Effective treatments, what are they? Two broad classes, psychotherapy and medication. Psychotherapy at this point in time across the various disorders, cognitive behavioral therapy is the most effective. There has been research study after research study, randomized controlled trials identifying this. And while there are certainly other types of psychotherapies that work for specific disorders. CBT is the one that across the myriad of disorders is the most effective. And another point for why it's so effective across a variety of disorders. Is that if someone says for example, receives kind of behavioral therapy for depression. And they're also experiencing anxiety or an eating problem. The things that they have learned and practiced and CBT for depression also help with anxiety and eating. And so one, it was not just those three but those are the three most significant ones for students. And so I will explain a little bit more about what CBT is and how it works. But it boils down to helping people identify kind of those unhealthy styles of thinking. Remember the whole the smiley face with the frowny face that I showed you before? And so helping people identify when they're saying things like I'm not good enough. I'm not smart enough to be able to identify those thoughts and replace them with something. That's a lot more healthy. Because you can imagine, well, I'll save that for a few spots, okay. >> Keeping us on the edge of our seats. >> I know, I know, I know. And then medication there are a variety of effective medications and like psychotherapy. They are somewhat effective. For some people they're extremely effective and for some people they might not work at all. And so it takes a very precise medication management. And I would recommend that people see psychiatrists or some extremely well-versed in the varieties of medications for these. But they can certainly be effective. And then we also know that there is some cases where the combination of psychotherapy and medication affords an even greater benefit. So now I want to describe CBT a little bit more since this is, well since I promised I would. Okay, the idea is that what we think can affect how we behave and how we feel. So if you can imagine your best friend saying you're not smart enough to be here. You don't belong here. You don't look good today. What'd you do to your hair? Would you like that person very much? >> No, absolutely not. [CROSSTALK] >> So if we would have this kind of self talk to ourselves. No, it feels terrible. And so this might then influence our emotions, making us feel sad, angry, what have you. And these might influence the way we behave. Here's the model again. Simply talking about the ambiguous situation typically associated with some kind of negative appraisal in the case of mental disorders. And so what we're doing is trying to retrain this piece and then it also focuses on a variety of behavioral techniques as well. Okay, so I did tell you that CPT is not the only psycho-therapy. It's one that I strongly recommend because I've been reading the literature for decades now. And it has a lot of empirical support, but there are others and that are particularly effective for depression. Including interpersonal therapy and behavioral activation and with different areas of emphasis for both. But you will see that all of these it's but identified or usually about eight sessions. At least 8 to 12 sessions is what we know to be kind of the optimal therapeutic dose. And there's a lot of variability in this at this is actually what's been identified through randomized controlled trials. So with any one individual that the length of time may differ. But when we're doing controlled trials, we have to have a standard dose across. So this is what's been identified dose wise to be effective, but for any one individual it might be a very different range. And then we had talked about access to treatment. And how you know less than one in four people are actually getting adequate treatment for a variety of reasons. Some of them being simple physical access to care, but also potentially some hesitancy and receiving care and Michael. I think you mentioned before about a variety of issues. And I kind of want to get your thoughts more as to why people might not be getting adequate treatment. In addition to known disparities toward access to treatment are like the. Let's say the typical student, typical college student who might experience some suffering. What are your thoughts as to whether people would be. >> I'm always astounded by the differences that people sometimes have in terms of physical problems and psychological difficulties. And so often I've come across people who when they're experiencing a psychological difficulty. That's not a difficulty. That's not a problem. That's just something that you pull yourself up and get through on your own. You don't get help from other people. There are messages that can be cultivated either within families and individual societies to write those things off. And if anything, it's a sign of weakness if you actually need help for something like that. >> Right, right, right. [CROSSTALK] >> When I think of these things, I think of them as one and the same, right? Michael's one year away from being a psychologist by the way, so his but yeah. No, I think that I feel that that is something that's kind of a pretty pervasive in our culture. Because this whole one must white-knuckle it through their difficulties and other to do anything else would be a weakness of some kind. And you don't see that with like, you have a sinus infection while you'll get over that just go through the pain. While yeah, have you noticed this? Is it specific? Is it like a silicon generational thing, is it a family-based thing? Is that like, you know? >> I don't know. I think it's a student. I could see it for both undergrads and graduate. And other types of students that you know, we sort of applaud pushing through our classes and pushing through projects. And so we sort of tend to generalize that to perhaps our mental health as well, yeah. >> Another thing I can think of is, you know with with mental illness people may not know as much. All right, when you're in a depressed staying compared to for example, say cancer you may think well, this will just go away. Why, why I'm busy I have so much to do. I don't have the time to do this, and maybe it'll just go away. It's a lack of information of knowing what actually may happen with this. Unfortunately, it doesn't go away. I wish it did. Sometimes it can but yeah, often it doesn't. >> Or even just an understanding of like, you know, you might look at those diagnostic criteria. And have a conception of what depression is that's more narrow than that list. So you might think of depression as you know, just low mood rather than if you're not enjoying things. That might not be something that you sort of grouped into your conception of depression. So you might not be able to self identify that within yourself. >> And then, outside of this obviously stigma against mental. I mean, that's kind of like feeding that internal dialogue that there's. It's weak to get treatment itself. >> Self stigma as well as actually institutional stigma. And I think that's it is a perception of stigma and there's actually a real stigma like. And research bears this out and likely due to faulty knowledge about it, yeah. I think people have experienced a great deal of fear with respect to mental health mental illness as proportionate fear. >> And then with access, you know psychotherapy depending on where you go can be very expensive. Getting the same quality of care within your price range can be very difficult. And all of a sudden we have groups of people that need this treatment. I meant but are eligible for cannot pay for it. Can't get to it. What do you do with that? >> And I think some of it is health policy. >> Yeah, and some of the people, you know, we're going back to those risk factors. Some of the people who are most likely to develop these things are those who may be low SES. Because with low SES may come more stress. [CROSSTALK] >> Absolutely, and food and security and all the various factors. >> All of those. >> Yeah, 100%. >> And then that's the group that also may have have more difficulty getting the treatment they need and absolutely quite a problem. >> Yeah, yeah. We could get into the the world of health and policy and access to health care for an entire other series of lectures. And these are all obviously extremely important the positive thing is since changing things are changing. >> They are improving, you know, I think this field what's interesting is relative to other fields. It's very much at its infancy still in terms of the research of what we know about how these things come about. And how we fix them. >> And when we can progress and we do know that there are some treatments that help. And you know 50 years ago, that was not known, right? So things are coming along. And one can now with some education and hopefully with the removal of some barriers to access to treatment. It does exist now, at least which is not something that was the case some decades ago. Okay so again, I wanted to end this segment identifying the appropriate place for intervention. And to really encourage people to look for specific clues of when this kind of normal experience of feeling bad or feeling sad or feeling anxious. Has turned the corner to being something that would be that would warrant intervention or treatment seeking. And so when you find yourselves, when anyone finds themselves getting into frequent arguments or withdrawing from loved ones. Or really experiencing difficulty with worker with school really encourage you to to seek treatment of some kind. And there are even multiple empirically supported self-help treatments for people who might have some hesitancy potentially. And I've heard students voicing concerns about the administration learning they're in treatment and so on and so on. In those cases, there are certainly a variety of self-help treatments. If someone seen just more private that are helpful. >> One thing about this that I think it could be interesting is not only looking into yourself. But looking to those around you looking to your friends. I think in some ways can only perpetuate stigma to not ask. As if asking if someone's okay isn't appropriate, because there's something wrong with that. When you see these things hmm, ask somebody maybe just check in. >> Yeah, that's excellent.