Podcast
The Psychology of It All
Hosted by Dr. Raymond Zakhari, NP · EN
Dr. Raymond Zakhari is a triple board certified (adult-adolescent, family, psychiatry) nurse practitioner and trained in sex therapy. He owns and operates a concierge men’s health medical Housecalls practice in Manhattan.
To learn more about his private practice log on to www.MetroMedicalDirect.com
16episodes
Episodes
Newest firstAll episodes
Why You Keep Repeating the Same Patterns: A New Model of the Mind
Apr 3000:10:12Tap to summarizeWhy do certain behaviors keep repeating—despite insight, treatment, and real effort to change?In this episode of The Psychology of It All, Dr. Raymond Zakhari breaks down a deeper model of human behavior that goes beyond traditional psychiatric diagnosis. You’ll learn how the Research Domain Criteria (RDoC) framework shifts our understanding of mental health from rigid labels to underlying brain and nervous system processes.From there, Dr. Zakhari introduces Imprinted Arousal Patterns (IAP)—a clinical framework that explains why patterns like anxiety, overworking, compulsive habits, and substance use persist and return under stress. Rather than viewing these behaviors as failures of willpower, IAP reframes them as learned nervous system loops designed to regulate internal states like stress, boredom, and emotional discomfort.Through clear, real-world examples, this episode explores:Why insight alone doesn’t stop repetitive behaviorsHow stress triggers relapse across different conditionsThe role of the nervous system in anxiety, addiction, and compulsive patternsWhy some people feel uncomfortable with stillness or calmWhat effective treatment should actually targetThis episode is essential listening for anyone interested in mental health, behavioral patterns, addiction, anxiety, trauma, and high-functioning burnout—especially those who feel “stuck” despite doing the right things.If you’ve ever wondered why you keep returning to the same habits—or why traditional approaches only partially work—this episode offers a more precise and clinically grounded explanation.For those interested in the full theoretical framework, see the original publication:Zakhari R. Imprinted Arousal Pattern (IAP): A Transdiagnostic Clinical Reasoning for Compulsive Behaviors. Journal of the American Psychiatric Nurses Association. Published online April 30, 2026.https://journals.sagepub.com/doi/10.1177/10783903261443980
Transcribe →Why We Can’t Just Stop: Process Addiction, Compulsive Behaviors, and the Hidden Function They Serve
Apr 700:19:35Tap to summarizeWhy do people keep repeating behaviors they know are harmful? In this episode, Dr. Raymond Zakhari explores process addiction and compulsive behaviors through a deeper, patient-centered lens. From gambling, pornography, and shopping to workaholism, chaotic relationships, and digital overuse, these patterns are often less about pleasure and more about emotional regulation, shame, familiarity, and nervous system conditioning. This episode explains why “just stop” rarely works, how compulsive behaviors can serve a hidden function, and why understanding that function is essential for real change.Mentioned in this episode:The classic Bob Newhart “Stop It” therapy sketch, a humorous reminder that compulsive and self-defeating behaviors rarely respond to simple commands or willpower alone: https://youtu.be/aAhA7KfbJgg?si=YJ4z2i9JPs2XtPij
Transcribe →Why ADHD should be diagnosed last
Mar 3100:15:07Tap to summarizeWhy does everything suddenly feel like ADHD?Difficulty focusing. Procrastination. Emotional overwhelm. Restlessness. Brain fog.Scroll through social media and you’ll find endless videos telling you these are signs of ADHD—or trauma, or anxiety. And for many people, those descriptions feel accurate.But here’s the problem:These symptoms overlap across multiple conditions.In this episode, we take a step back and examine what’s really going on.Because what looks like ADHD may actually be something else entirely:– chronic anxiety– trauma-driven hypervigilance– sleep deprivation– stress overload– or even learned patterns from family and relationshipsWe break down why ADHD, PTSD, and anxiety disorders can look nearly identical on the surface—and why getting the cause right matters more than matching a label.We also address a growing cultural shift:Diagnosis is no longer happening in the clinic—it’s happening online.Short-form content has made mental health more accessible, but it has also created a rise in what clinicians call “diagnosis shopping”—searching for the label that feels most validating rather than the one that best explains the symptoms.This episode explores:– Why ADHD should often be diagnosed last, not first– How psychiatric diagnosis is actually a process of exclusion– The difference between symptoms and causes– How anxiety can be learned and transmitted from parent to child—or even between partners– Why some children are labeled instead of the environment being examined– The confusion between “little t” stress and true trauma– How ACE scores are often misunderstood– And why building an identity around a diagnosis can make treatment more difficultWe also take an honest look at modern psychiatry:In a system built on short visits and high demand, treatment often becomes symptom-driven rather than cause-driven. Medication can help—but only when it’s targeting the right problem.At its core, this episode is about one idea:Symptoms are easy to recognize. Causes are much harder to identify.And good mental health care depends on understanding the difference.If you’ve ever wondered whether your diagnosis is actually correct—or if you’re treating the right problem—this episode will challenge the way you think about mental health.Key Takeaway:Psychiatric diagnoses are tools for treatment, not identities. The goal isn’t to collect labels—it’s to understand what’s actually driving your symptoms.Psychiatryhousecalls.com
Transcribe →When Therapy Makes Things Worse: The Hidden Situations Where Counseling Backfires
Mar 2400:16:26Tap to summarizeTherapy is often presented as the universal solution for relationship conflict, family tension, and personal struggles. But what happens when therapy itself becomes part of the problem?In this episode of The Psychology of It All, I explore the uncomfortable reality that counseling is not always helpful—and in certain situations it can actually make things worse. When the psychological conditions for real change are not present, therapy can become a performance, a battlefield, or even a shield that protects harmful behavior.We examine the hidden dynamics that can undermine couples therapy, family therapy, and even individual counseling. These include abusive relationships where therapy may increase risk, personality patterns that manipulate the therapeutic process, addiction that distorts accountability, and situations where one partner has already emotionally left the relationship.I also discuss a phenomenon many families quietly experience: pseudo-insight—when someone learns the language of therapy without changing their behavior. In these cases, therapy can unintentionally reinforce dysfunction instead of disrupting it.Finally, we look at a practical question many families face: when is it appropriate to include everyone in therapy, and when is it safer to work only with the members who are ready and able to participate constructively?This episode offers a clearer framework for recognizing when therapy can help—and when other boundaries or interventions may be necessary first.If you or someone in your family is navigating complex relationship dynamics, you can learn more about my clinical work and consultation services at:https://psychiatryhousecalls.comBecause sometimes the most important step in healing is recognizing when the usual advice doesn’t apply.
Transcribe →Borderline Personality Disorder in Relationships: Why You Feel Like You’re Walking on Eggshells
Mar 1700:21:24Tap to summarizeWhy do some relationships feel emotionally exhausting, unpredictable, and impossible to stabilize?In this episode of The Psychology of It All, we take a deep dive into Borderline Personality Disorder in relationships—a pattern that often leaves spouses, parents, friends, and coworkers feeling like they are constantly “walking on eggshells.”Borderline Personality Disorder (BPD) is frequently misunderstood and often misdiagnosed as bipolar disorder. But unlike bipolar disorder, BPD is typically triggered by interpersonal conflict, perceived rejection, and fear of abandonment, leading to rapid mood shifts, emotional volatility, and unstable relationships.In this episode we explore:• The 9 diagnostic traits of Borderline Personality Disorder• Why arguments often fall into the “Courtroom Trap”• How double-bind relationships make partners feel like nothing they do is right• How BPD differs from bipolar disorder• How trauma, attachment disruption, and imprinted arousal patterns may contribute to the disorder• What to do if you realize you are married to someone with BPD• How parents can recognize early warning signs in teenagersMost importantly, we discuss practical strategies for protecting your emotional stability, setting boundaries, and recognizing when professional treatment may be needed.If you or someone in your life is struggling with complex psychiatric symptoms or unstable relationship patterns, professional evaluation can help clarify what is really happening.Learn more about psychiatric evaluation and consultation:https://psychiatryhousecalls.com
Transcribe →When Therapy Makes Kids Worse: Why Building Capacity Matters More Than Teaching Feelings
Mar 1000:13:24Tap to summarizeTeen mental health is in crisis—but what if some of the solutions we’ve embraced are actually making things worse?In this episode, I unpack a surprising finding highlighted by Olga Khazan in The Atlantic: a school program that taught teenagers dialectical behavior therapy (DBT) skills resulted in worse mental-health outcomes and poorer relationships with parents compared with a standard health class.How could a respected therapy approach backfire when taught in schools?We explore an uncomfortable possibility: when psychological frameworks are applied universally to healthy teens, they can sometimes create iatrogenic effects—harm caused by the intervention itself.In this episode we discuss:• Why many well-intentioned youth programs—from D.A.R.E. to self-esteem curricula—have failed to deliver results• How teaching adolescents to constantly monitor their thoughts can unintentionally increase distress• The difference between resilience and psychological capacity• Why teenagers may need challenge, responsibility, and competence-building more than emotional analysis• Practical ways parents can help children develop the ability to handle stress, failure, and uncertaintyParents today are told their children are fragile and constantly at risk. But raising mentally healthy adults may depend on something different: building the capacity to carry the weight of life rather than trying to remove the weight altogether.This episode offers a practical framework for parents who want to support their children’s mental health without unintentionally undermining their strength.
Transcribe →Breaking the cycle of addictions
Aug 1500:09:51Tap to summarizeIn this powerful 10-minute episode, Dr. Raymond Zakhari, DNP, triple board-certified nurse practitioner and combat veteran, explores the hidden patterns of addiction that affect Manhattan's most successful professionals. From the ritual of unwinding after demanding days to the subtle progression of dependency, this episode reveals why high-achieving individuals are increasingly turning to alcohol, cannabis, gambling, and other escapes.Dr. Zakhari examines the alarming rise in substance use among professionals aged 35-50, particularly women, and how cultural normalization masks serious health risks. Beyond traditional substances, he addresses modern addictions including workaholism, digital dependency, and compulsive behaviors that serve as emotional anesthesia for stress, trauma, and unmet expectations.Drawing from his extensive clinical experience treating Manhattan executives, healthcare professionals, and entrepreneurs, Dr. Zakhari explains the neuroscience behind addiction, the real costs to health and performance, and evidence-based paths to recovery. He discusses personalized treatment approaches including medical detox, psychotherapy, and concierge-level care designed for busy professionals who value privacy and convenience.Whether you're questioning your own patterns, concerned about a colleague, or simply seeking to understand addiction in high-pressure environments, this episode offers hope, clarity, and practical next steps toward reclaiming control.Topics Covered:Rising addiction rates among high-achieving professionalsThe role of stress, trauma, and perfectionism in dependencyModern forms of addiction beyond alcohol and drugsNeuroscience of addiction and recoveryTreatment options for busy Manhattan professionalsBuilding sustainable recovery while maintaining career successAbout Dr. Raymond Zakhari: Clinical Professor at Hunter College CUNY, founder of Metro Medical Direct, and pioneer in concierge addiction treatment serving Manhattan's professional community.Resources: AddictionDetoxManhattan.com | Confidential consultations availableKeywords: #AddictionTreatment #ManhattanProfessionals #ExecutiveHealth #SubstanceAbuse #MentalHealth #Recovery #Detox #AddictionTherapy #ProfessionalBurnout #NYC
Transcribe →Depression as a survival skill
Jul 1700:17:34Tap to summarizeWhen Men Go Numb: Depression as a Survival ResponseIn this compelling episode, we unravel the hidden ways depression uniquely manifests in men—not as sadness, but as numbness, burnout, and emotional shutdown. Through expert insight and real-world examples, you'll discover how the male nervous system uses "functional freeze" as a deeply wired safety strategy.We explore the roots of this survival response in childhood environments, chronic stress, and modern pressures to perform, revealing why traditional approaches often miss the mark. The episode offers a fresh biopsychosocial perspective, highlighting male-specific symptoms like irritability, anger, perfectionism, and withdrawal.Listeners will learn:Why numbness is often a protective adaptation, not a personal failingHow perfectionism and emotional suppression develop as early defensesThe biological mechanisms behind "shutting down," including Polyvagal Theory and nervous system regulationPractical, body-based interventions—like breathwork, movement, and micro-acts of agency—that cut through shame and restore resilienceThe importance of trauma-informed, gender-sensitive care for menIf you or someone you know feels disconnected, exhausted, or stuck in a rut, this episode will help reframe depression as information—not weakness—and point the way toward healing and reconnection.
Transcribe →Tailoring the fit
Jun 1400:14:58Tap to summarize🧠 Episode Summary:In this episode of The Psychology of It All, Dr. Raymond Zakhari explores why psychiatric treatments work for some but not others. It’s not just about the medication—it’s about the person receiving it. Using clear analogies and real-world clinical examples, Dr. Zakhari demystifies the concepts of moderators, mediators, confounders, and biomarkers—revealing how these variables shape treatment outcomes in depression and beyond.You’ll learn:Why some patients respond well to antidepressants while others don’tHow early symptom changes can signal treatment effectivenessWhat to consider before adding or switching medicationsThe difference between mediators, moderators, and confoundersHow inflammation, trauma, and even patient preference can shift treatment successWhether you're a clinician, student, or curious patient—this episode will change how you think about what "works" in mental health care.📌 Referenced in This EpisodePsychiatryHouseCalls.com: Dr. Zakhari’s flagship concierge psychiatric practice, offering discreet, in-home or virtual mental health care for New Yorkers seeking tailored, relationship-based psychiatric care. Services include diagnosis, medication management, second opinions, and lifestyle psychiatry—all with full privacy.MetroMedicalDirect.com: A comprehensive concierge medical practice for men’s health, executive physicals, mental wellness, and primary care—brought to your doorstep. Ideal for ultra-busy professionals who want whole-person care without waiting rooms.AddictionDetoxManhattan.com: A focused detox and recovery support service for clients dealing with alcohol or substance use in the privacy of their own homes. Designed for high-functioning individuals needing discreet and structured intervention without inpatient rehab.🔖 Disclaimer:This episode is intended for educational purposes only and is not a substitute for personalized medical advice. Please consult your own healthcare provider before acting on any content you hear.
Transcribe →From Trials to Trust — Seeing Through the Fog of Psychiatric Research
Jun 400:22:03Tap to summarizeEpisode Title: From Trials to Trust — Seeing Through the Fog of Psychiatric ResearchPodcast: The Psychology of It AllHost: Dr. Raymond Zakhari, NPWhy do some medications seem to work in studies but fall short in real life? In this episode, Dr. Raymond Zakhari walks you through the hidden layers of psychiatric research—from p-values and placebo effects to Type I, II, and III errors. Learn how small design choices can distort big findings, how to tell the difference between statistical significance and clinical relevance, and why discontinuation doesn’t always mean relapse.You’ll also discover how to use AI tools like large language models (LLMs) to critically analyze research articles—without falling into the trap of solving the wrong problem well. Whether you’re a clinician, a student, or an informed patient, this episode will sharpen your eye for what the science really says—and what it doesn’t.Topics covered:How Type I, II, and III errors mislead treatment decisionsThe placebo/nocebo effect and therapeutic allianceWhy some study designs exaggerate drug effectivenessWhat p-values actually mean—and how they’re manipulatedA practical guide to using AI to review research with discernment
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