Mental health with Alex Howard

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About Alex Howard. 

Alex Howard is Founder & Chairman of The Optimum Health Clinic (OHC), one of the world’s leading integrative medicine clinics.  With a team of 25 full time practitioners supporting thousands of patients in 50+ countries, the OHC team integrates a therapeutic coaching approach with functional nutrition.

Alex is creator of the Therapeutic Coaching methodology, and since March 2020, has been documenting his therapeutic work with real life patients via his In Therapy with Alex Howard YouTube series.  In the last few years, Alex has created some of the largest online conferences in the health and mind–body markets; including the world leading Trauma Super Conference. Alex’s online conferences have been attended by over a million people. 
Alex has published academic research in publications such as the British Medical Journal Open and Psychology and Health, and is the author of the books Why Me? and Decode Your Fatigue.  Alex’s latest book, It’s Not Your Fault – Why childhood trauma shapes you and how to break free is out now. 

Podcast transcript:

Welcome to the urban monk podcast. Dr. Pedram Shojai here with a doc have known for some time. Now, these big in the mental health space, he has been doing a lot of work in the trauma space. And, um, man, uh, he’s on a boat and row and hard and can use all the help he can get the world is facing a lot of problems right now with mental health. And so we talk about trauma. We talk about, um, the use of the word trauma and what that means in relation to your experiences. Uh, we talk about. Uh, big T little T and how those definitions might no longer, uh, encapsulate the dialogue needed around trauma. And we start talking about ways to resolve so this is a very important podcast you know at least three people that need to hear this podcast so i invite you to listen in share enjoy alex howard

Dr. Pedram Shojai: Alex, what a pleasure. Um, always nice to chat with you. You always bring, uh, such a great fresh perspective to the work and there’s a lot of work. So welcome.

Alex Howard: Pedram, I’m super excited for this. Um, I’ve had the pleasure of interviewing you a number of times. It’s really fun to do it on this side as well. So thank you for having me.

Dr. Pedram Shojai: Yeah, this is great. And look selfishly. Uh, I love this work because it’s a roll up of genius talking to so many genius people. And I feel like I learned a lot. And, um, You’re also your own distillery, right? You’ve done hundreds and hundreds of interviews with experts, uh, in the domains that you interview.

Dr. Pedram Shojai: So you have the most up to date relevant information when it comes to trauma. So I’m very excited to jump into this conversation with you. Um, let’s start by setting the table. Um, when we talk about overall health and vitality, when we talk about the wellbeing of the system, the. Inputs that come in from trauma that are often under the radar that are often, um, really not even acknowledged in a lot of people, um, end up in my clinical experience being the first place I got to go when someone, you know, someone will come in, we’ll do 5, 000 worth of tests and we’re like, look, we found it, here’s the problem, do these five things and you know, we’re going to get you out of this mess and then they self sabotage.

Dr. Pedram Shojai: As soon as I start seeing these kind of breakdowns in agency and someone’s self directed care, I start to suspect trauma, right? I start to suspect, you know, viral programming that is getting them to fall off good decisions. So I want to kind of set the table with that first before we get into the trauma thing.

Alex Howard: Yeah. You know, it’s funny when we were coming up with the title for my most recent book, which is ultimately a book on trauma. One of the sort of debates was, is the word trauma in the headline title of the book? And The realization was that, you know, we all have, we, we get this, we all have trauma in, in different ways, but many of us don’t identify as having trauma.

Alex Howard: And I think in a way, a broader, more helpful way of talking about this topic is have events that happen in childhood and have, has the way that those events were responded to, shaped and impacted our behavior. as an adult. And so in a way, whether it’s trauma or not is not so much the important question.

Alex Howard: The question is, are we living our best life on our own terms, or are the things that happened, and more importantly, the things that we learned about what happens and the defenses we set up to try and protect ourselves from the things that happen. Are they what’s driving our lives now? And if that’s the case, there’s work to do.

Alex Howard: And that work done successfully can truly revolutionize our life.

Dr. Pedram Shojai: I love, I love that perspective. You know, and we, there’s nomenclature, right? There’s big T trauma and little T trauma. And I think a lot of people that I interact with You know, you, you hear the stories. Oh, this, this poor guy watched his mom and his sister get raped in front of him in Rwanda before they killed the village and you’re like, well, well, my dad was a jerk, right?

Dr. Pedram Shojai: You know what I mean? Like, you’re like, that’s not even a fair comparison. Like that guy’s got trauma. Whereas the, the little t trauma of my dad being a jerk or, you know, being bullied in school. Also adds up. And so I’ve seen people try with the, you know, the capital capital T little T to try to say we all have trauma, but I really appreciate the way you’re framing it because it really is just the experiences that lead to the operating system we’re sitting on now.

Alex Howard: Yeah. I also think, um, I was, I was well corrected by, um, one of my team a couple of years ago when I was using terms, big T and small T trauma, because they made the point that sometimes the, the things that have shaped us the most. Wouldn’t fall under the category of a big T trauma. But the impact has been enormous.

Alex Howard: And, and actually really the, the, I think a more helpful framing around that is overt trauma and covert trauma. So things that are obviously traumatic, like I think many people be familiar with the research on adverse childhood experiences, which is a phenomenal body of research that’s been replicated in, in, in a number of different ways.

Alex Howard: That basically shows that if we’ve had traumatic events as a child such as. Um, parents that have addiction issues, or parents that have been incarcerated, or we experience physical or emotional neglect, or physical or emotional abuse, that there’s a massive increase in the likelihood of health conditions as, as an adult.

Alex Howard: Those things are fairly obviously traumatic things to experience. But covert traumas are things that we may well not label as trauma, and partly by the way, because of the brilliance of our physical and emotional capacity to adapt because we normalize to the experiences. And so we can have a whole bunch of covert things that happened during childhood that we, we functionally adapted to.

Alex Howard: Therefore, we’d never classify those things as being trauma. That was just the childhood that we had, but those things have shaped us enormously. And like, you know, a few examples of what this might be, let’s say, You know, let’s say one day at school we put our hand up in class and we were like a little over enthusiastic and we completely screwed up the answer to the question and everyone laughed and the teacher wasn’t very skillful in how they dealt with it.

Alex Howard: We felt rejected, we felt ashamed, we felt embarrassed and we were upset and we came home. And let’s say mom and dad are both in the home but they’re, they got a lot going on. Maybe there’s financial pressure, maybe they’re having difficulty in their relationship. And They noticed that we’re upset, but I don’t have the bandwidth to respond.

Alex Howard: Not because they necessarily don’t love us. They’ve just got their own, their own stuff that’s going on. And we’re then rewarded. For shutting down our emotions and they maybe even say they put us to bed and say, you know, well done for being a big boy or a big girl about about how you dealt with that.

Alex Howard: And there’s a whole bunch of these kind of experiences that we learn that not feeling our feelings and emotions gets us love, which one of the core emotional needs that we all have to be met as a child. So these kinds of experiences. It’s not because something awful happened relatively to the example that you gave.

Alex Howard: It’s not even because our parents don’t care about us and love us. Maybe the reason they’re financially stressed is they’re, they’re killing themselves trying to earn enough money to send us to the best school because they want to give us the best start in life. But we learn something really important from that example.

Alex Howard: We learn that our feelings and emotions aren’t important. And when you feel things, you should bury them and you should And then maybe we learn that in a bunch of different ways. And then We get so much stuff we’re shoving down, maybe some, some more, some bigger events happen, or maybe we’re quite sensitive in how we’re wired in our system, and over, over time, we really struggle to squash that stuff down.

Alex Howard: So we look for a functional way to adapt to the situation, and we find that when we smoke, smoke marijuana, or we, or we drink alcohol, we’re like 12, 13, 14 years old, it’s easier. And whereas everyone else is doing those things for a bit of recreation and fun, we’re now becoming dependent as a way to self medicate for the feelings that we’ve learned we’re not allowed to feel.

Alex Howard: And so really the point that I’m making is that yes, we can have overt trauma experiences. But we can have a whole bunch of covert things that happen that set up habits and behaviors. And then later in life, all of the interventions trying to manage the symptoms of the behavior and not looking back at how that was a functional adaptation to the situation we experienced.

Dr. Pedram Shojai: Yeah. And I’d like to follow that example out a little bit in how that. Shapes a life, you know, you’re 47 years old now You have your own family. You’ve got all these balls in the air And you have all these quirky things that somehow trip you up. You have all these little anxieties you have You know, these tendencies that you’re unaware of, how does one know that that might have been shaped from whether it’s the word trauma or childhood adverse experiences?

Alex Howard: Yeah, it’s a good question. Um, you know, in a way, it’s the age old question of psychology. How much is nature? How much is nurture? I don’t think the goal of therapeutic work is everyone becomes perfectly normalized to a slightly crazy world. I think, you know, in a way, our, Idiosyncrasies are the things that make us who is who we are like that’s part of the richness and the joy of life for me working as a clinician.

Alex Howard: The issue is where the adaptations that have been developed are now causing significant suffering in our life as an adult, or they’re in the way of us needing to make a significant behavioral change, for example. So. You know, a big part of my clinical work over the last 20 years has been working with complex chronic illnesses because of my own experience with, um, ME chronic fatigue syndrome as a teenager.

Alex Howard: And one of the things that you can find is that, yeah, chronic illnesses are complex, there’s lots of facets to it. But one of the, one of those facets that, um, can be a piece of the jigsaw for a number of people is that we learn in childhood that we get our, our needs met. And When we achieve and when we’re successful, maybe that that’s when we look good, our parents say, Oh, you look really beautiful today.

Alex Howard: Oh, have you lost weight? Oh, you look great. So we learn it in that way. Well, maybe we learn that when we’re top of the class or when we’re the best at sports. So we learn that the core need of love. is received when we are a certain way. That becomes part of the programming of how we relate to our life and in many ways fast forward a few decades and we’re seeing all the wins of that.

Alex Howard: We’re maybe financially successful, maybe successful in our career. But when we live in a way which is unsustainable, if we’re constantly pushing ourselves beyond our limits, if our sense of self worth is unhealthily tied to what we do and what we achieve, then in time that’s going to lead to some sort of state of burnout physically, emotionally, or so on.

Alex Howard: The challenge then becomes that the way we often try to solve the problems we face in our lives is through the strategy of the problem. So then you get someone that’s on a, let’s say, a chronic illness recovery journey or someone that’s working on optimizing their health, and they’re doing it in a massive achieve away.

Alex Howard: They’re trying to do everything all at once to the maximum level, and they’re actually causing more problems than they’re solving. And so what I’m looking for is not how do we turn everyone into sort of, you know, perfect human being. It’s where Are these habits, patterns and behaviors that we learn to adapt to the challenges that we faced and now creating more problems in our lives now, because one of the points that I think is really important to make whatever happened in childhood done, like we’re an adult now, the problem is that the habits and the behaviors and the things we learned to do to survive, those people aren’t the architect of that.

Alex Howard: Now we are. We’ve learned those ways of responding and in a way, you know, That’s the message of hope, because whatever happens, done, but it’s still alive in our experience if we’re still living and responding in that way, and that’s what we can change. And in a way, the healing of childhood trauma, to me, is less about healing something that happened in the past, and it’s breaking the habits and the behaviors that we learned to survive it.

Alex Howard: Okay,

Dr. Pedram Shojai: So we’re going to pause until this, it’s actually my gardener, we’re going to pause until he, he clears within a minute. Um, Uh, fortunately you were, you know, just rocking and so we missed most of the noise. Um, uh, yeah, what I’m going to do is, uh, edit team. This is, this is dead, dead space here. Um, the, what I’m going to do is I’m going to, um.

Dr. Pedram Shojai: Again, try to kind of contextualize this towards orthorexia and it’s kind of like the, you know, the podcast health Anxiety of knowing, you know, you know, there’s there’s always something to be doing and you know, all the stress

Alex Howard: yeah. Great place to go. Yeah, that’s good.

Dr. Pedram Shojai: Okay, so I’m gonna you don’t hear that anymore. He’s kind of far.

Alex Howard: No, but I’m just on my laptop speaker, so I’m, I’ve not got it amplified, so I hear you very clearly, but I wouldn’t necessarily get the background

Dr. Pedram Shojai: Okay. Yeah, I’ll just lean in. All right, I’m gonna clap in Um, yeah, one of the areas I see now in this health and wellness community is, nah, I’m going to have to wait,

Alex Howard: Yeah, no, it’s all good. It’s all good. We

Dr. Pedram Shojai: give it a sec.

Alex Howard: I’m in a rush

Dr. Pedram Shojai: Yeah, thank you. Um, you know, it’s Monday’s garbage day, Wednesday’s gardener day, uh, you know, Thursday’s, you know, cleaning crew day.

Dr. Pedram Shojai: I need to just like put everything in one day, so. Fuck it. You guys, you guys can ruin my Monday. That’s it.

Alex Howard: one day a week to, to a

Dr. Pedram Shojai: it. One, one, one day for all this stuff. Okay. He’s far enough. All right. We’re gonna start again. Yeah. One of the areas that fascinates me in this Alex is this health and wellness media, um, debacle that we’re starting.

Dr. Pedram Shojai: I mean, everyone’s listening to all the podcasts and getting all the latest information, and I’ve noticed that people with. Adverse childhood events, people with traumatic histories that have kind of dragged them forward and been less self aware end up getting wrapped into the orthorexia, right? They get up, get, get wrapped into the, I got to do everything right and I’m so stressed out.

Dr. Pedram Shojai: I missed my yoga or my, you know, kale smoothie this morning. And it becomes another form of anxiety. It becomes another type of suffering. And so I’d love to contextualize that with, through this lens of trauma.

Alex Howard: Yeah. I think it’s a great point, Pedro. Uh, you know, I’m gonna strip it back to a really simple perspective and then we can build it out a bit more. So for me, Healing in the physical and the emotional body is the product of our nervous system being in what I call very simply a healing state. So you can be in any one moment, one of two states, a state of stress or a state of healing.

Alex Howard: If we’re not in a healing state. A whole bunch of stuff doesn’t go our way. We’re not in a healing state. We’re expending more energy than we’re building. So we can be sat at a, you know, at our chair chatting to someone and we’re draining resources because our nervous system is over activated. We’ll find that It’s going to impact on our immune system.

Alex Howard: So one way of thinking about that is, um, we start to get immune sensitivity because everything’s a threat. The message from our nervous system to our immune system is it’s hyper aroused and it’s looking for things that are a danger or a threat. We’ll find that people’s emotional sensitivity is massively heightened because the research shows that when we’re in a state of anxiety and stress, we’ll perceive things in our environment that are not a threat as a threat.

Alex Howard: And so… If the way that we’re approaching our health journey is one of anxiety and stress, that we’re constantly trying to find the answers, the impact, the way, going back to my point earlier, the way we approach the problem is the problem. So the way we’re approaching it is driving what I call a maladaptive stress response.

Alex Howard: And so a healthy stress response is You know, you and I walking down the street here in London, we don’t see the big red electric bus. So we don’t hear the bus kind of thundering, not thundering, coming fast towards us. And we leap out the way, we get a hit of adrenaline and cortisol, and we have a healthy stress response to an immediate physical threat in our environment.

Alex Howard: We leap out the way. We’ve now got adrenaline and cortisol in our systems. It’s gonna take a little bit of time for that to wind down. So we’re a little bit on edge for a while. But after 5, minutes, we find us. And there’ll probably be a point a few hours later that you and I sat somewhere in a restaurant having, having dinner and we suddenly go, Oh, okay.

Alex Howard: Yeah. It’s all good. I feel safe. That’s a healthy stress response. You know, it’s the same analogy of thousands of years ago, the saber toothed tiger that’s chasing us. But when the threat is always there, and this is one of the products of childhood trauma, when we learn to not feel safe as a child, we have a perceived threat either internally or externally all of the time.

Alex Howard: The homeostasis of our nervous system shifts to break down that word homeostasis means, uh, same stable, consistent. So all of our bodily systems, be it, you know, blood pressure, blood sugar, um, hormones, they have balances. Those balances can change at different points in the day. You know, let’s say our core soul levels are higher in the morning and they go down through the day, but that each morning they’re going to go to roughly the same point and then roughly going to go down to the same point when we’re in a maladaptive stress response.

Alex Howard: The, the, the, um, uh, the, the baseline of our nervous system shifts. Now, the problem is that because we adapt and we normalize to it, we don’t realize we’re in that state many times over the years. People would come and see me clinically, and it would be very clear this was a piece of their jigsaw. I’m not saying it’s the whole jigsaw, maybe a bunch of other things need to be addressed, but this maladaptive stress response is part of it.

Alex Howard: And I would, and I would start to talk about this, and they would say, yeah, it makes sense theoretically, but that’s not the case for me. And yeah, they’d be so wired That I could be having to calm my own nervous system in the presence of the amount of adrenalized energy that would be there in, in that person.

Alex Howard: And so, whatever we’re doing for our health, be it nutrition programs, exercise plans, um, cold therapies, whatever it may be. If the way that we’re approaching it. And the outcome of what we’re doing is it’s dysregulating our nervous system. That thing is likely causing more harm than benefit. Now, of course, there is an absolute benefit from challenging our system in the short term.

Alex Howard: My point is not that we should be calm and chilled out the whole time. You go to a gym and you train a muscle, you stress the muscle and then the muscle grows back. Um, you tear it and then it repairs stronger. But we need to avoid a state where we’re normalized to living in a maladaptive stress response, because that’s probably the single biggest negative impact on the health outcomes that we’re trying to create.

Dr. Pedram Shojai: When you look at a, an antelope in Africa getting chased by a lion, um, either he gets away, or he gets eaten, right? But

Alex Howard: It’s quite a simple scenario, isn’t it?

Dr. Pedram Shojai: It’s pretty, it’s pretty binary, right? Um, but when he gets away, you could see them do this shake to let go of the adrenaline, clear it from their system. And then they, well, you know, lucky me, I got to live today and they don’t have this level of abstract thinking of why, why me, why was the lion picking on me?

Dr. Pedram Shojai: It’s always my bad luck. I mean, he’s just lucky to be alive. He moves on. We have all sorts of layers to our brains and our nervous system that then take this abstraction and run with it, and turn it into a narrative, and turn it into a woe is me, or whatever it is. Um, and a lot of times we see, and a lot of times we see that as an overlay inside someone’s nervous system.

Dr. Pedram Shojai: You just see someone coming in edgy and messed up, and so then, what are the remedies, right? Oh, you should do yoga, or you should calm down, or you should meditate. Um, and, you know, this advice is kind of thrown in a very trite fashion At people who don’t even have time for anything and yet are being told to do all these things without, uh, context.

Dr. Pedram Shojai: And so the, the resolution of this problem, the treatment of trauma, I mean, you’re, you’re a guy sleeves rolled up literally and figuratively right now, um, on the front lines, right? Um, and when these folks come to you, there need to be strategies employed that can actually start chipping away at this. So how do you, how do you do this clinically?

Dr. Pedram Shojai: When someone comes in, you see all this, you don’t just send them off to a yoga class, right? You, you arm them with tools and you help them. So I’d love to start getting into the inside baseball of that.

Alex Howard: Yeah, well, it’s a great question. You know, for some people with trauma going off and doing something like meditation or yoga as a starting point can actually make it worse, not better. It’s not true of most people. I think typically that they’re good practices. Um, One of the things that I found over the years is it’s not just what you do.

Alex Howard: It’s also the sequence within which you do what you do. And so what you’ll typically find is people that have had trauma that have for in addition the pattern we talked about earlier, which is not everyone with trauma, but they have a pattern around trying to win their way to happiness and love.

Alex Howard: They’ll come in wanting to go straight into the sort of the big heavy stuff and they’ll often again make things worse not better in the process. Insight. The my framework for working with trauma is is a five step process and it’s it’s um, it’s at the heart of something called the reset program and reset is a word that describes what we’re doing.

Alex Howard: We’re resetting the nervous system, but it’s also an acronym for the steps. So the first step is we have to recognize what’s happening. This goes back to and patron what you and I were talking about earlier that people normalized to the state they’re in. People can be in a massively dysregulated nervous system, but they don’t recognize that as what it is.

Alex Howard: And that recognition is going to happen. It needs to happen on two levels. There’s a macro level, like just the fundamental recognition that the system is dysregulated, but there’s also a micro recognition that we can recognize it when it’s happening. So we can see I was in a calmer state. This thing happened.

Alex Howard: I responded in that way, and then that’s, that’s what happened in my system. And so I start with psychoeducation and getting people firstly educated about the nervous system, how it works, but also recognizing and tracking their own nervous system over sort of five to seven days at different points to get some awareness of what’s happening.

Alex Howard: Both of the triggers, but also where’s the baseline because sometimes the baseline is so high. We don’t feel anything. We’re just, we’re just in a shutdown and that, and some, and again, people can come in and say, I don’t feel anything. Everything’s fine. And I’m like, not feeling everything. Anything is not fine.

Alex Howard: It’s like my, um, My mom once said to me years ago, she was like, you were such a good baby. And I was like, what is that? What was a good baby? It’s like you never cried. I was like, mom, because my system was completely shut down in trauma. It wasn’t a good thing. Um, but starting with with recognizing we then need to examine.

Alex Howard: We need to understand what, what’s the history, what’s the habits, what’s the patterns, what are the things that are happening unconsciously in us and the way that I often talk about the unconscious, it’s not this sort of Freudian, um, mysterious soup of all the kind of worst parts of us are unconscious is the things we’re not currently consciously aware of.

Alex Howard: Like right now as people are watching or listening to this conversation, they’re probably not aware of their breathing. But if you become aware of your breathing right now, you could speed it up, you could slow it down, you could take it deeper. And there’s lots of habits and patterns and ways of responding that once we have frameworks and a lens to understand those things, we can examine them and then we can start to make some different choices around it.

Alex Howard: And typically what I find is that The more you give people awareness of what’s happening, how it’s happening and why it’s happening, that alone can start to calm things a little bit because often people will come in and they just think they’ve, they’ve gone crazy. They’re the only person that has all of these struggles and all of these things.

Alex Howard: When you realize that actually there’s an intelligence behind it, that for example, you know, I lived for the first 30 years of my life in shutdown and then a chronic state of anxiety. The recognition that I’m in a chronic state of anxiety because I have all of these unprocessed feelings and emotions that I’m terrified of feeling.

Alex Howard: So I got to run at a million miles an hour to keep running away from feeling those things. It’s like, well, actually, there’s an intelligence to that, right? In a way, the walls, the walls that we build. To keep us safe as a child become the walls of the prison that keep us trapped as an adult. And so if we can understand that we are the architect of the walls, we can start to do something about that.

Alex Howard: And so we want to recognize what’s happening. We need to examine how it’s happening. We then need to start to stop the habits, the patterns of behavior. To me, there’s two elements to this. One is, uh, practices that will help us self regulate our nervous system. If we didn’t get, which many of us didn’t, healthy co regulation of our nervous system as a child from our caregivers, typically mum, dad, grandparents, or foster parents, or so on.

Alex Howard: If we didn’t get that co regulation, where the calmness and the safety in their system, when they held us, sent the message to our nervous system that we were safe, We typically didn’t learn then how to self regulate. And so we’re living with a dysregulated nervous system. Certain practices and tools, meditation, mindfulness, and so on can be helpful.

Alex Howard: Some people that they can be a trigger. We then need to have ways of breaking the habits and the patterns of thinking, which are perpetuating the cycles. And so the way that I teach it. Certain tools, techniques, pieces from elements of NLP, from mindfulness, that when you recognize a trigger, you can literally stop and then you reset your system.

Alex Howard: But here’s the important thing. If you only do those steps, you’ll find you’re spending the rest of your life doing those steps. They are an important start. They’re very important starting point. They also tend to build a sense of, um, less being a victim of what’s happening and a bit more, I don’t like the word control, but a bit more influence on the experience that’s happening.

Alex Howard: But then we have to come to the fourth step, which is the second E of reset, which is emotions. One of the primary reasons why our nervous system becomes Dysregulated is to avoid and escape feeling Feelings and emotions that we didn’t feel safe and we didn’t feel held to feel. Hatred, anger, rage, sadness, grief, Aloneness, whatever it may be.

Alex Howard: That stuff is held in our body. Going back to your example, when the lion or the tiger is hunting the antelope, the antelope, if it survives, you mentioned about the shaking that happens, that is all of that pent up flight, fight, trying to get away which is held. effectively processing to allow it to regulate.

Alex Howard: There’s some fascinating research. Um, Peter Levine’s been, been one of the real, um, pioneers of this work around how trauma gets held in the body and it gets held because we don’t get to complete that cycle. Particularly when we freeze, we don’t get to complete the cycle of releasing the energy of that fight and flight.

Alex Howard: And so, We all have all of this emotion that’s trapped and held. It’s like, so that is a metaphorical black sack of everything that hasn’t been processed that kind of gets shoved away. And that’s why you can be, you know, driving along the road and someone cuts you up and objectively someone’s just driving badly.

Alex Howard: It could be a bunch of reasons. They could be trying to get somewhere because someone’s in distress. It could be, you know, whatever. But we suddenly have a surge of murderous rage that we want to kill that person. It’s like, it wasn’t about someone driving badly. It’s about the history that’s been triggered, about maybe we never, you know, everyone else is more important than us, or we don’t get seen, or our needs are not taken care of, and this was a trigger to that.

Alex Howard: To do, to, to really do our trauma healing work, we’ve got a process and we’ve got a release and we’ve got to let go of those emotions. They don’t have to go out the way they went in. Doesn’t mean we have to relive the events that happened. We’ve got to move energetically what’s held in our system. If we try and do that first, Without building some psychological safety and scaffolding, we’ll often find we’re not very effective in that work.

Alex Howard: If, but if we don’t do that piece of work, we’re spending the whole time trying to calm the system. To truly get a lasting change in the nervous system, we have to have the combination of the tools and strategies to calm the system, and then the ways to process what’s held in the system. Then the fifth step, the T of transform, is we have to then transform the way we relate to ourselves and the way we relate to the world.

Alex Howard: One of the products of trauma is typically we become harsh, cruel, critical, rejecting of ourselves, and we teach other people how to treat us. And so we often set up the relationships in our lives as a mirror of the way that we’ve learned to treat ourselves because of how we were treated. And that’s the way that we stop.

Alex Howard: Trauma repeating in our future because we reset the way that we have those dynamics. So we’ve got to recognize what’s happening. We’ve got to examine why. We’ve got to stop. We’ve got to break the habits. We’ve got to do the emotional healing work. And then we’ve got to transform our life to reflect the things that are now different.

Dr. Pedram Shojai: I love that. I love the framework. Um, very well articulated. So Millions and millions of people are trying real hard without a framework. So, a lot of the stuff is somaticized, obviously. A lot of it is under the surface. So, I, yes, I got all sorts of angst and anxiety and, you know, I had a past, everyone had a past, so what?

Dr. Pedram Shojai: And now I play baseball, I go running, I do yoga. And I have a pressure release valve, which is, you know, great that you’re doing it. But it’s not. linked. It’s not symbol linked to the actual trauma. It’s not connected up with what it is that you’re trying to do. And so the pipes don’t connect. So I want to, I want to talk about how that is a near miss and yet just as bad in some instances, because you’re not actually healing the underlying issue.

Alex Howard: Yeah, that’s a great question because one of the things that people often say is, well, so you’re saying that, you know, my husband, wife, this person has not dealt with their anger. But they’re angry the whole time. They’re like, this person’s like constantly angry and that you’re saying they’re not feeling their anger.

Alex Howard: So there is a really big difference between acting out the feeling of emotion and actually feeling I’m processing the feeling of emotion, and I think the word you use patron was a really good one. It’s a mismatch, and it’s like I like the analogy of pipes. It’s like they’re just not joined up, and therefore it’s not processing, and we can be super angry, taking anger as the example and throwing out other people, blaming other people being triggered, being reactive, being this, being that.

Alex Howard: But what we’re actually doing is we’re making preemptive strikes to try and protect a vulnerable place inside of us. We’re not actually moving through the anger. We’re staying at the surface of the anger. Because if we move through anger, hatred, rage, those more um, aggressive slash protective emotions, what they’re really there for is to protect something.

Alex Howard: And what typically they’re protecting is the much more vulnerable emotions. Uh, sadness, grief, uh, loneliness, um, a feeling of insignificance, whatever it may be. And, and anyone that’s done, um, sort of deep emotional healing work is going to tell you that those places are way harder to feel. And what typically will happen is that one will have a lot of these protective emotions of anger, hatred, rage, this, whatever, and they’ll live at the surface of that for their whole life.

Alex Howard: And they’ll often cause a lot more suffering for other people. and themselves and they’ll create a load of relationships that are not holding and nurturing because everyone’s guarded and they don’t then get the support they need to effectively do this emotional healing work. And often we need a skillful therapist or a workshop container or something that’s that’s going to hold us in this to effectively do this work with feet.

Alex Howard: We’re fully feeling the emotion. and then we’re moving through it. We’re not staying at the surface, we’re moving through it and that is an act of surrender. It’s not an act of sort of control, it’s an act of fully feeling it. and surrendering and then seeing what arises next. And there are different emotional pathways that we can go down.

Alex Howard: And I, there are models out there and I’m always a little reluctant to be overly prescriptive because I think people do have very different experiences. But typically what you’ll find is more defensive emotions on a kind of surface layer. And then you’ll tend to find, often there’s a layer of fear as we move through those.

Alex Howard: And then there’s often emotions of, um, claps of sadness, grief, longing, and so on. And then as we fully feel those, there’s often a feeling of deficiency or emptiness or spaciousness and so on. And if we can fully feel through that. The, the, the, the, the real magic of, of well done emotional healing work is underneath all of this is what we seek, be it, be it the love, be it the, the courage, the strength, the sense of capacity, that what we’re missing is within us.

Alex Howard: The problem is that we’re trying to get it on the outside of us. And so to take the example of anger, maybe what’s missing is a sense of true inner strength. And so we’re angry at everyone else to try and try and show how strong we are because we don’t really feel strong. You know, it’s like the analogy I sometimes give here is it’s like there are people who want everyone to know how financially successful they are by the watch they wear, the car they drive, the house they live in, the places they go on holiday.

Alex Howard: And then there’s really rich people that just don’t give a shit. Like I don’t need anyone to know. I’ve had a number of really interesting experiences over the, I remember years ago, I was at the football as a guest of a friend of mine or soccer, as you guys would call it, and I’m sat next to this guy in a lovely chat, really simple guy.

Alex Howard: And then, um, We’re kind of chatting with someone else and you go, you know, that guy’s worth half a billion. I was like, you wouldn’t have known it, didn’t need anyone to know. There wasn’t a sense of trying to inflate it. And so when we don’t feel in touch with our true strength, for example, we’ve got to show everyone how strong we are.

Alex Howard: But if we can move through those layers, That which is missing is within us. It didn’t leave. We left it because we disconnected. We didn’t get the holding and support we needed and in the disconnect we feel the deficiency. And so, to go back to your point around aligning and lining things up, when we do this work in an effective way, A, it’s more scary because we’re letting go of control, not getting, trying to take more control, but then we actually find a pathway to healing and we find the pathway to what’s actually missing.

Dr. Pedram Shojai: I think a lot of folks when they hear this, um, having been on, you know, both sides of this equation feel. Like this task, it’s like, okay, yeah, I get that, but that’s daunting, right? That is daunting. You know how much energy it takes for me to hold up the storefront to just get my kids to school and get to my job and deal with the toxic people.

Dr. Pedram Shojai: And, you know, it’s like, I feel like everyone’s robbing Peter to pay Paul just to get through their days. And when. Faced with the, the real work of digging backwards to go back and heal and integrate and feel and go through and go through all of these, these areas of, of growth, um, it can feel overwhelming, right?

Dr. Pedram Shojai: So then they’ll spend the rest of their lives dragging, you know, this, this. bag of, you know, heavy, heavy baggage behind them and never get anywhere. But how do you, how do you speak to that? How do you get people to turn that corner and realize where the real work is and, you know, give them a shovel and show them how to start digging.

Alex Howard: Yeah. It’s a great question. Um, my answer is not as good as the question. So how I look at it is. You know, so, so, so the first, um, decade or so of my, of my clinical career, um, I pretty exclusively worked with people with complex chronic illnesses, particularly fatigue rated conditions. So things like me, chronic fatigue, fibromyalgia, Lyme disease, um, uh, co infections and so on.

Alex Howard: And people used to say, go, wow, you know, you have a really heavy client base. And I used to say, you know, I’d still say, and I have a really easy client base because the people I work with. They want to change. They want to do the work. And what a lot of therapists struggle with is compliance. Like, you have a great session, someone’s engaged, you set them homework, and they go home and they don’t do it.

Alex Howard: And so, kind of, they’re trying to change their life in, you know, let’s say they’re having sessions every other week, they’re trying to change their life in two hours a month. But they’re spending another 60 hours a month doing all the stuff that’s not helping them. And so, you know, I have a, The YouTube series where we do, um, film a film, people’s therapeutic journeys with me.

Alex Howard: And, um, we have one that’s releasing, um, in a couple of weeks from recording. So I imagine by the time this is out, it’ll be on my YouTube channel with a guy, um, called Paul who, uh, came to the filming, um, age 60 with his, um, daughter who happened to be trans, um, had taken her own life six months prior to filming.

Alex Howard: So Paul came in literally. He would define himself as broken. He’d wake up in the morning and just didn’t want to be here and was having suicidal ideation of his own. Someone like that, when you’re at that kind of crossroads in life, someone like that is going to do whatever it takes. And he did incredible therapeutic work over the nine sessions that we had together.

Alex Howard: Um, and there were plenty of defensiveness that we had to work with, but there was an absolute yes to doing the work. Now, how do you translate that? to someone like the example that you gave where someone life, life hurts and it’s difficult, but it’s just not, it’s not necessarily bad enough that one feels that they’re going to go to those places they spend their whole life avoiding.

Alex Howard: And the way that I, I’ve started talking about this more recently, um, I think is more helpful, but people, people will tell me, which is that this work. Is not just about getting out of pain, right? It’s like, you know, as you know, our conference series is, you know, trauma, anxiety, sleep fatigue, because often the thing that brings people in is trying to get away from, from, from the pain in their life, but trauma and unprocessed history.

Alex Howard: It’s not just causing us suffering. It’s also stopping us having what we really want in life. You know, if I think about the most, the things I most value in my life, I think about, you know, my relationship with my wife and with my kids, not because it’s always easy, but you know, marriage and kids is actually pretty hard work.

Alex Howard: Um, but the nourishment and the emotional satisfaction and the joy, like. You know, my eldest daughter, who’s 12, um, who’s, who’s, who’s neurodiverse, has incredibly severe dyslexia to the point that at 12 years old, she still can’t properly read and write. Um, her, um, and you know, she’s at a special educational needs school, so full of neurodiverse kids.

Alex Howard: Um, She had a netball match this afternoon and they won this match six nil. Like it’s just completely, just get thrashed every match that they play. The joy that brought me getting that message this afternoon versus all the other things that have happened in this, you know, in my career in recent time.

Alex Howard: But if I hadn’t done my own trauma healing work, I couldn’t have a relationship longer than three months until I worked through some of these issues, I couldn’t be emotionally available to children when we first had kids. because I was too consumed by the person I thought I needed to be to be loved and to be accepted and so on.

Alex Howard: So, you know, there’s folks that will, will go to the ends of the earth to follow a keto diet or to, you know, go through the misery of having freezing cold showers every single morning, which by the way, in an, I was doing it through this English summer was great. But as the seasons turned, that’s just got a lot harder, but I, folks are willing to do hard things, but often they don’t want to go to these places.

Alex Howard: And yet if you’ve been following, if you, if you’re committed to vitality into your health path and you’re doing all these things and you don’t do this piece, you’re potentially ignoring. The piece that’s going to make one of the biggest differences on. And if you’re finding the other pieces you’re doing, you’re getting significant, um, marginal gains week on week, month on month.

Alex Howard: I would just I’d keep doing what you’re doing. But if you’re finding diminishing returns or you’re finding you’re stuck, you’re finding you’re going around in the same loops. Then the definition of insanity is to do the same thing again and again and again and expect a different result and my experience is the suffering of not going to these places is infinitely more than the reality of what actually happens because our narrative is I’m going to go to these places and I’m going to, I’m going to fall apart.

Alex Howard: I’m not going to survive it. I’m going to disintegrate done. Safely and done well. It’s exactly the opposite. We find what’s missing. We don’t get lost in what’s missing.

Dr. Pedram Shojai: Uh, I love that. I feel like 85 percent of the health activity I see around me with, you know, millions of people and thousands of patients historically, um, can all kind of be boiled down to beating around the bush. Right. And

Alex Howard: That’s probably true of us as practitioners a lot of the time as well.

Dr. Pedram Shojai: a hundred percent, a hundred percent, because no one wants to talk about the thing it’s uncomfortable. So we’ll, you know, take ice baths and do a lot more things that are, uh, extracted from that, that kind of source discomfort. And we’ll put up with all kinds of other discomfort just to not feel that. And that’s where I ended up becoming a student of trauma in, you know, I just, I like to win, right?

Dr. Pedram Shojai: I like to win. And I would have a certain class of patients coming through and we had, you know, integrative medicine, functional medicine, lots of people coming through. And I never remembered the ones that maybe this is my own trauma. I never remembered the, like the slam dunks, you know, the people that would just, you know, listen and get better.

Dr. Pedram Shojai: It was always the ones that got away. And so I started looking at the commonalities of the folks that just. Didn’t heal that didn’t do what it was that we expected them to do. And nine times out of 10, it was this beating around the bush. There was this thing that they weren’t willing to talk about. It was this thing that they weren’t willing to look at, which was the thing, the centerpiece to all their healing that, you know, again, it’s, I would have to force them to either look or try to refer out and all of it.

Dr. Pedram Shojai: And, and, you know, to be, to be Frank, this trauma informed therapy universe. Has been emergent and, um, you know, it’s, it’s more recent, right? So 20 years ago, if you went after it and you were disappointed with the results of the therapy and, or the referrals you got, I promise you the world is different, right?

Dr. Pedram Shojai: You got guys like Alex Howard and the, you know, all these experts that he’s been interviewing who’ve come a long way in this.

Alex Howard: Yeah, it’s, you know, it’s, it’s, uh, appreciate that. Thank you. You know, I If you look at the advances that have happened in functional medicine over the last 20 years, like I look at when the Optima Health Clinic started and you know, I don’t want to distress, we were doing the best, we were doing great work for the time, but you know, just look at how the awareness and understanding and conversation around things like Lyme and co infections and mold has evolved in the last five years, let alone, you know, the last sort of 10, 20 years.

Alex Howard: Um, And the same thing has happened on the psychology side of these areas. And it, you know, in a way the interventions have, have, have been tried and tested for a long time. But the framing and the understanding and, you know, some, it was when we did the first trauma super conference, um, three and a half years ago, I was like, Holy cow, I’ve been working with trauma for the last 17 years.

Alex Howard: We just haven’t called it that. And then it goes back to where you and I started. I don’t think the words are the most important thing. The thing that matters is what’s determining our life now is often what happened in the past and. That stuff can be changed and it can take time and it can take courage and it can take the right support can also take timing, you know, someone’s going through a kind of major life event right now.

Alex Howard: They’re just trying to survive. Let yourself focus on surviving late. It’s not everyone to jump into this right now in this moment, but. You know, it was so much effort in to trying to be positive or trying to sort of create a good life and it shouldn’t take effort to do that. Like, sure, sometimes you’ve got to be disciplined with your mind and we can get reactive and go off into narratives and so on.

Alex Howard: But our baseline should be a place of joy, happiness, and enthusiasm for life. And if it isn’t, it’s because there’s stuff in the way. And you can spend your whole life trying to get away from that stuff. Or as you said, you can, you know, call a spade a spade and go, right, let, let’s deal with this.

Dr. Pedram Shojai: Yeah, I can’t tell you how many people I know who ferment their own kombucha and soak their chia seeds and, you know, 20 minutes of plank in an ice bath and all this other stuff. Yet, the center that, you know, the center of this storm, really. Is the mindset, the programming and the narrative that’s drawing them.

Dr. Pedram Shojai: Frankly, and you know, the, the metaphor I would use for what you had kind of alluded to earlier is, you know, as a peacetime economy and a wartime economy. And you know, someone who’s sitting in Ukraine as we speak right now is looking over their heads for drones or bombs. It’s hard to relax, right? And, and that way of living.

Dr. Pedram Shojai: Is, you know, all the, all the, you know, longevity studies have shown this. Those people don’t live that long, right? You live under stress long enough, systems start to collapse, and so it’s on us, the onus is on us to recreate a peacetime economy so that our cells can thrive, so that our gut lining can thrive.

Dr. Pedram Shojai: So all these other things that we talk about can actually work.

Alex Howard: And, you know. Just to just to bring another piece into that as well. The natural instinct of our physical body is towards healing, right? So you get a cup in your hand or whatever, and as long as you keep that cup clean, you might need to stitch the skin together so that it can, it can heal, heal to itself.

Alex Howard: It will naturally heal. You don’t go to the. to the hospital to get the drug that makes your skin heal. You may get a painkiller. You may get an antibiotic to deal with infection that happens, but that healing happens. Same is true. You break a bone. In fact, you break a bone. As long as you set the bone, the strongest part of that bone is eventually where the break was.

Alex Howard: The same is true emotionally. We have a natural instinct towards healing, but we’ve got to create the environment and the space that can allow that to happen. When we live in a maladaptive stress response, when we normalize to being in a dysregulated nervous system, that natural capacity towards emotional healing and physical healing is not in play.

Alex Howard: And that’s where you can take Endless amounts of supplements and not absorb them or react to them. You can do endless kinds of, you know, ice baths and, um, you know, whatever it may be, but if your body’s not in a healing state. If your nervous system is not coming back to a healthy baseline, you are not going to have the benefit from those other pieces.

Alex Howard: And you know, it’s funny, your example, um, uh, 20 or so years ago, I was in a relationship with someone and that relationship was, was, was breaking down at the time. And in just, just full transparency, I’m sure I was, um, at least half responsible for that. So my next comment is not to refer that person under the bus, but Her response to it as we were clearly having these issues was I need to go on a juice fast And that’s like how does you going on a juice fast deal with the fact that we’ve got issues here in the relationship?

Alex Howard: But that was the strategy that had helped other times in the past and so it’s like well That’s just the thing that I do when things aren’t working Um, and, you know, in a way, you know, just like in in in business, you know, one of the things that I find in my in my work life is typically the things that that causes the biggest problems are the things that we don’t pay attention to.

Alex Howard: right? Like there’s the areas that we feel more confident, more comfortable, more like we know what we’re doing. And that’s where we tend to put the energy into. And, but they’re not, that’s not typically where we have the problems. It’s the problems are in the areas where we don’t pay attention. And that’s where then we start to have trouble.

Alex Howard: Same is true in our health. You know, there are equally people, by the way, that spend an enormous amount of energy doing their trauma, healing work and so on. And they don’t pay attention to their diet, to their lifestyle. And that’s also a problem. Like my, my point here is not to say this is the piece that matters the most.

Alex Howard: My point here is that if this piece is being, um, ignored, it’s probably really important, but it’s important in part of that wider context. And that’s one of the reasons why. I love making online conferences and why I love being interviewed on online conferences because you’re going to have a whole load of other great speakers talking about these other pieces.

Alex Howard: And my point is not my bit’s more important than everyone else’s. My point is my bit’s also important. And by the way, it’s not just my bit. It’s lots of people’s bit, but, but it. Yeah, for the body to heal, it’s got to be in a healing state for us to have real vitality. We’ve got to have our nervous system well regulated.

Dr. Pedram Shojai: I love that perspective. I mean, if you think of mindset as one of the four wheels on the bus, diet, exercise, sleep, you can’t, you can’t drive the bus without all the four wheels turning, right? And this oftentimes is the neglected piece because you can’t see it, right? It’s easy to know when you’ve gained 20 pounds, right?

Dr. Pedram Shojai: It’s really easy to hide trauma to strangers. I mean, the people around you know, but you know, they know.

Alex Howard: half of all that we do, yeah.

Dr. Pedram Shojai: Exactly. Alex, I really appreciate this framework. I really appreciate, um, the, the breadth of your knowledge and your wisdom in this. Um, and I really thank you for the work that you’re doing. You’ve been, you’ve been on the front lines really sitting with the, the, the thinkers and bringing this discussion to the forefront, which I think is a really, uh, powerful and challenging play, right?

Dr. Pedram Shojai: These aren’t easy things to talk about for most people, uh, but they’re important things to talk about. So, I really, um, I really welcome, uh, people to check out your work and continue to follow you. What’s the best place to find you?

Alex Howard: Yeah. Thank you, Pedram. I appreciate you. And I appreciate the conversation. Um, so my website is alexhoward. com and that’ll signpost you towards the various pieces that I do. Um, towards the optimum health clinic, um, towards our therapeutic coaching practitioner training. My most recent book, um, it’s not your fault.

Alex Howard: Why childhood trauma shapes you and how to break free. Um, and also I mentioned the YouTube series. Um, that is a great way to see what we’re talking about really alive in, in people’s lives and, and, and stories.

Dr. Pedram Shojai: I love it. Big fan of what you’re doing. Uh, please keep doing that work and always, always a pleasure.

Alex Howard: Thank you, Pedram. I appreciate it. Thank you, my friend.

Hey, it’s Dr. Pedrum a quick break here to remind you that I’ve done a 10 part series on trauma. I have also recorded a masterclass called healing, emotional trauma with three of my favorite trauma informed therapists out there. Uh, there are solutions. There is a way out, um, And we now know a lot more than we knew 20 years ago when I got into clinical practice. And so we’re in a Renaissance when it comes to the treatment. Of trauma, trauma related, um, issues around mental health. So I invite you to check those out@theurbanmonk.com. They’re in the academy. They’re in the courses, they’re in the series. I. I invite you to check those out theurbanmonk.com. Sorry. I invite you to check those out theurbanmonk.com. They are under series under courses. They’re there. They are not going to watch themselves. They’re not going to sit there and heal. You magically, you watch them, you learn, you activate, you find solutions and you move forward in life. Uh, hope this is helping keep listening. This is important stuff.

I hope you enjoyed this episode. Uh, Alex, Howard’s been doing some great work. I’m a big fan of the work he’s been doing, and I’m a big, big fan of what I’m seeing out there in this world of trauma. Uh, informed therapy. There are a lot more tools, like I mentioned, that are available to you now, whether it’s psychedelic assisted psychotherapy, somatic therapies, there are many ways to climb this mountain. But. You have to hike, right? No, one’s doing it for you. Check it out. Check out the healing, emotional trauma masterclass inside the urban monk academy. Check out my series on trauma. Uh, check out the mind, body resources inside the temple grounds. It’s all here to help you. You have to step in to start helping yourself to the entire universe will conspire to help you from there. We’ll see you soon.

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Dr. Pedram Shojai

NY Times Best Selling author and film maker. Taoist Abbot and Qigong master. Husband and dad. I’m here to help you find your way and be healthy and happy. I don’t want to be your guru…just someone who’ll help point the way. If you’re looking for a real person who’s done the work, I’m your guy. I can light the path and walk along it with you but can’t walk for you.