wearing a fabulous outfit and I was like, where is it from? And she's like, oh, it's from, you know, wherever. So there's so many ways, you know, genuine compliment following up on, asking questions. Like, you mentioned this last time, like, let's say somebody was in a cast in one of the classes. The next time, they're not being like, how are you doing? Like, it's just so obvious, these opportunities, but we don't take them. We don't take them because we're like, number one. They're going to think we're crazy. And studies have shown that strangers actually really like connection with you more than you think. There's something called a liking gap, where people assume that you like them a little bit less and that there's a mismatch. And we find out that both people actually like each other better than they thought they would to strangers. So there's like a million reasons why you should talk to people for the health benefits. But I love what you said, and I'm like that where I think schedule it, you know, these four M's, meaningful connection, mastery, mindfulness and movement. I schedule them as if my life depends on them. Because really our life does like the quality of our life depends on the quality of our relationships. And we know that when we look at women and men in their 40s and 50s, the one of the single biggest predictors of course their habits when about what are you going to predict what their life is going to look like in their 70s and 80s? It's looking at the quality of their friendships.
- [51:03]
B
Oh, I love that. I, I have loved this podcast so much and I'm so excited for everybody to read your book. Just remind me, is it on pre sale? Can people purchase it? Is it going to be available on Amazon?
- [51:15]
A
Yes.
- [51:15]
B
So all of the above. We're going to link it below.
- [51:17]
A
All of the yes, all of the other. Practical Optimism is available for pre sale now and you get the first chapter if you order it on pre sale. Now I have on my instagram which is Dr. Sue Varma the word Dr. D O C I T O R Sue S U E Varma V A R M A on Instagram a link to the pre order incentive. So if you're listening to this before the February 20th, you can download the first chapter for free as well as this quiz that asks you to rate, you know, how much of a practical optimist are you and which of these eight pillars you may want to pay more attention to. And after February 20, the book is available everywhere. Books are sold, Amazon and really at Barnes and Nobles. You know, you name it, it's, and it's, it's out there and it's being translated in seven or more languages and it's not even out in English yet. So I'm so excited that people in can read this in Chinese and Turkish and Spanish and Arabic. So it's, it's Korean. Very, very exciting.
- [52:12]
B
Oh, congratulations. That is such a milestone and I, I honestly think that everybody needs to see someone in terms of whether it's a psychiatrist, therapist, life coach. I think everyone, especially in our day and age, everyone can definitely benefit from it. But now we have your book. So Dr. Sue Varma, thank you so much for being part of the neuro experience.
- [52:34]
A
Thank you so much. Thank you for having me. What a great conversation and I learned a lot from you too, so thank you.