Latest / Mind & Medicine - A Behavioral Health Podcast by Sentara / Exercise and Our Mental Health with Gabriel Villarreal LPC - Episode 1

Transcript

Exercise and Our Mental Health with Gabriel Villarreal LPC - Episode 1 · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:16
  Speaker 1: Hello and welcome to Mind and Medicine, the Sentara Podcast.
• 0:16
  Speaker 1: I am Tommy Bateman, your host, and today we'll be talking with Dr.
• 0:16
  Speaker 1: Gabriel Villarreal about exercise and mental health.
• 0:17
  Speaker 1: Before we begin, here are a few important CME announcements.
• 0:17
  Speaker 1: his episode is accredited for AMA PRA Category 1 credits for full accreditation, designation, and disclosure information, please refer to the show notes.
• 0:20
  Speaker 1: We want your feedback if you have any ideas or questions.
• 0:23
  Speaker 1: Find that form also in the show notes.
• 0:25
  Speaker 1: Now the show.
• 0:27
  Speaker 1: All right, Gabriel, thank you for joining us today.
• 0:31
  Speaker 1: I know we want to talk about getting massively swole and how that relates to our mental health.
• 0:36
  Speaker 1: But before we get going, uh tell us about yourself.
• 0:39
  Speaker 1: Yeah, thanks for having me on.
• 0:41
  Speaker: Um my name is Gabriel Villarreal, licensed professional counselor in the state of Virginia and uh strength conditioning certified.
• 0:47
  Speaker: Um got into the space uh through my master's program.
• 0:50
  Speaker: Uh I was going through clinical mental health uh master's program at Radford University and signed up rather impulsively for a half marathon.
• 0:59
  Speaker: And um, you know, really through that whole training regimen, I really had to dial in uh what I was eating.
• 1:06
  Speaker: I had to dial in uh well, I had a training regimen.
• 1:09
  Speaker: Um, you know, those kinds of splits working up into distances so I could be ready to run the race in November.
• 1:17
  Speaker: This was probably August.
• 1:19
  Speaker: Um and I just kind of recognized that um as stressful as that first semester of graduate school is, um, it felt like I just had uh a buffer that my peers didn't have.
• 1:31
  Speaker: Um I can count on you know uh two hands how many of my peers I saw cry that first semester because it's just so hard.
• 1:38
  Speaker: Uh and um and it's not that I'm a super tough guy at all.
• 1:43
  Speaker: It was I just felt uh even keel.
• 1:46
  Speaker: And I remember going to my professors and saying, like, you know, I'm running three days a week, I'm working out.
• 1:51
  Speaker: I really think there's something here to uh uh exercise and and buffering stress and and worries and anxiety, and I I'm just able to take everything and try.
• 2:02
  Speaker: What do you guys think about that?
• 2:03
  Speaker: And they were like, probably not, like maybe you should just focus on school.
• 2:08
  Speaker: Uh and uh and I said, cool, I'm gonna do it anyways.
• 2:12
  Speaker: And I started digging into the science, and and there really wasn't a whole lot.
• 2:17
  Speaker: There was a bulk in the 70s and 80s about exercise for depression or exercise for anxiety, but but it really just kind of tapered off uh in the late 70s.
• 2:27
  Speaker: Um so got through graduate school, did that whole thing, and and you know, the whole time I just knew like I need to get my license, and then I'm gonna open up a gym and really try to bridge exercise and mental health because I I do think that I'm right.
• 2:41
  Speaker: And um lo and behold, uh Dr.
• 2:44
  Speaker: John Rady published a book, I think, in in 2014, called Spark, the revolutionary new science on on brain health or something like that.
• 2:53
  Speaker: Um, and in that book, he he outlines uh all of the data that he's that we've had over you know however many years we've been doing research on on exercise and mental health and says, no, here's a mountain of data that says it's helpful for depression.
• 3:07
  Speaker: Here's a mountain that says it's helpful for anxiety and ADHD and autism and Alzheimer's and and substance abuse or disorders.
• 3:14
  Speaker: Um and I said, you know, like, oh, this is this is it, this is my Bible, this is you know vindication.
• 3:19
  Speaker: I knew I was right.
• 3:20
  Speaker: Um and and then I was kind of off to the races, you know.
• 3:23
  Speaker: I I started my gym business um purely out of uh financial reasons, uh worked in community mental health, which wasn't getting paid enough for uh or well for, and I needed I needed to pay rent.
• 3:39
  Speaker: And so I started a gym, and um, and that's sort of how everything took off.
• 3:45
  Speaker: And I'm and and I'm still doing it.
• 3:47
  Speaker: I run a class for um uh ADHD boys in my gym.
• 3:51
  Speaker: I run two classes for ADHD boys out of my gym.
• 3:54
  Speaker: Been doing that for almost seven years, and uh during COVID, I started a new thing, and I just ended up calling it the hybrid system, uh, where I I split time.
• 4:05
  Speaker: I work with an individual for an hour twice a week, and we work out for 30 minutes.
• 4:11
  Speaker: And immediately after that, we have a traditional talk therapy counseling session right on the turf.
• 4:16
  Speaker: Um and I started doing that just really out of necessity during COVID.
• 4:21
  Speaker: Uh I couldn't run classes and I was booked at my practice, and I had parents saying, Hey, we're missing this piece, we're missing this exercise piece because we're all on lockdown.
• 4:31
  Speaker: Can you just work out with them and then do the session?
• 4:34
  Speaker: Um and I said, you know, I wanted to do that for years, but I just could not figure out a way to market that.
• 4:41
  Speaker: Like, how do you explain to parents that that's helpful?
• 4:43
  Speaker: Uh, and lo and behold, the parents did it for me.
• 4:46
  Speaker: And so I've been doing that since um since we opened, you know, gently opened things up post-COVID.
• 4:52
  Speaker 1: So let's get into that.
• 4:53
  Speaker 1: You say you don't have to explain it to the parents, but how would you explain it to the parents how um blending the uh mental health and exercise service together uh would benefit um their child or the even themselves?
• 5:09
  Speaker: Yeah, because we do serve adults as well.
• 5:11
  Speaker: Um I think colloquialism, colloquial-wise, whatever the word is, um everyone kind of knows that exercise is helpful for their mental health.
• 5:21
  Speaker: But if you talk to most pediatricians or most uh doctors and and and said, how come?
• 5:28
  Speaker: Like why?
• 5:28
  Speaker: What's happening in the brain and the body?
• 5:31
  Speaker: Um, I only think a handful would really know.
• 5:33
  Speaker: Um, and I think uh some of that handful would say like endorphins, which is not at all how endorphins work.
• 5:39
  Speaker: Um and that's not an at even that's not even why that works.
• 5:43
  Speaker: Um and so what's happening, uh, you know, we we kind of figured this out with John Brady's uh book, Spark.
• 5:51
  Speaker: Um when we exercise, our our heart rate gets to a certain threshold, and our brain literally dumps neurochemicals into our brain.
• 6:01
  Speaker: Um and so the way that I help parents understand it is imagine your your son is on an Adderall or a stimulant medication, and and that Adderall says, Hey, I need you to make more dopamine and neuropinephrine.
• 6:13
  Speaker: Um, because that's the symptoms, that's why ADHDs are the way they are.
• 6:17
  Speaker: There's this deficiency of these two neurochemicals.
• 6:19
  Speaker: Um, when they work out, when our boys get to a certain heart rate threshold, the brain just says, Here's dopamine and norepinephrine, here you go.
• 6:28
  Speaker: Um and that can last anywhere between 30 to 90 minutes uh post-exercise.
• 6:34
  Speaker: But the really cool thing that John Rady did not have the long, the long look at when he wrote that book is what happens to the chronic exerciser, or what happens for the exerciser that um that is uh you know worked out through high school, played high school sports, uh, and then as a parent is still working out and hasn't stopped.
• 6:56
  Speaker: What does the brain look like then?
• 6:57
  Speaker: And sort of what he theorized or hypothesized was if we drip the faucet when we work out, if we're fresh off the couch, um if we're a chronic exerciser, we don't only turn up the faucet, we have more hoses by which these neurochemicals are able to be produced at baseline.
• 7:15
  Speaker: Um, I don't think anyone's really done a deep dive into what that looks like actually, but that was sort of his idea is is I wonder if we just have more opportunities to at baseline make these neurochemicals.
• 7:28
  Speaker: Um the long and short of that that question is I would tell parents it is literally medicine for your child and for yourself, um, regardless of the diagnosis.
• 7:40
  Speaker 1: Oh, that's very, very interesting.
• 7:42
  Speaker 1: So I can imagine then you you describe the hybrid system where you're working out with a kiddo ADHD year for 30 minutes, they get that dopamine, you know, hit from the um from the exercise, then they sit down with you, and I bet they can focus on a sesh, you know.
• 7:58
  Speaker: Yes.
• 7:58
  Speaker: So what what the craziest thing is what parents uh a lot of parents who have like uh resistant um the you know, kids that are resistant to regular talk therapy, what happens is that dopamine does get flowing, the conversation is a little bit easier and it starts flowing.
• 8:15
  Speaker: And what usually happens, I would say 90% of the time that I've been doing this, what happens is I have to say, hey bud, like we're over time.
• 8:24
  Speaker: Like I need you to stop talking.
• 8:26
  Speaker: Like I need you to leave, leave the gym because I have someone else coming.
• 8:31
  Speaker: And it's and it's almost like they become that young ADHD again, where you know, I'm thinking of in your example, I'm thinking of a teenager where maybe when they were eight or nine or ten, they just talk non-stop.
• 8:44
  Speaker: Yeah.
• 8:44
  Speaker: And you're just like, and as a parent, you're just driving and you're like, oh my gosh, will this kid please stop asking me questions?
• 8:50
  Speaker: Right.
• 8:51
  Speaker: Um, it's like that, only they're 16 and it's and it's really good information and it's a really good session that you just have to be like, ugh, we're like 10 minutes over again.
• 9:02
  Speaker: Um, and so we're gonna pick this back up on Wednesday.
• 9:06
  Speaker 1: Yeah.
• 9:07
  Speaker 1: So you're really getting straight to juicy stuff as a therapist from doing the exercise ahead of time.
• 9:14
  Speaker: Yeah, and I think the way that that I work as a therapist is not is I'm very direct, um, which is not how we were taught.
• 9:20
  Speaker: We were said that you know, taught this is kind of a way you could do it, but I wouldn't.
• 9:25
  Speaker: Um I I just I just am because I I specialize in ADHD.
• 9:30
  Speaker: So the vast majority of the clients that I see have ADHD, and I just know that left to their own devices, they'll go from A to Y back to C, all the way to F, and then in no rhyme or reason.
• 9:45
  Speaker: And so really directing that, hey, uh last week you said you were having trouble writing this paper.
• 9:51
  Speaker: Uh, let's talk about that.
• 9:52
  Speaker: Yeah, but my girlfriend said this weird thing.
• 9:54
  Speaker: Like, I know we can get to that, but this is where we need to go right now.
• 9:59
  Speaker: So, what have you done uh for this paper?
• 10:01
  Speaker: And where are we gonna start today?
• 10:03
  Speaker: Um, in really holding their feet to the fire, it it it builds momentum and like a snowball.
• 10:09
  Speaker: We're talking about this outline, talking about how we're gonna do it, assigning due dates for each step.
• 10:14
  Speaker: And then uh now that we've done that, I have a clear head and I don't need to talk about my girlfriend.
• 10:21
  Speaker: Like we've cleared all the clutter and I have some perspective, even though we didn't even address it.
• 10:28
  Speaker 1: Right.
• 10:28
  Speaker 1: Okay.
• 10:29
  Speaker 1: So you mentioned some of the the science behind it, um, that it's allowing us to be our own medicine so we don't necessarily have to add something else to to get our protein receptors going here.
• 10:42
  Speaker 1: Um why don't more doctors talk about this?
• 10:47
  Speaker 1: Without insulting the doctors or listening to this right now, but um what what what um why can't this be a go-to, uh a first step when it comes to uh treatment?
• 10:59
  Speaker: So the the the the the cynic says other countries do this at at baseline.
• 11:05
  Speaker: Uh in the UK, you're depressed, let's start uh going to the gym.
• 11:08
  Speaker: And here's even a stipend to go to the gym.
• 11:10
  Speaker: Okay.
• 11:11
  Speaker: Um I think where uh the United States gets stuck is there are so many options.
• 11:19
  Speaker: Um, if I have a 16-year-old that's like I want to work out, and the doctor says, okay, then just go run.
• 11:26
  Speaker: I mean, yes, I signed up for a half marathon.
• 11:29
  Speaker: What I didn't say is that was my first and last half marathon.
• 11:32
  Speaker: Um I never ran one again.
• 11:34
  Speaker: I got three miles into it and I was like, I want to go home.
• 11:36
  Speaker: This is super boring.
• 11:37
  Speaker: Um, and so I discovered power lifting, and I've been doing uh some form of strength training ever since then.
• 11:44
  Speaker: And so I think it's the there's so many options, we don't know what's gonna work and what's not gonna work.
• 11:51
  Speaker: And I don't think it it makes sense to many doctors to say, Well, Johnny, uh, why don't you start by running a 5k?
• 11:58
  Speaker: Um, and Johnny's like, that sounds like no, I don't want to do that.
• 12:03
  Speaker: And then it's well, why don't you go start lifting weights?
• 12:06
  Speaker: And it's like, okay.
• 12:07
  Speaker: And you have an ADHD, and they're like, what does that even mean, lift weights?
• 12:12
  Speaker: I don't even know what that means.
• 12:14
  Speaker: And also, um, the the likelihood that that is um kept up with without some help is really low.
• 12:23
  Speaker: And so, like, I talk about the UK and then prescribing that.
• 12:26
  Speaker: I don't know what the recidivum rate is, recidivism rate is um, if they're keeping up with it or not.
• 12:32
  Speaker: Um, and I bring that up because I I came across a study a long time ago um that was like exercise does not help clinically depressed clients, patients.
• 12:42
  Speaker: And I was like, weird, why not?
• 12:44
  Speaker: And I went through it, looked through it.
• 12:46
  Speaker: Turns out they took like uh six clinically depressed college students who were just discharged from inpatient hospitalization and said you can have access to the university's uh athlete or like collegiate gym, like for our football players.
• 13:03
  Speaker: Right 24-7, whenever you want to, you can come use a state-of-the-art equipment.
• 13:08
  Speaker: Like one person showed up because they were like, we don't know why, so it must not work.
• 13:14
  Speaker: It's like, no, when you're clinically depressed, like getting there is a weird thing.
• 13:18
  Speaker: Is Herclean is a Herculean effort, let alone I'm actually gonna take advantage of this elite uh equipment that I don't even need, right?
• 13:27
  Speaker: Because I'm fresh off the couch, I don't need this stuff.
• 13:30
  Speaker: Um, and come up with a program that benefits my my my mind and my body.
• 13:36
  Speaker: Like that is that doesn't make any sense.
• 13:38
  Speaker: That would be like um a patient coming into one of the doctor's offices, uh, of one of the doctors that's listening and says, Don't worry, I'm gonna use all the equipment in here.
• 13:49
  Speaker: You can just step outside and then I'll tell you what's going on with me.
• 13:52
  unknown: Right.
• 13:53
  Speaker: That's not how that works at all.
• 13:57
  Speaker 1: You're telling me though that it this has not been properly studied, you know, thoroughly studied.
• 14:02
  Speaker: It is so it's so hard uh to find a good study.
• 14:06
  Speaker: Um I go through, and and when I say good study, um I mean for a good duration.
• 14:13
  Speaker: Uh uh sample size is whatever, but a good duration, I'm talking just like bare bones.
• 14:20
  Speaker: I want a control of no one doing anything, or maybe a control of someone doing just medicine, or a control of someone just doing therapy.
• 14:28
  Speaker: And then I want uh a group that's doing uh therapy and exercise, and maybe if we're super uh lucky, one that's doing all three.
• 14:36
  Speaker: Yeah.
• 14:37
  Speaker: Um, and then I want to know what exercise is, like in quotes, what exercise is.
• 14:45
  Speaker: Um, because I've seen everything from water uh aerobics, which yes, my grandmother would benefit from water aerobics, but if we pool a bunch of uh college students, it's gonna do a whole lot of nothing.
• 14:58
  Speaker: Um I've seen horseback riding, I've seen archery, um, and then I've seen uh strength training.
• 15:04
  Speaker: Okay, but what what does that mean?
• 15:07
  Speaker: Like, are you powerlifting?
• 15:09
  Speaker: Yeah, are you Olympic weightlifting?
• 15:11
  Speaker: Are you doing one set of 10 on every machine in the gym?
• 15:16
  Speaker: Like what is the exercise selection?
• 15:18
  Speaker: Um, or are you just or are you just uh you know on the treadmill for for uh 30 minutes a day?
• 15:26
  Speaker: Um all have their place, but I want to know what those things are so that we can really get down into what is helpful and what's not.
• 15:35
  Speaker 1: Because I can imagine, I mean, you know, you're a certified trainer, but you know, my basic knowledge of it is you know, power lifting obviously powerlifting and um even bodybuilding, but powerlifting and running on a treadmill or getting on the peloton, three completely different things, even treadmill versus peloton, you know, three couple different things altogether that target different body systems have different effects on the body.
• 15:59
  Speaker 1: So I can only imagine that those different types of exercises will have different effects on the mind as well.
• 16:05
  Speaker 1: Yeah, absolutely.
• 16:07
  Speaker: And and and we don't even have to get into the to like age.
• 16:10
  Speaker: Um, you know, I I I work with a lot of um women who uh well, you know, being in the counseling field, the majority of my coworkers or or peers are women.
• 16:20
  Speaker: Right.
• 16:20
  Speaker: Um and they're all uh around my age, right?
• 16:23
  Speaker: Almost 40.
• 16:24
  Speaker: And I'm like, if you are not doing some sort of strength training, it's life is gonna be really hard later.
• 16:29
  Speaker: Oh, yeah.
• 16:30
  Speaker: Like, and so we're not even talking about that.
• 16:32
  Speaker: We're just talking simply about what is the minimum effective dose of quote-unquote exercise so that you can get these medicinal benefits.
• 16:40
  Speaker: And to find that in the literature is really, really hard.
• 16:45
  Speaker 1: So we can't find it in the literature too well, or at least not enough to do a good meta-analysis on this, but let's talk you know, less scientific and more personal experience then.
• 16:57
  Speaker 1: So, yeah, in your practice, uh, what have you seen?
• 17:01
  Speaker 1: What I mean, you've probably experimented around, tried new things.
• 17:04
  Speaker 1: What's worked for you?
• 17:06
  Speaker: Yeah, so um, and so what I can say for the literature, just so your listeners know, sure, uh that 90% of the research on exercise and mental health is is all cardio based.
• 17:18
  Speaker: Um and it's and and I and I reason that because it's super easy to stick a bunch of people on treadmills with heart rate monitors so that we can see what's going on, uh, which is all well and good.
• 17:32
  Speaker: I think that's great.
• 17:32
  Speaker: I think that's a great option for everybody.
• 17:35
  Speaker: Everyone needs to be doing cardio for your for your cardiovascular health.
• 17:38
  Speaker 1: Um, than having them, hey, you're gonna learn how to do a power clean.
• 17:42
  Speaker: I'm sorry, I probably just made the point you're about to make, right?
• 17:44
  Speaker: No, you didn't, but that's that's a good point, too.
• 17:46
  Speaker: Is now uh in this research, I have to have somebody else come in.
• 17:49
  Speaker: That's another person that's more variables.
• 17:52
  Speaker: But um that's also why uh exercise selection is is so random.
• 17:58
  Speaker: It's that they probably have one researcher on board uh who who played high school football and it's like I know what they need.
• 18:06
  Speaker: Um but to your point, I digress.
• 18:08
  Speaker: Uh, you know, what what does that look like?
• 18:10
  Speaker: For me, I think about the client, and every client that I have, I I I start with a blank Word doc and I'm creating what their program is is gonna look like for the duration that they're gonna be with me.
• 18:24
  Speaker: Uh and vast majority of of my clients are with me uh for this hybrid system for three months at the very least.
• 18:32
  Speaker: Um I've had clients that have stayed.
• 18:35
  Speaker: Um, I have one kid that we I was just talking to his mom.
• 18:39
  Speaker: Um he's been with me for three years and two months.
• 18:44
  Speaker: Um and um and and it has evolved.
• 18:48
  Speaker: What does he need?
• 18:49
  Speaker: You know, he's on the spectrum, and so we know that that kids on the spectrum have low muscle tone.
• 18:54
  Speaker: So uh as silly as it sounds, it's like, bro, we gotta we gotta pack it on.
• 18:59
  Speaker: Like I need you walking sideways through doors because you already have a this disadvantage as someone on the spectrum.
• 19:07
  Speaker: And so um, and you would come in or a coach would come in and say, You're just bodybuilding with him.
• 19:13
  Speaker: And it's like, I am just bodybuilding with him.
• 19:15
  Speaker: Like that's all he's doing.
• 19:17
  Speaker: But I'm structuring it in a way that he's receptive to, I'm structuring it in a way that he's comfortable with, and um putting just enough pressure on him so he wants to come back the next day.
• 19:28
  Speaker: And after doing it for three years, um, you know, this is literally his mom tell me this, what's today, Monday, last Thursday, that um he's meal prepping.
• 19:39
  Speaker: This is a 14-year-old kid.
• 19:40
  Speaker: He's meal prepping.
• 19:42
  Speaker: Yes, he's on the spectrum, has ADHD.
• 19:44
  Speaker: Uh he's mom says chicken and rice he he packs for school.
• 19:49
  Speaker: Um and so it's like, oh man, this kid's entire life changed through working out and through talking things through.
• 19:58
  Speaker: And so um there is there is that component where the longer we stay, there's gonna be definitely different outcomes.
• 20:06
  Speaker: Um, but even with the client that I know, let's say parents say we can afford to do three months, I really say, okay, what what do we need?
• 20:14
  Speaker: What do we need to get done in these three months?
• 20:16
  Speaker: Um, what does the kid what are the kids' goals, right?
• 20:19
  Speaker: Um, I've had kids that are like, I play soccer, I don't care about being jacked, I just need to be faster so I can make the high school team in a couple years.
• 20:27
  Speaker: And it's like, okay, your programming is gonna look very, very different, but we're gonna structure it in a way that again, you're receptive to that you can take on board and keep coming back the next day and the next day and the next day.
• 20:38
  Speaker: Um and then I do, I do have the the ADHD boys that are like, I want to be jacked.
• 20:44
  Speaker: And I don't care about what mom says that she wants me to talk about.
• 20:47
  Speaker: Um, I just want to uh fill out my sleeves.
• 20:50
  Speaker: And it's like, all right, we'll do that.
• 20:53
  Speaker: And lo and behold, we work through that, work through that, work through that.
• 20:57
  Speaker: Hey, mom says uh you're having a hard time getting up in the morning.
• 21:00
  Speaker: What's going on?
• 21:01
  Speaker: And then that's when all the other work starts.
• 21:06
  Speaker 1: Thank you for listening to Mind in Medicine.
• 21:08
  Speaker 1: Please remember, check the show notes for details on how to claim credits, provide feedback on the podcast, and find any resources mentioned.
• 21:15
  Speaker 1: That's it for now, but keep an eye out for another episode for more evidence based education for healthcare providers on the go.
• 21:20
  Speaker 1: Be well.