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Cognitive Control, Emotion Regulation, and the Psychophysiology of Anxiety w/ Dr. Jason Moser
11 Plays1 month ago
n this episode, I sit down with Dr. Jason Moser, professor of psychology and neuroscience at Michigan State University and director of the Clinical Psychophysiology Lab, to explore what the brain’s response to errors, emotions, and internal conflict reveals about mental health. Dr. Moser’s groundbreaking research on cognitive control, anxiety, emotion regulation, and resilience sheds light on why some people struggle more with worry and perfectionism—and how simple tools like journaling, mindfulness, and even belief in placebo can help us manage emotional challenges. From neural biomarkers like the ERN and LPP to personalized, low-cost interventions, we dive into the science that connects our brains to our behavior, and what it means for creating a more compassionate, adaptive approach to mental health.
Dr. Jason Moser is a professor of psychology and neuroscience at Michigan State University and the director of the Clinical Psychophysiology Lab. His research investigates the intersection of emotion, cognition, and behavior, with a focus on anxiety, resilience, and how the brain monitors mistakes and regulates emotion. He is widely recognized for his work on neural markers like the ERN and LPP, and has pioneered research translating laboratory findings into practical, scalable tools to improve mental health. His work has been featured in Scientific Reports, Nature Communications, Psychophysiology, and mainstream media outlets like VICE, Yahoo Life, and PBS KIDS.
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Transcript
Interplay of Emotion, Cognition, and Behavior
00:00:00
Tony Montgomery
right, today we have on Dr. Jason Moser, who's a professor of psychology and neuroscience at Michigan State University and the director of the clinical psychophysiology lab.
00:00:11
Tony Montgomery
um The lab centers on the interplay between emotion, cognition and behavior in the context of mental health, especially focusing on anxiety and depression. Jason, thanks for coming on the show.
00:00:23
Jason Moser
Absolutely, thanks for having me. Excited to be here.
00:00:26
Tony Montgomery
No, yeah, i appreciate that. Like we were just saying, our work kind of overlaps with with what we're doing. So I'm excited to um pick your brain a little bit about the emotion regulation strategies that you're using and what kind of like the the future of your of your work and and what that entails as well.
00:00:32
Jason Moser
Thank you.
00:00:41
Tony Montgomery
um One of the things that um you kind of built a lot of your um kind of reputation on is this idea of cognitive control and, and how people can utilize that as far as like self regulatory abilities of, um, being able to, ah control the things that they focus on and, um, how that relates to anxiety and the way that you, you measure it.
00:00:52
Jason Moser
and
00:01:05
Tony Montgomery
Um, so would you mind kind of giving a quick breakdown of, um, what exactly cognitive control is and then how you guys measure it in your lab and like, what are some of the things that you're finding? um with with the cognitive control research that you're doing.
00:01:19
Jason Moser
Yeah. So, you know, I started off really interested, you know, specifically in cognitive control around mistakes. And so that was a lot of where I entered the conversation about cognitive control and how that might be affected by emotion and then how that might tell us something interesting about anxiety and depression and maybe even tell us something about how we might treat anxiety and depression in particular ways.
00:01:42
Jason Moser
um And so really, for me, where I started was very much like cognitive control is about, you know, how well in a situation where the goals and demands are pretty clear, how well are you able to stay focused on those goals and demands of the task at hand?
00:02:00
Jason Moser
um and continue to pursue those goals and and meet the kind of parameters of the task over some sustained period of time. And if things go awry, if you make a mistake or you get distracted for some reason, maybe it's because the experiment is actually rigged that way on purpose to distract you or to present stimuli that are a little conflicting, like we often use the flanker task.
00:02:24
Jason Moser
And we've used the arrow flanker task. We've used versions of it that use letters as well, where we're trying to show people, you know, multiple competing stimuli that pull for opposing responses.
00:02:36
Jason Moser
And what happens when you're asked to really focus your attention, stay on task, meaning focus, respond to whatever you see in the middle of the screen and don't worry about other things on the screen that up appear in the periphery or maybe somewhere else in in your in your view.
00:02:51
Jason Moser
How well are you able to resist that distraction, stay focused on the task, respond as we're asking you to. And if you can't and you lap and your attention lapses or you and you make a mistake, how well do you bounce back?
00:03:03
Jason Moser
How well do you re-engage in a way cognitive control, kind of reactivate those goals, those task parameters, those instructions to then perform the task as we've asked you to, which is usually do it correctly and do it quickly.
00:03:16
Jason Moser
And so that's really where I started was just like cognitive control is about how well you can kind of stick to the the task at hand. And when you do lapse, how well do you rebound and get back on on track?
00:03:30
Jason Moser
um So i don't know if you wanted to follow up on that, but...
00:03:33
Tony Montgomery
Yeah, so um besides the the task at hand, how are you measuring, you guys use EEG, correct? And um how are you measuring the relevancy of um whether the task had a negative impact or a positive impact?
00:03:40
Jason Moser
Right.
00:03:48
Tony Montgomery
You guys use things like the error-related negativity spikes within EEG.
00:03:53
Jason Moser
Right.
00:03:53
Tony Montgomery
Can you kind of go over those differences and like what that tells us when the person is making that and kind of quantify that with the actual um mistakes that they are making.
00:04:05
Jason Moser
Yeah, so, you know, with these simple, they're simple two choice reaction time tasks that are speeded. So we're asking people to, hey, the the target, the thing you're supposed to pay attention to is in the middle of the screen.
00:04:16
Jason Moser
And sometimes you're going to see stuff in your periphery, you don't really have to pay attention to that. So really focus your attention on the middle of the screen. And obviously when you have things in the periphery that are that are pulling for the exact opposite response, let's say, you know, the thing in the middle of the screen is is you've been you've been given an instruction that that means you should press the left mouse button.
00:04:37
Jason Moser
um And then we present things in the periphery that pull for a response with the right mouse button. um And then you get distracted and you press the right mouse button instead of the left one, you've made a mistake.
00:04:49
Jason Moser
So the first thing we do is we record their accuracy and their reaction time. And what normally happens in these sort of two choice speeded reaction time tasks is when you give people kind of conflicting information where one stimulus asks them to press one button and the other stimulus asks them to press the exact opposite button or a different button, you see people slow down and they make more mistakes on those types of trials.
00:05:14
Jason Moser
And so cognitive control is basically measured from person to person in a way, like how good your cognitive control is, is how much do you have to slow down to stay focused on the on the target in the middle of the screen. If you have to slow down a lot, that means maybe you don't have with the greatest cognitive control and you're distractible.
00:05:32
Jason Moser
And on those sorts of trials where there's this ah distracting information, do you make more mistakes than the average person? you know um And if you make more mistakes, then again, it seems like you're distractible and you don't have the best cognitive control.
00:05:46
Jason Moser
And then what we're also able to see, so accuracy and and reaction time are handy in and of themselves. And then we record a lot of EEG. And in the EEG, we look a lot at The error-related negativity is how much does your brain kind of reboot you in a way after the mistake. So after you press a button that's wrong, your brain generates this automatic little blip in the EEG signal that we can see.
00:06:09
Jason Moser
that shows up at like the front of the head. We think it comes from the anterior cingulate cortex, which is ah the ACC, which is a pretty big component of the kind of cognitive control system in the brain.
00:06:21
Jason Moser
And what it does is it kind of signals that something's gone awry. We need to um re-engage attention. We need to re-engage in the task. So that we can get back on track.
00:06:32
Jason Moser
And what we've seen with the kind of magnitude of the error related negativity or the ERN is, you know, kind of the bigger it is, the more cognitive control generally a person has, the smaller it is, it seems that the person has less cognitive control.
00:06:45
Jason Moser
And so what's been really interesting for me in terms of like, okay, well, what might that tell us about anxiety, which has kind of been this long-term 20-something year now love-hate relationship with this little brain blip is, you know what is it actually telling me about anxiety? Because what has been found over the years in other people's research, and we've done a lot of this research as well, is that anxious people, people with anxiety disorders, people with OCD, obsessive compulsive disorder,
00:07:13
Jason Moser
tend to have bigger ones of these yeah ERNs. They also tend to be more distractible and a little slower, not necessarily always more error prone on these kind of conflicting trials, but they tend to be a little slower um and they have this bigger yeah ERN. So it seems like the cognitive control in anxiety and OCD is kind of confounding in a way because they have this big ERN, which suggests maybe they don't have the best, you know, maybe they have really good cognitive control actually, but their, their behavior tells us a different story, which is, well, maybe they actually don't have great cognitive control because they're also distractible.
00:07:50
Jason Moser
And it's really that kind of paradox that I've been obsessed with for a very long time, not in an OCV way.
00:07:55
Tony Montgomery
Yeah.
00:07:56
Jason Moser
Um, but, um, I've been really, really fascinated by that's really been kind of my entry point into just trying to really unpack what is it about cognition, emotion, how they interact with each other, how they affect each other and what that tells us about anxiety and its treatment. So it's like that conundrum that I unpacked over the past 10 or so years of like, why do folks with anxiety have kind of a bigger yeah ERN, which suggests maybe they have more cognitive control, but their behavior suggests that they have poorer cognitive control.
00:08:26
Tony Montgomery
Yeah. And that goes to the idea that these, these disorders are more complex than the singular brain regions that we're looking at, right?
00:08:33
Jason Moser
Right.
00:08:33
Tony Montgomery
Like the whole mono mean hypothesis of serotonin being the biggest driver, right?
00:08:37
Jason Moser
Sure.
00:08:38
Tony Montgomery
So it definitely, so within this paradox, what, what have you, what have you hypothesized of to maybe why, why this exists and, and what do you think it's connected to?
00:08:49
Tony Montgomery
um
00:08:50
Jason Moser
Yeah.
Cognitive Control in Anxiety
00:08:51
Jason Moser
So, I mean, at the, at first, a lot of people were just kind of like not thinking a ton about cognitive control with relationship to this, um, big ERN and anxiety. They were actually saying, oh, this big ERN and anxiety must mean that people with anxiety are afraid of mistakes because it kind of like intuitively makes sense. Oh, people with anxiety are afraid of bad things happening.
00:09:12
Jason Moser
When you ask them to engage in a task in the lab, a bad thing that could happen is they could make a mistake. you know They're kind of perfectionistic maybe, and that's why they have this bigger e bigger yeah ERN, but it was never really interpreted in the context of actually a much larger literature that's been out there for even more decades, um mostly mostly kind of pioneered by Mike Isink over in London,
00:09:36
Jason Moser
who's observed for many, many years that there is, again, this kind of paradox where if you just have behavioral data, it appears that folks with anxiety are slower at tasks, but not more error prone, which is kind of a, you know, it's again, kind of a um ah question mark is like, well what's that about?
00:09:56
Jason Moser
um But you know I'm a clinical psychologist as well, and I know the kind of top accommodation that anxious students get is more time.
00:10:07
Tony Montgomery
Mm-hmm.
00:10:07
Jason Moser
anxiety does distract us. And so there were a bunch of studies that, so while I'm kind of thinking about cognitive control more broadly and how it relates to anxiety, other people were kind of stuck on this. The ERN means that people are afraid of mistakes.
00:10:23
Jason Moser
And I was kind of like a little on the fence about that because there are a bunch of other data that don't quite fit that narrative. One in particular was my actual master's thesis, which is my first project I did when I was a graduate student at the University of Delaware in 2010, you know, eons ago.
00:10:39
Jason Moser
And what we tried to do is we tried to scare undergraduates who have spider who had spider phobia, in the lab and we recorded their yeah ERN while they performed a flanker task while I hung out in the room with them with a tarantula in my hands walking it through.
00:10:54
Jason Moser
So I had to get over my fear of spiders first, but I did that for half of the experiment.
00:10:56
Tony Montgomery
Yeah.
00:10:58
Jason Moser
The other half of the experiment, I used a Koosh ball and just like walked it on my hands if anybody knows what the heck a Koosh ball is anymore, but it's like this rubbery, um hairy looking thing that was, you know, fun kind of fidget toy.
00:11:10
Jason Moser
um So they'll look kind of like those stringy fidgets now that people have. um But anyway, what we figured was, hey, let's let's induce fear in these undergrads with spider phobia. And if that fear kind of translates or um migrates to their fear of mistakes, then we should have a bigger ERN in these undergrads with spider phobia while they're scared with the tarantula in the room versus when the we're just playing with the Koosh ball.
00:11:36
Jason Moser
And of course that didn't pan out at all. Instead, what we found more was they were just more distracted and they weren't paying as close attention to the flanker task when I was in there with this spider who we called Lavern, L-A-V-E-R-N.
00:11:49
Jason Moser
Um, and they were more distracted, but they actually didn't perform much differently. And their yeah ah ERN was kind of like, was completely unaffected. Um, there were some other brain potentials that were smaller, some attention brain potentials that suggested they weren't paying as much attention.
00:12:03
Jason Moser
Um, but that was like one piece of evidence, like, well, it's maybe it's not about anxiety. And there are a number of other findings that don't quite line up, you know, in terms of when you make, um, Error is more costly, let's say, in a task by incentivizing them with points or money.
00:12:19
Jason Moser
Folks with anxiety don't have even bigger and bigger ERNs, which you might expect if they're afraid of mistakes, they should be afraid of mistakes that are more important or more costly. And that doesn't really seem to pan out. So I have basically kind of jumped over to Mike Isink and his group. We just actually wrote a review paper that just came out kind of speaking to how the yeah ERN fits in their broader narrative about the cognitive control deficits and anxiety broadly.
00:12:45
Jason Moser
which is what I think is actually going on. And this has kind of, again, led to a number of other kind of discoveries and ways of interpreting kind of cognitive control and emotion regulation and how hard that is for people with anxiety and depression and OCD and trauma is that what's happening actually in these silly little tasks in the lab is folks with anxiety come in and they're pretty motivated to perform well, but they also have distracting anxious thoughts that are likely banging around in there. They worry about how they're doing. They worry about whether they got a good grade.
00:13:19
Jason Moser
They're worried about finances, maybe whatever it is, but they come to the task kind of already dual tasking by having their head filled with all these worries. And for the most part, they can stay focused. And what I think proposed, which was kind of the key to the whole, the whole kind of conundrum was why would it be that if anxious people are more distracted by things in their head, why would they actually like be pretty good at tasks, maybe slower, but not error prone, not like really bad at tasks, is that we know plenty of, I'm sure you know plenty of these people as I do, we know a lot of overachieving anxious people out there.
00:13:55
Tony Montgomery
Mm-hmm.
00:13:56
Jason Moser
So what happens with anxiety, it's kind of this double this double um pathway where on the one hand, they're more distracted, but there's an awareness of that distraction. So they overcome it, by engaging in more effort.
00:14:08
Jason Moser
And so they put more effort in the task to achieve a pretty similar level of performance as people who are non-anxious, but it comes at a cost of being effortful, being tiring. And if you've heard people say, I'm so exhausted or so overwhelmed by this, I can get a good grade, but it's so tiring.
00:14:27
Jason Moser
That's what I hear from my clients all the time. I have a lot of high functioning you know clients who have anxiety disorders and the like, and for the most part, their their lives are okay, but it's really exhausting.
00:14:38
Jason Moser
And they they describe burnout. So what I feel like the yeah ERN is doing is the yeah ERN is is kind of the the, for anxious folks, it's their brain's ability to kind of
00:14:40
Tony Montgomery
Thank you.
00:14:49
Jason Moser
ah they have to put in more effort to rebound and pay attention and re-engage in the task after a mistake than somebody who's not anxious. So it's not about being afraid of mistakes.
00:14:59
Jason Moser
It's actually, it takes a lot of effort and the signal in their brain that helps them engage that is this yeah ERN signal, which is like it says, hey, wake up, we got to pay attention, but that signal's bigger because they need to engage more attention and take more effort to kind of get back on track, if that makes sense.
00:15:16
Tony Montgomery
and Okay. Yeah, no, that makes that makes a lot of sense. um And is is this something that they're consciously aware of that they they are aware that it's going to take more effort, they go into it knowing that effort is the thing that they need to focus on? Or is this very um unconscious, subconscious of their test taken?
00:15:35
Jason Moser
Well, in this particular scenario, in the yeah ERN task, there's it's completely implicit. So we we don't we don't kind of ask that much about effort. we have There are you know some other signals like um that we can we can measure implicitly that kind of speak to the same um idea, like they tend to have higher skin conductance responses when they're engaging in a task, which can also mean they're engaging more effort.
00:15:59
Jason Moser
But in the e yeah ERN test, we're generally kind of interpreting the yeah ERN just based on itself. But there's a ton of other data that if you actually ask people with anxiety, hey, how how did you find this task? They often will self-report it was more effortful.
00:16:13
Jason Moser
um other skin you know Other studies that use peripheral physiology also find higher effort rating, you know have higher effort scores in like skin conductance and and the like. And so if you put all this together,
00:16:25
Jason Moser
if you explicitly ask them or you see kind of their brain dynamics in real time, it suggests that what they're experiencing in the moment is that they have to put in more effort to kind of get the same result out. So it's like, you know, the old comparison between if I drive a Chevy Impala, know,
00:16:40
Jason Moser
and pump it with all its gas and it goes, it chugs through all that gas for 50 miles versus a Prius, you know, you're working less efficiently because you're kind of always dual tasking and always kind of trying to overcome the distracting effects of the worries in your brain.
00:16:56
Jason Moser
And so we're continuing to try to connect to those things as much as possible with multiple measures at the same time. But what we've done so far is say, Hey, here's what the yeah ERN looks like. We have a bunch of experiments to kind of test this idea.
00:17:09
Jason Moser
um about effort and what happens if you increase effort or decrease effort. or you um We did a study where we asked, um just one one kind of quick example is, we did an expressive writing study where we had um folks who identified as high-end worry come in and ah in two different groups.
00:17:28
Jason Moser
One group wrote about how they brush their teeth in the morning, they had a cup of coffee, completely unrelated. The other group came in and wrote about how nervous they were about the task, what they were worried about doing, that they were going to fail, that we were going able to you know read their thoughts and see how anxious they were and how ah much they struggle.
00:17:46
Jason Moser
And sure enough, the group that got the expressive writing right before the ERN task had a smaller yeah ERN when they made mistakes than the group that just wrote about their day, um even though both groups performed exactly the same. And so we basically said we made the folks with worry who got all their worries out. They offloaded all those worries beforehand.
00:18:07
Jason Moser
We made them more efficient at the task. They didn't have to use as much energy basically to do the task because we, we got rid of those, those worries for them. Um,
00:18:15
Tony Montgomery
Interesting. Mm-hmm.
00:18:16
Jason Moser
And so all these different data together, we've kind of put together to suggest that it really seems like hyperactive brain activity that we see in some of these more, cognitive these are purely cognitive tasks. Like there's no no emotion in these tasks really, except for maybe if you have wins and losses or certain points, you know, then it's kind of motivational in these tasks without emotions.
00:18:39
Jason Moser
It really does seem that they're, they're trying to kind of stay engaged and it takes a little more for them to stay engaged. Um, than person who's not anxious, which again, fits totally with what we see in um real life is, you know, test taking for college students who are anxious, the number one accommodation that you get at a resource center or whatever is you always just get more time, which makes sense.
00:19:02
Jason Moser
Because if you had more time, you can do just as well. But the problem for folks who don't get accommodations who are anxious, they can look like they're struggling more because they just don't have enough time because they're constantly trying to overcome the distractions of the worries in their head.
00:19:16
Tony Montgomery
Yeah, no, that's very interesting. Do you know if there's any research, have you guys any done research where you have somebody come in, they do the task, and then you have them maybe come in, you know, four hours later to repeat the task to see if that spike in the ACC causes a depletion. So maybe they're worse at the task later on, like think of it as like a college student has an exam in the morning.
00:19:40
Tony Montgomery
And then they have exam in the afternoon.
00:19:40
Jason Moser
Mm-hmm.
00:19:42
Tony Montgomery
are we talking about glucose depletion of that brain area that makes them not be as efficient or be able to, you know, maybe they're, maybe the errors become magnified because they're just not cognitively as sharp as they once were because it got depleted so much.
00:19:56
Jason Moser
Right. Yeah. I mean, we don't have a study just like that. It makes a lot of sense to do that. What I, what we do have is we have evidence where for people with anxiety, they're more likely to make more errors in the second half of the task than our people with non-anx, with, with less anxiety.
00:20:11
Tony Montgomery
Mm-hmm.
00:20:14
Jason Moser
So the idea being the same as what you were just suggesting is as they tire, you know, the the majority of them, most of the mistakes in this sort of like really simple video game task, you know,
00:20:26
Jason Moser
are in the second half or in later in the, in the, um, in the experiment for lots of people, but it's even more so for people with anxiety.
00:20:35
Tony Montgomery
Yeah. And then how do you think that relates to the idea of um the whole willpower hypothesis of that being able to get depleted by Roy Baumeister?
00:20:45
Jason Moser
Yeah, i am.
00:20:45
Tony Montgomery
you familiar with that, with the idea that willpower can be depleted over time?
Willpower and Cognitive Reserve
00:20:50
Tony Montgomery
And um is correct me if I'm wrong, but is that relegated to the anterior cingulate cortex as well, that motivation kind of resource area?
00:21:03
Jason Moser
Yeah, I mean, it's it's more complex, as you alluded to earlier, right, that we're not just talking about the ACC rules all of this. The ACC is a hub, and that's why I'm so fascinated by it and I've been obsessed by it. But it's a hub that receives information from all sorts of other areas of the brain. So it receives information from the lower parts of the brain, which might be the more core motivational systems. Like it receives information from the amygdala and kind of the emotion centers. It receives information from the basal ganglia,
00:21:31
Jason Moser
and kind of these reward dopamine hit areas. And so it's trying to integrate information from the bottom up, but it's also receiving information from other cortical areas that are trying to you know tell it, hey, what are the parameters of this task again? What are we supposed to be paying attention to?
00:21:46
Jason Moser
There are lot of these feed forward and feed backward connections that the ACC has. But what I can say is I do think that what the ACC tells us um and what we know from the work with anxiety and kind of depletion is, um I do think it's the case that for many people with anxiety, their kind of working memory capacity or their their cognitive capacity is somewhat depleted.
00:22:17
Jason Moser
And you just kind of have to tap into it just right. Like, this is why anxiety fascinates me the most, because we were also talking before we got on about, you know, exercise and you know exercise can be helpful to anxiety. And we know that um anxiety can can interfere with performance. And so there's this whole kind of like very much a bi-directional relationship where anxiety can actually boost performance at some level by so by there's these kind of like peak zones, right, of performance. And some of that is about stress or about activating the system.
00:22:51
Jason Moser
So anxiety is about activation, which I do think helps the system kind of engage and pay attention, right? A lot of what anxiety is kind of natural functions are is to kind of like keep us alert and pay attention to the environment so that we don't get eaten by a, you know, a saber tooth tiger or whatever, or be beaten with a club by one of our members of our tribe who don't like us so much anymore.
00:23:13
Jason Moser
So like it it has this activating and attention ah focusing, you know, um element to it. But it can also backfire and it can be associated with distraction and distress when it goes awry and when it keeps us kind of out of touch with what's going on in the environment. So I think anxiety in and of itself is depleting.
00:23:34
Jason Moser
um And I think what we see, the effects of that depletion you can see on performance, whether it's in cognitive tasks or sport performance, or you see it in relationship performance, let's call it, or whatever else, or or on the job performance, is very much a ah a kind of depletion, so to speak, effect, where anxiety just kind of saps those resources that would otherwise be dedicated to what we're supposed to be doing in that moment. Just like if I were super anxious about
00:24:05
Jason Moser
interacting with you on this podcast, right? I would be stumbling a lot. I might be not responding for long periods of time. And that's a depletion effect because I'm not meeting the demands of our task right now, because maybe I'm somewhere else in my head, worried about what you think of me or what listeners might think, or I'm thinking about what I got to do next.
00:24:24
Tony Montgomery
Yeah. so So if there's a depletion effect going on, um how how do we begin to to replenish that, rebuild that? um
00:24:34
Jason Moser
Yeah.
00:24:34
Tony Montgomery
you know With the willpower thing that comes to mind is you know they they did the research on it showing that willpower does get exhausted. But then Carol Dweck from Stanford, she did research to show that if you believed that your willpower was going to be deteriorated, then it did.
00:24:50
Jason Moser
Yeah.
00:24:51
Tony Montgomery
And if you believe that it wasn't going to... then it didn't, right? So um i it's yeah I know you do some work with beliefs and and mindset and how that changes the trajectory.
00:24:56
Jason Moser
Mindset, right?
00:24:59
Jason Moser
Yeah.
00:25:01
Tony Montgomery
um So what what are some intervention type strategies that maybe we could use with anxious people to help replenish this idea of depletion throughout the day, um whether it also be something along the lines of like, glucose absorption and taking in carbohydrates before you do a task to make sure that your glucose is fully, your glycogen is fully stored and all that type of stuff.
00:25:09
Jason Moser
Yeah.
00:25:24
Tony Montgomery
What have you found to be um both clinical and in the research to be effective to help kind of replenish this depletion?
00:25:25
Jason Moser
yeah
00:25:33
Jason Moser
Yeah. and I'm glad you brought it back to willpower. I kind of, I wanted to to say a bit more about that is, you know, willpower is, and about replenishing in general. and And it's interesting way to think about it.
00:25:44
Jason Moser
um
00:25:44
Tony Montgomery
Yeah.
00:25:45
Jason Moser
What I will say about willpower is, I don't know, willpower is just so tricky because it's so such a loaded term. You know what i mean?
00:25:50
Tony Montgomery
right
00:25:51
Jason Moser
everybody Everybody's very upset about willpower, right? Or like so many people talk about it and they're like so into willpower.
00:25:54
Tony Montgomery
yeah
00:25:59
Jason Moser
So it's it it feels like such a lightning rod concept that I don't i don't generally talk about willpower as a thing, generally. I'm im i'm generally just talking about like, well, what what are the dynamics at play for the different motivational systems and the multiple tasks or resources that a person has and they're allocating to various things? Like, how does that all play out?
00:26:20
Jason Moser
um Whether we have this kind of, you know, maybe maybe instead of willpower, we could talk about a reserve, right? you know, that we have a reserve available to us.
00:26:26
Tony Montgomery
Yeah.
00:26:28
Jason Moser
And um that what I found interesting about, and you know, people with anxiety is actually, it does look like they do have a reserve, right, in a way, because, yes, if you if you ratchet up the the stress, and you ratchet up the difficulty of some particular task, whatever it is, you can start to see breakdowns and performance for people with anxiety, we know what that looks like choking under pressure or whatever, right.
00:26:51
Jason Moser
But in a lot of different ways at a moderate level of difficulty or stress, like anxious folks can dip into a reserve and overcome that to still do pretty well. Right. um And so I'm, ah more kind of interested in how do people solve problems with the resources they have at their disposal?
00:27:09
Jason Moser
And when things break down, what do they do about it? What do they do about it next? um And so, I think the concept, ah so so willpower, I'm going to put ah aside for a second, if you don't mind.
00:27:22
Jason Moser
But this idea of like replenishment or or what does my ah growth mindset do for us, right? So I think there are lots of different ways to think about either replenishing or the way, and I i want to go back to that that notion in a little bit, but what i've What we've kind of done is we've tried to give people tools that are easy to implement. So it's kind of like preemptive in a way. We're going to give you something that's easy to use so that you don't get depleted.
00:27:52
Jason Moser
But then you could also think about, well, but because a lot of what we give people as tools are actually pretty depleting to use, right?
00:27:57
Tony Montgomery
Mm-hmm.
00:27:58
Jason Moser
The kind of therapy tools or let's say even like mental performance coaching tools or whatever, like a lot of them are hard, you know, like cognitively and they're cognitively demanding.
00:28:05
Tony Montgomery
right
00:28:08
Jason Moser
And we're always like giving people people advice that's like on the face of it good, but it's actually pretty complicated. So what we've done is we've been thinking more about like, how can we make things like super easy for people to do rather than thinking about replenishing per se. But I've started to think more of replenishment, you know, kind of with exercise, cetera. And, you know, things like that movement that we can talk about in a sec.
00:28:29
Jason Moser
Um, But I think the way we've gone so far is to say, okay, the issue at hand really is we actually don't want to load folks with anxiety up too much with hard things to to multitask with, right?
00:28:44
Jason Moser
So if they're coming in and they're saying, hey, I'm anxious,
00:28:45
Tony Montgomery
Yeah.
00:28:47
Jason Moser
about, you know, test taking, or I have these distracting panicky feelings sometimes in my chest and I get hot, you know, rather than saying, okay, let's, I don't know, let's do cognitive reappraisal or cognitive therapy. I do some of that, sure. But what's been frustrating is how hard that is for people to do over time is, you know, we give them this test. It's like, well, reinterpret that feeling as not harmful, you know, and try to practice that over time or reinterpret neutral faces. Like what, what you're seeing in front of you right now is actually somebody's paying attention to you and really engaged rather than bored and, you know, thinking you're an idiot and that's all fine. And those, those strategies can be helpful. But I think what we we're learning over and over is because people with anxiety are already taxed. And this goes for people with depression, OCD trauma for the most part.
00:29:38
Jason Moser
is that they're already taxed and if you look at their frontal cortex and these other systems that are reflective of kind of what their core capacity is you know to to pay attention and be in the moment they're taxed already we know that um in lots of different ways brain activity looks like it's decreased or a certain uh parts of the brain are have decreased you know gray matter or or you know just less efficiency in the system and so we know There are deficits in you know frontal brain capacity for a lot of people with anxiety.
00:30:07
Jason Moser
So why do we keep giving them things that are super hard? Forget about it. What about what about mindfulness? Everybody wants to do mindfulness, right? Mindfulness is amazing. but but but Sure, but you know how many Westerners or know how to do mindfulness well or quickly?
00:30:19
Jason Moser
Very few, right? It's not baked into our culture. um And so teaching people to do mindfulness sounds great on the face of it, but so few people actually carry through with it and they find it difficult to implement. Not only do they find it but you know difficult to find five or 10 minutes a day to sit on a cushion and do some meditation, but they also don't quite exactly know what the heck you mean when you say, hey, be mindful when you wash the dishes or be mindful when you're you know grilling outside or while you're vacuuming or whatever you're doing.
00:30:50
Jason Moser
So a lot of the data we've collected and we've seen in the literature as well as like every, all of these different strategies are like drawing on these cognitive systems that are already sapped in people with anxiety. Why are we doing that?
00:31:02
Jason Moser
So one thing that we've done um is use a strategy called distance self-talk or third-person self-talk, which sounds really kind of goofy on the face of it, but it's it's really effective and it's not difficult to do at all.
00:31:16
Jason Moser
And we've shown in some neuroimaging studies and some ah
Intervention Strategies for Anxiety
00:31:20
Jason Moser
behavioral and kind of like social situation sort of studies that um if you talk to yourself in the third person about how you're feeling,
00:31:31
Jason Moser
You can do that really quickly without using frontal brain systems. And it kind of naturally leads you to give yourself advice and do the reappraisal, so to speak, as if you were talking to a friend.
00:31:45
Tony Montgomery
Mm-hmm.
00:31:45
Jason Moser
And so what we've shown is if you say, okay, hey, Jason, Jason's looking at at at Tony's face and he's here. He's like, you know, um Jason is nervous about what he thinks and,
00:32:00
Jason Moser
Jason's worried that he's going to think he's he's weird. And he you you say that, but then say, well, you know, Jason knows that he's done these sorts of things before. It's fine. You know, they're going to get along just fine. It's, you know, it's all good.
00:32:11
Jason Moser
um That what we find is the more you're able to reflect on, and this this goes for like present moment, Past and future, if you reflect on like a breakup or you you think about something in the future as Jason's worried about ah this flight he has to take to Spain. He doesn't like he doesn't like flying very much.
00:32:28
Jason Moser
And he's worried about the the the turbulence. But Jason knows that you know air travel is very safe and he's been on thousands of flights and thousands of hours. It's it's going to be fine. And so what we found through all these studies is that people with anxiety and depression, they can use these strategies. They're not difficult. they They don't use, it's not harder for them to do it. The brain activity does not require frontal brain activity. Instead, it's kind of like a switch in the medial prefrontal cortex, like ACC sort of area where it kind of switches your brain automatically and to start thinking about yourself as somebody else.
00:33:00
Jason Moser
So like another Jason, um, so it's as if I'm talking to another Jason and saying, Hey, Jason, you know, you can do this. And so we've done that and we're doing a treatment study right now, uh, with people, with anxiety and depression to see if we can train them to, to do this strategy more routinely in their everyday life. And it helps with symptoms, but we've done it in the lab. It's effective.
00:33:23
Jason Moser
We've shown that it's effortless more or less. Um, and, um
00:33:32
Jason Moser
you know it's It's something that doesn't require them to do that much, and it's not depleting in and of itself. And so that's why we like it. That's one example. We have a couple of other examples of things, of other strategies that were but we've been using that feel less effortful.
00:33:49
Jason Moser
But that's just one one ah example of, okay, we can... we can go back to the kind of like, well, how can you replenish? But what we, the kind of strategy we've taken is to say, look at all these things that are so effortful for people to do.
00:34:01
Jason Moser
How can we make them less effortful and maybe even effortless for them to apply in their daily lives?
00:34:07
Tony Montgomery
Yeah, essentially reducing the noise, right? Like with when when you work with people with autism, a lot of the emotional ah empathy that they they don't have and all the issues that they have with ah conversations and looking at people, they a lot of it is just that they're inundated with so much noise and so many things they have to pay attention to that they just don't know where to look or how to respond or any of that.
00:34:31
Tony Montgomery
And by them closing their eyes or them looking down, they're able to reduce the noise and and listen better and pay better attention. And there's research to support the idea of like you know not looking someone in the eyes.
00:34:42
Tony Montgomery
Looking off in space allows you to be a better listener as opposed to just trying to focus on, oh, did this land when I said it?
00:34:49
Jason Moser
Right.
00:34:50
Tony Montgomery
Or are they paying attention? Or any of these things that... As a professor, when you teach a class for the first time, you're constantly judging whether or not you're doing a good job by staring at the students face.
00:35:00
Jason Moser
So,
00:35:01
Tony Montgomery
And over time, you learn to just not pay as much of a attention to it. So essentially, you're just reducing the noise in a very effortless, effortless way, which, you know, like you said, it makes it makes a ton of sense to to be able to do that.
00:35:15
Tony Montgomery
um Working with the students that I have, a lot of times they'll have, you know, test anxiety and, you know, telling them, hey, like, what what what was your GPA last semester? oh you did 4.0. So what in your past would indicate that you're going to struggle with your your test today? you know and And just by shifting that mindset allows them to be like, yeah, you know what? like I've studied, I've done the work.
00:35:38
Tony Montgomery
Previous tests have shown that I've gotten A's so that I shouldn't have to worry about. today um And it is very simple to to do and to to teach. One of the studies that we just completed in in our lab was we were using cognitive reappraisal during exercise.
00:35:55
Tony Montgomery
And one group was doing cognitive reappraisal. The other group was getting motivation as, as normal. And we just taught them simple things of, you know, if you get bored, they were doing it on a stationary bike. So you can imagine the level of boredom that comes with that.
00:36:08
Jason Moser
Uh-huh.
00:36:08
Tony Montgomery
They're blinded to everything, but just the power output. um So we told them, hey, if Borden comes up, you know try to reframe that as like a challenge. How can you push through it? um If your legs start to burn, try to reshift that towards the more they burn, the better you're going to um adapt.
00:36:18
Jason Moser
Uh-huh.
00:36:23
Tony Montgomery
The bigger your muscles, the better you're going to get. you know All those simple things. and And what we found was they were able to improve um in performance compared to the control group. And then we did a three and six week follow up in the group that had cognitive reappraisal, um didn't show any differences in in palms or Beck depression inventory or the motivational Breck motivational test.
00:36:47
Tony Montgomery
But six weeks afterwards, the cognitive reappraisal group outperformed the control group in all those categories, showing kind of like just that one week of practice that we did on the test.
00:36:58
Tony Montgomery
They were able to take that into you know their real life situations. So what they learned in a week, was able to show six weeks later to improve mood, depression scores, and and motivation.
00:37:08
Tony Montgomery
And just those emotion regulation strategies are so easy to teach.
00:37:10
Jason Moser
Nice.
00:37:12
Tony Montgomery
I think it took us, I don't know, two minutes, two to three minutes of their warmup to teach them it. And then we just kind of reiterated it through the intervention.
00:37:18
Jason Moser
Yeah.
00:37:21
Tony Montgomery
And yeah, it was one of those things where we also saw, um, better hrv response so they had better um sympathetic arousal and bringing it back down the parasympathetic arousal than the control group um so they were able to push themselves further but then also bring themselves back down just by using cognitive reappraisal strategies um which was very very cool to see but it goes to the point that you're making of like yeah there's these simple strategies can be huge with people if they're taught correctly and if they you know they
00:37:28
Jason Moser
Yeah.
00:37:39
Jason Moser
ah huh
00:37:45
Jason Moser
Yeah.
00:37:53
Tony Montgomery
Like you said, it can't be something that they had to spend 30 minutes a day doing or else they're not going to do it. Right. Cause then that could cause them more depletion.
00:37:58
Jason Moser
Yeah.
00:38:00
Tony Montgomery
So, um, that is very interesting that you're, you're finding that with the, with the anxiety stuff, how you're talking about it makes me think that, um, people, kids that are anxious could possibly be getting over prescribed for ADHD.
00:38:17
Tony Montgomery
Cause wouldn't those kind of be the same thing where they have a hard time controlling their focus? do you yeah
00:38:24
Jason Moser
Yeah, yeah. Great, great question.
00:38:26
Tony Montgomery
yeah
00:38:26
Jason Moser
um Something that i am I am constantly fumbling into more and more. i I was never an ADHD person and I'm very much a cognitive person. So it's it's just interesting studying anxiety and being kind of like relatively...
00:38:41
Jason Moser
in a sense, being more interested in anxiety, in cognition, even though I'm very much interested, interested in emotion. I'm just, I kind of come at it from more of like a cognitive science or cognitive neuroscience bent. Um, uh, anyway, so I continue to, to grapple with the overlap between anxiety and attention deficit type disorders, ADHD, you know, attentional problems, whatever it is, because yes, we all kind of land on the same thing, which is like, Oh,
00:39:09
Jason Moser
you know What we're seeing is that it's hard for people to pay attention. Sometimes you see that you know you know you see it in the test results. they can't They can't perform or they're distracted so much that they can't actually show up to class for whatever reason.
00:39:23
Jason Moser
And what's been really fascinating, not only for kids, but kind of where I started was with undergraduates is the number of times we have undergraduates coming into our clinic for a ah a test. they they They want like a kind of IQ and achievement test basically, or a cognitive test to get accommodations for class. They all come in saying, I have ADHD.
00:39:45
Jason Moser
Can I get a diagnosis so I can get accommodations? And then maybe I'll go and get prescribed Adderall or whatever.
00:39:53
Jason Moser
90% of those, this might be a little exaggeration, but let's say it's like 75% of those students coming in thinking they have ADHD and wanting an ADHD diagnosis leave with an anxiety diagnosis.
00:40:04
Jason Moser
So what's interesting is when you get to kind of adulthood, which is where I started a lot of my career, we've I've done more and more kids stuff over time, but where I started was much more focusing on adults is that as adults, what we're seeing more is that people are distractible, are having difficulties with controlling attention. It's mostly due to anxiety, stress, they're distracted, they're going to their phone, they're doing other things, they're kind of all over the place.
00:40:31
Jason Moser
we see it more as an anxiety problem. Because ADHD is really something that for most people should have started when they were really little, they likely would have had and a diagnosis early. Sure, there are plenty of kids who go undiagnosed.
00:40:43
Jason Moser
But if you make it all the way to college, and you're a decent performing student, maybe not as well as you want, it's it's kind of hard to say you likely have ADHD. Now, that's not to say it doesn't happen. But a lot of the time, what ends up happening is those are those are you know students with with anxiety.
00:40:59
Jason Moser
so that was one thing that would just like always come up. And so as I've gotten more into to working with kid populations, we are actually seeing quite a bit of overlap. And some of these kids do have ADHD as a pure diagnosis, and some have anxiety and some have comorbid.
00:41:15
Jason Moser
Now I'm still of the mind. I don't quite know whether the high comorbidity, which in some ways can be like 50, 60% between child ADHD and and child anxiety. That seems like too high for me to be like, these are different things. They're probably similar things.
00:41:29
Jason Moser
And with the the kind of, I know well how hard it is to do a good diagnosis, and a lot of people do not get great diagnostics. um that and And not to mention that the symptoms in the diaa in the diagnostic manual are quite overlapping between these two things. And if it's not ADHD hyperactive type or even combined type,
00:41:51
Jason Moser
If it's ADHD inattentive type, it's hard to argue that there's not a ton of overlap just phenomenologically with anxiety because so many of the things kind of end up overlapping. you know you You try to like tease out what came first, right? Was it that they were a little inattentive and then that made them anxious over time because they started to not do well and then they get anxious and hyper-focused on themselves?
00:42:13
Jason Moser
Or was it that they were anxious and they became and inattentive? And that's harder to... to grapple with. But what we've started to do with some of the treatments and models we're developing for kid anxiety is like, look, if you look across all the literature and you try to say like, what are the core deficits or core challenges for people with, or the core challenge with people with mental health concerns or psychopathology, attention is a huge piece of it.
00:42:41
Jason Moser
Right. Like you just look across like everything, you know, whether you're talking about anxiety, ADHD, um conduct problems, schizophrenia, depression, PTSD and trauma, OCD, you know, you name it.
Early Intervention in Mental Health
00:42:57
Jason Moser
Attention, attentional difficulties are pretty core.
00:43:00
Tony Montgomery
Mm-hmm.
00:43:01
Jason Moser
And so, or cognitive control, if you want to kind of, but you know, expand it and say that it's a difficulty in controlling and adapting attention over time, which somebody might call cognitive control, which is, can you stay focused? And when you're distracted, can you bring it back sort of thing?
00:43:16
Jason Moser
um This kind of notion of attention and cognitive control, there's a lot of ah slippery overlap there too, in terms of the, just the concepts. Yeah. So what we started to do is actually we say, well, you know what we could do then is just build core capacity for cognitive, effortful control, attentional control early in kids with anxiety and ADHD or, and, or ADHD.
00:43:38
Jason Moser
And maybe that's where we need to start is just kind of like a lot of what I'm interested in is just kind of like developing core capacity for control, for attention, or at least making it easier for people to maybe draw on a reserve of attention and and cognitive control.
00:43:40
Tony Montgomery
Thank you.
00:43:53
Jason Moser
um And so that's, that's how I've seen it overlap. So like, I don't, I don't need it to be called any diagnosis. Like, you know, I don't, I don't, it doesn't necessarily concern me that it's this, that, or, you know, it's exactly anxiety or it's exactly ADHD or it's first anxiety, you know, whatever.
00:44:09
Jason Moser
These things have core, you challenges which are around focusing, maintaining and adapting attention and cognition over time. And I think if we kind of focus in on that as one core capacity to build up to train to treat early on, I think you could have a lot of impacts on a lot of mental health problems over the full arc of development.
00:44:32
Tony Montgomery
what does that What does that look like for those adolescent populations as far as the tools that you're giving them? Because I would have to imagine as over the last 10, 15 years, there's been a reduction in physical activity, um and increase in ultra processed foods.
00:44:46
Jason Moser
Yeah.
00:44:48
Tony Montgomery
um So I would have to imagine that plays a huge role in their ability to maintain attention because they just have so much energy that they're not able to expend.
00:44:48
Jason Moser
Yeah.
00:44:57
Tony Montgomery
So they're constantly trying to pull attention otherwise. And I know you also studied sex differences as well.
00:45:01
Jason Moser
Yeah.
00:45:04
Tony Montgomery
um And we can talk about that afterwards. But we're like, what are some of the tools that you're giving these these kids within the research that you're seeing to build um good efficacy?
00:45:14
Jason Moser
Yeah. And, you know, in terms of we're just starting to do some exercise, actually, but we haven't thought a lot about um diet necessarily or and and nutrition directly.
00:45:24
Jason Moser
It's totally, you know, it's totally related, going to make it, you know, going to be important. We've started to focus more on the kind of physical activity part. Not to mention, we haven't even mentioned the the big elephant in the room, right?
00:45:35
Jason Moser
Social media, multimedia use, like as as another core distractor that's kind of more omnipresent than ever.
00:45:37
Tony Montgomery
Right.
00:45:42
Jason Moser
um but So what we've done is actually, even in little, little kids, so you were you were talking about adolescence, I'm talking about like four and five-year-olds. So if we can start super early, because people do get diagnosed with anxiety and ADHD and all sorts of things at four or five years old, right?
00:45:58
Jason Moser
um ADHD, you kind of have to. yeah kind of definitionally to get diagnosed with ADHD. You have to see those sorts of problems that early. So we've actually been developing and testing out. We just finished a, a, a pilot randomized control trial with little kiddos with anxiety, various anxiety disorders, um, who could also have ADHD or ODD. Many of them did have ADHD. Uh, ODD is oppositional defiant disorder, kind of just more distractible and impulsive, not kids who are really going to make a, um,
00:46:28
Jason Moser
a real mess of our environment because we were doing group treatment, but kids who were more, you know, oppositional to, to instructions from adults. We kind of let them in, but ADHD was kind of the core um additional diagnosis we let in.
00:46:41
Jason Moser
And what we basically did is we, we built a camp, a camp style treatment, group treatment. So we would have about six kids at a time come into the lab They would each be assigned a counselor.
00:46:55
Jason Moser
um And that counselor was a paraprofessional, really. So an undergraduate or a recent postgraduate with a BA level or a BS degree. And they would be matched with an individual counselor.
00:47:06
Jason Moser
And then there was kind of one camp leader who was a graduate student in in our case who would kind of direct the whole camp. But it was basically like three hours five Saturdays in a row, um, across the summer, many times. Um, sometimes we had, we could get them going in the fall too, but we did it a lot of times over the summer as kind of a camp.
00:47:27
Jason Moser
Um, And what we did in the camp is we actually played we basically like tried to develop core capacity for cognitive control, attention, effortful control, these different terms that are interchangeable, where we had them playing games that we knew would exercise these frontal brain regions. And simple games like red light, green light.
00:47:46
Jason Moser
um We had them solving puzzles you know on purpose. We had them do... um you know, blow up the balloon to a certain level or pop the balloon. You know, we had a bunch of different games.
00:47:58
Jason Moser
Simon says stuff like that, all sorts of games that were specifically chosen that would kind of exercise, so to speak, you know, um focus, impulse control, um you know, inhibitory control, ah flexibility in their thinking. We had some of them do like different, like I said, puzzles.
00:48:20
Jason Moser
And so we did that for five weeks. And our control group was just kind of like free play. We just had the kids do kind of whatever they wanted. And then the parents were supposed to play either these kind of cognitive control games at home with the kids or just spend more special time.
00:48:35
Jason Moser
And while everybody kind of got better over time, which was nice to see, what we did see with the the kind of cognitive control training games group is they actually got a little even even more better.
00:48:46
Jason Moser
um over time and their anxiety symptoms. um Their capacity for effortful control did kind of change a bit. Some of that might be practice, which is actually okay with us.
00:48:56
Tony Montgomery
Mm-hmm.
00:48:57
Jason Moser
um But we're seeing that for sure, this approach, which is to kind of engage kids in a group format that's fun in play, but specifically choosing play type games where where they're exercising their frontal brain regions can have downstream effects on their anxiety.
00:49:15
Jason Moser
So this is what we're trying to do is kind of like build that capacity through fun, through games, through an engaging environment, and then something they can translate to home with their families. um And so i think the earlier we can get them, the better.
00:49:29
Jason Moser
um And so that's what we've started to do with little kids. But for sure, I think incorporating more physical activity is another way to go that I'm interested in doing and and figuring out exactly what it is about physical activity that can be helpful for people with anxiety and depression.
00:49:44
Jason Moser
um But that's kind of where we've started with the little kiddos is building that capacity through games that we know will work on, on um you know, frontal control brain regions.
00:49:56
Tony Montgomery
Yeah, that's super interesting. and So it's it's just organized play, essentially, i trying to get them to
00:50:03
Jason Moser
Yeah, it's organized play with with a focus on choosing games or different activities that they can play individually with their counselor and cooperatively with some of their campmates that we that we have pretty good evidence that are are building capacity for these core functions of cognitive control that we know are important.
00:50:24
Tony Montgomery
And the other group, did you did they have counselors with them as well? Did they the same amount of attention?
00:50:27
Jason Moser
Yeah, they did.
00:50:29
Tony Montgomery
Okay.
00:50:30
Jason Moser
Same format. It's just that the counselors didn't tell them anything to do. They just said, what do you want to do here? A bunch of blocks. Here's some coloring books. Here's some rocks. You tell me how you want to play and I'll follow your lead.
00:50:41
Jason Moser
Whereas in our kind of camp kid power, we called it, um, this, these effortful control games, we had a script and we had a number of games in the way that we played with them. And we titrated up the difficulty of it at times, you know, the red light, green light, faster or slower sort of thing.
00:50:56
Jason Moser
Um, and so, they both had the same amount of attention. One was just given, you know, games that we felt were, were exercising that muscle in their brain. We were hoping to, to increase.
00:51:07
Tony Montgomery
Yeah. And that's ah i like that idea of having it just be incrementally more adaptable, a little bit more challenging, right? Cause then that's going to keep them engaged and and intrigued with it.
00:51:17
Jason Moser
Yeah.
00:51:17
Tony Montgomery
And it's also going to force them to adapt just like an exercise. You have to progressively overload in order for you to have adaptations.
00:51:24
Jason Moser
Yeah.
00:51:24
Tony Montgomery
You're going to do the same thing with the brain and doing that at that age when they're the most, where they're extremely malleable and plastic makes, it's a ton of sense.
00:51:31
Jason Moser
Right.
00:51:33
Tony Montgomery
um Why do you think, Has this always been an issue, anxiety within this age range, or is this just something that has come about over the last 10, 20 years?
00:51:44
Jason Moser
No, we've known that that there are little anxious kiddos out there for a long time. And they, you you know, oftentimes what happens is they don't present to treatment. They're underdiagnosed in large part because, you know, the interference that a lot of them are experiencing. You know, parents at that age, you know, I think a lot of parents are are confused or conflicted about like what to do with a kid that young.
00:52:07
Jason Moser
um And we know that they present, know, kind of out in the world. Um, but we haven't done actually a lot of research on them. So I don't think this is a new phenomenon per se.
00:52:19
Jason Moser
um I just think we're, we have to pay more attention to it because there just hasn't been a lot of research focused on it for reasons you might imagine, like, you know, those little stinkers run all over the place, you know, their, their lives are complicated.
00:52:29
Tony Montgomery
Right.
00:52:32
Jason Moser
They're, you know, some of the parents have them at home. Some of them have them in a, um, you know, at a preschool or a nurse, you know, something like that. So I think it's just a population, an age population that has not yet really been reached, but we know that most people with anxiety disorders who have anxiety disorders as adults were diagnosed pretty darn early.
00:52:55
Jason Moser
um And the earlier, we know the earlier you can detect these things, the more chance you have at at change and and recovery and actually preventing kind of full full-blown disorders that, you know, interfere with people's lives for decades.
00:53:09
Jason Moser
um So I would say it's more of just like an un understudied and untapped population that we know has kind of been there.
00:53:16
Tony Montgomery
Yeah. And then with the anxiety disorders, there' there's a lot of subcategories. Do they present differently as they age?
00:53:22
Jason Moser
Mm-hmm.
00:53:24
Tony Montgomery
Like, do they present with the same social anxiety that a teenager, you would assume, would present as with the thought of, like, people are judging me, everyone's looking at me, I'm the center of everyone's attention, right?
00:53:36
Tony Montgomery
Versus kids at that age, I would assume that maybe that's not as as prevalent.
00:53:37
Jason Moser
Yeah.
00:53:41
Tony Montgomery
So does it does it change over time or... Is it the same kind of anxiety presenting itself throughout the lifetime?
00:53:51
Jason Moser
Yeah. i mean, I think social anxiety is a good example because that's pretty well preserved across the lifespan is like basically get little kiddos with anxiety are are anxious about social situations for like the same sort of reasons they might be anxious later. Sure.
00:54:07
Jason Moser
It gets more complex and the scenarios and the, you know, and the, the consequences they're thinking about are get more involved, you know, and but it's still pretty core that like, I'm nervous. These people aren't going to like me and I'm going to be ostracized basically. And I'm going to be alone essentially like that's the core of social anxiety at any age.
00:54:27
Jason Moser
um What is, Kind of more interesting is that something like separation anxiety is quite common. You know, that's probably the most prevalent of the anxiety disorders in kiddos.
00:54:38
Jason Moser
Whereas you don't see separation and anxiety in adults as much, although the DSM has changed and there are a lot more adults who are being diagnosed with separation anxiety um in ways, especially like with their partners and things like that, maybe not with parents per se, but more with like
00:54:44
Tony Montgomery
Thank
00:54:54
Jason Moser
caregivers or loved ones or partners or you know their spouses. um But that's where you see the the biggest difference, I would say, is you see that separation anxiety disorder has generally been kind of like a kid-specific disorder.
00:55:07
Jason Moser
um that you don't necessarily see play out in adulthood. But, you know, whether it's, ah so, you know, separation is pretty common. The next is social anxiety, and that kind of looks similar-ish.
00:55:18
Jason Moser
And then generalized anxiety disorder, GAD, that can start really early as kiddos. And that kind of looks the same too. It's like they're worried about a lot of stuff. They're worried about their parents' health. They're worried about maybe their own health.
00:55:29
Jason Moser
They're worried about, know, the, how, how well things are going at school. They're worried about, you know, whether some other bad random thing they think might happen is going to happen. They might be worried about storms, you know, so they're worried about a lot of different things, which is very similar to what happens with people with, you know adults with GAD. It's just like the content might shift a little bit, just like with social anxiety, the content might shift a little bit, but the core ideas are still the same.
00:55:57
Tony Montgomery
Yeah. Could separation anxiety in adulthood look like codependency?
Causes and Management of Anxiety
00:56:01
Tony Montgomery
i would have to imagine that would be very similar.
00:56:01
Jason Moser
Yeah, totally. Yeah, i mean, something like that. You know, what we have for adults is we have dependent personality disorder, and which has been in the DSM for forever.
00:56:04
Tony Montgomery
Yeah.
00:56:12
Jason Moser
And that has always been seen as almost like ah you know, it's codependency, but almost like a severe ah version of social anxiety. But now I think people are kind of reconceptualizing as maybe that's kind of what adult separation anxiety disorder might look like. So, excuse me, I think we're evolving As we're just seeing that, I think what's been interesting for me over time has been, you know, we think of things as so much like this is a disorder of childhood.
00:56:37
Jason Moser
This is a disorder of adulthood.
00:56:38
Tony Montgomery
Right.
00:56:39
Jason Moser
Like we were just talking about ADHD, for example, take that. So many people just thought ADHD is a kid disorder and nobody really paid attention to like, where'd all these ADHD kids go?
00:56:50
Tony Montgomery
right
00:56:50
Jason Moser
Right? Like we don't send them off to an Island somewhere. Like they're in there. They're all around us. And now all of a sudden we have a surge in, in the prevalence in adult ADHD, it's actually like, well, no, we don't. It's just nobody's been looking.
00:57:02
Jason Moser
Everybody just forgot that those kids grow up. And sure, many of them are on Adderall, but like some are not on Adderall for life. I don't think that's a great idea anyway.
00:57:09
Tony Montgomery
right
00:57:12
Jason Moser
And many have been living with it and struggling with it their whole lives. And we just haven't paid as close attention.
00:57:19
Tony Montgomery
Yeah. Do we know... correlationally or foundationally, like what is causing this anxiety to, um, progress or to happen in, in young kids.
00:57:31
Tony Montgomery
Like my, my thought process is that, um, research by Robert Sapolsky, where they're looking at, um, cortisol levels in utero of, of moms, typically those babies have a enlarged amygdala and a small prefrontal cortex that
00:57:46
Jason Moser
All
00:57:48
Tony Montgomery
And that's something that is due to the cortisol response and glucocorticoids and all that in birth, um which obviously gives them ah disadvantage as they continue to grow, which a lot of violent criminal offenders have small prefrontal cortex, large amygdalas.
00:58:04
Jason Moser
right.
00:58:04
Tony Montgomery
Is there something foundationally like that that is happening with anxious people? Or is there correlations to maybe socioeconomic status, maybe single parent households, things like that, that could be um foundationally building this anxious group of people?
00:58:22
Jason Moser
Yeah, I mean, as you know, as well as I do, that these are multifactorial, you know, problems. And so I think we we have a reasonable amount of evidence that if you pack in you know, genetic loading from a parent or parents or or relatives with anxiety already on board, if you pack in stress during pregnancy, if you pack in stress during ah but the birth process,
00:58:28
Tony Montgomery
Right.
00:58:48
Jason Moser
or complications during the birth process. if you If you add in, right, low socioeconomic status or or just under-resourced um in in early childhood, bullying, other bad, you know, trauma, other, you know, unexpected bad things happening, a family member losing a job and then having to move or whatever, um that we know a lot of packing in uncertainty and some of these risk early risk factors around stress that might be mediated by you know, uh, cortisol or glucocorticoids or, um other infections, maybe,
00:59:25
Jason Moser
um that affect brain development, you know, that we know a lot of those things are packed in there along with, with genetics. um I kind of, you know, along those lines, I generally think of Dave Barlow, who's one of my, my favorites in the anxiety world, who's developed most of the evidence, know, many of the evidence-based treatments for anxiety and depression.
00:59:45
Jason Moser
You know, he's got this kind of like three factor model um of, of anxiety and depression are or, or negative affective psychopathology development, which is like, Hey, but people are born with some sort of vulnerability factors, let's call them, like some of these things we're just talking about, whether it's genetic or early in utero or at birth complications or increases in stress-mediated um ah chemicals or or what have you.
01:00:11
Jason Moser
So they're they're ah that's kind of what they're they're loaded with. And then if some other environmental stressors happen pretty early, then you' you're kind of like you're set on a path to probably develop some stress or anxiety-related disorder, right?
01:00:25
Jason Moser
then in terms of like which one you get, it's probably shaped by additional unique environmental factors that put you in one direction or the other. Let's say I've worked with people who have fear of vomiting before called emetophobia.
01:00:41
Jason Moser
The one woman I worked with, you know she had anxious relatives in her family. She was you know early life, maybe she had some stressors and she was also taught, this is the other piece of the puzzle we were talking about, emotion regulation, is people are often taught poor emotion regulation strategies from their caregivers early on. And the major one is just like avoidance of expressing emotion and managing emotion, right? Like Keep that to yourself.
01:01:04
Jason Moser
And so if you're learning all that, and then she just so happened to be in an elementary school class one day, and a friend of hers who was sick turned around and like vomited on the floor right right beside her.
01:01:15
Jason Moser
And boom, all of a sudden, that's that's what she struggles with now is fear of vomiting. or she did until I treated her. But that's the kind of the way I think about it is like, we have these vulnerability factors that we're gonna keep digging into and trying to figure out. But like, there's a lot in there that I think is just, it's just gonna be challenging to like pinpoint anything like big amygdala, small prefrontal cortex, like maybe, but you know, there's a lot more to the story, right? So there are these biological vulnerabilities, some of which we have some sense of, but I think if you start thinking about it in a broader context, like, yep, there's some vulnerabilities, then they have stressors early in life.
01:01:49
Jason Moser
And they're taught poor emotion regulation strategies, which generally has to do with like emotional avoidance. And then they have some unique experiences in their life that shapes the way that they feel ah about certain situations, whether it's social situations or it's vomiting, or let's say it's dirt and germs in general. and then you get OCD because you have...
01:02:08
Jason Moser
you know, you get sick one day from, you know, touching a doorknob or whatever. i think that's kind of how I generally think about these things. And so there are early enough signs for kiddos and that the earlier we intervene and the earlier we kind of correct in a way, these poor emotion regulation strategies, we can kind of protect against any of those additional unique experiences they might have that might shape a specific anxiety disorder or set of anxiety disorders. Yeah.
01:02:35
Tony Montgomery
Yeah. So with the idea of of being able to control um some of these some of these symptoms, and we talked about exercise being one of these ways that we could do that. um Some of the research shows that like high intensity interval training is a great way to
01:02:49
Jason Moser
Hmm.
01:02:53
Tony Montgomery
help people with anxiety control their anxiety symptoms. Um, the idea if you can take someone through intensity interval training, and they're going to have very much the same symptoms as an anxiety attack would have of being able to not control their breathing.
01:02:59
Jason Moser
Hmm.
01:03:09
Tony Montgomery
um having these anxious thoughts of this is hard, when is it going to be over? um Have you seen anything along those lines that would indicate that that is an appropriate intervention?
01:03:12
Jason Moser
Thank you.
01:03:19
Tony Montgomery
um Because we also see like moderate exercise is great for depression. um so is there certain exercise interventions that you found to be more impactful for certain disorders?
Exercise and Mental Health
01:03:30
Jason Moser
you know That's literally what my student, Kenan Sayers, and I are really trying to figure out. Kenan came to me from North Carolina. He's got a dual degree in psychology and exercise science and physiology.
01:03:43
Jason Moser
and i've i've over the past Since the pandemic, I've started to kind of get back into running. I used to run when I was in high school, and then i got off it. And so I'm doing like half marathons and and trying to do more marathons. And so I've gotten really into like sports psychology from my own personal experience.
01:03:59
Jason Moser
And what, what I think, what we're, what we're seeing, I think, is that there are definitely ways, there are some general principles of exercise that I think have anxiolytic effects.
01:04:10
Jason Moser
And then I think there are some specific types of exercise regimens that might work better for certain populations. I don't think we have great data on that now. And that's why it's kind of frustrating. On the one hand, it's like, hey, everybody should get out and exercise, which in a way is like, well, no shit. Everybody should get out to exercise for all sorts of reasons, right? Like for health, for weight loss, for...
01:04:30
Jason Moser
um exposure to nature, even if you can get outside, you know, all sorts of benefits of, of movement of the body, whether it's yoga or running or HIIT exercises.
01:04:42
Jason Moser
So I'm a little frustrated that we don't have more answers of like specifically how to like tailor that stuff, but we do know physical activity is generally good for emotion, cognition, and things that matter for psychothology.
01:04:54
Jason Moser
Um, but keenan and i just finished up for his master's thesis kind of alluded you know getting back to one of the conditions you alluded to which is he's interested in in something called anxiety sensitivity um which is more or less uh panic uh panic disorder sort of symptoms which is you're afraid of your own internal bodily sensations um now anxiety sensitivity is also about
01:05:11
Tony Montgomery
Yeah.
01:05:18
Jason Moser
Some other aspects of like you're you feel like you might be going crazy and that bothers you or um you're concerned about how other people might perceive your physical appearance when you might be anxious, like you have red cheeks or something.
01:05:30
Jason Moser
um But Keenan and I were like specifically going in with it like, okay, for people who have high anxiety sensitivity or like basically fear of their own internal sensations, which is what panic is all about, is like your heart starts to flutter and you're like, oh my God, i'm going to have a heart attack.
01:05:44
Jason Moser
We said, let's have those people come in and let's have them just moderately jog on the on the treadmill. But what we were really interested in was we were curious, does running and getting up to that moderate intensity, does it actually make people start to think about having a heart attack? Because it's it mimics a panic-like symptoms. That's the whole idea.
01:06:06
Jason Moser
And then are they able to reinterpret that to get through it? And so we then did an emotion regulation task with them right after, but you know, um, yeah, before and after they exercise actually trying to remember the study, it's just finished and we're writing it up and I, I can't keep them all straight sometimes.
01:06:24
Tony Montgomery
Yeah.
01:06:25
Jason Moser
Um, but we did this emotion regulation test before and after they exercise or before and after they just rested on the, on the treadmill. And basically we were just asking the question, do people get better at reappraising Um,
01:06:38
Jason Moser
after they've exercised with the notion that if you are able to push through an exercise regimen that kind of feels like it's inducing the symptoms you're worried about, do you get better at reappraising? So we just finished the the results, analyzing the results. And it's kind of interesting what it seems to, what seems to happen. And I'll tell you a little bit more about the task we used.
01:06:57
Jason Moser
We use an EEG task where we set, we showed people who have panicky type symptoms. We showed them images of people who looked like they were having a panic, panic attack. Like they showed them images of like, or,
01:07:08
Jason Moser
doubled over or, you know, looking crazy or whatever, um, looking like they're feeling like they're out of control. Um, and so, We showed them these images and we asked them to either look at them passively or we also asked them in in a different block. We said, hey, look at this image and think about overcoming it. That it's like, you know, this person's having this experience. I might share that experience, but like this too shall pass.
01:07:33
Jason Moser
You know, i can deal with this. i'll I'll be able to get over it. um And what we noticed was after they exercised, and this was more so than after they exercised relative to when they rested is,
01:07:45
Jason Moser
They actually, when they just looked at those pictures, not even trying to reappraise on purpose, when they looked at the pictures, they actually had less of emotional response than what what they did before they exercised.
01:07:53
Tony Montgomery
Yeah.
01:07:57
Jason Moser
And what we saw in the EEG components when they reappraised, we actually saw that it seemed like they were actually paying more attention to the picture. than they were before exercise. So it looked kind of like they were more willing in a way.
01:08:12
Jason Moser
this was This was completely backwards to what we expected. I'm just going to put it out there.
01:08:17
Tony Montgomery
yeah
01:08:17
Jason Moser
the In terms of the reappraisal findings, for the passive viewing findings, that was actually what we thought would happen is after you exercise, you just kind of have less of an emotional reaction to these same kind of scary looking panicky pictures. And that is what happened.
01:08:30
Jason Moser
But during reappraisal, they actually had the bigger brain signal to these negative looking panicky images. And we thought they were going to have a smaller one because we thought, oh, they'd be able to reappraise it and it would be even easier to get past it. But instead, it looks like they were actually paying more attention to it and engaging more with it. That was greater than what they did before exercising. So we're trying to figure out, we have that study. We have another study with trauma survivors who we also had come in and do a reappraisal task and exercise on the treadmill in between.
01:09:00
Jason Moser
And the findings are just kind of more complicated than we thought, but it seems that like exercise is definitely enhancing people's ability to kind of like maybe implicitly let emotions wash over them and also giving them more cognitive capacity to think through something that looks or feels scary, which I think on the face of it does make some some intuitive sense, which is like, you know,
01:09:15
Tony Montgomery
Right.
01:09:27
Jason Moser
After exercise, we do know that exercise boosts boosts cognition, right? You have better focus, you have more attentional capacity.
01:09:31
Tony Montgomery
right
01:09:34
Jason Moser
And so we think like what exercise might be doing is is um helping people focus more on things that they find scary and also being able to let them go then when they're given the option to also just kind of like have your own natural reaction to the to the the image. So...
01:09:51
Jason Moser
This is all to say that we're using the treadmill as one way to do some of these studies. We haven't like pinpointed anything in particular. We tried to do this with this panic study, which was kind of the original rationale.
01:10:05
Jason Moser
But what Keenan and I have done since then is really tried to kind of bring the literature together and try to really figure out, are there multiple pathways for multiple, for different types of disorders? So like with panic disorder, or people with anxiety who are concerned about physiologic sensations, does cardiovascular exercise, well, maybe it's hit because you can ratchet up the intensity or maybe it's moderate to higher intensity running, whatever it is.
01:10:32
Jason Moser
Does that sort of exercise work better for people who have that sort of anxiety? Maybe strength training is really important. we've We've done some work with this and some hypothesizing around this.
01:10:43
Jason Moser
Maybe strength training is actually super important for trauma survivors and maybe in particular for trauma survivors who are females of vi um survivors of sexual assault.
01:10:53
Tony Montgomery
I
01:10:54
Jason Moser
that it fits more into a narrative of of building back you know capacity. And we know that when folks are traumatized and when females are sexually assaulted, we know they tend to have beliefs that the world is dangerous and that they might fall apart and they can't handle it anymore.
01:11:11
Jason Moser
What if we give them back that empowerment by having them do strength training, for instance? I think there are lots of opportunities like that. I think for depression, for instance, maybe baby strength training,
01:11:23
Jason Moser
is also good for depression because we know for depression, overcoming anhedonia and kind of, you know, um, feeling more, um accomplished and mastery is actually a really important piece of recovering from depression and what a treatment that's been out there for decades called behavioral activation actually helps people with depression do is like feel more mastery and accomplishment over that. Maybe strength, rate maybe any sort of exercise is fine for depression.
01:11:49
Jason Moser
But I think that question that you asked is really important and critical because we don't know whether there's a matching we should be doing. But Keenan and I have been starting to develop this model based on some of the findings we have and a review of the literature that maybe there are ways to think about what different types of exercise has effects on these core systems of like cognition,
01:12:10
Jason Moser
um you know ah avoidance motivation, approach motivation, and how that might relate to anxiety and depression differentially. I think there's a huge upside and possibility to look into that more, but we just don't we don't have the answers to that right now.
01:12:24
Jason Moser
Yeah.
01:12:25
Tony Montgomery
Yeah, I mean, that's definitely my read of the of the literature with the idea of moderate intensity exercise seems to be, um aerobic moderate intensity exercise seems to be more beneficial for people with depression, um maybe not as much with people with anxiety.
01:12:42
Tony Montgomery
um And a lot of that comes down to BDNF is one of the big hypotheses of depression. brain derived neurotrophic factor being released to help improve synaptic plasticity.
01:12:50
Jason Moser
yeah
01:12:53
Tony Montgomery
And that comes from moderate intensity at a dose dependent um dose response rate as well, which is very interesting. The more you do, the bigger the release seems to be important as well.
01:13:05
Jason Moser
uh
01:13:06
Tony Montgomery
um But yeah, the idea that, at least from what I've read, that the the prefrontal cortex gets a lot more oxygen and and blood flowing through it and the connectivity, the white matter tracks from the amygdala to the prefrontal cortex seems to be strengthened in people um after aerobic exercise, which helps them with decision making, and fear response and things along those lines. um We've seen that with um females doing exercise as well within the research they did.
01:13:35
Jason Moser
you
01:13:35
Tony Montgomery
reactivity, reaction times, and EEG signaling. And the females that did exercise actually improved their reaction time and decreased their attention to negative stimuli um after the intervention. So those things have different impacts depending on what issues you're having, what but but you're currently going through.
01:13:58
Tony Montgomery
And um i think it is important to kind of standardize that. and Daman just wrote a paper on the idea of trying to standardize um protocols and how we measure exercise to make sure that we get the most accurate um measures of those things.
01:14:11
Jason Moser
Yep.
01:14:15
Tony Montgomery
you know And it's it's it's difficult to do. the idea of, I think the restrictions of academia makes it hard to create a program that will help, you know, because you have to have like progressive overload, you have to have all these things that we talked about with the kids, like they have to be challenged throughout.
01:14:34
Tony Montgomery
So how do you create a program that's, you know, eight to 12 weeks to 16 weeks, that is individualized for each person, like you just can't do that within the research. And I don't know if that's something that we'll ever be able to overcome, because a lot of the research that I've seen is very much standardized to this idea of you're either doing 30 minutes,
01:14:52
Tony Montgomery
you know, three days a week, there's no progressive overload. And then after eight weeks, you know, you're you look at the results and my immediate train of thought goes, that's really boring.
01:15:04
Tony Montgomery
So having people that have depression be like, Hey, we're going to some really boring mundane exercise.
01:15:05
Jason Moser
Yep.
01:15:09
Jason Moser
Yeah.
01:15:09
Tony Montgomery
You're not going to get them to want to do it. Right. So what I look at is like, how do we get people to adhere to exercise and enjoy exercise?
01:15:17
Tony Montgomery
How get motivated to do exercise as well?
01:15:17
Jason Moser
Mm-hmm.
01:15:18
Jason Moser
Right.
01:15:20
Tony Montgomery
Um, is that something that you guys are also looking at, um, trying to combine maybe some CBT type stuff to improve motivation along with exercise? Is that maybe something that you're looking for next steps?
01:15:34
Jason Moser
Yeah. i mean, I think we're, we're thinking about a lot of things along the same lines that you guys are.
01:15:37
Tony Montgomery
Yeah.
01:15:38
Jason Moser
And, you know, we could spend another five hours just talking about that, but you know, I'm part, I'll go back just for a minute to link it back to, I love exercise. i do a lot of it.
01:15:49
Jason Moser
I enjoy running quite a bit and I like going to the gym and doing some weight training here and there. I like pickleball, all this stuff. My frustration with exercise is the same frustration I have with therapy and the types of therapies we have is like a lot of people don't want to do it.
01:16:04
Tony Montgomery
yeah
01:16:04
Jason Moser
right? And people find it too hard. um And so i continue to struggle with like, how can we make these things easier? How can we make people motivated to do these things?
01:16:16
Jason Moser
Is it matching the exercise to the person? I completely agree with you that the protocols that are in the literature are super boring. um And so I've started to think about, you know, well, look, there's so much content out there, right? Like,
01:16:31
Jason Moser
Peloton's got billions of exercise programs and exercise classes. Apple Fitness Plus has introduced a ton more themselves. There are so many different ones out there that already exist.
01:16:45
Jason Moser
And within the research domain, I think what we could do is borrow those.
01:16:49
Tony Montgomery
Mm-hmm.
01:16:50
Jason Moser
and and There's nothing stopping us from saying, hey, I'm going to take Kelly's 12 Peloton rides, let's say, who's on Peloton, and I'm going to use her 12 Peloton ride.
01:17:03
Jason Moser
you know I'm going to pick three of her hits. three of her endurance sessions and whatever, you know whatever. whatever And I'm going to build a program basically built on content that already exists that's way more engaging and way more fun than any of the stupid stuff that we do in the lab.
01:17:18
Jason Moser
But I'm going to do that systematically. I'm going to give that to people and I'm going to have whatever we thought about. I bought a Peloton um treadmill for the lab recently precisely for this purpose, which was like, why don't we just use the content that already exists and lots of people can access already?
01:17:28
Tony Montgomery
Mm-hmm.
01:17:34
Jason Moser
um and test it out we have no clue whether these things are better or worse or whatever and then like compare it to a business as usual sort of thing and so i think there are ways to become more naturalistic in what we're doing by by leaning on the content that already exists or borrowing the elements from the content that we know is out there that's really interesting and creating some of our own that's actually not boring.
01:18:01
Jason Moser
um And so I think there are opportunities that we can take by by either borrowing content or partnering with proprietary you know and and industry to to work together, to do studies. um So that's a piece of ah piece of what we're trying to think about doing is like, there's so many things we could actually just use, you know Nike, Nike, um, running Nike fitness, Nike there, those are free.
01:18:29
Jason Moser
Those are just out.
01:18:29
Tony Montgomery
Yeah.
01:18:29
Jason Moser
That's like super accessible. And they have a lot of great, you know, trainers who are on there who talk to you on your headphones and stuff. Like, why aren't we, aren't we using that to treat depression rather than something that we, we just create that, you know, again, it can be standardized enough because you can give these same things to people and they can take them home anyway.
01:18:45
Jason Moser
Um,
01:18:46
Tony Montgomery
yeah
01:18:46
Jason Moser
I think that's one opportunity one missed opportunity so far is I think we should just be using some of this amazing content that's out there to just make it more engaging. And I think experimentally, there's no real major drawback to that. If we do it within that though if we create things that are still time-limited and consistent across people, I think we can do it.
01:19:05
Jason Moser
um The other thing that I do think is is going to be really interesting. And so that's part of me trying to try to think like, can we make exercise more accessible and more um interesting to people? Because I think that sort of exercise that we might rig up in the lab is not going to be terribly interesting to people.
01:19:23
Tony Montgomery
Right.
01:19:23
Jason Moser
um And so like, we got to figure out ways to engage. I think group activities are always a way to, to, you know, get people to do more exercise. You probably know about more about this than I do, but, And talking to my kinesiology pals, you know, doing things as a group is always more effective. And so like, I think we got ah lean to lean into like, forget the one-off sort of exercise. Like we should think about getting people into groups and and testing it that way.
01:19:47
Jason Moser
Again, more naturalistic experiments that I think are still totally legitimate and we should have out there.
Combining Exercise with Psychological Skills
01:19:52
Jason Moser
And then I do think in my view, i really do believe the million dollar um question slash research approach and agenda would be, let's start marrying movement with psychological skills.
01:20:08
Tony Montgomery
Yeah. Right.
01:20:08
Jason Moser
And so we already know from the sports domain, right? They already do that, right? So like there's a whole other field that I've become much more interested in sports psychology where there's like all these psychological skills people are already using to help with performance.
01:20:23
Jason Moser
But they're the same skills basically, that we teach our clients in therapy.
01:20:29
Tony Montgomery
right
01:20:29
Jason Moser
you know It's just that the context is slightly different. They're telling people to use these same sort of, whether it's mindfulness or attentional focus to positive things or positive self-statements or reframing, same sort of skills. They're just using it in a very specific context, which is around performance and around sport performance to motivate and and reduce the noise and reduce the distraction And so everything seems so compatible to me.
01:20:53
Jason Moser
So at the end of the day, I think what could be very therapeutic for people who are not necessarily engaged in sport, but they want to leverage the benefits we know of of exercise and figure physical activity, and then psychological skills that we teach in all sorts of different contexts, whether it's in mental fitness performance, mental fitness or in therapy, is I do think there's this opportunity. And I don't know if you know about this this hypothesis, you probably do. And I always screw it up.
01:21:21
Jason Moser
But it's one of my favorites that I haven't quite tested, but I want to is the cross stressor adaptation hypothesis. my My student, Chris Webster, introduced this to me years ago when he was one of the first students I did.
01:21:34
Jason Moser
ah have now but do i have three students who are doing a joint psychology, kinesiology, clinical psychology, kinesiology ah degree because we're really interested in merging these worlds. is that if you're able to, let's say, we did an experiment during COVID and Chris still hasn't published it.
01:21:51
Jason Moser
I got to get it out there.
01:21:52
Tony Montgomery
Yeah.
01:21:52
Jason Moser
But the idea with this cross-dresser adaptation but idea is what if we ask people to run or to do strength training or do HIIT? And while they're doing it engage in psychological skills, similar to what you were saying around the focus being on the performance and the pain of the performance.
01:22:10
Jason Moser
But what if we actually like have them exercise across ah even one session or multiple sessions where some of the sessions we have them focus on using those psychological skills to improve performance of the exercise or to adapt to the performance of the exercise? What if we do that? But maybe in some other sessions, we actually have them continue doing the exercise, but now we have them work through a psychological problem they're dealing with.
01:22:33
Tony Montgomery
Mm-hmm.
01:22:33
Jason Moser
their depression, their anxiety, their social anxiety. What if we have them do that? And what if we bridge these worlds and such that you can kind of work through psychological problems, not just the pain and the fatigue of exercising, but also the psychological pain and fatigue around life?
01:22:49
Jason Moser
during movement to kind of piggyback and bootstrap the the benefits of movement in these various ways. And I think that's where the action's at. And and there hasn't been enough of those studies done out there where you're using reappraisal or mindfulness or whatever other strategy that we can stick into an exercise regimen to not only overcome the difficulties of exercise, but the difficulties of life. I think that that's that's like where I think ah there's a huge, huge upside there for us to explore.
01:23:20
Tony Montgomery
Yeah, no i I couldn't agree with you more. um as um'm ah As a veteran myself, I tend to look at like what a lot of the veterans are doing with therapy and stuff like that. And I've gravitated a lot towards reading um a lot about ums psycho psychedelic assisted therapy.
01:23:31
Jason Moser
Mm-hmm.
01:23:35
Jason Moser
Uh-huh.
01:23:36
Tony Montgomery
And MDMA is one that shows to be very promising for ptsd And when you look at the mechanisms of of MDMA, it's you get inundated with you know the 5-HT2A receptors, and it makes you more empathic, and it makes you able to deal with um you know these adverse situations in a more loving and and friendly way.
01:23:44
Jason Moser
Mm-hmm.
01:24:00
Tony Montgomery
I'm like, what can we do with exercise that can i can mimic that in a sense?
01:24:04
Jason Moser
he
01:24:06
Tony Montgomery
And my thought um is that like, maybe we'll do some high intensity interval training for like 20 minutes. And then that'll, like you like you said earlier, that'll start to make them focus on things, right? Within your research, they were able to focus a little bit better And then right after that, have them do like a 20 minute therapy session immediately after when we're vulnerable, when they're able to fully express themselves, when their ego is depleted because it's left on the treadmill or on the bike, are they able to break through like they do and in MDMA sessions?
01:24:28
Jason Moser
her Right.
01:24:36
Jason Moser
Yeah.
01:24:41
Tony Montgomery
So that's something that, I would love to to be able to do research on as well as like, how can we make them vulnerable to where we can add therapy afterwards or within this within the session to make them feel like they can open them?
01:24:54
Tony Montgomery
How can we expedite the alliance into like a couple of sessions like they do with with psychedelics, right?
01:24:56
Jason Moser
Yep.
01:25:02
Jason Moser
Yeah, I think that's that's also right on. The timing of these things and like how you combine, right? I mean, like there's a whole literature on like how you combine therapy and medication. That's been there forever. It was like one of the first papers I ever worked on was the combination you know therapies, medication plus therapy,
01:25:19
Jason Moser
you know, plus CBT, does that work better than either one alone? And there are a lot of complex answers to that question. But I think there are all sorts of, and you know, people are now futzing with the timing of those things.
01:25:29
Jason Moser
What if you do therapy first and then do medication for maintenance, or you do medication first, and what kind of medication?
01:25:31
Tony Montgomery
Mm-hmm.
01:25:35
Jason Moser
Is it a, is it an immediate effect of like doing propranolol for veterans, you know, with PTSD, for instance, and like, You have more of a window to work with memories if you, if you, you know, um, hit them with this medication first and then you can do prolonged exposure therapy. I was all, I also worked with veterans during my internship at the Boston ah consortium, the national center for PTSD when I was there.
01:25:58
Jason Moser
Um, And I think there's also things we could talk about in terms of like the military training that's also very similar to kind of sport performance, some of stuff that I know you're probably much more intimately you know aware of, but the psychological skills that that veterans get trained with.
01:26:11
Jason Moser
Yeah. But this notion of timing, I think, and staging is really important. One thing that I've noticed lately that speaks directly to the the kind of experiment you just put out there is what I've been noticing when I'm kind of freaked out about something and I go run. So running is my go-to.
01:26:30
Jason Moser
If I'm freaked out about something and I run, during the run, it actually makes it worse. so
01:26:35
Tony Montgomery
Yeah.
01:26:36
Jason Moser
you know You know, I'm trying to use my psychological skills, but I've i've activated the system, right? So I'm i'm like, i'm I'm stressing my body out already. And if I'm mentally stressed, sometimes it's not, it doesn't make it easier. It actually makes it worse. And I feel worse during the run.
01:26:52
Jason Moser
But then, you know, what happens is as soon as I'm done with the run, there's like this this wave of just like relaxation that comes over, even more so than when I'm not trying to work through ah problem during the run, I actually feel more relief.
01:27:05
Jason Moser
And so I think there is something to this, like you activate the system first, you know physiologically there there are mechanisms, but I also think psychologically you know you're stressing the system and then you're allowing the system to kind of come down and recover from the
Mindset and Psychological Adaptability
01:27:20
Jason Moser
stress.
01:27:20
Jason Moser
And there might be a ah special window in there during that recovery period where, right, people are more open. People are more open, more willing, maybe because of depletion, maybe because of, you know, some of the other mechanisms that are ah actually like increasing willingness or acceptance or, you know, an openness ah to experience that that kind of mimics the MDMA stuff too.
01:27:43
Jason Moser
But I think that sort of staging would be really interesting to look at as well.
01:27:47
Tony Montgomery
Yeah, it's definitely something that ah comes to mind whenever I do um ultra marathons and I do a lot of hiking.
01:27:56
Tony Montgomery
And yeah, thank you. And the idea is that like, you know, maybe the first, like with a hike, with say you do like a 25 mile hike to go camping.
01:27:56
Jason Moser
Good for you.
01:28:06
Tony Montgomery
The first like 18 to 20 miles, you just have, you're inundated with like junk. Right. It's just like these thoughts that come in your mind, these songs that you just can't get out of your head.
01:28:14
Jason Moser
Yeah.
01:28:20
Jason Moser
Right.
01:28:20
Tony Montgomery
you're going to it like ultra stress, you're going to think about that. You're going to ruminate and you're going to.
01:28:24
Jason Moser
Right.
01:28:25
Tony Montgomery
And what I found was like, there's a certain point in time where if you put in enough effort, your brain starts to say like, oh, we've done this enough. Now we can let you like truly think about what you want to think about.
01:28:39
Jason Moser
Right.
01:28:39
Tony Montgomery
and and like, you almost allow the muse to come in and then you can start thinking about like, interceptive things like you, the ego is gone because you just destroyed it through exercise. And now you're able to get like into the deeper thoughtful stuff.
01:28:49
Jason Moser
Right, right.
01:28:52
Tony Montgomery
So I think there is, um, a big component of that idea of like, dopamine with effort versus dopamine without effort, you know, you start to get the extra, like everything just kind of works together.
01:29:02
Jason Moser
Sure. Yes.
01:29:06
Tony Montgomery
Like your body, it almost is like your body and brain like gives you, um it gives you a reward for the effort that you're doing.
01:29:10
Jason Moser
Thank you.
01:29:16
Tony Montgomery
And it could be within that window that you can have these sessions, you know, and you can get
01:29:22
Jason Moser
Yeah. I mean, what's interesting, the paradox that you even just like highlighted, sorry to cut you off there, but like, it just made me think about this paradox that's still, that's there with what we're talking about is, you know, exercise can kind of deplete the ego or the frontal brain.
01:29:36
Jason Moser
But at the same time, we know that if you exercise moderate, at least moderately, like it boosts attention.
01:29:41
Tony Montgomery
Mm-hmm.
01:29:41
Jason Moser
So I think there's like, it's depleting something about the ego maybe, but like actually enhancing other pieces of it. if we're going to stay in the kind of ego, um you know, concept for now is like, it does, it it does seem to like increase some sort of like attention or willingness or maybe openness of attention while at the same time kind of depleting in a way the little chatterbox, you know, maybe, maybe. So it's like,
01:30:04
Jason Moser
it's not a full depletion of the frontal cortex or, or ego, so to speak. It's like, it's a depletion of kind of the, the noisy parts of it. And so maybe it's kind of a signal to noise that it, that it shifts with exercise. Is it like boost the signal and decreases the noise um through some of these mechanisms that we're talking about?
01:30:23
Tony Montgomery
Yeah, I mean, that's that's, at least that's the way I think of it is like, you're right. Like we do know the prefrontal cortex gets all this oxygen and gets better delivery.
01:30:31
Jason Moser
Right.
01:30:33
Tony Montgomery
And I feel like, the default mode network gets quieted down towards the end, right?
01:30:37
Jason Moser
Quiet it down.
01:30:39
Tony Montgomery
And the same thing you see but with meditation and that's the exact same thing you see with with psychedelics.
01:30:39
Jason Moser
Right. Yeah.
01:30:42
Jason Moser
Yeah.
01:30:45
Tony Montgomery
One of the ah leading researchers in psychedelic assisted therapy has this idea, um his name is ah Robin Carhart Davis.
01:30:46
Jason Moser
Right.
01:30:56
Tony Montgomery
And he has this idea of that mental health disorders um come from too much order in the brain. Your brain's constantly trying to have these error predictions and it's trying to shape the way we see the world.
01:31:04
Jason Moser
Hmm. Hmm.
01:31:09
Tony Montgomery
And with depression, you can get into this, you know, ruminative state of like, I can't do anything.
01:31:13
Jason Moser
yeah yeah it's a closed it creates a closed system right yeah yeah
01:31:14
Tony Montgomery
um You know, so what psychedelics does, Yeah, so what psychedelics does is it puts you a little bit more towards chaos and it allows you to dive into these other areas.
01:31:23
Jason Moser
her
01:31:26
Tony Montgomery
And that's his hypothesis on mental health disorders and why psychedelics seem to be so impactful.
01:31:27
Jason Moser
yeah makes sense to me and
01:31:33
Tony Montgomery
And I think exercise, hard exercise can have the same effect.
01:31:38
Jason Moser
That potential.
01:31:39
Tony Montgomery
Yeah, I think so.
01:31:40
Jason Moser
Yeah, totally.
01:31:40
Tony Montgomery
Yeah.
01:31:41
Jason Moser
No, I'm with you.
01:31:42
Tony Montgomery
Yeah.
01:31:42
Jason Moser
Yeah. Right. Open. It's kind of like opening the opening the mind and the brain to possibility or different ways of thinking or, or openness to different experiences, which is very much the MDMA stick, right.
01:31:54
Jason Moser
Is that it's opening you up to these, like you're just willing to hear and say and feel.
01:31:54
Tony Montgomery
Yeah.
01:31:59
Jason Moser
and I think exercise, I think you're absolutely, that's what I've, I've started to have the same. I think you're absolutely right. And I'm having similar sort of, um, intuitions and insights with my own exercise and some of the research that we're doing that. Yeah, maybe it does. It's like, it opens you up, you know, it's the same sort of like critical window that, you know, i don't know if you know about that work with propranolol, um, where, um, with military veterans, um, this is Liz, um,
01:32:27
Jason Moser
Phelps at and NYU, she had done some research where it's like propranolol kind of like opens up the system more willingness in a way, like quiets things down and quiets the sympathetic system, opens people up maybe more to going through their trauma memory.
01:32:42
Jason Moser
It didn't totally work out. It kind of works, but it kind of doesn't. But like all the this, this same idea um like, what are situations in which, and I tend to be the non-pharmacologic person,
01:32:53
Jason Moser
you know, interested in non-pharmacologic means and rather movement and physical activity in our own minds is like, what, how can we create situations where people are more open and willing to be chaotic, so to speak, to open up their system?
01:32:57
Tony Montgomery
Yeah, right.
01:33:06
Jason Moser
Cause this is what I talk to my clients a lot about too. It's just like, So many clients come in and be like, oh, I'm so broken in a way with my symptoms. I'm like, actually, it's really functional what's happened to you.
01:33:16
Tony Montgomery
yeah right
01:33:16
Jason Moser
is your so you know Your system has become organized in a way this way, and it and it quote unquote works. like that's what that's That's how it works. What we need to do is we need to mess with it.
01:33:28
Jason Moser
but We need to tell it.
01:33:28
Tony Montgomery
Right. Right.
01:33:29
Jason Moser
There's actually different ways of doing things. like You can go out on a Friday night with your friends and have fun. You can speak up in class, raise your hand, and things go okay. so In a way, it's actually very functional. It's not dysfunctional.
01:33:42
Jason Moser
It's just functioning very well in a way that you don't like, you know that doesn't work for you.
01:33:45
Tony Montgomery
right
01:33:47
Jason Moser
so like we have to perder you know We have to disrupt and like perturbate that system to open it up to different ways of organizing, which is i think, you know, we're on the same page there.
01:33:57
Tony Montgomery
Yeah, no, definitely. And one of the things that you've experienced, like experiment with, with research is the change in the belief system through ah placebo trials where you told them this is a placebo, but if you take it, it'll be effective.
01:34:07
Jason Moser
<unk>
01:34:10
Jason Moser
Yeah.
01:34:14
Tony Montgomery
And yeah.
01:34:15
Jason Moser
and So work.
01:34:16
Tony Montgomery
And some of the research, are you familiar with Aaliyah Crum's research out of Stanford?
01:34:23
Jason Moser
Crumb sounds so familiar, but I'm not, I'm not, it's not coming to mind.
01:34:26
Tony Montgomery
Yeah, so she did, she's done a lot of research with beliefs and changing your perceptions. And one of the ones that is really famous is the housemaids research where um they took this group of housemaids and they asked them if they thought their work was exercise.
01:34:35
Jason Moser
Mm.
01:34:40
Tony Montgomery
And, um you know, one group, they but they all said, no, they don't think it's exercise. So one group was put into this, um you know, work is not exercise. And then the other group was put into this, we're going to teach you your work is exercise.
01:34:54
Jason Moser
is an exercise.
01:34:54
Tony Montgomery
And, you Yeah. And they didn't change anything. They didn't change their eating habits. They didn't change anything other than their mindset. And what they found was that the group that learned that their work was exercise was that they they lost weight.
01:35:07
Tony Montgomery
They improved their blood pressure. They improved their um stress response. through their questionnaires and they, they had more well, well-being in in their life because they thought it was exercise.
01:35:19
Tony Montgomery
So just those things of like shifting your belief system without actually changing anything is is so powerful.
01:35:20
Jason Moser
Hmm.
01:35:25
Jason Moser
Right.
01:35:25
Tony Montgomery
And that's something that you've done within your research. Um, can you elaborate on what exactly you've done with the whole belief system, placebos, and, and how maybe we can incorporate that into some of the stuff we've already talked about with helping people, um, with, with mental health disorders.
01:35:45
Jason Moser
Yeah, you know, I think beliefs are really where the action's at. The question is, right, how do you develop ah healthy beliefs or or leverage beliefs that we know can have, you know, measurable impacts like on on weight loss or school performance, right? So the the famous early studies by Dweck showing, you know, the intelligence mindset having an impact on actual achievement in kiddos, especially kiddos who are struggling to start.
01:36:09
Jason Moser
Yeah. So I'll get to the placebos in a second, but I think in general, beliefs and perceptions are so huge. We know that from our current, you know, we know that from the world too, that what you believe really drives what you do and how you organize your own narrative and the narrative of the world.
01:36:22
Tony Montgomery
Right. Mm-hmm.
01:36:25
Jason Moser
So I think it's a huge, huge piece of psychology that we, um, we need to pay attention to and and try to leverage the good, the good parts of it anyway.
01:36:34
Tony Montgomery
right
01:36:34
Jason Moser
Um, there are lots that There are lots of beliefs out there that are very dangerous. um But um I think you know with growth mindset, so that's where I started really with beliefs. I hadn't given beliefs that much of attention before hooking up with a graduate student of mine, Hans Schroeder, who's now at Michigan in psychiatry. And he kind of cued me into this whole growth mindset idea. And it actually started with a simple study we did where we showed that if you induce a growth mindset about intelligence in undergraduates, um you can actually increase their attention to mistakes and their ability to adapt to mistakes. And it was like, you know, very quickly in a very implicit sort of way. So it was just like a very powerful way. Hey, if we get you to think that, you know, mistakes are good things and they're opportunities to learn, you actually do learn from your mistakes in a simple task more so than people who were given a fixed mindset that, oh, you're just, you're as smart as you're going to be. And that's that.
01:37:27
Jason Moser
So we did we done we did some of those experiments, but what I started to get more interested in with with mental health and we started to do more kind of questionnaire studies was, well, maybe people have different beliefs about their own anxiety or their own depression, like where it came from or how much they can change it.
01:37:41
Jason Moser
And what we've shown ah over a bunch of studies now is that if you have a more fixed mindset about your mental health, basically, you know You do tend to have higher symptoms. You tend to reach for unhelpful emotion regulation strategies like substances more often.
01:37:57
Jason Moser
You tend to have a harder time in therapy, actually, even. Whereas the reverse is true, is if you're a more growth-oriented person, like, hey, I have some anxiety, but I can actually change it or it's possible for me to change my depression or whatever.
01:38:12
Jason Moser
If you have those sorts of beliefs, you are actually more open and and amenable to intervention. And you actually bounce back more from stressors than if you think your mental health is a kind of a core component of who you are that's basically baked in.
01:38:25
Jason Moser
um And so I think the more we can be sending messages to people in general, I think this is a ah piece, you know, a huge piece of it, that we get inundated with messages about um Even even biological ah biological essentialism, I think, is a really tricky bug because we know that telling people that you know depression is is due to a chemical imbalance in your brain or whatever, that does actually help them feel less shameful about their disorder.
01:38:51
Tony Montgomery
Right.
01:38:52
Jason Moser
The problem is it actually makes them feel like their prognosis is worse, worse though. That's the main issue. They think they're just going to have it forever. So that's a real double-edged sword of there.
01:38:59
Tony Montgomery
right
01:39:01
Jason Moser
So you know I think one thing to think about is just like, what are we telling people about mental health? Are we telling them it's a brain disorder? Which for most lay people, if you tell them it's a brain disorder, they don't know what that means other than, oh crap, I'm probably screwed for life.
01:39:14
Jason Moser
like That's basically what a lot of, you know that's how a lot of lay people understand biology is. Biology is fixed. Environment and personality is, and the mind is is malleable. So I think the way we talk about biology in mental health has got to be shifted. It's like we have to also teach people like biology is malleable just like anything else, honestly. Like you can change it. you know think some people have a sense of that. Like, oh, if I eat more sugar, I'm going to be hyper, you know, sort of thing.
01:39:42
Jason Moser
But in terms of mental health, I don't think they make those same connections. um So I think there are lots of different messaging in the way we talk about people's mental health and whether it's malleable or fixed and whether it's biologically or genetically driven or environmentally driven. I think there's a lot we can do to make people feel more empowered that they have control over their mental health, basically.
01:40:01
Jason Moser
And so that's a whole line of, of kind of beliefs research that I think is really important to be talking about more and how we talk about it with our clients and how, you know, everything's a day you're, you're all, it's all adaptable. You can strengthen. This is why I think sports and like, and, and, um,
01:40:17
Jason Moser
Physical activity is such a great partner in mental
Placebos in Mental Health Treatment
01:40:20
Jason Moser
health is because people also know you can get stronger by bo going to the gym, but they don't always think about that in the same way with their minds.
01:40:20
Tony Montgomery
I don't.
01:40:27
Jason Moser
But I think there's a total translation that if we continue to get people to believe that, and you see that even you know obviously in this mindset research, right you just give people a different way to think about something and all of a sudden phzzsy ah physically they've changed.
01:40:39
Jason Moser
um So I think we need to keep leveraging, you know push pushing on those levers where you can make psychological changes that have physical effects and physical changes that have psychological effects because we know theyre they work both ways.
01:40:53
Jason Moser
um Which leads me to this this research that we got interested in with my postdoc, Darwin Guevara, who's now at Miami University in Ohio. He was really interested in just the idea of placebos.
01:41:04
Jason Moser
Again, another kind of like a pretty big effect, which is basically a ah belief effect. It's an expectation effect. Similar to the mindset stuff is like, if you expect and you believe that your anxiety is kind of fixed and there's nothing you can do about it, you're probably just going to have it forever, right?
01:41:17
Jason Moser
Like that's just what's going to happen.
01:41:18
Tony Montgomery
Right.
01:41:19
Jason Moser
It's going be hard to nudge it if that's just the way you think about it. So if you think you're getting a treatment, right? and you are given all these expectations that you're gonna get better if you keep putting this pill in your mouth.
01:41:33
Jason Moser
It turns out there are huge placebo effects on mental health, on IBS, on ADHD, all on pain, chronic pain. And that's really kind of wild, right? Because these people are not given any biological interventions in this pill usually that they're getting. But if they expect it to be there, like in a blinded research study, right, of you're getting a placebo, but you don't know it,
01:41:58
Jason Moser
There's huge placebo effects. The problem with the placebo effect, right? because we and And in depression, it's like one of the biggest. like Depression has a giant placebo effect.
01:42:06
Tony Montgomery
Right.
01:42:07
Jason Moser
um through you know We see this with randomized controlled trials of antidepressants that the majority of people with depression who generally have mild to moderate depression, 80% of their response is due to expectations of placebo.
01:42:19
Jason Moser
And it works just as well as an antidepressant, which debunks the whole kind of serotonin hypothesis, which you alluded to earlier. There's a small proportion of of patients who do seem to get some real benefit from serotonin reuptake inhibitors, but many of them actually are just fine with placebos.
01:42:31
Tony Montgomery
right
01:42:36
Jason Moser
The problem is you can't you can't do that in real life, right?
01:42:39
Tony Montgomery
Right. Right.
01:42:40
Jason Moser
Like you can't say, I'm giving you medicine, patient, and lying to them. Like that's not okay.
01:42:46
Tony Montgomery
um
01:42:47
Jason Moser
Not going to fly. So what if, you know, non-deceptive placebos were an option? And so that's what Darwin really got it interested in was like, you know, what if you just tell people they're getting a placebo, but like, you should just think that this is going to help you. And if you think it's going to help you, you'll get better.
01:43:06
Jason Moser
Like, let's see if that works. And there's actually a decent amount of evidence, again, mostly in like IBS and chronic pain, that if people are given a placebo and told it's a placebo, it's called non-deceptive placebo. um and But they're told that if you just believe in this, and they show them all sorts of data, like brain data and biological data that says like, if you just believe this is going to help you, it will, because look at all these placebo results out there.
01:43:32
Jason Moser
Right. They just believe that it was going to help them. And it did. So what they found is that you can get people to have fewer IBS, you know, um and fewer sleep problems, fewer pain, you know, less pain, um even fewer ADHD symptoms by the same, by the same principle of just like, they're just expecting, even though they know it.
01:43:50
Jason Moser
So you don't have to be tricked to get the effect right now. Not everybody gets it. Some people are very skeptical that, you know, they don't want to deal with some fine. Okay. There'll be, there'll be jerks about it. It's okay.
01:44:02
Jason Moser
But if people are willing to believe it, you they can get better. And what I think we're starting to learn, and I'll tell you about some of the specific studies we did really briefly in a second. But I think what we're learning is if you have the belief and expectation that something that you're doing repeatedly is part of a regimen and you're told by repeatedly,
01:44:23
Jason Moser
to do it by somebody with authority and you're given enough information that's convincing to you and you engage and it's not, and it's like, that's a big piece of it, but you're also leveraging a behavior that you've likely done your whole life that has been medicinal.
01:44:38
Tony Montgomery
Mm-hmm.
01:44:39
Jason Moser
right It's just a learned behavior that when I take this thing that this authority figure told me to put in my body that will make me feel better. Just think about the millions of times your caregiver gave you something and said, here you go, honey, you're going to feel better if you take this little red.
01:44:54
Jason Moser
you know, goop in your mouth, you're just reactivating those healing properties of this learned behavior. I think that's a huge piece of it. And so just because you know that there's no active ingredient, that you're just being given something kind of like helpful from somebody who's trying to be caring to you. And that activates all sort of like health, you know, uh,
01:45:13
Jason Moser
self-healing properties and and you see these benefits. I think it's fascinating. And Darwin and I are continuing to collaborate on this stuff. But what was missing at the time that we did some of our studies is what if you did it with emotions, with emotional health?
01:45:27
Jason Moser
People had been doing it more with kind of like what we traditionally think of was medical, even though pain, would still say is psychological. Lots of people think about it as a medical condition, especially, you anyway, um nobody had done it with like,
01:45:33
Tony Montgomery
Right.
01:45:41
Jason Moser
emotions. So we did an experiment in the lab first with EEG. And then we, we saw effects in there and we took it out in the real world. And so the, the study in the lab was pretty simple, was literally just like, we gave somebody, some people, we gave them nasal spray and said, hey we're going to give you this nasal spray.
01:45:57
Jason Moser
It doesn't have anything in it, but we're giving you this because if you think this has emotional, you know, district, you know, anti, anti-stress properties, we're going to show you a bunch of nasty pictures that are going to stress you out. But if you take this nasal spray and you think that it's actually going make you feel better, you're not going to have that big of a reaction to these these distressing images we're about to show you.
01:46:17
Jason Moser
The other group, we just sprayed them with the nasal spray and said, this is just to help the EEG signals settle. And so what we found was we did it. We actually replicated ourselves, which was actually pretty amazing.
01:46:28
Jason Moser
ah Nature Communications made us do that before we got the publication. And they were like, we believe the first, but we want to see it again. And we were actually able to replicate it. was very, very exciting.
01:46:38
Tony Montgomery
Nice.
01:46:38
Jason Moser
um One of the first times ive replicated ourselves like back to back that way, which is pretty great to see.
01:46:42
Tony Montgomery
Yeah, that's crazy.
01:46:44
Jason Moser
a But what we found was that the brain signal we were looking at, they this this kind of brain signal is like an emotional sensitivity brain signal, it was smaller when the people were given nasal spray and told that if they think it's going to make them feel better, it did. And so that was like the first like biological data we had we were aware of to show that non-deceptive placebos can actually impact emotional reactivity in the moment, at least brain data.
01:47:10
Jason Moser
um And so we took that idea and we said, hey, if it works there, let's let's take this into the real world. And we actually did a study during COVID for people who were who had high COVID stress.
01:47:21
Jason Moser
And we recruited them in. And half of them, we just said, hey, fill out these questionnaires for the next two weeks. The other half, we... found on Amazon. They're actually placebo pills on Amazon. You can buy for 20 bucks for 30 pills and they're called Zeebo pills.
01:47:37
Jason Moser
It says pure placebo, like right on the bottle. And so we sent them this bottle and we said, Hey, take two of these a day for the next two weeks. And the reason we want you to do that is because of this non-deceptive placebo effect. We actually used our own data in doing a zoom meeting with them to try to tell them kind of what they could expect. We said, look, we told these people to do this. It quieted their brain.
01:48:00
Jason Moser
Look at all these other effects you can get for pain and IBS. So if you take these pills twice a day and you think they're going to help with your COVID anxiety, they will. And sure enough, we published this paper earlier this year where the group that got the placebos who knew about it had significant decreases over two weeks in anxiety, COVID anxiety, depression came way down. That was the biggest effect.
01:48:21
Jason Moser
Uh, And it was, you know, it was remarkable, um the big kind of treatment response we got just by telling them, if you believe this repeated activity you're going to do by putting this sugar pill in your mouth, because we tell you it's going to be good for you, they got better.
01:48:36
Jason Moser
So these beliefs and expectations and these and these learned behaviors that are medicinal, I think, are are really big.
01:48:37
Tony Montgomery
Yeah.
01:48:43
Tony Montgomery
Yeah. I mean, all that makes sense except for the nasal spray one, because all the other ones, you gave them some data that showed that the placebo effect could have, you know, positive.
01:48:56
Jason Moser
Yeah, we did show them that in the, in the nasal spray one too, as part of the nasal spray, we, we had them do the nasal spray and we showed them a bunch of, and like show them like a PowerPoint, which just like, if you do this, look at all these other data that will, that if you do this, it does work.
01:48:56
Tony Montgomery
Okay.
01:49:05
Tony Montgomery
okay
01:49:10
Jason Moser
So we gave them, it was very similar. i forgot to mention that exactly.
01:49:13
Tony Montgomery
Okay.
01:49:14
Jason Moser
We just use nasal spray in that one. Cause kind of fit the situation. We use Zeebo pills for the other one. Cause it kind of made sense. Um, but we did give both of those groups the kind of rationale for why we're doing it in like a little PowerPoint, um, uh, talk basically presentation.
01:49:30
Tony Montgomery
Yeah, okay, okay. Yeah, because the idea of educating them is something that is extremely important when it comes to um any type of behavior change and placebo and things along those lines.
01:49:40
Jason Moser
Yeah.
01:49:42
Tony Montgomery
A lot of the stuff I read with like the health, healthy, I think it's healthy mental or healthy behavior therapy, where the ideas they they come in and they um teach them about the health benefits of exercise and try to get them to create their own ideas of what the benefits are um to get them to buy into the program that they're going to do.
01:49:51
Jason Moser
and
01:50:03
Tony Montgomery
But you have to have that explicit idea of like, this is what's going to happen when you start to change your mind.
01:50:09
Jason Moser
Yeah.
01:50:11
Tony Montgomery
um And so, so why do you think, why do you think that's so powerful?
01:50:11
Jason Moser
Yep.
01:50:16
Tony Montgomery
What changes, Do we think there's like things that change in the in the brain? Do we think that there's things that change with the way they see themselves?
01:50:27
Tony Montgomery
like what What do we think is is making this change in their ability to have this effect with the emotional stuff?
01:50:37
Tony Montgomery
Because I understand with the biomedical stuff, right you you still get the same type of And correct me if I'm wrong, but you still get the same type of response. So for like pain, you still get a dullness of the the pain receptors. You still get a, um you know, you still get the H5HT2A receptor bind.
01:50:37
Jason Moser
Thank you.
01:50:58
Tony Montgomery
Like, so you still get those things. What is it that's happening with the emotional responses, do you think?
01:51:05
Jason Moser
I mean, I think what at least what we saw in the brain data is that you know the the reactivity that we expect to see in this brain signal, it's called the late positive potential, which we know from a lot of other research is basically you know a signal that comes from the visual system, but is basically turned up and turned down by the amygdala.
01:51:27
Jason Moser
um and by the ah the a sympathetic nervous system. So the more you're activated, whether it's for aroused, basically, like if it's a really kind of distressing negative image or a really exciting positive sort of scenario, you have this big response.
01:51:44
Jason Moser
So I think what we're we're seeing with this is that where we're getting a kind of implicit quieting of that that distress signal that it's just you know in terms of exactly the the mechanisms per se. I mean, i think its I think the cognitive system, and this is why I like this non-disceptive placebo, kind of to bring it full circle, um is non-disceptive placebo is is an example of an effortless strategy because we didn't find other changes, like really big changes in like effort per se. But I think there's something we're doing
01:52:19
Jason Moser
with those With that sort of intervention that's similar to the third person self-talk, which is like we've kind of switched the brain into a different mode of processing, which is a more accepting, a more open, a a kind of more aware. I think it's both kind of like a more aware, but an awareness approach.
01:52:39
Jason Moser
And an expectation that they kind of know what's going to happen and they kind of know what to expect in a way. And they and they kind of know how to handle what's coming their way. So I think these kind of building expectations or building a perspective where you're like, I know what's going to happen. I kind of have control and there's certainty over this situation.
01:52:59
Jason Moser
I think that's likely a big piece of it is just like, I'm doing something for myself that is... um that is helpful. And I think that sets the brain into a less threat mode. I think it's more in kind of like, it's more in a challenge mode or it's more in a, in a relaxed mode, just just from the start.
01:53:20
Jason Moser
And I think that's why I like these sorts of strategies because I think they're simple. And something like the non-diceptible placebo, which also brings in this other wrinkle of like, is there something you actually have to do actively each trial? Or is it just like you set it up from the beginning? Because the third person self-talk, they actually get reminded to do it every time they see a distressing image. Whereas with the non-diceptible placebo, we just like put them in ah in ah in a mode.
01:53:45
Jason Moser
We're just like, hey, you just did this nasal spray, which is probably going to make you feel better if you think it is. um So I think it it like literally sets... Whether it quiets the default mode network or quiets the salience network, I think it likely has that.
01:53:59
Jason Moser
It's just kind of like, I think there are ways, and we we kind of know this from the network analysis of the brain, I think it toggles it.
01:54:05
Tony Montgomery
Yeah.
01:54:05
Jason Moser
you know between a, I'm in a threat situation. When you come into a lab and you don't know what the heck's going on, and all of a sudden I say, I'm going to start showing you pictures of gore and blood and threat, you know people probably turn into a threat mode a bit, right?
01:54:18
Jason Moser
And then they start to see that we we we present them with different scenarios. Some are threatening, some are boring, some might be exciting and positive. And so I think you a lot of times when you're a lab, you're already in that threat mode, which is kind of also bringing it full circle back to the anxiety, you know, sort of stuff that we said is people who come in these testing situations are probably in a threat mode.
01:54:37
Jason Moser
And so when we give them these sorts of strategies like the non-deceptive placebo, I think we switch them into a... into a safe mode, you know, in a way. um And I think that's what that late positive potential brain potential wheat we um we looked at kind of told us is that we did quiet down.
01:54:54
Jason Moser
Now, and it doesn't seem like at least from the kind of prefrontal cortex data that we have in those data, it doesn't seem like they're having to kind of like repeat and tell themselves that like everything's okay, everything's going to be fine.
01:55:05
Tony Montgomery
Yeah.
01:55:06
Jason Moser
it seems like it just does toggle them and into this is a safe place. And I've just been given something that makes, make me feel okay. i don't know if that directly answered your question, but like, that's just where my head goes.
01:55:15
Tony Montgomery
yeah
01:55:16
Jason Moser
Cause I don't have a lot of other physiologic measures from these studies to speak exactly what's going on. But I do think it gives people kind of like psychological safety, some psychological certainty and control.
01:55:29
Jason Moser
and I think those, that framing, that broad framing, allows people to toggle into more of a safe mode rather than a threat mode in there in their brain.
01:55:40
Tony Montgomery
Yeah, no, I couldn't agree with you more. A lot of the stuff that I've been reading, the idea of providing agency and certainty to people seems to be kind of a cure for a lot of mental health disorders because, you know.
01:55:48
Jason Moser
Yeah, it's huge.
01:55:53
Jason Moser
I mean, we know and uncertainty is a huge source of anxiety and stress, like for sure.
01:55:57
Tony Montgomery
Right. Yeah. So that makes that makes a lot of sense. That definitely connects all the dots there. um I think that that pretty much covers everything that I wanted to talk about, Jason. Is there anything else that you wanted to touch on that we might have missed?
01:56:13
Jason Moser
you know I think I'll just bring it all kind of full circle. And we've talked about a lot of different areas that i' I'm glad we we're both kind of passionate about. So this has been a lot of fun. and And a lot of the way I connect these things is you know really trying to think about overall well-being and health, that we don't have to keep these like sharp lines between this is physical, this is mental.
01:56:35
Jason Moser
The more we're coming together to try to bring... All of the different strategies we have to help people feel healthy and well, I think is where it's going to be. And the more that we can make them palatable, easier to do, part of everyday life, you know making people feel stronger, more empowered, more agentic,
01:56:55
Jason Moser
more over control of their lives and boosting that capacity for control. i think we have so many different tools at our disposal to help people do that. And we don't have to feel siloed. I mean, this is what I like about these sorts of conversations is that we don't have to be siloed in our little areas is that we actually integrating things is going to be much more um impactful long-term.
01:57:20
Jason Moser
And so the basic principles of like, make it easy, make it palatable, make it acceptable and make it something people can, can do and make habits out of in their daily lives from any sort of walk of life, I think is really important.
Conclusion: Integrating Strategies for Well-being
01:57:35
Jason Moser
And the last thing I will say though, is that it is ah a bit of a challenge that we all have to come up with is we have to tailor this to individual needs and resources because we have so many tools.
01:57:47
Jason Moser
And I think It is amazing we have all these tools and we can integrate across all these different disciplines. The problem is how do people make choices about which ones to choose when?
01:57:58
Tony Montgomery
Right.
01:57:58
Jason Moser
And so that's kind of like the next level. You know, we've talked about lots of different ways that we could make exercise work or we could make, you know, different sort of cognitive strategies work or building capacity for cognitive cognitive control maybe.
01:58:10
Jason Moser
Now I think, you know, if we're in that mindset and we think we can push a lever for beliefs and we can push a lever for cognitive control and whatever, we then have to really get down and dirty, which I'm doing some work with my colleague Ethan Cross at the University of Michigan, is we have to figure out like,
01:58:26
Jason Moser
But when should these people use these different strategies? because And who are the people who should use these ones and not those ones? And I think that's that's another grand challenge is we've got so many strategies, so many so many fads that people want to kind of glom onto and then they get frustrated because they don't work. We have to help people find ones that really work for them in the intensity, in the in the messaging, um and in the acceptability that that I think is is also a big piece of kind of what do we do with all these strategies that we just talked about is we have to figure out what works for whom, when, um and have people develop their own toolboxes that work for them and take those along along for the ride.
01:59:09
Tony Montgomery
Yeah, no, I couldn't agree with you more. The more we adapt that biopsychosocial model to individually improve everyone is is definitely the the way forward. um So I appreciate you coming on and spending two hours going over all your stuff.
01:59:23
Tony Montgomery
It's a fascinating research and I'm excited that you're interested in in the same things and trying to push this field forward.
01:59:24
Jason Moser
Absolutely.
01:59:31
Tony Montgomery
So I appreciate your time. All
01:59:34
Jason Moser
Yeah, this has been a lot of fun. Thanks for having me on.
01:59:36
Tony Montgomery
right, I'll talk to you soon, Jason. Thank you.
01:59:39
Jason Moser
Take care.