Living a Life in Balance

We were BUILT to SURVIVE: The Science of Trauma, Resilience and the Future of Mental Health Care

• Abdullah Boulad • Season 1 • Episode 1

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Dr. Sarah Boss, Clinical Director at The Balance RehabClinic, breaks down what’s missing in mental health today. She explores the rise of overdiagnosis, highlighting how it often leads to mislabeling and ineffective treatment. Therapy is far more than just conversation; it’s a multifaceted process that requires a deep understanding of the individual, their history, and their biological makeup.

Dr. Boss also discusses the impact of trauma and the importance of resilience, explaining how science is reshaping our understanding of both. From the gut-brain connection to emerging advancements in psychiatry, she offers insights into the complexities of modern mental health care—what’s working, what’s not, and where we go from here.

🔗 Watch now for a conversation that could shift your perspective on mental health and open new doors to understanding the human experience.

About Dr. Sarah Boss: Dr. Boss brings a wealth of expertise, with specialized training in psychiatry, psychotherapy, neuromodulation, and functional medicine. Her approach blends the latest scientific advancements with a holistic, patient-centered philosophy, enabling her to address the whole person—mind, body, and spirit—in her clients' treatment.

[00:00:47] - Dr. Boss’s Journey & Motivation
[00:02:30] - The Evolving Field of Psychiatry & Holistic Training
[00:06:56] - Misconceptions About Psychiatry & When to Seek Help
[00:10:12] - Preventative Approaches, Cultural Differences & Society’s Impact on Mental Health
[00:17:09] - Understanding Different Mental Health Specialties
[00:22:20] - Loneliness, Community & the Role of Social Support
[00:29:35] - Genetics, Epigenetics & Intergenerational Trauma
[00:32:56] - Misconceptions About Mental Health & Empowerment Through Neuroplasticity
[00:40:33] - Root Causes of Symptoms & The Risk of Quick Fixes
[00:45:42] - Integrative Psychiatry, Nervous System Regulation & Holistic Approaches
[00:53:41] - Challenges in Healthcare & The Role of General Practitioners
[00:57:02] - Understanding Trauma: Self-Regulation, Balance & Safe Healing Environments
[01:09:48] - Combining Therapies for Better Outcomes
[01:12:10] - Neuromodulation, TMS & Neurofeedback for ADHD
[01:20:16] - The Power of Individualized Mental Health Care
[01:25:39] - Group Therapy vs. Individual Therapy: Benefits and Considerations
[01:27:16] - Book Recommendation: The Anxious Generation
[01:29:00] - Technology’s Growing Impact on Mental Health
[01:32:14] - Lessons from Clients & Personal Growth
[01:34:51] - Dr Sarah Boss’s #1 Advice for Mental Well-being

For further information and support, visit our website:
https://balancerehabclinic.com/

Follow Dr Sarah Boss:
https://www.linkedin.com/in/dr-med-univ-sarah-boss-881761105/

Follow Abdullah Boulad:
https://www.linkedin.com/in/abdullahboulad/
https://www.instagram.com/abdullahboulad/

You can order Abdullah’s book, ‘Living A Life In Balance’, here:
https://www.amazon.com/stores/author/B0BC9S5TCF

Follow The Balance RehabClinic:
https://www.linkedin.com/company/thebalancerehabclinic/
https://www.instagram.com/thebalancerehabclinic/



Abdullah Boulad 00:00:00  Welcome to the Living a Life and Balance podcast. My name is Abdullah Bullard. I'm the founder and CEO of the Balanced Rehab Clinic. My guest today is Doctor Sarah Bos, psychiatrist, psychotherapist, and clinical director of the balance. I've known Sarah personally and professionally for over ten years. She is the most skilled mental health practitioner I've ever met. In this episode, we dive into her 20 plus years of training and experience integrative psychiatry, genetics versus epigenetics, generational trauma, and the latest mental health techniques that are available today. I hope you will enjoy. Sarah. What motivated you to do what you do today?

Dr. Sarah Boss 00:00:47  Already when I was a child, I was thinking there. There are few things in life or that's how it seemed, at least that are infinite. I was thinking the the space, the universe, which is incredibly interesting and beautiful, thought that it's simply infinite. They're black holes and we can never understand it. Or at least not now. There's always something to explore. And then there is the the human mind and the nervous system, also infinite.

Dr. Sarah Boss 00:01:16  And that's the beauty about it. That's why I thought, becoming a psychiatrist gives me about the same as exploring the universe. Infinite options. And each person is is a universe.

Abdullah Boulad 00:01:31  And you wanted to discover the mind or the human. what was your most, attracted, element in here?

Dr. Sarah Boss 00:01:42  I think it's, it's a combination. I think it's beautiful to to to be with each individual and feel like everything is, new to explore. And you can hopefully take your time to really understand what's going on and to really be able to hopefully, help and support. And then there's also, I think it's such a beautiful thought that something is, is will never stop, like all my life until I die, there will be so much to discover, to learn, to be interested in and not like some other jobs where you do maybe the same every day and and and you feel frustrated. Maybe in the evening. That was my topic then.

Abdullah Boulad 00:02:30  Yes. So but it also means is what we know today about that subject may be shaken up in the future.

Dr. Sarah Boss 00:02:40  Absolutely. Like everything in medicine, it's amazing. Like most specialties, after two years they double the knowledge or triple even. So like for example, psychiatry now is so incredibly different to the 70s or to 1900, when they were still doing brain surgeries and things like that that we can just not imagine anymore. It's not that long ago.

Abdullah Boulad 00:03:04  Yeah. No, no. And but you you didn't just finished being a psychiatrist. saying just so it's a long, long study you had to go through, but you went you went on and and went into further educations. why? And what motivated you there?

Dr. Sarah Boss 00:03:25  Yeah. No, definitely. I think in total it was already 20 years of training. So after becoming a medical doctor and psychiatrist, of course I needed to become a psychotherapist as well. I don't just want to prescribe medication and have limitations there. So I went into the whole field of psychotherapy, which is also incredibly broad if you if you're interested in it. So there are many different methods you can develop.

Dr. Sarah Boss 00:03:53  And once I did that, I noticed that, of course, it's it's very important, all the talking therapies and it's beautiful. All all the options there are. But still it's just not enough to really understand, a whole human being. So I, I got into the field of functional medicine and, you know, including nutrition and the brain gut axis that we knew back then, that is very important. And we can't just ignore and, thinking about the microbiome, about micronutrients that might be influencing us. And then I also became a neuromodulation specialist to be trained in modern devices, also part of the future of psychiatry that we can apply to not prescribe so much medication or in case medication doesn't work. And then after that, I was still feeling that something's missing. It's just not enough. And then I got into Somatic Experiencing, which I found the most useful for me to to just get the full picture, so to say, which is so beautiful, to work with the nervous system without talking much and and that all together like this five trainings I think I really needed as a psychiatrist today.

Dr. Sarah Boss 00:05:21  I wish everybody could have that, and I hope it will be the future for everybody to be trained in those, at least partly, or at least to understand how important each part of it is.

Abdullah Boulad 00:05:33  That's that's amazing. I mean, this is like, a full clinical team in one person. What you're explaining, is there anything you haven't done in the field of mental health medicine, psychiatry?

Dr. Sarah Boss 00:05:50  I'm sure there is, But I think the most important now that is out there now. I did too, but then the beauty is I don't have to do it all myself. Now we have our great team, but what I can do now is really supervise it. Well, as I had all the trainings myself, trained properly.

Abdullah Boulad 00:06:08  Exactly the experts and.

Dr. Sarah Boss 00:06:09  Yes, or I can also do the fine tuning, which is beautiful. Usually I do get clients that have tried a lot of things already in their life. I've seen many different psychiatrist psychotherapists and now I can, do the fine tuning, see maybe what could be, useful and, and see it from like from an outside perspective also.

Abdullah Boulad 00:06:35  Oh. Very interesting. Yeah. It's, when, when we look today out in the world, they are miss concepts about psychiatry and and and mental health. well, from from your perspective, what are these and what are trends and what is causing this happen?

Dr. Sarah Boss 00:06:56  Yeah, yeah. Unfortunately I think there is still a lot of stigma about it. Like still a lot of people think psychiatry is something where only, you know, a psychiatrist is somebody that only a crazy person is supposed to see, or that it's something bad to to be seen in the office of a psychiatrist. Or some people also still confuse, diagnosis. For example, we still hear, nowadays that somebody would say he's a schizophrenic because he's changing his mind all the time, even though that has nothing to do with, with, with this diagnosis. And so, so these kind of things, I think we still see and, and then also, I think a lot of fear still, because psychiatry used to be quite rough as a speciality out of the need, also because people didn't know what else to do.

Dr. Sarah Boss 00:07:54  So there are still movies around, you know, where you see people with electro shocks or with these, you know, tied into those ropes and all kinds of.

Abdullah Boulad 00:08:04  So you can guarantee to me that this is not happening. This is not happening anymore.

Dr. Sarah Boss 00:08:09  We don't like it as much as any person. It was also traumatizing for the for the people that had to apply that. And no, it changed so much nowadays. Like I said initially, it's such a beautiful field actually. So human, so kind, so understanding, and actually to be something where everybody feels like he could go to if everything else didn't work, or if they just don't feel good at all, like, a rescue island, you know, where you're always welcome. Like, even on a psychiatric ward. That's what the whole meaning of it. You can go there if you feel lost in desperate. That's where people are that can deal with that.

Abdullah Boulad 00:08:54  But where is where is the edge where I feel still okay, I can manage or I need, I need external help.

Abdullah Boulad 00:09:05  I need the psychiatrist, or I need a psychotherapist. Okay. How can someone find out when is the right time to seek help?

Dr. Sarah Boss 00:09:15  Well, that's a really good question. I think in general we shouldn't wait too long because it's our life. Maybe we only have one and it's our quality of life so in doubt. I sometimes think if we already think about it, maybe we should go already, because then it tells us something. But of course we can try first to speak with our family, to speak with our friends. But if we notice, for example, that we're changing a lot, that we, for example, wouldn't do things anymore, that we used to like sports activities going out if we withdrawing or if we if we don't sharing anymore, if we see changes in our behavior and in our quality of life, then I would really go out and seek help to just to not quantify it also.

Abdullah Boulad 00:10:03  Yeah, exactly. In today's world is, psychiatry becomes a topic once you feel you are at the edge.

Abdullah Boulad 00:10:12  It's maybe too late. Yeah. you can manage life any any more by yourself. So. So what you're saying is that, psychiatry or psychotherapy, mental health in general will become more also prevent preventive, going forward into the future. Absolutely. Like we do we do sport as a prevention, but, with, with therapy and psychiatry, we don't do that today.

Dr. Sarah Boss 00:10:37  Exactly. We wait way too long. Absolutely. Yeah, yeah, we should start in schools already. As always. everything we want to change. So we should we should start with with more prevention in mental health in schools. But there is the tendency, like my little son already had yoga in school when they were three, in a public school. So that is a hopeful thing.

Abdullah Boulad 00:11:01  Nice. Are there any other misconception or global global mental health problems issues which are rising?

Dr. Sarah Boss 00:11:13  yeah, I think it's it's how we use diagnosis, which is also culturally a bit different. Like in some Middle East countries, there seems to be the trend that a lot of people are sent with the diagnosis bipolar, for example.

Dr. Sarah Boss 00:11:29  Whilst they might have mood swings like everybody has mood swings sometimes, but they might have mood swings that are more intense out of another reason without being bipolar right away, or confusion about symptoms in general, or also addiction when only addiction is seen and not what is really, you know, behind it. Usually a trauma and where the addiction is just the behaviors somebody would come with. And then also in other countries like the US or England, there is a rise at at the ADHD diagnosis, for example. That is everybody seems to have that now and almost in every class, a lot of children. And that is also, I think, a trend we're seeing that people are labeling that sometimes, but where the, the cause is another one. And also the approach should be another one.

Abdullah Boulad 00:12:29  Yeah. So, so you, you see clearly and I can confirm that also when I, when I speak with, with clients, I, I, I can relate to that. So the Middle Eastern definitely get more diagnosed with bipolar or a mental psychiatric disorder compared to someone in the UK or in the US, where ADHD seems on the rise.

Abdullah Boulad 00:12:52  And there I. I wonder, is it really on the rise because new techniques of diagnosis, or is it on the rise because because of other elements happening in the world?

Dr. Sarah Boss 00:13:08  Definitely. I think the the second. Absolutely. I think it's not for everyone, of course. No doubt that it does exist. But I think in most cases it is either sleep deprivation or the whole social media smartphone problem we're facing the last 15 years now, which we see a lot of effect already in our society at every age. And then there is a lot of trauma in the background that if we don't see it, we misdiagnosis. Where, for example, ADHD symptoms is a typical way of showing that our nervous system is dysregulated and that we're not safe and that we're not, at is at a resilient place where we should be. Yes.

Abdullah Boulad 00:13:59  And looking also at the regional differences, staying there for a bit, I, I often see also certain tendencies where regionally, psychiatrist therapists rely more on medication intake, medication based treatment versus more holistic or others.

Abdullah Boulad 00:14:19  how how do you see this development happening regionally?

Dr. Sarah Boss 00:14:24  Yes, that is very, very true, unfortunately. I think it's important to understand the understand that most healthcare systems don't have the money for more time. That's the big problem, like a usual psychiatrist in many countries, has seven minutes for a client, sometimes 20, but even 20. I mean, how are you supposed to really understand somebody in 20 minutes? Like, my first consultation is usually 90 minutes. Really understand somebody. So of course you can't offer much in 20 minutes or in seven. Imagine. So all you have. And that's what these people are trained with. It's like acute medicine. You have to prescribe to help somehow or to try it at least. So that's one thing. And then another thing that is immensely important is that most psychiatrists are not trained even in psychotherapy. So I was lucky when when I started, I had my training in Austria and Vienna, and we had a huge, change in the, in the system before I started.

Dr. Sarah Boss 00:15:31  That was good because they, they force all the force. Back then it was it was just it wasn't easy to to, apply it. every psychiatrist to do psychotherapy training in their, in their free time, like in the evenings, on the weekends and pay for it themselves, which is really hard to start to. But now it's, it's the most normal thing. So I think this kind of, revolutionary, changes happen throughout whole Europe now and throughout the whole world. You just simply can't, break those specialties apart. You know, it used to be psychiatry and neurology. That used to be one, because back then, people in German, we still say that somebody has a problem with the nerves, but they don't think about the nerves in my leg. They think they think that I have we have nerves in our brain, only the mental nerves. Exactly. So that used to be like 60 years ago. That was that was normal. Nowadays it's completely different. Immense specialties. We would never, you know, put together anymore.

Abdullah Boulad 00:16:39  I feel also there is a misunderstanding or a misconception around which specialty. Specialty does what? Because the Saka people mix up, going to psychiatrist, but going to psychotherapist or a psychologist or a counsellor or or a practitioner. Yes. what? Can you explain it in your words, how you see the differences between all the special specialties or types of therapists?

Dr. Sarah Boss 00:17:09  Yeah. Well, a psychiatrist is is a medical doctor and has, usually 12 to 15 years of training and can prescribe medication and is usually, until now, more for the more complex mental problems also diagnosis. Exactly. And then, a psychologist has usually five years training and then the clinical part in a hospital 1 or 2 years and then is there for talking therapies. And if and if they add psych psychotherapy to it, then they're, they're trained in. One method can be, for example behavioral cognitive behavioral or psychoanalysis or systemic therapy. So it's very good to to really check what kind of training somebody has even before starting treatment.

Abdullah Boulad 00:18:00  Yes.

Dr. Sarah Boss 00:18:01  To to really get somewhere to somebody that has experience and a good training also and a good approach, not just, from an evidence based side, but also, how how the mindset is of each method.

Abdullah Boulad 00:18:17  You mentioning methods. There are plenty of methods. And sometimes people, or clients, when I speak to them, they ask me, do you do offer eMDR? Do you do offer systemic therapy? Do you do offer DBT and CBT and so on. So what is the minimum qualification a psychotherapist, a good psychotherapist should have for for someone to to trust to go to. and what are the type of treatment specializations, more the modern world, practical.

Dr. Sarah Boss 00:19:01  I think what we know from, from evidence studies also and in general, from our experience is that there is psychotherapy methods like systemic therapy, for example, that is more effective than others because it's just looking at the whole system, family, society within ourselves. So that's very useful, for example. And also that's why some insurances in some countries reimburse certain methods and others they don't because they couldn't find enough evidence to pay for it. So that's also depending a bit on which country you're at. And then there is also I think it's essential that you get somebody that has also trauma therapy.

Dr. Sarah Boss 00:19:44  And to get somebody, which are most of my colleagues. Fortunately, we we find each other that are continuously in trainings. Like if we love our job, we we don't stop. There is one training leads to the other, one book leads to the next. And we continuously in a in a process. And we can apply many things and we don't even, put it on our website or we don't have to to to mention it because if we find like that could be useful, we use it. It's like having a big toolbox. And and depending on the day, in the moment you use a tool. And then what is essential? What I would always look into that we understand recently is that you have somebody that is also trained in a bottom up approach would be which would be working with the body, working with the nervous system, not just talking, because only talking we know is mostly not enough. It's important, no question. But it's it's so much more effective and more beautiful to to combine it with also working with our with our nervous system and with how we're feeling and how we're sensing and and combining those two things.

Abdullah Boulad 00:21:02  Yes. This is also what I often hear is, yes, I did ten sessions of ketamine therapy or ten sessions of this. And it did not help. Yes, because it was too isolated. You did. They didn't look into the different areas, which we will hopefully dive into in a bit as well. But there is, there is one, one, one big thing which is also on a global scale, happening in the world, in today's Western society. I mean, coming from a Lebanese background, we we we are much closer as a as a community, families friends and and and and we see each other. We just see each other to watch TV together. Sometimes it's. Yeah, it's it's not just to, have an appointment like in Switzerland, in the Western world. Yeah. Now I in a year from now, I will have on Sunday at 2:00. I may have time for you. That's that's not how it goes. It's very spontaneous. And this is also how I live my life with my family.

Abdullah Boulad 00:22:03  We never have appointments a month in advance. It's it's. Yeah, for me. I want to live now. And what am I in the mood to do at this at this point? But in the Western world today, we have loneliness as a big topic.

Dr. Sarah Boss 00:22:20  Absolutely.

Abdullah Boulad 00:22:21  And and from, from statistics we know that most From 15 years to 30 years. About 60% feel lonely today. So what? What is the cause? Why is this happening in this world?

Dr. Sarah Boss 00:22:36  Yes, loneliness is a is a big problem of our society. And, it changed so much in, in the last generations where the individual became so important and it, it was felt to be something like a human development, to be individual and to make your own decisions. Also to live in a city people moved a lot to from the countryside to living in, in, in villages or living in families to living in a city in a small box, like I sometimes say, everyone in his own box. And we know now that that's really not, something that makes us happy and something we should look for because we're mammals and we are.

Dr. Sarah Boss 00:23:22  We are social animals. They were developed. Social animals. We need each other. We know that from from. From from studies that were somehow even brutal when when there was when there were babies that were given food and water and medication and everything they needed, but no touch and no love, and they died. We know now that we really, really need it. And not just as a baby. We need it all our life. So that is really something that changed a lot in our modern Western society. And the other cultures don't have that yet, fortunately. And also, what's really sad is that the trend goes even further. Like young people nowadays, since we they have smartphones and this huge problem of social media, they tend to not even one girlfriend and boyfriend anymore. Like they're not looking for partners. They have less sexual relations, like less discovery, which was always part of growing up or becoming an adult that you would be curious you know about connecting to each other. So these things statistically even get more and more lost, which is really, really, alarming for our whole society and also the community in general that used to be community life of any kind.

Dr. Sarah Boss 00:24:45  It can be religious, no matter which which religion it can be. Joining a club, doing sports, most people don't have that. And if you don't have a child, that somehow forces you to to go to school meetings, even that some people don't do anymore, you you might not do anything and have no community sense anymore. And the bigger the city is, the harder it is. If you don't join a group, for example, to collect garbage on the beach or things like that, that those are modern options. But we know that community is a is a, a preventive factor for us. It's a it gives us resilience and we need to belong. We need to feel like we're part of a group and a part of someone else and something bigger. And that it's a it's a very important topic, I think.

Abdullah Boulad 00:25:38  Yes. It's there are also differences, regional differences. As we as we know, I was just recently in the mountains and the Swiss Alps, beautiful, sunny, a lot of snow.

Abdullah Boulad 00:25:52  And and then in the mountains, you you have the cultural side. Everyone knows each other when you walk across the streets. Hi, Sepp. How are you doing? So it's just this little interactions during the day. gives you already a sense of belonging to to a larger community. Yeah, but once you enter into a city like, London, Paris or New York, you get anonymous, so you cannot just say hello to everyone. People will look at you strangely. Yeah. so what would you tell these people who lack of connection or communities to do what can they go out and seek. To to help them.

Dr. Sarah Boss 00:26:39  Well other human beings as much as possible to join groups can be anything yoga, qigong, Pilates groups, art, music playing a band play or sing in a choir. We know from studies that's one of the healthiest things. And most preventative things we can do is singing in a choir. It's the nervous system, vagus stimulation, and really healthy. And it's beautiful to be part of a band.

Dr. Sarah Boss 00:27:07  For example, if you've ever had that, it's so beautiful you're doing something together or it can be anything. Or join the sports group, play on a team together, or do community work, like, Like you're collecting garbage from a beach. I said earlier, I think that's also a beautiful thing to do, even with with children already, so that they see that we're supposed to care and we do it together, and it's not all lost. And the whole world, just getting worse. So joining groups and then maybe also, self-help groups if needed, you know, groups would what, they have something in common or where you might have a relative that has a diagnosis or you yourself or any anything that could, you know, be fitting to your life?

Abdullah Boulad 00:27:56  No, that's that's that's beautiful. I mean, any kind of interaction where you get out and be with people. But this, this tap to, to get out, that might be a critical moment. But I think there are today also options and solutions online.

Abdullah Boulad 00:28:13  If you if you want to try out online groups help groups are or. Absolutely. I'm pretty sure there are singing groups online or.

Dr. Sarah Boss 00:28:21  Yes.

Abdullah Boulad 00:28:22  Yes. If someone wants to explore, there's a karaoke experience.

Dr. Sarah Boss 00:28:26  To to meet at least to. It's easier maybe to to, find it online, but then go there. For example, there are hiking groups all over the place or or language exchange groups of any language you like to learn or practice or you want to to offer for somebody else these kind of things, or working with animals or working with, with people in need. In an NGO, with children. There's so many options out there. It's really about making the first step and doing it.

Abdullah Boulad 00:28:59  What comes also to my mind is, looking into mental health in general and regional differences. There is certainly an element of genetics versus epigenetics. And what causes now all all the types of mental health disorders today. Who do you see also specific conditions which are more genetic related or more epigenetic related, like the the live environment surrounding and our today's routines?

Dr. Sarah Boss 00:29:35  Well, I still believe that some disorders are more, more genetically influenced.

Dr. Sarah Boss 00:29:42  For example, autism, ADHD, mood disorders, like depression. And then I think the epigenetics is the most most important factor for, for most, most conditions or most struggles we have in general, because it depends so much on what we live through, how much stress we are exposed to. And I mean also mental stress even. It depends so much on how our own pregnancy was what happened to my mother when I, when she was pregnant with me. That I don't even fully know because I wasn't present there. But these things affect us so much. And then what happens later on? How what happens in our life? And then if some something gets activated or not, and if we have the resilience, if it's just getting too much and then we we develop a symptom or a condition or if we have enough resources and stability, to cope with it despite. And so there is a lot more research now on resilience. So we want to ask the question why is somebody not developing a disorder even though this and that happened to him.

Dr. Sarah Boss 00:30:58  So that's a really interesting question. And I also I also think or we know now that trauma for example, is, is is passed on up to three generations. We know that from studies. So what happened to my grandparents or even their parents might still have an influence on my life, but only if something else happens. And if I don't take care of myself, or if I don't have enough coping mechanisms and resources and, depending on many factors. But to just simplify it on genetics is usually not the case anymore, which is a good thing, because then we're not we don't feel helpless.

Abdullah Boulad 00:31:41  Yeah. So they can certainly influence each other. Genetic and epigenetics. Like for example, when I think about drugs or cannabis consumption and what it can.

Dr. Sarah Boss 00:31:50  Do to some people due.

Abdullah Boulad 00:31:52  To.

Dr. Sarah Boss 00:31:52  Exactly.

Abdullah Boulad 00:31:53  Brains and or maybe someone would, would need to have some genetic elements so then they can manifest in a, in a.

Dr. Sarah Boss 00:32:04  In a different.

Abdullah Boulad 00:32:05  Way.

Dr. Sarah Boss 00:32:05  Way. Yeah. We do carry risk factors inside of us that we might never know because we we weren't exposed yet.

Abdullah Boulad 00:32:14  See, if we rely too much on genetics or. Or something like a diagnosis. This is, for me a big missed concept as well that people think, now this is me. Yeah. You know, I'm in the situation. Yeah, this is my life. This is not going to change. they feel like stuck, maybe.

Dr. Sarah Boss 00:32:36  Yeah. Helpless.

Abdullah Boulad 00:32:37  Helpless. but also the identification with, with the disorder or the identification with. Yeah, my parents had that. Or my father is an addict or my uncle. We have it within our family. what would you tell these people? are there ways out?

Dr. Sarah Boss 00:32:56  Absolutely. 100%. I even saw clients that came with diagnoses like ICD ten. They would tell me I have f 63.2 and f 10.2, like they knew even the codes, and they saw so much they identified, or they would come with half a meter of reports of other, practitioners. You can read about me. And I said, no, no, no, you tell, let's just meet.

Dr. Sarah Boss 00:33:23  Let's start over. No, definitely we can, we can we can change almost everything. If you look at it, I love evolutionary psychiatry in that way that if you look at us as a human species, we survived so many things. I mean, we had we were living in caves, we were living outside. Now we, we, we forget about that. And because we are all in our on our beautiful furniture, but, we are we are made. We are built to survive, actually to to survive many things and to adjust and adapt. And that's the beautiful thing. So if we if we can take a moment, take some time and have a good therapy, including our nervous system and process things that just accumulated throughout life. Then we can change so much and I would really go away if we can, from all those diagnoses. We need diagnosis of course, to reimburse still with insurances for for studies, for data collection to compare of course. But in the in the day to day, we, we don't really need diagnosis.

Dr. Sarah Boss 00:34:36  We need to understand what's going on with someone and we can tell them, okay, you have symptoms of this or that and why. And we want to understand why what what is the what might be the coping strategy behind it. Why did you develop those symptoms. And that's how we would look at it nowadays if we have the time and

Abdullah Boulad 00:34:58  And the resources.

Dr. Sarah Boss 00:34:59  The resources.

Abdullah Boulad 00:34:59  All the needed exact elements in place, because I also feel everyone has some type of symptoms of different, different, traits or disorders, if we may say so. But, and this is what makes us unique. Yes. so I always also tell clients, how can you expect, just saying you are this, bipolar or borderline or, only ADHD. So they identify themselves also with this disorder later on. This is where I, I have a bit problem, seeing happening just to, to put the disorder, on, on on a person. Yes. And then leave them with it.

Dr. Sarah Boss 00:35:46  Exactly.

Abdullah Boulad 00:35:47  Or just give a medication and and let them believe.

Abdullah Boulad 00:35:50  Yeah. They need benzo will help you now or when you feel anxious. Now take this pill. And that's not not the right approach from what I understand.

Dr. Sarah Boss 00:36:00  So yes, definitely. Because then also these people Feel like they need it. They depend on it. They feel like if I don't take this, I'm not well. And and that's not the way to go. Actually, you know, medication is can be great. I mean, without antibiotics, we I don't know where we would be now, but we we need that sometimes. But we don't need that to to it doesn't replace like working on where something comes from. And that's the beautiful thing because once somebody understands I have symptoms of not im then we can understand okay, why why did you develop them and we want to validate them. That's also something that's really important for me. We firstly want to validate. We don't want to say this is bad. You have a pathology. You have a disease. No. We want to understand okay.

Dr. Sarah Boss 00:36:53  Why did you develop this hyperactivity or this hypervigilance this ad symptoms. Why do you think did you need that? And then usually we see that it's a it was a coping mechanism to survive psychologically. And and that's what we made for actually to survive many things. And if we can take a moment and understand where it comes from invalidated and see that it was needed, maybe in our childhood, maybe to, to to make it through to, to to deal with something then, then the whole concept becomes clear that, okay, I'm not this, I just developed it and I'm much more than that. And that happened to me. And now I can change things.

Abdullah Boulad 00:37:39  And what it does, it empowers the person, the human being, to to believe in themselves and to make a change. yes. That's what I love about that.

Dr. Sarah Boss 00:37:52  Absolutely. And to become also more caring and loving, which is a big topic we should all learn in our society. But that that they they can understand. Okay, why did I, did I become that way? What was missing? What needs weren't met? Maybe by my parents or by my surrounding.

Dr. Sarah Boss 00:38:12  And and then they get they get more, more compassion, self-compassion for themselves. And that's essential than understanding. Okay. As a small as a small child, I didn't get that. I needed it and I didn't get it. And then the question is, how can I give it to myself now? Who can I surround myself with? What can I do that is good for me? And we can change things. That's what we call also repairing thing in a good therapy, that we are also supposed to do that until the client can do it all, all by him or herself. But that's what we can do. Even later on. We can give ourselves what we would have needed, partly at least. And we can change things always. We have immense neuroplasticity, what we know from psychiatry, which is beautiful. Our brain is incredible. If we have a stroke, we can learn everything over again. If we lose an arm, we can learn to write with the other. So why shouldn't we be able to to change also other behavior and other conditions?

Abdullah Boulad 00:39:16  Yes, I think this this will give trust to so many people that believe in their the body can recover.

Abdullah Boulad 00:39:25  Yes. It's like if you if you cut your little finger it will heal. Yes probably. Yeah. It will have maybe a scarf but it will heal. And the same is also with our brain. and the connection, the neural connection. We will talk about that a bit, hopefully to, simplifying, a little bit the story of, believing in what is underlying versus just believing on, on medication intake. I just had this morning, actually a little conversation with one of my daughters who just turned 2016. Yes. She's been not feeling so well the last couple of days. And then she was asking for a medication. Like an ibuprofen. Simple. and I tried to explain to her again. Also. Look, let's. You can you can suppress this now, or we can work together on how can we work on the underlying cause to strengthen your immune system. So let's understand that. And I think that's also something we we need to try to to tell people. Let us understand what is underlying to your current situation.

Abdullah Boulad 00:40:33  What are the symptoms and where do they come from. And then we can do the right work.

Dr. Sarah Boss 00:40:39  Yes, exactly. Beautiful way to put it. Or like if we have a wound, we can just cover it without cleaning it and letting it heal. Just cover it up with a Band-Aid. I'm saying sometimes and not feel it. Like what stimulants do with many A.D.D. symptoms of children. 1 or 1 big example. We have many clients with that. And I think everybody that with all these weight loss injections that are so misused now by clients that instead of working, why they're eating, overeating to soothe themselves, they give themselves those injections where we don't know what the long term effects will be in an abusive way. So that's, I think, another big trend we see recently.

Abdullah Boulad 00:41:27  I see it across different ages and also clinicians and doctors who use it. What do you where do you see the effects? Let's say short term we we don't have long, long time data on on on on the usage.

Abdullah Boulad 00:41:47  But do you see any, any development or tendency.

Dr. Sarah Boss 00:41:51  Yeah, we do see already quite a lot of possible side effects, a lot in digestion, which is already a huge thing just to without going into details now. But if we understand how important the microbiome is, the brain gut axis, our digestion, for example, every functional medicine specialist is knows that if we if we don't have regular gut transition, we that's a risk factor we really like. Somehow poisoning is a strong word. That's what they say. They're quite radical about it, but it's a risk factor. We shouldn't keep certain things inside of us and for a long time. So if this medication is like blocking our metabolism and that's what it usually does, that's the a mild side effect. there is already a huge thing I think, for the general wellbeing. And then there's also side effects like kidney problems and mental health. You know, people get depressive or people get all kinds of symptoms. So in in general it's again this quick fix what we see in our generation and in our society people, of course we have all those all that medication with the first generations to have all that medication there.

Dr. Sarah Boss 00:43:09  Of course, it seems great at first sight, but then it's we can't use it as a quick fix and to say, okay, I want to lose weight. I give myself an injection. I'm not a robot. This whole every gram of fat also has an immense metabolism of its own in my whole body. I can't just take it away and put like. Also, if you do surgery, we have to work on it psychologically. We have to understand where it comes from and really deal with it to change it for good and the diet and everything and the microbiome and so on. But it's just, that's also something, you know, a big trend. We see it lately.

Abdullah Boulad 00:43:48  Yeah, I believe I believe someone needs to weigh out what is really, because overweight has side effects, certainly on the body short, long term and using the medication. And and someone needs to weigh out what is what is, less likely to be harmful for one being.

Dr. Sarah Boss 00:44:09  Absolutely. But what I meant now are the clients we see lately they don't have real overweight.

Dr. Sarah Boss 00:44:15  Some of them not at all, some even underweight. It's really a it's become it's being abused. So I think we really have to be careful as specialists to prescribe it.

Abdullah Boulad 00:44:26  Can it be mentioned or categorized as a a tendency for an eating disorder today?

Dr. Sarah Boss 00:44:34  Absolutely. I would even say maybe eventually we see it as another form of purging. You know, that purging with people would also use, laxatives or do whatever other thing to lose weight. I mean, it's another way of chemically Influencing your weight and in an unhealthy way with the only purpose of losing weight. Yeah.

Abdullah Boulad 00:45:01  We can. We can hope that long term we know more and we know better about that. You you have spoken now so nicely about all the different techniques and, and, areas of your expertise also. my understanding of psychiatry today, if I can summarize that is, the future integrative psychiatry. And can you just summarize this in your words, how you see it and how how what elements should integrative psychiatry contain. And every practitioner or any treatment center should implement.

Dr. Sarah Boss 00:45:42  Well I think what's important and I understand that they can't always be one person like we talked about before, but it's important. Important to not split the human being anymore. Like psychosomatic. or just to see the brain and the body. And because just that's just not helpful, especially in more complex conditions. So I think integrative psychiatry should always be looking really at the root cause of everything and really seeing the whole human being developed animal as a whole and understand what's really going on, and that in every way that entails functional medicine with nutrition, the gut, for example. Then we have to also always keep in mind, of course, this story over many, several generations, if we can trauma history really, really have to understand what does trauma mean. And the meaning of it changed completely, which is great, a great development. Now recently it changed completely to what it used to be. And we need to understand, that trauma effects can be so different looking so differently. And we really have to detect it and we really have to understand it.

Dr. Sarah Boss 00:47:05  And which comes to the next thing the so-called bottom up approaches. Now we know that the vagus nerve going through joint like combining, connecting our body, the organs, the gut with the brain, we know that this nerve is is immensely important for the parasympathetic nervous system, for everything that we call also being relaxed, being calm, being curious, digestion, relaxation and so on. So this nerve that we want to actually influence all of us because we want to feel relaxed and we want to sleep well, but in this nerf, we know now that 90% of the information goes from the body to the brain and only 10% goes top down. Some say 20, but it looks more like ten, which means that in in evolution, like our our setup is towards this is not so important. This got incredibly developed throughout evolution to developed. I think we really have to learn how to handle it. Also we get a lot of very intelligent patients, which I love about our work as well. So what we always we these people have to learn is it's like having a racing horse up there or a Ferrari.

Dr. Sarah Boss 00:48:26  You have to learn how to drive it, and you have to learn how to turn it off as it does what it wants. And we we can't sleep anymore and we can't stop overthinking. So if we understand this and that the 90% information goes from the body, then then we can influence it. The nervous system. And if we do that as a psychiatrist, as a somatic experiencing practitioners, any therapist that is trained in bottom up approaches can also be a body therapist that does yoga or qigong. If we influence this, then the nervous system, signals to the brain everything is good. All we're safe. Relax. And that's what we want to have. All of us. That's what we do with our children. Nobody needs to tell us that we do that naturally. When we. When a baby cries, we hold it, we soothe it. We call me down. We call regulated. It's nervous system. That's called vagus stimulation. And if and that we have to understand because if we don't do that, we're always just working on the surface and we're trying something.

Dr. Sarah Boss 00:49:31  It might work, but it might not. And it's also using time. A lot of clients get really frustrated because they tried so many things, and they might end up thinking, okay, I've seen so many therapists. I've tried so many things. I'm hopeless. It's. I'm helpless. Nothing works. But it's just not true. It's something. Mostly, most of the time is that that link is missing.

Abdullah Boulad 00:49:55  So what you're saying is integrative psychiatry doesn't just focus on the brain, on the mind and the mental side, but it should also integrate the body from inside out as well as the nervous system how it's connected. what other elements would you see as part of integrative psychiatry today.

Dr. Sarah Boss 00:50:19  Yeah. Actually almost everything. if, if you think about most, most mental issues also have a lot of physical symptoms like our clients usually have problems with digestion with, sleeping, with, pain, any kind of, any kind of physical Symptoms as well. So we, we don't need to to understand. And that that is usually a sinus of the nervous system being not regulated.

Dr. Sarah Boss 00:50:53  And it's, it's very important to approach it that way also and not to split it apart. And in another part of integrative psychiatry can also be to spare medication or to help clients that don't respond well to medication, which there is a big part of it as well, is to use modern devices and to be trained, for example, in in direct current stimulation, in neurofeedback or in TMS, or using poly vagal informed therapies like the Safe and Sound Protocol, all these kind of modern things that are out there that are very effective, with barely any side effect. So really safe. And, a great alternative and option if, if people have knowledge about it and access to it.

Abdullah Boulad 00:51:51  Yeah. So you definitely add then some technology based treatment I think as a, as a category this is called neuromodulation. And there are different techniques today. Someone can can access additionally to, to the traditional talking therapies, medication based treatments, but also the holistic. I fully understand it's it's logical to me that we have to look today at the person as a whole, and not just to isolate the mind and this is this or the, the feet or the pain.

Abdullah Boulad 00:52:28  So it is definitely holistic and integrative. And then I have my own experience. back in Switzerland, I had my, my own struggles. where I, I was, I was hospitalized myself when when I had a heart attack. And then after that was still my early, early days figuring out what happened to me, why did it happen to me? And then I was pushed from one specialist to another and and everyone looked at it so isolated, like the cardiologist said. Yeah, everything is perfectly well with you. yeah, but I don't feel that way. What if it happens again? So there are a lot of things anxieties came up and, a lot of maybe symptoms I felt I have, but maybe it was just mentally, and, and I needed to figure out where and why, but I did the hard work to go and search and speak to people. And I didn't feel well taking care of in the sense that one hand or one source helped me to look at myself holistically and understand myself.

Abdullah Boulad 00:53:41  And this is, I think, what in, in today's, health care system is missing. They, they work to isolate it or they push, from one side to another. maybe you have some experience with your type of clients as well?

Dr. Sarah Boss 00:53:59  Yes. Definitely true. I mean, it's also partly because there is so much knowledge now. I mean, it's not even, for example, that one cardiologist is just a cardiologist. Now they've specialized because the it just doubles and triples all the time, everything they need to know. So it's impossible for one specialist to know it all or to to keep up with it. And then we're supposed to keep on being in trainings and it's just impossible. So I think what's missing, what in what used to be the case was a GP like a general practitioner that would overlook it and that that's not the case anymore either, because they don't have much time and it all has to be quickly done. In the countryside, it still works. There is still general doc practitioners.

Dr. Sarah Boss 00:54:52  They would go to the home of somebody, they would know the children, they would even deliver it. That's beautiful. That's also a connection to a family. But those things are rare nowadays. So maybe there should be the function again of somebody like taking over this role of of putting the information together and seeing the, the integrative part of it, because the tendency is there in all specialties. We want to look at it more integrative, but who connects them between each other. So the beauty of psychiatry nowadays is also I think that we see the clients after they've been at all the specialists you mentioned, because then one will say, okay, I don't know what to do with you anymore. All the values are good. Go see a psychiatrist also because they don't know what to do anymore. And. And then that's then when that ends. Usually, you know, that journey of of checking doctors, and trying out things, that's when it usually ends. We can also have that role, but it shouldn't be that way.

Dr. Sarah Boss 00:55:57  Of course, that somebody has to go through so many. So many spots.

Abdullah Boulad 00:56:03  Yeah. But I I'm, I'm today more and more I mean what I have been talking about is many years back now. But today I see more and more psychiatrist with, with further educations in psychiatry, psychotherapy and and and functional medicine and more holistically oriented as well. And I think that's, that's some sort happening. But you need in the first place to to get to a psychiatrist, or, or

Dr. Sarah Boss 00:56:31  To know what you're looking.

Abdullah Boulad 00:56:32  For, what you're.

Dr. Sarah Boss 00:56:33  Looking for. Exactly, absolutely.

Abdullah Boulad 00:56:35  So if we if we look at the the nervous system, because the nervous system, especially with traumatized people, anxiety and other other disorders, that it plays a big role. Yeah. How how is someone who's traumatized feeling or how how is the nervous system, playing a role here?

Dr. Sarah Boss 00:57:02  Well, usually what we see a lot and what we all know, more or less, is that a trauma is not how we used to see, like something that happened.

Dr. Sarah Boss 00:57:14  It's not about what happened. You need the same thing. Two people can be in an accident and one you afterwards develop symptoms and the other one doesn't. So it's not really about only what it what happened. It's about living in the here and now, inside of our body. Inside of our nervous system. Not living safety. Living as if it was still the case. You know, as if I was still in that moment. Still being threatened by it. By something, or by an accumulation of stress and things that happen. So what we usually see is that the nervous system is either either over activated, which could be, you know, the typical fight and flight symptoms. People would come with anxiety, with feeling stressed, unable to to relax, to stop thinking, ruminating, not being able to sleep, thinking about problems at night, maybe changing, you know, not being curious anymore, not feeling like relating to other people anymore, these kind of, sympathetic symptoms, we call them.

Dr. Sarah Boss 00:58:27  And then there can also be the typical Shut down if we simplify it now. People that would feel like, okay, maybe I've tried to fight them or they wouldn't call it that way, but I've tried a lot and now they just feel helpless. And they, they feel like they, they shut down, which could be a way of, of, of seeing depression in a way like depression is somehow also seen that way on a state where somebody loses interest in things he usually likes to do, or going out or connecting to people or trying new things and, and just shutting down somehow, or even the posture. We see that sometimes in people like they have less, less expression, sometimes just feel like, you know, the tone is, is is different. So that's what we usually see when we speak about the nervous system. And then there can also be this more complex, states of having a mixture between it, which is quite confusing for the clients. They can be from one moment hyperactive, over activated, stressed with the heart rate up, going into shutdown, dissociating, feeling completely numb and disconnected and not knowing what's going on, and then maybe jumping into the next state again.

Dr. Sarah Boss 00:59:46  And so like we call it dysregulation of our nervous system. And that's what we see a lot in, especially in traumatized, clients.

Abdullah Boulad 00:59:55  How can someone connect with this or regulate this by themselves or, and when when is a practitioner needed to to help that person?

Dr. Sarah Boss 01:00:07  Well, we can do a lot ourselves of course, which would be anything that is good for us, which is we can call vagus stimulation or however we want to call. It can be anything with breathing. If somebody likes to do breathing meditation, qigong, yoga, sports, a little bit of running, but slowly. It's not about, you know, overdoing something. Again, a lot of nature connecting to nature again. Being in a forest, for example, I think is one of the most, rewarding and, and, healthy things for me. And, do you like taking care of the body, not just sitting there? We have the tendency in our society to just sit there. The more problems we have, the more we just sit there with frozen with it and we don't move.

Dr. Sarah Boss 01:00:59  But our nervous system is still the same as many, many years ago, where we're supposed to move. We're supposed to fight and flight. If there is a tiger in front of me, I'm supposed to do something about it, and my nervous system doesn't get it. Why? I'm just sitting there frozen with all my problems in my head. Because the problems. I have the same effect as the tiger in front of me. No difference. So we need to work with that. We need to let it out to simplify it and do movement. Getting to action again, but not overdoing it. Some clients also have the tendency then to try to help themselves, but then they overdo it. They like sensation seeking and they start bungee jumping and and motorcycle racing, and they disconnect more and more because they have more and more extreme sensations. And that's not the way to go. So to answer it, we have to go really slowly, like we call in chemistry titration one drop after the other slowly, and then give our body time to, to adjust again to, to work with that.

Abdullah Boulad 01:02:07  Yes. No, that's that's I think what, what what is missing. Just to have the right balance to to jump or not to jump, to take little baby steps from one state to another. Yeah. but when what comes into my mind when when we now speak about the nervous system? What is the cause and the effect? So what is is the nervous system shut down and effect of what? And and does it have effect on different things if this question makes sense to you.

Dr. Sarah Boss 01:02:46  Yeah I think the cause is usually always trauma. But like trauma now in a wider meaning trauma can also be for example a question we always ask how was the birth. For example, sometimes we see clients that are really dysregulated and in detail, you know everything was fine, my childhood was fine and everything was perfect. And then you ask, but but I see that your your physiology shows me something else. So how was your person then? They say, oh, I almost died. You know, the the cord was around my neck, I was blue, I almost died, they had to reanimate me.

Dr. Sarah Boss 01:03:23  I almost didn't make it. That is a trauma. It's, That and even smaller things. And these things leave already body memories inside of each one of us. And that's normal. We're built to survive most of it. It doesn't mean that we will have a problem, but what we should understand is that we're piling up. charges. We're piling up, tension inside of our system and throughout our own history. Like what? You could see it like, what if you want to make a fire, like, more and more wood is piling up, and it just can be that there is there there comes a day when it's getting too much. Even if it wasn't a specific great thing, the event that happened now compared to everything else, but it was just getting too much for your nervous system to regulate itself, to cope with it naturally. And then we really need or should get some help with maybe a somatic experiencing practitioner to work through that carefully. and not and not try to to stress ourselves even more with, with some kind of methods that which we sometimes tend to seek help with.

Dr. Sarah Boss 01:04:40  So, so that's that's the thing to do it really carefully like to take one would after the other and then they're all connected anyway and in this chart and help our nervous system to bounce back into the resilient state that we all can be at. And like dogs and cats most of the time, and there's a lot of beautiful techniques and methods we can do. We can support that with and we can learn also to do at home and things like I mentioned before, everyone that had has a child or had a baby ever naturally knows what it means. We never thought about it and nobody usually explains it to us. We do that naturally, but that's the same principle. We have to regulate the baby because the baby can't. It's screaming and we don't even know at first. Is it? Is it hungry? Does it have pain? Is it tired? We don't know. It doesn't matter. We want to regulate it, call regulate it. And that's all we need to do for ourselves, because we need that all our lives.

Dr. Sarah Boss 01:05:43  And the less we pile up, the easier it gets.

Abdullah Boulad 01:05:47  Yes. When I when I think about trauma and you mentioned it that we we save it in our body, I think about the sponge which, which everything we, we experience in life, we we we take it in into us. And then the release, the release of it is like letting letting pressure out not to, to to overwhelm the system. So always like the to have the right balance and the right play between letting out and and and.

Dr. Sarah Boss 01:06:16  Yes. Yeah. exactly and that always in a safe, safe atmosphere. We should never forget that, because trauma therapy used to be, more intense in the beginnings, which was important in development. So a lot of people are scared and they think, if I go into a trauma therapy, then I'll be exposed to my worst moment. That's not at all what we're doing anymore. It should be really always on the basis of, really secure, really stable relationship with the therapist. So one thing I really want to mention, also, it's so essential to be regulated as a therapist because like with the baby, we are co regulating each other all the time.

Dr. Sarah Boss 01:06:58  Sometimes we don't notice, but we even detect more than one metre if somebody's regulated or not. That explains why sometimes we feel more interested in getting to know someone and sometimes we don't. We might not even think about it. Or sometimes dogs would bark at one person and the other one not, and nobody thinks about why. But it's really interesting. It's this dysregulation we notice here in a new reception level, completely unconscious. So that's already part of a therapy where nothing has to happen. We don't even have to talk much, but just regulating to another human being is already really beneficial and can be such an important step for a traumatized person to feel safe and feel okay with somebody and and then build on that trust to carefully exploring and lose the fear of looking inside and of keeping it together, and maybe even dissociating already out of fear and disconnecting from everything that's going on. So it's a really, really beautiful process, which I'm trying to say. So trauma therapy. I was really surprised. In somatic Experiencing, you deal with, you know, the topics are like the the, the most horrible trauma you can possibly imagine.

Dr. Sarah Boss 01:08:19  That's the kind of clients you get prepared to work with. But even though it's, it's so, so, negative somehow what happened with other what human beings can do to each other in war crimes in, in, in all kinds of horrible situations that the message is so beautiful, it's so positive. And everybody that did that training is so believing in that is living that in this positive way of out of it and really being part of that journey is a beautiful thing.

Abdullah Boulad 01:08:54  I met a while ago, Peter Levine, and, I know about his work and he's the founder of Somatic Experiencing. But I know also that Somatic experiencing can be trained by anyone. Yeah, you don't need to have a specific Education or background to do it. So from my experience being with clients and talking also to different types of specialists and therapists, I feel, I, I feel that, some combination is needed because it cannot be just isolated. just somatic experiencing by itself. What is your experience working with clients and what is the essential combination or, to, to be added to be successful?

Dr. Sarah Boss 01:09:48  yeah, I usually agree, especially with our patients, because of of course, once you have a, a problem, like a mental condition of whatever kind or you are traumatized, it's it's absolutely essential that that.

Abdullah Boulad 01:10:05  Can complex, more complex cases.

Dr. Sarah Boss 01:10:07  That you have a combination that the best thing is always that you Psychotherapist or your psychiatrist is also trained in that and can can just be there whatever happens, you know, it's also something beautiful to live through that I hear that a lot that they feel like I can cope with anything, whatever comes up, no matter how dark and scary. No problem. We we trained in it. We can deal with it with whatever comes up, and then they don't have to be worried about it anymore. And with somebody that is not trained in anything but somatic experiencing coming more from a body therapy area, there can be a really difficult moment when when that happens, so that I wouldn't recommend. But for clients that are not complex and not traumatized, I think it's actually great that the more people are trained in it, the better. I mean, the more understanding the better, because I think most people that do that already do parts of it with their work, like massage would touch or cranial sacral or.

Dr. Sarah Boss 01:11:13  Rolfing. All these kind of things where you're so close to somebody, you can really, you know, things happen. People start crying sometimes just by being touched and and things open up without even knowing it. So it's beautiful that they, they can they can go deeper then. But I also think it's really important if, if somebody is not stable enough to first refer to somebody with the whole training behind it, and then maybe take over later again and see it that way.

Abdullah Boulad 01:11:44  Right. You also mentioned something which is fairly new in, in the psychiatry field. it's the neuromodulation and the different techniques. Can you explain what techniques are out there? What are the differences, what do you prefer and for what cases they make sense versus other traditional methods.

Dr. Sarah Boss 01:12:10  Yeah. Well, I think it was a huge, huge improvement in psychiatry. You know, they used to be the famous electroshock that we know from some old movies, and that's quite invasive for people. And they're also quite scared of it. So coming from that, maybe to start with, there is nowadays something called direct current stimulation.

Dr. Sarah Boss 01:12:32  And this is really, really great methods, especially for for patients with depression, also with chronic depression, with depression that, you know, clients that tried many different medication already didn't respond to it, or, or patients that don't want to take any medication out of whatever reason. And it's something that is really effective. Level a evidence from the World Health Organization has the highest evidence there is. So we know it works for most people and that without side effects, barely. Like if people drink enough water and keep hydrated, they have no side effects. If they don't, they might have a slight headache. I tried it myself. I always try everything myself. You barely notice it. You have a small current here and it's like a tingling. Like as if you would have a bug in your hair and that's all you feel. And usually you only have 10 to 15 sessions, 20 to 30 minutes, and you get significantly better. It's also working really well for craving for addiction, for some OCD clients, for a lot of neurological clients after stroke, when they still have problems with, with finding words or or other kind of impairments, cognition.

Dr. Sarah Boss 01:13:53  Also for acoustic hallucinations, there are many protocols and it's continuously evolving. And it's also quite interesting. It's a neuro enhancement. So we know that after an hour afterwards, our brain is stimulated that we have like a window of opportunity so we can memorize better, we can think better so we could use that time. I'm always trying with our clients to do something, useful afterwards, like to learn something they want to learn or do some mindfulness exercise or something. You know, that.

Abdullah Boulad 01:14:26  Is this time window of.

Dr. Sarah Boss 01:14:27  an hour, about.

Abdullah Boulad 01:14:28  An.

Dr. Sarah Boss 01:14:29  Hour.

Abdullah Boulad 01:14:29  And do the, let's say, tDCS. That's what you're talking about. Does it is it helpful just by itself? Just someone? Yes. Go to tDCS and this should help. Or does it have to be combined, let's say with psychotherapy or other techniques.

Dr. Sarah Boss 01:14:46  When we do it? Of course it's done by a psychologist or a psychiatrist. And while we do, we talk. So we we use that, especially the hour afterwards. We should use it for, for therapeutic purpose.

Dr. Sarah Boss 01:14:59  But it is effective in the studies by itself also. But in general, of course, we shouldn't do. I mean, we, we always want to have the whole package and integrate. Exactly. So that's what we do also. But it's really great, a great option and a great new innovation and safe and effective, which is really good. And then there is transcranial magnetic stimulation TMS, which is also, a great development for patients with major depression or chronic depression or for OCD, or also for people with sleeping problems, insomnia and, addiction craving and more and more focuses are also part of research. So TMS is something that, you can apply. Usually you do it with a psychiatrist in his practice or in a, in a medical center. And you just sit there and you have a coil with magnetic stimulation. It is quite big and quite loud. So it's not some something everybody has, like the tDCS. It's more it's handy. You can take it anywhere. You can even go on a whole home visit if needed to the clients, residents and or outside or wherever you want.

Dr. Sarah Boss 01:16:25  So the teammates is the, the bigger device, so to say. So it's more it's usually done in hospitals even, and a lot of research done. And then there is neurofeedback, which is a very important especially for the whole topic of children with ADHD or ADHD symptoms, because it would be the treatment of choice. And most people don't know that. So they, they, they haven't even heard of it. Even though neurofeedback would solve the problem long term of somebody not being able to focus or having attention problems or sleeping problems. So if we know that and if we see that, for example, stimulants only are effective where we take them, if we would stop taking them, we have the same symptoms. It's only symptomatic when we take them. So a neurofeedback is the treatment. So we should really spread that information. And a lot of health care systems now reimburse it even and have programs because of course long term it's so much better for the children to not take medication, not depend on it and really get better and avoid all the long term effects of somebody with ADHD or ADHD symptoms that usually then later on feel like they they have problems at school and they have low self-esteem or other kind of, problems.

Dr. Sarah Boss 01:17:54  So neurofeedback is something really easy to summarize. It really easy to do. You sit it as a device. It's like a computer. You have electrodes on your head. It's like a real time EEG, and you see your brainwaves and you see them in a software that is adjusted to your age. It can be more like a game, or it can be just in colors, or it can be music. So you learn how to influence your brain. It's like biofeedback, where you learn how to influence your your blood pressure, for example, or your breathing, and you learn how to influence your brain activity, which is really great for all of us because we we learn in the end, we learn self-regulation. We learn how to activate the brain and focus if we want to, and how to deactivate and relax and sleep and whatever we want to do when we want to, and how to switch between those states. And in the end, everything is in life, if you want to see that way is is around that we always.

Dr. Sarah Boss 01:18:57  We constantly in different states and activation mode and we we we can really benefit from that. And that's again the neuroplasticity that is immense. We can really use other parts of our brain. We can have a better connection because we believe that in psychiatry there are a lot of problems, are network problems that maybe two networks don't work perfectly together or one is inhibiting another one. So we can influence that and quite, specific in detail to everybody's needs and everybody's EEG. So that's a great development. Also evidence based high high evidence, incredible evidence also for anxiety for sleeping problems and also very, very safe no side effects, which is a beautiful thing. Also not a standalone therapy. It should be part of a psychotherapy where you also speak, of course, with the therapist Therapies before and after and understand, you know, how they can incorporate that to their real life, how they can use the new skill, this implicit skill, implicit learning, like learning how to ride a bike or play an instrument, you learn it by doing it and you shouldn't lose it again, which is beautiful.

Abdullah Boulad 01:20:16  Yeah. So there are beautiful techniques which which are out out here now which can replace in some cases medication which have, potentially long term effects. but I'm, I'm also pretty sure it needs more education or knowledge on, on the practitioners or therapist side to define which one to use in this moment or for what case or what combination of, the therapy environment someone should have. Because that's the next level of of individualized care, looking looking forward. How our field of mental health and holistic integrative psychiatry may lead us to to the knowledge to define what is the best combination of treatment for this specific person, because at the end, just giving information can also be sourced these days by ChatGPT or other AI solutions. But that might be, as of now at least, talking about individualized care. And, and I'm very passionate about individualized care because I had my personal experience, I, as I shared before where I, I wanted to have one source helping a human being on a 360 degrees level holistically, as we say, how do you see the benefits or where do you see the benefits of treating one client at a time in a residential care versus a community based or small group based therapeutic environment?

Dr. Sarah Boss 01:22:08  Yeah, it's it both has its benefits.

Dr. Sarah Boss 01:22:11  I would say that, the individualized care, of course, has the huge benefit of adjusting 100% to, to one's needs. So that is that is beautiful. Of course, if it's possible, it's beautiful, especially initially to really have that time, have thorough assessments, really getting to know the team, building up trust, which is a major topic for most clients in that especially when they come with trauma history, which are most clients nowadays. So that gives us an immense, benefit, especially when it comes to feeling safe, which is again, we talked about it here on an unconscious level. But if we are somewhere and, and and everybody takes care of us and we can start trusting, we can start letting go and maybe letting go also of defense mechanisms or being frightened and really being able to open up and work on deeper topics. So that can be very important for, for most clients is essential, even especially in the beginning, to feeling safe, to feeling like we can really adjust and we can really understand and maybe adjust day by day to the needs of somebody and to the speed of somebody with the program and with everything around it and the diet and and the rhythm.

Dr. Sarah Boss 01:23:41  This did everything. And and then of course, we know also from studies and experience that we are like we talked about, social beings and community can be very effective. We learn from each other. So it can be then be great to to also join a group, maybe sometimes once ready and and feel the, the effect of of also being in a group or joining also group sessions or doing like we do at our clinic. Sometimes they do certain things together, like a yoga class or a hike. like also sometimes it's really good to to do it slowly, like to increase the contact with others in the community, like to get used to it again and to feel comfortable with it. And, and then also to be able to work on it in individual sessions, like what happened? How did I feel? maybe it was frightening me, or it was stressing me somehow and and not overdoing it again, but really working on it right away to feel more comfortable with it so they can. I think that that is a great, opportunity to do so.

Dr. Sarah Boss 01:24:55  But then there are other clients that it might not be so complex where from the beginning on, they would like to be in a community, because that's where they learn most and from each other. Or also programs like, around addiction can be really useful sometimes

Abdullah Boulad 01:25:12  To see other also struggling. So there is definitely not one size fits all in that in that field or benefits here and benefits here. But what I, what I understand is the individualized side of care with eventually part more individual as one client setting and then a combination of being with others may be helped.

Dr. Sarah Boss 01:25:39  Yes. Because also but the individual care most people never had it and and might not even understand that that's where some issues come from. But they, they, they would feel then the first time maybe that they really taken care of, that they're really important and like 100% from every angle. And that's, that's a really beautiful experience that there is so much time for me now. Not everything is possible and everybody cares about me really getting better.

Dr. Sarah Boss 01:26:15  And that can also be a healing experience to really be important for once. And, and to really feel like somebody has time, especially in the healthcare systems nowadays where, you know, after 20 minutes they start looking at the water type in the computer and it's clear time is over. Unfortunately, the next one is waiting. So that can be really, really important also, and would be interesting to have explored that further one day.

Abdullah Boulad 01:26:43  You know, beautiful and I think individualized care, as I said, is, is, will be the future. More and more organizations are jumping in into this to, to to look at, the, the, the person as a whole. so wrapping things up for, today's show. Is there a book you think about? which could be interesting for, for everyone out there listening to our show today?

Dr. Sarah Boss 01:27:16  Yes, definitely. I would like to recommend The Anxious Generation by Jonathan Haidt. Absolutely important to read it. not just for parents and teachers, because it's a lot about the threads of social media, about what it does to our children, but also for everybody in general, because it shows really beautifully, how our society changed from play based childhood now to digital childhood and our in society in general, how we became so much less community based like we talked about.

Dr. Sarah Boss 01:27:57  Which also means people are more frightened, not just more lonely, but more anxious about everyone. We don't even know our neighbors anymore. If we live in a big building, and if they look at us, we might think, what do they want from me? Or what problem do they have? So this is an incredible development in our society that we should do something about. So I really, really encourage everybody to read it. And it's immensely interesting also to think and check and be critical. Every one of us. What does the phone, what does the smartphone do to us? How did it change our life? How much is it dictating us and not we the phone? And how much does it decide about where our attention goes, where our time goes? I encourage everybody also to check the the use on the phone where you can see how many hours you used your device and what you did with it. We have to be so careful with that. It's it's really we see that every age we have people 75 plus.

Dr. Sarah Boss 01:29:00  They become so addicted to it that they get a divorce from the wives and they can't let go of the phone. So no age is protected from it. And we really, really should do something about it as a society and be critical.

Abdullah Boulad 01:29:15  So you would you would suggest, actually to everyone to do this time limitation on their phones, not just for their.

Dr. Sarah Boss 01:29:23  Children and what yes, be critical about it, all of us and ask for example again, how how often do I still read a book or how often to disconnect and relax, which is not in the end, we know that. Do I just use the phone instead? And to really be, we have to be really critical about it. like when we about wine, how often do I drink? Which we also critique about it. When we drink a bottle of wine every day, every one of us would honestly think, oh, I think that's not the way it should be. It's exactly the same way to think. Look at it.

Dr. Sarah Boss 01:29:57  If I'm on it more and more and more, and if it distracts me, or if I open the phone and, and I want to check my meals, for example. But while I check my emails, I get so many notifications and other things that catch my attention that it's just not the way it should be, and our brain can take that. It it's just too much for us. It's making us all have ad symptoms, all of us, that there is no way around it. And we have to be really strong to say no and put limits to that.

Abdullah Boulad 01:30:30  Because if it's difficult for us adults to do it, then I can imagine also how it must be for our children. So it's our our responsibility. It's our responsibility to.

Dr. Sarah Boss 01:30:41  Act.

Abdullah Boulad 01:30:42  On on that and to observe that and explain. And not just through through, rules and limitation to give them the understanding. Why are are they, do they have to reduce their use of social media or phone technology?

Dr. Sarah Boss 01:31:02  Exactly. And be good role models.

Dr. Sarah Boss 01:31:04  And also the, the governments they, they need to protect in the end like it used to be, which we talked about it earlier with smoking. Smoking used to be no problem. Even on planes. We had long distance flights and were, just with other smokers in a small room, and nowadays that's unthinkable. But it's exactly the same. We need regulations, we need protection, we need clear notation.

Abdullah Boulad 01:31:28  Yes, like some countries they have developed like, phone use or apps, certain apps not to be used, under 16, the age of 16 and in some countries or in some public schools. To forbid phones. But it's still unfortunately not. Not everywhere the case. my I'm getting to to an end. So you you have come across a lot of, patients, clients you have been working with in the past. How is this affecting you as a as a as a human being, not a psychiatrist or a therapist. And what do you do to stay in balance in your daily life?

Dr. Sarah Boss 01:32:14  Well, I think I'm growing through all our clients.

Dr. Sarah Boss 01:32:17  I learn from everyone. And I'm really lucky that I, I get so interesting clients from all over the world, different cultures, different backgrounds. So I learn new stories all the time. I don't I don't ever I don't go to the theatre anymore or to the opera I get that usually in my in my work already fulfilled all the beautiful stories I hear, all the information about their life. It's very beautiful that my clients really want me to understand them. So they really explain. And I really listen with not just with my head, but with my nervous system. And that is a really beautiful thing. So I would even say I would go that far to say that usually my, my, my job is not how it used to be anymore on in acute psychiatric ward, which is a lot of tension and it's really difficult, but now it's the opposite. It can be really beautiful in like a it gives me something. Also, it's it's that's how it should be a co regulating beautiful connection between two people for an hour or 90 minutes where, where we together try to make things better, which is a completely positive and beautiful way of thinking about it.

Dr. Sarah Boss 01:33:35  So that's one thing. And then the other thing I, I, I connect a lot in to nature. For me, nature and we know also also a part of the book that nature is so much more powerful than we are as humans. So if we are in a forest, for example, we can't, analyze the leaves and the greens anymore. It's just too much. So we just leave it as it is and realize how how beautiful it is. We don't have to analyze it anymore. So that's it's really interesting. if you look at that. So I, I really need nature. I go, I go every morning to for, for a run, but not fast. More like coagulation type of, bilateral stimulation and connect to nature. Spend time with children, spend time with, positive people around me and and do many things that are, I feel like are good for my nervous system.

Abdullah Boulad 01:34:37  I have one question to you. So what would you give everyone in the world? Or what would you suggest everyone in the world to do if you if you can reach out to them?

Dr. Sarah Boss 01:34:51  Slow down.

Dr. Sarah Boss 01:34:52  I think we should all all, all slow down. And we have to remind ourselves every single day. Because life is so fast this year.

Abdullah Boulad 01:35:03  This is beautiful. It's like being on a mountain somewhere in Italy. And just you see these old people sitting at the side of a road and, and just watching the other people walk around.

Dr. Sarah Boss 01:35:16  Yeah. They don't need to go in the mindfulness training.

Abdullah Boulad 01:35:19  No.

Dr. Sarah Boss 01:35:19  Yeah.

Abdullah Boulad 01:35:21  Beautiful. Thank you so much. I appreciate it talking to you a lot today. and, I, yeah, thank you very much for all the work you do.

Dr. Sarah Boss 01:35:31  Thank you so much.