Ep. 199- Does Therapy Really Have to Take Years?
Most people think therapy means talking about your past for years. But what if that's not always true?
In this episode, Dr. Kibby is joined by clinical psychologist Dr. Chandler Chang, founder of Therapy Lab, to explore how mental health treatment is changing. They discuss why many people expect therapy to last indefinitely, how targeted, evidence-based treatments can often help much more quickly, and why matching the right treatment to the right problem matters.
Dr. Chandler explains Therapy Lab's unique approach of creating focused treatment plans for specific challenges like panic attacks, insomnia, breakups, self-esteem, and anxiety. Together, they discuss the difference between long-term supportive therapy and goal-oriented treatment, why exposure therapy is so effective for anxiety disorders, and how setting clear expectations can improve outcomes.
They also dive into the future of mental health, including AI, personalized treatment, and whether technology will replace therapists or simply make therapy more effective. Along the way, they explore what makes human connection so valuable, where AI can genuinely help, and where it may unintentionally make things worse.
Whether you've been curious about therapy, wondered if it has to take years, or are interested in where mental health care is headed, this conversation offers a thoughtful look at what the future could look like.
-
Our AI therapist going to take our jobs, Like are we going to get wiped out?
And there are a lot of companies making chat bots for mental health, right?
Don't know what this is going to look like in five years, but I know right now there is a premium value attached to good human care.
0:21
But why?
This is like the essential theoretical question.
Why?
Hi guys, welcome to a little help for our.
Friends.
A podcast for people with loved.
Ones struggling with mental health.
Hey, little helpers.
Today we're going to talk about what mental health looks like in the modern era.
0:41
So I have a really special guest today.
Her name is Doctor Chandler Chang.
She is such a brilliant founder and clinician, and she's become a really good friend of mine because she's one of the few people that I've met who is trying to figure out how can we make mental health treatment work these days, right?
1:04
We have so much new technology, new ways of thinking, new research on mental health, and yet there are so many people who one can't find therapy that actually helps 2 feel like therapy doesn't work.
Like they might be in therapy for years and years and years.
1:21
And it's nice they get to talk about their problems every week, but they don't get better.
Doctor Chang, I was going to call it Chandler because that's how I adore it.
Chandler is one of those people who saw that problem in our field and it's like, let me try to make a different solution.
1:40
Let me try to fix this.
She has made this brilliant, cool clinic called Therapy Lab.
So I'll tell you a little bit about it.
She is a she's the CEO and founder of Therapy Lab, which is a PhD LED telehealth native mental health practice that gives evidence based CPTS and psychological assessments across 8 states.
2:05
And they also have psychologists for kids and adults.
So it's all virtual and it's really focused on what problem do you have?
Let's give you a really specific time limited treatment that helps you.
2:22
You have a panic attack X amount of sessions and we will address that problem.
You're going through a breakup, we give you something else for that, right?
So it's kind of what we're all been looking for.
Like I'm going through this really hard thing.
I want to find a therapist, but we just end up going, OK, I guess we're going to see a therapist and talk about our moms for the next couple years.
2:45
And you know, I'll still have these panic attacks, but no therapy left does something very different.
Chandler is a licensed clinical psychologist.
She went to Princeton for her undergrad and got her PhD from the University of Georgia and she trained at UCLA and NYU Child Study Center.
3:05
So she is like the best of the best.
Over the past six years, she has built therapy lab from the ground up, like all by herself into a multi state clinically credentialed platform bringing really high, high quality, research backed approach to accessible mental health care.
3:25
It's really incredible.
She also is on the board of Pilgrim, an Independent School, and she's based in LA.
She has two kids who she says keep it real.
But she is just such a lovely person and she's one of the few people who I really think is going to make a difference in the future of mental health.
3:48
So she's one to watch, she's one to listen to.
And we talk a lot about what has been broken in mental health treatment and how she and Therapy Lab are thinking about fixing it.
And she gives some really cool examples about what Therapy Lab does to help people who are like, I have this big problem mental health, I don't have a lot of time.
4:08
I want to get this fixed right away and I want to get better so I really hope you enjoy this conversation.
I will put the link to therapy lab in the show notes if you are interested in checking it out or just following what someone like Chandler is doing.
4:24
Because you know, lying on the couch talking about your dreams is not the way anymore.
We actually know how to fix mental health problems.
So enjoy.
Welcome back, little helpers.
I'm so excited to have this guest, Doctor Chandler Chang, who's a clinical psychologist and CEO and founder of Therapy Lab Chandler and I have gotten to be good friends.
4:51
Hopefully, if you think So what one or two years in this world of trying to innovate in the mental health world.
And I don't know if you know this, but every time someone asks if there is a good therapist I know of in LA or California, I say you and I just think you're super cool.
5:14
So that's my that's my intro to you.
Thanks.
Kippy back at you.
Yeah, it's great, Great that we connected.
Yeah, I'm so happy with it when we became friends and like, I don't know, like we're colleagues in a funny way.
5:29
But tell, tell us about I wanted to talk to you about innovating on mental health, right, Mental health treatment in the modern world.
And it's just such a cool topic because a lot of what we know works is like so old, right?
5:47
It's like we, we've, we have crawled a little bit past Freud, but not a ton as much as like if you're looking like healthcare from that day to now, it's like dramatically different.
But we do we, we're, we have a lot of old ways of treating mental health and people like you and me are trying to figure out new ways of doing it.
6:09
And you have a super cool way of doing it and you have super cool modern treatment.
So I want to hear all about it.
So, so nice.
Thank you for that brief introduction.
Yeah, tell us a little bit about therapy lab and like what you do and I want to I'll.
6:28
Tell you in a nutshell what therapy lab is and of course we'll go into it, but then and then after that I want to take you back into I was I was basically innovating 20 years ago when my career started, but it was just very quietly and in a different way.
But therapy lab is the creation that I came up with after 10 years in private practice where I saw people coming to therapy where the with the expectation that they were going to be locked in for years.
6:53
And it to me it felt like we weren't getting to the benefit of therapy as quickly because there was that expectation.
And also we are people as clinicians, we're trained to deliver evidence based care.
7:09
But I deeply felt like the wider greater population did not know there, there were really great treatments for some of the things they were experiencing.
For example, trichotillomania, it's such a weird word, but it's such a common experience where people might pull out their eyebrow or pull out their hair or pick at things.
7:27
That's such a specific example.
But if you were someone experiencing this, you may think it would might be the last thought you would ever have pretext.
BT of course, that there's actually an evidence based treatment for that.
So basically I just launched therapy plan therapy lab with the idea that you can go to the website and see a plan for what you might have.
7:46
But I will tell you I this is this is really going to date me, But who cares?
It was 2008, I believe, when I first became licensed and I was the only therapist I knew of in LA who had a website with with prices.
8:03
I just put up my set, my session rate.
And at that time there was even a debate.
I know this sounds crazy, but there was even a debate as to whether people should have business cards or not.
Therapy has changed so much since that time.
It was still a time of like, oh, you're kind of quiet and you don't advertise.
8:23
And of course, we are in a vastly different era now.
Wow, do the people just found you through insurance and clinics or will it kind of?
If you didn't have a website, what do they do?
What do they do?
There, you know, they were solo private practitioners, and I think it was all word of mouth.
8:42
This would have been before I really launched my practice, but I thought, oh, probably people are using the Internet to try to find someone, and this really is a different era that we're talking about.
But yeah, I've always just thought making it easy for clients to find us and find the right treatment is actually a huge part of the treatment success.
9:03
If they can't find you, then they're not going to benefit.
So yeah.
That's crazy.
So I've always thought.
A lot about what is.
What is the experience like for the clients of It's Always?
And then the other thing, when I first moved to LA and I was in, you know, I was maybe early 30s, I remember looking for a therapist myself.
9:26
And in those times, you would call and you would leave a message and you would wait for them to call you back.
And I just found the experience to be honestly really scary and intimidating and overwhelming because I didn't know what it was.
No one had a website.
9:42
They they were, it felt intrusive to ask what the rate was in this really weird way.
So things are, things have really come a long way since then, luckily I think for everyone.
Yeah, but is it back then?
9:58
Are still people expecting years and years of therapy?
Like how do people come in thinking about therapy now that's like wrong or outdated?
So I do think that there is a real growing push for therapy to make more sense for the modern life.
10:17
And we hear this all the time.
People call therapy lab, Oh, I heard about your model.
This is exactly what I've been looking for and I can't find it.
It's hard to find a therapist who right from the get go is going to say, I don't want you to be here for a long.
Let's see how we can work efficiently to keep your cost reasonable, but to get you to see a benefit.
10:39
And so having these plans, you know, we're, I don't know how how nerdy your audience is, but we are basically built on the unified protocol.
We.
Are.
Obsessed with the unified protocol, which is basically like a 16 to 20 session protocol that is meant to treat diagnosis of all kinds.
11:00
Because it's built on the idea that most diagnosis include a few different symptoms that are on a spectrum.
And if you treat emotion regulation problems and treat symptoms in that way, it can be really helpful.
So we love that, but we also can treat, for example, insomnia.
11:17
We can treat in five or six sessions and we make it clear upfront.
Maybe that's weird to people.
We make it clear to people upfront that that is usually what happens because if you start therapy with this expectation that you're going to do the work and get and get to feeling better quickly, there's a treatment effect there.
11:35
It's not a placebo effect.
It's sort of like planting the idea that you're going to do this and you're going to love it and you're going to feel better.
And so for example, with insomnia, you have to ask people to be sleepy for a couple of weeks, but if you know it's only a 5 or 6 week treatment, you're going to do it and you're going to actually get to recovery quicker.
11:55
That's cool.
Isn't that cool?
It's super cool.
What so tell tell us more about the plans.
Like how many plans do you have?
What are they?
Is it like like a CBT protocol or is it different?
What what it?
What's your solution to all this?
12:11
We are definitely we lean CBT, cognitive behavioral therapy is our JM we are.
And so we use a lot of the same interventions across the plans, but the plans are kind of, I think I literally picture, I picture a tall building in New York.
And therapy has in the past giving you one door to enter.
12:29
It's a door where you enter therapy and your therapist kind of tells you what's going on and may or may not give you an endpoint and you just start.
I wanted to give people, we have about 15.
We have a lot of plans.
We treat all ages, but we give you a doorway, a different kind of doorway where let's say you are struggling with self esteem.
12:50
We have a self esteem plan and it's based on a lot of positive psychology, psychology principles and it includes the VS Strength survey.
It's really fun and interesting.
So we are like, oh, you don't have to be here forever.
Do you want to just address yourself like what you're experiencing as a self esteem problem?
13:07
Use that door or use that door.
And so right away we take the power from the therapist to tell you what's wrong.
We give it to the client to say like, I want to go through that door.
I want to talk about myself esteem or I want to talk about a breakup.
So a break the breakup plan is another popular one that we basically just put out there because we get so many people start therapy after a breakup.
13:27
I think I've always been fascinated by that.
That's cool.
So you're more like problem oriented, like what problem are you struggling with right now?
That's the plan that you can they choose or are you guys being like real you will be good for the breakup plan.
13:44
So some people call with the plan, they've chosen the plan.
Most people call and say, I don't know, I like these plans, but I don't know.
And so absolutely, you're going to figure that out with your therapist.
Your therapist will help you pick a plan.
Can can you have a menu?
14:02
Can I can I be like, let's do the break up plan and then the self esteem plan and then the insomnia plan?
Like can you stumble a package?
Absolutely, yes, yes, yes.
And our therapist also can assemble kind of a, a sequence of interventions based on a very customized approach definitely.
14:22
That's so interesting.
That's really cool.
So why do you think that's not more common like that seems like a like a lot of people thankfully know more about CBT, right?
Like these kind of very specific, like CBT for trauma CBT like, but do you think that most people are still in like still think of therapy as this psychodynamic blah, blah, blah?
14:50
Or like what?
What's the disconnect here?
Why don't we have more of you?
Good question, because of course we hear from the people who are excited by this format, but we hear so frequently that format makes so much sense.
But you're right, it's not really readily available.
15:08
I, I will say, and I'd love to empower people if you are about to start working with the therapist, certainly if you want something like this, you can ask your therapist, Hey, I only have 4 sessions or I need to keep my budget to this.
What we, what can we do in that amount of time?
But I honestly, can we think, I keep thinking we need a different word for two different kinds of things.
15:28
So a lot of people want a support, they want a weekly support and they do want it to be long term.
And there's nothing wrong with that.
And that currently is called therapy.
On the other hand, let's say we have a really busy professional, maybe a law firm partner.
For some reason, we see a lot of lawyers at therapy lab and they're struggling with sleep and they don't really want to talk at length for many, many sessions for support.
15:52
They really just need to work on their insomnia.
We also call that therapy.
So in a perfect world, I would love to have two different words for those two different valid needs.
They're both valid needs which just happen to specialize in the second one.
Yeah, it almost like the supportive therapy is almost closer to like coaching or like or group, but like one person of just a place to come in and talk about what you're going through that week and what's stressful and kind of like that.
16:24
That's a very particular need that, you know, it's a very different need than someone who's like, I can't sleep and I need this to be fixed now.
Right.
Yeah.
I also think ideally you have a place to check in in case things are sort of going sideways.
16:40
Like let's say you have undiagnosed manic episodes sometimes or maybe you have ADHD and you're working with the supportive therapist who may not have the training to spot that.
That's one concern I have in another part.
Part of the mission of therapy Lab is to offer annual check insurance for people.
16:58
So that let's say maybe you need a targeted plan for some specific problem.
Great.
But also, could we could we normalize just having an annual check in with someone who could spot or or help you prevent more concerning problems that might come up?
17:18
Interesting.
What?
So it's almost kind of like an acute crisis like you work on like acute problems and then do a check in for maintenance.
Is that how you think of it or?
You know, that's the reality of the situation.
It's kind of interesting.
When I first started therapy lab, I thought it could be really cool to help people just deal with life.
17:38
So we had some very life hack kind of plans, for example, a problem solving plan, a decision making plan.
These were only two session plans and to be honest, I loved them.
17:54
They were not very popular because I think for someone to actually decide to come to therapy lab, it usually is an acute problem.
Isn't that interesting.
So you might come for the acute problem, but you might come back for the more life optimizing plan.
Huh, got it.
18:11
Got it.
This is more from my own interest.
What was your like?
You know you're talking about years and years ago.
Being an innovator with a website wasn't.
That so wild.
Wild.
18:29
And we're like, people are going to laugh at us in 10 years.
We like, remember when they thought ChatGPT was like mind blowing?
Now we have like, I don't even know.
I don't even want to know what we're going to have in 10 years.
But what was it like for you to start to innovate?
Like what was it like for you to build therapy lab and start to do something new?
18:48
Was it was it easy?
Was it, was it hard to people have backlash or questions?
What was what were like the biggest challenges in that journey?
I think it will never cease to be challenging to start and continue to grow a company that's doing something that is different and not and has not been done before.
19:12
I think it's tricky and behavioral health and mental health because of the influence of insurance and the the entities that pay for mental health have had a large hand in saying how it should be delivered.
And we are private pay because we are building very intentionally for what we think clients need.
19:38
OK, so, but, but real talk like what have been the things that have been hard?
I think I, I think my strength as a leader and as a CEO is just, I love the vision that we're headed towards.
To me, the hardest part is my own impatience.
19:56
I get impatient because I want to build everything all at once.
But I've also learned like, OK, piece by piece, what feature do we need next?
What feature will our clients love?
What feature will our providers love?
It turns out that that is, is a really wonderful way to develop slowly, to develop this platform slowly.
20:16
Although I'd love the magic wand and just tomorrow have the platform exactly how I want it.
Give an example of like the features that you've built or things that you've built for your clients or patients.
Well, one thing that I would love, you asked about the plans earlier.
20:32
Do people pick a plan themselves or do they do that with the therapist?
I would love for people to be able, this is an example, I would love to, for people to be able to describe their life experiences, to describe what they're concerned about and to have an automated experience where it says, oh, you should do therapy for five or six weeks.
20:52
And this is what these are the interventions that your therapist should focus on based on your presentation.
And there is evidence that I mean, different people have different responses to different sequences that of interventions.
So I'd love to automate that for people because I think it would be so satisfying, like a ways for therapy.
21:14
And I know that there's a segment of people who are like, that is so weird, I don't want any part of that.
But I also know there's a large group of people who would love that kind of optimization feeling for something that in the past has been so abstract.
Yeah, yeah.
21:30
Usually that's like treatment planning or triage, right?
It's like figuring out or assessment, like figuring out what you, what you're going through and what you need, and like matching you with a good plan that works.
Yes, yeah, at.
Any time like to be like, oh, I'm going through this and then come back to therapy lab and be like, I'm now going through that.
21:50
What do you think will be helpful?
Right.
Get a recommendation.
I love that I have so many clients who will start therapy lab and say, I would just want to be directed a little bit.
And I think I, I, there's this trope that comes to mind from old school therapy where the client might say, well, tell me what to do or tell me what's going on.
22:11
And that used to be like, Oh, well, I would, I'm never like the therapist would sort of imply like absolutely not.
It's for you to figure out.
I don't believe that that I think if you're someone, if you're a client and you and you want to be told this is what could help you next.
22:28
For example, exposure therapy.
We know that exposure therapy is not intuitive and it might not come to your mind, but it works so well.
Sometimes you need to be told, hey, this is what you should do next.
So I think I love the idea of disrupting those old stories that you can't just be told what you should do next.
22:46
Do you know what I mean?
Yeah, I mean, this is this is The funny thing about how people, people's expectations and what they need from therapy might change, but the structure's the same.
I get like there as you were talking, there was that like, you know, the devil's advocate, like argumentative part of my brain that was like, yes.
23:11
And when we've the, the way, like psychodynamic, the old school way of doing therapy is like really letting the patient and all their stuff come up and guide, right.
And This is why, like therapists don't like traditionally jump in and say you should do XYZ.
23:29
It's because, yeah, like people coming into therapy, like them finding their own solutions and working through that is powerful in its own way.
And sometimes, you know, you come in for, you know, how many times this therapist we've had people come in because they're like, I'm going through work stress or a breakup or I can't sleep.
23:49
And it's so weird.
And actually, it's something else, right?
It's actually like they've just gone through a big loss and they can't sleep, right?
So how do you guys navigate that?
That tension of like, people come in wanting to be told what to do, but also there's a lot that comes out from them when they're not told what to do.
24:14
That makes sense.
It sure.
Does clinically you know?
Yeah.
I mean, one way to frame it is we know that reassurance seeking is can be problematic for someone with generalized anxiety disorder.
If you have GAD, you're going to be asking people constantly, am I OK?
24:30
Am I doing the right thing that could show up in therapy, that could show up as someone excessively asking, is this the right thing We should we do be doing this today?
Should we be focusing on this in session?
And so having the right conceptualization, oh, that's actually not going to be helpful for you in the long run.
24:47
A little bit more self-reliance and providing your own certainty for yourself is better in your case than me directing you really explicitly.
So absolutely, that's why it's so complicated.
I also feel OK.
So two things I would say about 3040% of clients who come to therapy lab end up wanting to stay longer beyond a plan.
25:07
And so we make it very clear that is OK because if you've had a really good experience with your therapist and it's opened up some insight or some other areas for exploration, you are in that door and you can stay.
The other thing is a few times, not a few times, probably more than a few times over the course of my career as a clinician, I'll have people say, you know, this isn't quite working for me.
25:32
I want to have more of an exploratory experience.
And so we work pretty closely with dynamic therapists who like to refer to us for a very specific behavioral intervention or we might refer out and collaborate with somebody who works in that way.
Because, you know, like I said earlier is back to that point, they're kind of two different things.
25:51
It's kind of two different types of therapy.
But yeah.
It's kind of like we were used to it in healthcare, but we have a PCP who's there to like check in and then you have like acute crisis like, oh, I need to go to a sports medicine doctor because my back is all messed up.
26:10
You know, something that's specialized.
But we they, we in healthcare, we think of it as like going to a different doctor or specialist.
Yeah, that's true.
That's interesting.
It would be interesting to create a different language, don't you think?
But that doesn't sound like an easy task.
26:26
No, no, because even if we we are, we're trying to do different names for it.
But people still go.
I'm having a hard time.
I want a therapist, right?
And they don't know exactly what that means, right?
It's like, oh, I'm having a hard time.
26:42
I don't feel good.
I have to go to a doctor, right?
Instead of like, I don't feel good.
I should go with a gastroenterologist, right?
That's it Takes a lot of like knowledge about what's available, right?
Yeah.
It's interesting because I think it kind of goes back to the question, OK, Like when you said you think of me or my team, if you have to refer to someone, when I think of some, if I need to make a referral, I think who is a clinician, I know who I hear the clients enjoy working with and they go back to.
27:13
And I know that that might be a little, that might be something we don't often say out loud or hear very much.
But if you aren't going to go back beyond one session, you're not going to get and, and you know there.
And I say that because I think it's really applicable to technology.
27:32
So if you're going to use an app, there's so many apps now on the market and some of them are really well built and really well designed.
But if you're not going to go back to it, then I'm probably, if it's not, it's not an app that people want to go back to like Duolingo I think of or you know, there was a time when everybody was doing new more different things to help exercise more.
27:53
If you're not going to go back to an app, I'm probably not going to recommend it that app to my clients.
But it's similar to human clinicians too, how you think about that?
It's yeah, I mean clinicians where people stay for longer, but then you also, you know, you have to have that good balance of therapists who actually help, right?
28:20
There's a lot of like, yeah, there's a lot of really nice, safe, kind, lovely, supportive therapists out there that.
You.
Could, you know, people have been seeing for years, but like, there's not a lot of change or there's not a lot of improvement or, you know, I don't like people have trauma symptoms after like many years, like what's going on?
28:41
So I think it's like a balance, right?
That's so true.
I'd love to share a little bit about a case kind of along those lines too.
I got permission from this person to share more information about because I think it's so illustrative of the way we work.
29:00
I began working with someone with panic disorder and it was pretty intense.
And the person, like many people who are has, have, have experienced panic symptoms that are so alarming to them that they then start to shy away from going outside or going to crowded spaces or airplanes, for example, for fear of losing control and having a panic attack and facing embarrassment or just facing the intensity, the emotions that come for some people when they have those symptoms.
29:34
And then they also might start carrying benzos or other kind of safety objects.
So it can be really complicated.
And this person had been in dynamic therapy for I think about 7 years to try to overcome the panic, expect that panic cycle that he was experiencing.
29:52
He was.
Having attacks for seven years.
And trying to manage the panic by avoiding the triggering situations.
Yeah.
And which we know can keep the panic attacks perhaps at Bay, but also puts you at risk for depression, for a collapse of everyday functioning.
30:16
If you're not leaving your house, you're not going places.
And this person happened to be very high achieving and needed to get out and was kind of forcing himself out out but reliant pretty fairly reliant on regular benzo use for that benzodiazepine, which is a, you know, basically kind of calms your system down, but it has pretty intense side effects and and can be at risk for problematic use or addiction.
30:46
I think the word is out about that that benzos are not are right for some situations, but probably not for ongoing multi year daily use.
So anyway that his psychiatrist had recommended that he try a different approach and put him in touch with therapy lab knowing that we do very focused CBT work.
31:06
And I think from the get go, just hearing like, Oh yeah, like this is bad.
This is a bad, this is tough.
This is a pretty serious presentation of panic that you're showing me that you're that you're presenting, but there's a treatment for this that you've never been exposed to.
31:25
And I'm pretty confident that you're going to have a good response to this.
And let me just explain the idea.
All of those symptoms that you've been running from and that you've been avoiding and setting up your life around avoiding, we're going to go into them.
We're going to experience them.
31:40
And you're going to learn with repeated experiences of difficulty breathing or whatever the feeling is that you're OK.
And that is going to just completely change your experience with these symptoms or change your relationship with the symptoms so that you're not afraid of them, but that you're curious about them.
31:59
And so that's how you begin the process of.
Anyway, Long story short, and I think it was about 3 months, he basically had stopped using benzos and feels completely free.
And I recently write, well, I'm here if you ever need a reboot or a re up of the courage that it took to completely switch channels.
32:23
I think he was also really desperately ready to be free of this.
But I honestly think it was pretty shocking to realize that there was a treatment for this that he didn't know about and that he didn't really understand and that it worked so very quickly that it's a little, I think it's upsetting.
32:46
It definitely drives me as a clinician to get the word out.
But I think it was a little, it's a little upsetting that we're not as a profession a little bit more clear that for panic disorder, dynamic is like, don't just limit yourself to dynamic work, but try exposures.
33:03
Well, can you give, can you give us a picture of what those three months looked like?
Like just just from perspective?
I mean, I mean, I've been in your shoes, but from perspective of someone with panic attacks, it sounds so easy, but also terrifying to be like, oh, I'm going to what do you mean?
33:25
I'm going to feel those things and feel OK.
It feels like I'm dying.
What do you mean?
Like, So what does it, what does it look like?
What does exposure to panic look like?
I think it's, it starts with just explaining how this works, explaining the cycle that when you have this feeling that you're going to die, then you might take steps like taking a benzo or avoiding the situation that in the short term feel like a relief, but over the long term create actually fuel the fear because your brain doesn't have the opportunity to learn.
34:04
Oh, I'm actually OK.
In that situation, you're, you're preventing your brain from adapting.
Like, oh, OK, that, that was a really scary maybe if the first couple of times that happened, but I'm OK.
So it's just explaining the mindset and that the cycle.
34:21
And then you can start, the typical kind of approach is to start to develop a hierarchy for exposures or a list of things that the person is avoiding.
And to really also pause for a second and say, what is, what are the benefits of avoiding those places?
34:42
Oh, well, I don't have to.
If I don't go on an airplane, I don't have to feel this way.
I don't have to worry that I'm going to feel panicky on the on the flight.
OK.
And then what are the consequences of not flying?
Oh, well, I don't get to.
We've had, we, we also treat flying phobias at therapy lab.
35:00
We've had so many people not go.
I mean, we're in LA.
We've had people not go to Cannes to pick up an award or you know, like, I mean, it's kind of silly and maybe not relatable to everyone, but not to get an award or not to travel or not to do that important business meeting that you need to do in London, for example.
35:17
So really being clear this, these behaviors of avoidance are there for a reason, but the reasons for behavior change are also pretty vivid and we want to make sure those are locked in.
And then finally, with exposures, you know, the traditional thing is to make a list of all the things that you're avoiding and then gradually go through them.
35:39
But I also tell people that I want them to embrace an exposure lifestyle.
So it's not just about taking off the box.
I went to the grocery store today and then I'm going to tell you in the next session, it's about live your life until the next session looking for opportunities to challenge yourself a little bit.
35:57
And so it's more than just taking off a ladder of exposures.
It's like, like, sorry, it occurs.
But like, yeah, I'm going to do everything hard I can't do today because that is actually going to help me get over panic disorder, you know?
Yeah, yeah, yeah.
36:14
And now that we're now that I'm like hearing it, putting myself in a patient's position, I can understand why like high achieving people who needs results would really gravitate to the way you're describing it.
36:30
Because it if if you were to say to me, yeah, you like, let's do therapy for several, several years to uncover the unconscious problems I'm and and then I have to like expose myself to all those hard feelings.
I would be like, Oh, no, like, 'cause it what it feels like is I would feel like I'm just changing who I am today.
36:52
And versus like what you're saying, which is like there's a time limit.
Like you're gonna look for those exposures and like be, you know, in some, some ways, like brave and confront the things that scare you really intensely for a couple months.
37:08
Like I could do that.
Exactly.
Yeah, suddenly I'm a brave person, right?
Like that's true.
You know what I mean?
Yes, I think it's it is a different part of yourself that you're inhabiting.
If you're in dynamic therapy, you are really in touch with your vulnerability and the parts of yourself that were hurt perhaps or I think I don't know as much about dynamic therapy, but I think that that it's harder.
37:37
Maybe you're right, it's harder to accept the challenges of facing tremendously scary things when when you're going to work with me on panic, I'm going to say you think you're weak.
37:55
Let's rewrite the script.
Let's go do something incredibly hard today.
And it's not for it's maybe not for everything that for everyone, but I think that that's also a way as a clinician, my superpower is that I'm going to be charming, I'm going to be fun and I'm going to be tough.
38:12
And honestly, a lot of people are asking for that.
They, you know, they and that that's how I'm going to get you to go do something you wouldn't dream you could do.
And if you come back and you say, I wasn't able to do it, then let's walk, let's problem solve, let's figure this out.
But I'm going to get, we're going to, we're going to get you to do things that you didn't think you could do because that is such an unlock to so many different, so many aspects of mental health is avoidance is probably kind of an underlying thread for mental disease.
38:47
And so we want to route that out.
And I mean, I understand I could be thought of as like, not toxic positivity, but toxic like efficacy.
And I'm OK with that.
If, if that's the worst criticism you might hurl at me.
Like, yes, I'm toxically gonna push for you to be efficacy, for you to have self efficacy.
39:06
OK.
I'm like laughing toxic efficacy, like don't call it toxic.
I've now I'm seeing why you must be a great exposure and like anxiety disorder therapist because you have this really nice balance of like kindness, friendliness, like positive.
39:29
But you also like, yeah, now that I'm thinking about it, like you are pretty direct and you push for like hard things in a way that doesn't.
It's not like you're gonna do.
It's like, yeah, we're gonna do that and it's gonna, it's hard and that's okay, like.
And it's gonna be interesting.
39:46
It's gonna be interesting.
I'm a big fan of wonder, and let's go in with a sense of wonder to that thing you've been bringing fear to.
Yeah, well, thank.
You thank you for for saying that I love, I love, love, love working with panic in particular, and I love anxiety and also by the way, I am very anxious.
40:09
Those of us who are, you know, like so I'm anxious.
I, I, I think by birth I'm like pretty socially anxious, but like, I think we'll just have to just.
I can never tell that that's so funny.
40:25
What do you think is the future of mental health treatment?
That's a big question.
What do you like in the where do you think mental health treatment should go?
I mean, I hear all the time, you probably hear all the time that our system is broken.
40:42
It's so hard to find a therapist.
People don't think it works.
It's so hard to get into, right?
Like there's so many hurdles when it comes to mental health treatment.
Where do you think this is all going, especially in the world of like technology and AI?
41:02
I think it would be very cool to give people more control and insight into themselves into, OK, what's going on with me?
Why do I feel this way?
What a little bit more using technology, a way to.
41:17
We talked a lot about measuring outcomes and mental health, and it's really hard because we have these measures that are kind of clunky or kind of superficial.
I would love for us to really focus on being able to measure and understand ourselves and then hand that directly to humans so that we can we can use technology to have more insight into ourselves.
41:38
And I think a big part of that would also need to be converging with biology and how much you move your body and what you're eating.
And also like, what was that conversation like with your boss?
Like all of those things that in a, in my vision of the future is that you'd be able to reflect like, hey, I'm not feeling so great this morning.
41:58
Let me use maybe have technology as a way to support my insight into that.
That also gets into precision medication.
Precision therapy, I think is something that I hope we see more of, which is I feel like we're kind of the the genesis of that at therapy lab and I would love to be able to move in that direction.
42:18
For people who don't know what precision therapy or precision treatment is, can you just describe, is it as you're saying, like I have a problem, get the treatment for it, or is there something more than that?
Well, I don't have a deep understanding, but for example with precision medication, a lot of people benefit from SSRI, SSRI's, a lot of people don't.
42:38
And so we have a lot of hammers in psychiatric medication, but we, it would be neat if we if every person had their own tool, if we were able to design medication that really fits for your biology and your specific problem.
42:54
I think that's a vision of the future that would be really neat.
And by the same token, even a little bit more attainable than that is precision therapy, where if you come to therapy lab, we can customize this sequence of therapy interventions.
That's just for you.
So I like to call it precision therapy because it's customized and it's a fact.
43:13
It's designed to be effective for you because everyone's so different, you know?
Yeah, that's awesome.
That's really cool.
How does how does it like, how do you feel about or talk about the ways that technology can support that?
43:30
What do you think about everyone using ChatGPT for their, you know, like talking about AI like everyone like late at night being like ChatGPT?
You know, what should I order for lunch tomorrow, right?
Like what do you think about people using AI for that kind of mental health support?
43:48
I think it's really cool.
I happen to be a user of of Claude in that way.
And I just, you're a Claude girl, OK?
Yeah.
I'm a Claude, I mean for now I am.
I was chatting to PT and I'll probably go back, but I just think it's cool to have another perspective.
44:04
I love it, I love it.
I also think that some people, if they're having a hard time, can get caught in it.
It can either become a little addictive to have that constant reassurance or or it can feed into some maybe altered perceptions of reality that are not healthy for people.
44:24
So that's that, that's how I feel.
What do you think?
Well, now I'm curious.
You know, we started off this conversation talking.
You mentioned how for people with anxiety disorders, reassurance is not helpful.
But then there is this tool, Claude or Chachi BT pick your pick your buddy that yeah, you can spend every minute of your day type into the either them and being like, what do you think of this?
44:50
You think this is right And getting like the Chachi BT like I think you're on the right track.
You, you know, getting that like reassurance.
Do you think that's a problem or do you think that's OK now that we have a tool that can do that all day?
I think it can be a problem.
45:06
And I also think it's kind of a lot to ask the designers of these products to consider the impact.
I mean, to a certain extent, yes, we have.
We can expect that these tools to be designed for safety and mind, but I don't know, I think we're going to need to educate humans on the potential cycles they could get in if they start seeking that reassurance.
45:30
I don't know, it can't be.
We're in deep water now, aren't we?
It's really fascinating.
Yeah, I mean, I can talk, you know, I can see why it's problematic, but at the same time, like I do it.
So I'm like, is it really right?
45:46
Like if we get, if we could get that reassurance whenever, is that really a problem?
I think that's a great question.
I like it.
I I'm cognizant when I'm looking for it and getting it and that it feels good.
46:02
But I wonder if you if you're in a depressed state or you can see, yeah, you can see where it could become potentially harmful.
It's really.
Interesting, isn't it?
46:18
I also wonder sometimes when my mind is swirling a little bit, I'm thinking what what kind of impact on our our in our species will this have in the way that we think because it is, it's really deeply integrated into many of our daily thought processes at this point.
46:36
I know, I know what you know, I'll ask you the question and I haven't thought about it, but what do you think?
You know, a lot of our, you know, our mental health world people are like, Oh my God, are AI therapists going to take our jobs?
46:56
Like, are we going to get wiped out?
And there are a lot of companies making chat bots for mental health, right?
If I like AI chat bots for mental health, do you have a sense of what AI will be used for and can replace versus like do you think that they're going to completely replace us or is there something about a human therapist or human that's like something that we look for I.
47:26
Don't know what this is gonna look like in five years, but I know right now there is a premium value attached to good human care and I don't see that lessening.
But why?
This is like the the essential theoretical question.
47:45
Why?
Because let's say you have an like we're able to make a ChatGPT that can say all the right things, can be trained on all of the treatment, all your plans, right?
Yeah.
But still, as you know, I don't know about your experience, but I still see people go cool, cool.
48:04
I still want to talk to a person Like, why is that?
I mean.
I guess, I guess there there's also a segment of the population that really does enjoy talking to having therapy through a digital experience.
For example, the research from the VA, you know, and veterans working on PTSD really benefited from that experience.
48:26
And we're more open to talking with a chat bot, but there's also a lot of research that even if you're talking with a chat bot, knowing it was knowing there's a human component to it.
It was designed really carefully by humans or there's there are humans in the loop reviewing what the chat bot is saying, I think enhances outcomes.
48:47
Why?
I guess back to your question of why.
Why a human?
Why is there a premium?
Why can't AI AI therapists just be super well trained and just do the job?
49:08
I mean, I love Weymouth.
You're driving so well all over Lai Love.
Them have you?
Do you use them a lot?
Not a lot, but I'm very delighted when I need to use one.
Oh my God, I found them so terrifying.
49:24
First of all, I heard that actually there's like people abroad who really just remote drive them.
So it's like, it's not really like a driver list.
It's like just they're not here.
And the video game you're.
Like, you know, I'm in the back seat to this empty car otherwise, and we're like creeping up against a busy intersection in LA and I'm like, oh, oh, like I hope the crash test works.
49:48
Why?
Because there's a even a person could be just as bad at driving.
Why do we trust people more?
It's so interesting.
My boys are my boys are minors.
They're in their their teens but they were in a Wei MO.
We needed to send them home from something and they were in the Wei MO and actually got a phone call from a human that said you guys don't appear to be over 18.
50:11
Just FYI.
It's OK for now, but don't don't do a Wei MO without it.
An adult next time.
I thought it was so interesting because it was such a, it was such a sort of human kind of phone call.
You, it could have been a robot saying get out of the car immediately.
50:26
You are not 18.
And they're like, OK, guys like you really shouldn't be in here, but don't do it again.
Isn't that so interesting?
Wait, why?
What's going to happen if you're 17 versus 18?
In a way, MO.
I don't know actually, that's a great question.
50:42
I guess it's just their safety role.
Isn't that interesting?
But yeah, with humans and AI therapist, my honestly, my hope is that someday people will love to work with an AI therapist who's really good.
51:01
Wouldn't that be awesome?
That would be awesome if we knew that the therapist was always going to get it right.
And I think back to the original idea, I think it's going to be more on the intervention side of therapy.
Like, hey, you're not sleeping.
Let me help you walk through the steps versus the supportive therapy, but I don't know.
51:20
So 1/4 of Americans are using HBT for supportive therapy right now.
So it's it's interesting.
I know it's so interesting.
I think that the at least for now, unless the AI therapist figured this out.
51:38
I mean, there's, there's some things that people say like I just want to tell and share my experience with some with a human who can understand what I'm going through.
And that was just such an interesting thing because it's like there's something innate that we're trying to like connect to another human's experience.
52:00
Will you try to have a shared experience, even though logically we know that we have all very different experiences, No one's ever going to really know.
Like even if they have, if they're a human who has gone through similar things.
I'm not going to know exactly what you feel, but there's something about human connection and human empathy that feels like something important to our survival and care.
52:22
But then us therapists like even as you're describing exposure therapy for panic, a lot of what we have to do is make people do really uncomfortable things that they don't want to do, but it's good for them in the long term, right?
52:40
It's like, and having to balance giving you the agency as a patient and saying, I'm going to help you with your goals or whatever you want, but also I'm going to have to push you to do things that you're not going to like in the moment, right?
52:56
And I think that, like, so far, Chachi can't really do that because it's there to basically make you talk it to it all the time, right?
So it's not gonna, it's not gonna, it's not gonna like, push you out of your comfort zone unless you ask it to, Right.
53:14
So it's like it's too much of A yes, that's true.
Yeah.
You know.
Yeah, Yeah, that's true.
I love, I do think this first generation of AI companions and chat bots is really asking us to reflect a lot.
53:30
And I'm not sure humans are designed to reflect like daily, so many times a day.
And I love there's, there's a psychologist, Nick Allen, for example, who's building a companion that's a little bit more focused on behavioral activation.
And hey, don't, don't sit here and tell me how you're feeling anymore.
53:48
Go talk to your neighbor and and using AI to actually get people to do behavior change, which I love that framework.
But just if I like, if I can go back, you know, thinking about the human in me.
I am I am fully human.
54:04
Well, I love the idea of AI chem AI chem AI therapist being autonomous one day.
I will also say one of the joys of working with someone in middle age as I am, is I remember in grad school, people would say, I know it's your first time to treat panic, but tell them that this will work.
54:23
This works based on your experiences and go do it.
And I always found that so disconcerting.
But now it is such a joy to be able to say, look, I've seen this work 100 times.
Let's just trust me, Let's try this and know it's going to be hard.
Trust me.
And that is I can, you know, I think the authenticity when I say that I hope is really meaningful for my patients in a way that you you just can't.
54:48
That's not a chat bots experience.
A chat bot doesn't have life experiences.
It's it is different.
Yeah, Yeah, That's so interesting.
Well, as a final thought, is there anything that you want to share to spread a message out, like want to tell people about anything that you want people to know?
55:13
You can do therapy for two or three sessions and feel better.
I think that's basically my message.
And you can come back, You can come back a year later.
Like let's use therapy like a gas station.
But also we probably, I don't know about gas stations are not really a great metaphor.
55:30
We don't need those, but you know what I mean?
Use it.
Use it in a way that's useful for you, I think.
I love that.
How can people find you?
I'm going to put your links in the show notes, but tell people how they can find you, how they can get in touch with therapy lab, all the stuff.
55:48
Very simpletherapylab.com we try to make it easy for you to figure out what you need there.
And hello at therapylab.com if you have any questions.
Also I have an Instagram.
I don't have 50,000 followers like you but.
One day you will, yeah.
56:07
What's your Instagram handle?
Say it out loud.
No.
All right, Well, that's something on this.
It's know what your handle is.
Chandler dot Chang dot PhD is my Instagram and I've yeah follower every month.
56:29
Awesome and maybe more now now that you know what it is and can tell me.
Well, thank you so much for having this conversation with me.
You were so amazing.
Anyone in California or like therapy lab?
It's not just in California anymore, right?
It's like.
We are in eight states, Washington, Arizona, Texas, Michigan, Maryland, New York and Massachusetts.
56:53
Yeah, I'm licensed in Michigan, Texas and New York and Washington and California myself.
Oh my God, I didn't know that.
OK, great.
I'm going to have way.
More and by the way, I think of an amazing podcast topic I've shared this with you is like state differences in culture around therapy.
57:11
Is that would be.
Fascinating thing.
I wonder what ChatGPT would have to say about that too, based on their conversations in different states.
I could ask it.
So they'll be, they'll be topic number 2.
So that's yeah, that's an excuse to get you back on so.
57:28
Thank you Kibby for all that you do for mental health and getting and connecting with people.
Of course, of course, I'm so glad that we're friends.
I'm so glad you came on and I recommend all of you guys to check out therapy lab.com.
And if this was helpful, if you know someone who could benefit, send them, send them to Therapy Lab, send them their way.
57:49
So thank you so much and.
One find a note.
We're like half child psychologist, half adult psychologist.
I forgot to mention our kid work, but we love working with kids in this model too.
So send your kids.
Send your families.
All right, little holster, we'll see you next week.
58:07
And thank you so much, Chandler.
Thank you.
By accessing this podcast, you acknowledge that the host of this podcast makes no warranty guarantee a representation as to the accuracy or sufficiency of information featured in this podcast.
58:24
The information, opinions and recommendations presented in this podcast are for general information purposes only and any reliance on the information provided in this podcast is done at your own risk.
This podcast and any and all content or services available on or through this podcast are provided for general, non commercial, informational purposes only and do not constitute the practice of any medical or any professional judgment, advice, diagnosis or treatment and should not be considered or used as a substitute for the independent professional judgment, advice, diagnosis or treatment of a duly licensed and qualified healthcare provider.
59:02
In case of a medical emergency, you should immediately call 911.
The host does not endorse, approve, recommend or certify any information, product, process, service or organization presented or mentioned in this podcast and information from this podcast should not be referenced in any way to imply such approval or endorsement.
59:21
Thank you.