In this episode of Psychiatric News Special Report, host Dr. Sulman Aziz Mirza speaks with Dr. Sofia Matta about the May Psychiatric News article “Conflict, Disaster, and the Psychiatry of Displacement.” Dr. Matta discusses how modern conflict, disaster, social media, drone warfare, environmental exposures, and displacement are reshaping the way psychiatrists understand trauma. The conversation explores continuous traumatic stress, the limits of traditional PTSD frameworks, emerging treatments such as neuromodulation and psychedelic-assisted therapy, the role of hope and resilience, and why psychiatry must take a broader, whole-person view of mental and physical health in a rapidly changing world.

PsychNews Special Report is a production of Psychiatric News, a media platform dedicated to serving as the primary and most trusted source of information for APA members, other psychiatrists and physicians, health professionals, and the public about developments in the field of psychiatry and mental health that impact clinical care and professional practice. Learn more at psychiatryonline.org/journal/pn

Dr. Sulman Aziz Mirza (00:11) Alright, everybody, welcome back to the Psychiatric News Special News Report for the month of May. We have a great article, Conflict, Disaster, and the Psychiatry of Displacement. This is a great article. I was really looking forward to reading it and something that I've personally been thinking a lot about. We are joined by one of the authors, Dr. Sofia Mata. Dr. Mata, welcome to the podcast. How are you doing today?

Dr. Sofia Matta (00:38) Hi, ⁓ thank you for inviting me. It's great to be here and ⁓ to be able to talk about this topic, which is on a lot of people's minds.

Dr. Sulman Aziz Mirza (00:47) Yes. this is, can you give us a little bit of a bio background about yourself and what some of your motivations for writing this article were?

Dr. Sofia Matta (00:59) Sure, sure. Well, I think that it's important to place it within the context. So I ⁓ attended medical school in residency in New York City at Cornell and was actually there on 9-11 and saw the aftermath of the World Trade Center and the impact that it had on the city. And then ended up working in the Army as a civilian at Fort Drum and then the Navy interested in the impact of not only just trauma but head injury and the impact it has on the physical body as well as the mental health implications.

Dr. Sulman Aziz Mirza (01:40) Yeah, I'm an upstate New Yorker and I was in college. I can remember the Tuesday morning and missing out on organic chemistry lab that morning. Just, you know, I think it was all imprinted on all of our minds. Plenty of family in that New York, New Jersey area. So yes, that's, think we, the millennials of the world, the world and beyond are looking at that point as like, this was a discrete moment that changed. American history, ⁓ the way that we look at like trauma and stuff and how that affects us and the whole idea of like secondhand trauma. And now 25 years later, things are the same, different.

Dr. Sofia Matta (02:26) You know, there are some similarities, but there are also some stark differences that can be seen, especially with the advent of technology, artificial intelligence, and drone warfare as well.

Dr. Sulman Aziz Mirza (02:42) Yeah. So talk to us about that. know when we were looking at the article again, like it goes over, I think the main thesis of the article is about moving, shifting our view of trauma away from like discrete traumatic events into continuous threat exposure or threat saturation. Can you talk to us about that a little bit?

Dr. Sofia Matta (03:05) Sure, absolutely. So a lot of what we're learning from these more recent conflicts are from colleagues in the Middle East and also in Ukraine. And it's really through discussions with them and seeing what they're experiencing firsthand, you know, that could include, you know, the exposure of drone swarms. It's not just one, it's like a hornet's nest. And you hear them overhead buzzing. And that's the world that we're living in now. But it's not only just the drones that are weaponized. The evolution of them over the past six months has been quite remarkable so that it's not only technologically advanced, it's also videos that are live streaming for content, for likes, and being seen by the people who are being ⁓ victimized as well too and living through that. So I mean, I think that the impact of the drone swarms and the fires and then also not just within conflict, but right now we're dealing with wildfires in Atlanta and Georgia, and then also in Florida as well too, due to drought. So the world is on fire, as they say, and it's not really just a metaphor, it's a lived reality for so many people.

Dr. Sulman Aziz Mirza (04:31) Yeah. One of things I was really excited about with the article is the fact that, again, I've done a lot of stuff on social media and going through the Twitters and the Instagrams and YouTubes and et cetera and the doom scrolling, right? And how we are constantly being exposed to warfare and disaster. People will say disaster porn almost, right? Or trauma porn. of just genocide porn, whatever we want to say, where it's just like a constant. And there's, you the way the algorithms work is you look at something and the more time you're lingering on it, the more that you're going to get of it. And even though you may not like love what you're seeing, a lot of times people are getting traumatized, secondary trauma from seeing stuff, they get more and more of it fed to them. And then like, You know, kind like we referenced in the beginning with 9-11, there was so much of that secondary trauma from watching the news footage all day and days and just repeatedly seeing this, disaster and everything, the tragedy that were occurring. And we're just redoing that again, right? With social media how it is nowadays.

Dr. Sofia Matta (05:49) Absolutely, and it's more intelligent as well too. So they're doing this because of the algorithms and we've created this world where trauma is not only experienced, it's replayed and amplified and then reinforced. So you see the drones online almost immediately after the event and then you see them again and again. It's not passive, it's actually re-exposure. And people think that they're staying informed, but neurologically, I think that there's a connection there to your autonomic nervous system, to feeling stress, even if it's vicarious. I like to think of like almost like a blast model. So you've got a radius of a blast area. And obviously the closer that you are, the more impact. But I have colleagues that are in the Middle East. have colleagues in Ukraine. And when you lose connection with them or don't know how they are or know that, you know, they have to go down to a bomb shelter. You know, these things are impacting people. But even if you want to say that it's just a doom scrolling, you know, it has a negative impact. There's another term that's called Glee freshening. So rather than looking at the negative content, you know, making sure that you also spend time. on a more positive aspect so that you're not just continually looking at all of this negative content because it can wear on.

Dr. Sulman Aziz Mirza (07:19) Where is this out? know, like, again, you know, I'll give my little bit of my own background. we're Pakistani Muslims and, you know, we're constantly being talking about everything that's going on over there and Palestine and everything that's there. And it's just, the constant content of, just seeing everything that's terrible going on. you know, like, my wife, you know, will be in bed and, it's nighttime and it's one o'clock in the morning and I see stuff or hear stuff that I'm just like, OK, you got to it off. You gotta turn it off or else it's just gonna seep into daily life, right? And just you're not gonna be able to function at all.

Dr. Sofia Matta (07:57) Absolutely. There's no psychological after anymore. So it's all this continuous threat. So we're just completely saturated in it. And so I think that that's part of the challenge is that oftentimes when you think of diagnostic points of entry, if you think of the PCL or the DSM criteria for PTSD, and I made this point within the article, you know, it's oftentimes based on past events. So, you know, I think that we need to be mindful of where the field is heading because there is this dread and this anxiety, not only just because of what's happened, which can be dozens of events, especially in conflict zones or in those who have been displaced by wildfire or other natural disasters. You know, there's this looming sense of fear, worry, anxiety, disconnection from family and from home. If you think about it, there's no place like home, right? We all think about home. And so when you are no longer at home, you have this feeling that you're no longer connected. And we know that that can lead to isolation and worse outcomes as well too.

Dr. Sulman Aziz Mirza (09:16) Dive into that a little bit more. the whole, the conceptual shift, I guess, from PTSD as this like singular past event to this CTS continuous traumatic stress of this ongoing, can you dive into there a little bit more? Just as a shift on how we should be looking at things.

Dr. Sofia Matta (09:34) Sure. Well, so there are several different aspects. Number one would be, well, so what is the phenotype of what we're seeing and what people are experiencing? You know, rather than with PTSD, which might be, you know, discrete criterion A's where people have these exposures to an event, you know, we had ⁓ the Patriots Day here from the Boston Marathon with the, you know, ⁓ with the bombing, but we just had, you know, the Boston Marathon this past week. on Monday. you know, that was a discrete event, but it has obviously caused an impact for us here in Boston. But then also, you know, whether it's conflict or displacement, there's this, it's not just the intensity of the threat, it's the absence of silence. There's no shutting it off, like you mentioned.

Dr. Sulman Aziz Mirza (10:24) Yeah. And then you'd also mentioned that there's, I mean, there's neurobiological differences that occur when we, again, look at PTSD, we know there's those neurobiological differences that occur. How does that differ or what's different, I guess, with this living in a threat mode or living in a threat world?

Dr. Sofia Matta (10:46) That's a great question. So if you're thinking about something in the past, you could then consider doing something like an exposure therapy or ⁓ cognitive processing therapy, prolonged exposure, things where you're trying to extinguish this autonomic response to the whole, hypothalamus, pituitary, adrenal axis changes, or the autonomic nervous system, the fight or flight. It's hard to rest and restore. when you're worried about the safety of the environment that you're in. And so in discussion with our colleagues in the Middle East and in Ukraine, they do not want to get rid of or extinguish that vigilance because it could be the matter of life and death.

Dr. Sulman Aziz Mirza (11:35) I would always say, know, I mean, my child's house and fellowship was in downtown Baltimore. And, you know, we'd be working with residents and students and they were like, well, why are people afraid of, you know, the stuff in the neighborhood? And I was like, well, you have to be, you know, it's, you know, again, like when we talk about it, it's like a threat, it's not paranoia if it's a real thing, right? You have to be aware if you're concerned that somebody's going to jump you. Like, again, it's context dependent. you if you're concerned that stuff is going to happen to you, because it happens, like you have to be more vigilant, you have to be more prepared. like, like you mentioned, can be life and death and preventing adverse effects from happening to you. living in that, living in that mindset. So with, you know, with, you know, on the cusp in a way of like DSM six and that's getting rude about, and this whole controversy about like, chronic PTSD, CPTSD versus PTSD and is this a real thing? what do you think, why do you think that psychiatry has been slow to recognize trauma, ⁓ how it changes and how it's different and how it's not just quote unquote PTSD anymore?

Dr. Sofia Matta (12:55) Well, you bring up several very important points. Number one is that the field is evolving and changing. And the most recent iteration of the DSM has involved working groups that have looked at this specifically and the changes are coming. But obviously, it's such a large workforce group that is looking at this takes a while to change. So looking at biomarkers, looking at genetic aspects, are going to be incorporated within the DSM. So we are getting there, but I think the challenge is needing to do the research on it and also having a good solid base before we make changes. A lot of what we're talking about, the continuous traumatic stress, the paper that I referenced is from 2026. This is a new and evolving field that we're just seeing right now or just becoming more aware of. I'm certain in past wars, like the great world wars, I'm certain that these same situations existed and also probably the same responses, but we called it something different. I think we're getting there, but we have to take the lessons learned from the past and also apply what we're seeing now because the future of treatment relies on us determining, okay, so what's the difference in seeing the people who are returning home from the Middle East are service members. There may be a difference between the symptoms that they show compared to the previous wars in Iraq and Afghanistan.

Dr. Sulman Aziz Mirza (14:36) you know, that even though it may be just like a handful of years, like very different, very different presentations, right? They're totally different. And then again, like we talked about, the social media just amplifying, re-amplifying, reliving it. We can't just run away. And then we know that Hollywood also likes to make movies very quickly about stuff that's happening. So again, like we're seeing this getting thrown on the silver screen and actors are getting awards for these portrayals. And it's like, What about the people that were actually there, right? And what they experienced.

Dr. Sofia Matta (15:09) Yeah, I think that as we enter this new era, it's as if the environment has changed faster than our frameworks have.

Dr. Sulman Aziz Mirza (15:18) It's like, kind of, think you were referencing a little bit like war and conflict is like content now. And it's hard to kind of take that step back and separate it and be like, no, these are real people that are experiencing real events and real traumas and still ongoing that are continuing to occur. So.

Dr. Sofia Matta (15:37) So the big question is, you know, so what can we actually do about this?

Dr. Sulman Aziz Mirza (15:42) Yeah. So what can we do? Yeah. So I think you pivoted a little bit with some of the, with the article you talked about some of the ways to kind of treat it or ways that we can recognize it. Can you talk about that a little bit? Yeah.

Dr. Sofia Matta (15:57) Sure, sure. So I'd like to recognize the sort of evidence-based treatments. So the gold standard for treatment of PTSD is the use of manualized evidence-based therapies, such as cognitive processing therapy, prolonged exposure, or the other exposure-based models. And the challenge I think is right in that area where we're saying that, you know, I don't want to become less vigilant because I'm worried that it's going to, you know, lead me to end up, you know, either badly wounded or dead. know, so there's hesitancy to engage in those. And then when you turn to the medications, know, FDA approved sertraline and fluoxetine, and then within the Department of Defense and VA guidelines, for PTSD, they mentioned Vimlofaxine, which are fantastic medications, but they can take six to eight weeks to really sort of see the full effect. And you're also dealing with people who may not want to take medication. So within the military, also globally, there can be hesitancy to starting medications and they aren't the gold standard treatment. So where is the field heading?

Dr. Sulman Aziz Mirza (17:08) Yes.

Dr. Sofia Matta (17:23) And right now we're seeing a lot of neuromodulation, you know, and then also psychedelic assisted therapy. You know, I like to discuss that there's a lot of hope there. There's some hype. We have to really recognize that some of these medicines which have been around for millennia, you know, there's some real hope. And, you know, the recent executive order from President Trump You know, I'm really hopeful that this can decrease the barriers for us to engage in more research with these molecules that could potentially save a lot of people's lives. But at the same point, I want to recognize that something that is small, like a neuromodulation machine that can be used in conflict zones or in those who are displaced might be one of the easier adopted technologies that may help. reduce or dial down that vigilance while also promoting alertness in cognitive improvement and also improving mood and function.

Dr. Sulman Aziz Mirza (18:30) Yeah, jump, or can you talk to us about some of those neuromodulation techniques, some of those kind of in vivo interventions that can be done? think we, like a lot of us were practicing in the field, like we're like, oh, we know, like, you know, we know how to deal with the PTSD, right? We know how to like, you put them on a med and we give them to put them on like TFCBT and you know, boom, the PTSD should be dealt with. And we know that's not always real life. Right. And a lot of us are not in those combat zones or in the moment and in those situations. So, explain, jump into some, I guess, dive into some more interventions in the moment that we can do.

Dr. Sofia Matta (19:11) Sure, sure. if I can just, if you will allow me, I think that if I explain what it is that I do right now for work, because this is how I became exposed to all of these, you know, novel treatment interventions, and also not just for treatment, some of them are marketed or geared for performance. So actually improving how you feel so you don't need a diagnostic point of entry. So I'm the senior director of medical services at Homebase, which is a national center of excellence that treats active duty special operations forces, veterans and their families from across the entire country, all at no charge. It's one of four warrior care network sites with the wounded warrior project, including in Marie, UCLA and Rush. within this setting, I had been tasked a couple of years ago and looking at the strategic vision of where we're heading as a program, looking at where the field is heading in terms of managing the invisible wounds of war, including PTSD, traumatic brain injury, behavioral aspects, mental health, and then also cognitive aspects. So part of that did involve looking at FDA-cleared and FDA-approved devices that can be used And you know, our program is a mast therapy that does 70 hours worth of treatment condensed into two weeks. So it's quite remarkable how we can do what it is we do in such a short period of time. But not wanting to rest on our laurels, we wanted to figure out is there a way that we can do even better than what we're doing right now? So that's when we started looking at non-invasive vagus nerve stimulation. the version that I mentioned in the article is called Gamacore. by Electrocore, it has FDA ⁓ designation of, gosh, I'm forgetting what it's called, was in 2022, a breakthrough device. It has a FDA breakthrough device for PTSD. It's actually FDA cleared for acute migraine treatment and prevention, cluster headache treatment and prevention, but also has evidence in. neurocognitive symptoms and in PTSD as well too. So it was a clear choice as one that we wanted to implement within Homebase.

Dr. Sulman Aziz Mirza (21:44) How's that kind of gone or what have you seen in real life with that?

Dr. Sofia Matta (21:50) So I want to say that there are some people who respond very well and there's some people who say, I don't like how it feels. It's a noninvasive vagus nerve stimulator on the neck, but the majority do experience significant improvements in stress and then also in headache and pain as well too.

Dr. Sulman Aziz Mirza (22:07) ⁓ Good. And you had mentioned, know there was again, that just the topic last week of the Ibogaine and like the breakthrough or just the executive order to kind of put some money into there. And there was some, I guess, controversy around how it was done with a via Joe Rogan text. ⁓ But at the same time, I think we're all for kind of like putting money towards research and seeing what can work, ⁓ what can work, what can not work. I think there's, you again, we can talk about like some of the potential risks that come about with people jumping ahead of, you know, jumping ahead of the evidence, right? And saying, well, let me just go and get a bulk order of Ibogaine and take care of this myself and et cetera. But at the same time, like, let's try to do things the right way.

Dr. Sofia Matta (22:56) There's actually a great story about the Ibogaine DMT study. ⁓ Dr. Nolan Williams, who is the one who developed the ST, the Stanford Accelerated Intelligent Neural Modulation Treatment, is also the one who did the study on Ibogaine and DMT in Mexico with the majority of Navy ⁓ special warfare. veterans and Marcus Capone and Amber Capone, had Veterans Exploring Treatment Solutions, is the one who actually produced a fantastic documentary that's available on Netflix called In Waves and War. definitely recommend that you watch it. It is going to be played at the EPA on Tuesday. So we are going to be screening the documentary there as well. but, know, we lost Dr. Nolan, he died by suicide in October. So he was a colleague and a friend and it just shows that what we're dealing with is really life and death. And Marcus Capone ⁓ and Amber with however it happened, Joe Rogan podcast or whatever, if it leads to changes, within the FDA and scheduling of ibogaine so that we can do research more readily. Because the biggest challenge, think, is the fact that we can't do research on it, given the current scheduling. And some of the barriers to it ⁓ need to be brought down so that we can do the research that's required so that we can get it to more people and that they don't have to go to Mexico to have the...

Dr. Sulman Aziz Mirza (24:48) Yeah, it's, you know, when I put on my addiction medicine hat, it's like that aspect of like, we just want to be able to the research, right? We're not advocating to like, say everybody like go out and again, go to your local guy in the corner and get all this stuff. It's like, let's allow the scientists to do the research and, you know, standardize it. If this is helpful for some people, great. You know, let's try to make it safe as possible and then see what we need to do kind of going forward from there. Let's bring back to what we're talking about a little bit. We took a little bit of a detour.

Dr. Sofia Matta (25:23) So I did, you know, I did want to sort of clarify what I had said about GammaCore just because I actually probably made it sound a lot more negative than it really is. So I just want to make sure that, you know, it comes across that. actually think it's a fantastic treatment and I do use it for, you know, service members and veterans who come through. It can be done within four minutes. So that's another thing that's quite remarkable about it. It's two minutes and then like a several second pause and then another two minutes. So it's extremely fast in terms of how quickly you can have the treatment. ⁓ I have actually tried it myself. you know, what I've noticed is that sometimes, you know, I have my own background, right? So I've lived in New York on 9-11. I grew up in New Orleans. So Hurricane Katrina. So dealing with that in family life, I wasn't able to get in touch with for a week and a half. I've got my own challenges with insomnia. so for me, what I notice is that when you feel like you're dragging and you don't have that energy, you've got that fatigue, and I can just use the Gamma Core for four minutes and definitely it feels like it wakes me up. I feel better, I feel renewed. And so... And none of that is necessarily on label, but it's personal experience. So getting that qualitative feedback from patients as well too, and the experience, it's doing more than just treating headaches or treating stress symptoms.

Dr. Sulman Aziz Mirza (27:00) No, definitely. mean, I think there's the role of anecdotal evidence is something, It's, know, again, like I always tell when I'm working with my residents is like there's the research and studies and evidence and then there's the patient in front of you. You know, if they're going to say that like whatever it is that they're doing is working for them, who am I to say like, well, you know, the research says something else and it should not be working for you. But, you know, that's the rest of your life. you know, like I think this is, you know, part of part of these novel therapies is seeing what works, right? And trying them out and just getting more and more data. So that's great to hear that it's helpful. yeah, I mean, something you can get done in four minutes is a lot better than the four weeks that maybe the Zoloft or the, maybe the venlafaxine will do something in maybe four weeks. So awesome.

Dr. Sofia Matta (27:54) And importantly, it's portable and self-administered.

Dr. Sulman Aziz Mirza (27:59) any potential adverse effects for things, those kind of devices.

Dr. Sofia Matta (28:06) Good question. So usually it's extremely well tolerated and there might just be like some sort of local reaction that is extremely time limited and goes away relatively quickly. So mostly very well tolerated.

Dr. Sulman Aziz Mirza (28:18) I've had a lot of patients like ⁓ seizure patients who have like a similar kind of device, I through godsends. know, for a lot of people who have like seizure disorders and especially the headache disorders, it can be massive, massive godsends and yeah.

Dr. Sofia Matta (28:37) Sure. The biggest contraindication is the presence of implantable devices, like the Inspire or cervical hardware or things where you would have to be careful about applying an electrical stimulus to the area. Also, ⁓ carotid calcifications. They didn't really have any known... It's more that it's, you you just want to be careful and mindful. And so that's when you just don't do it because of that, not necessarily that there are, you know, case reports of, you know, serious side effects from it. It's just, and, you know, the, the, the need to be really careful for that population more than anything.

Dr. Sulman Aziz Mirza (29:24) You'd mentioned also in the article we were talking, we focused a lot about like kind of the visible threat, the visible traumas ⁓ that we see and that we're exposed to. And you'd also mentioned invisible threats like toxins in the environment, PFAS and et cetera. Can you jump into that a little bit?

Dr. Sofia Matta (29:46) Sure, sure. So a lot of my experience with that is from ⁓ service members and veterans who've been deployed to Iraq and Afghanistan and exposed to burn pits. So we wrote an article on that and the toxic exposures. ⁓ Part of what we do is early detection and diagnosis center. So MGH has EDDX that's led by Dr. Alicia Sequest. And so because of these exposures, we wanted to be able to provide an evaluation and to formally document whatever exposures that they have. And the biggest one that came up was burn pits and then also, know, exposure to solvents, things we don't necessarily think about. So the people who work on, you know, the fast plants, you know, the top guns, you know, they have exposure to fuel or depleted uranium, you know, and Some of these are over periods of time, not just one, but specifically as it goes with burn pits, those have exposure to particulate matter like polyfluoroalkylated substances, so PFAS. And then also one of the things that in talking to the veterans, said, well, also let's not forget the plastic bottles of water that were baking in the sun at 120 degrees. You know, and we know that these have these, you know, nanoplastics that come out. And now we know that they're not only connected to physical health, so risk for cancer, but also they're also associated with gut biome interaction. So inflammatory bowel disease or, you know, leaky gut from blast exposure, but then also these molecules can increase the likelihood of developing. PTSD, depression, and also long-term cognitive impacts as well too. There are studies that are coming out now on ways to decrease PFAS levels. So that's sort of the new era of that. And you have to think that whether it's the wildfires in Maui or Los Angeles last year, or right now in Atlanta ⁓ or Georgia and Florida, but then also Sub-Saharan Africa, Australia. you know, the world is on fire. Long after the fires are put out, you're seeing respiratory illness. So we see that in, you know, the Los Angeles area, you know, near Altadena, you know. So one of the things that I heard when the Los Angeles fires were started was, that's, you know, that's Pacific Palisades. That's, you know, that's in the nice air. And I'm like, well, no, no, no, the air kind of travels, you know. There's no. There's no, it doesn't do zip codes. You know, and then it's not just during the fire. There's a long-term impact of that, whether that's chronic obstructive pulmonary disease or other respiratory almost airway, reactive airway disease, and then also the development of cancer as well.

Dr. Sulman Aziz Mirza (32:57) When we are looking at training for the future, right? Future psychiatrists, how do we prepare this next generation to be looking beyond, right? What's in the DSM currently and then kind of like for understanding that like the world is changing and we have to evolve and that things are different now. Like how, what are some ways that we can help with that, I guess?

Dr. Sofia Matta (33:21) So I do think that switching from a diagnostic point of entry is key. So moving to an exposure model, so thinking more holistically. And the topic within the VA is called Whole Health. We call it HealthSpan. So HealthSpan can be thought of as the years lived free of the diseases associated with normal aging. So we all know lifespan, that's how long you live. HealthSpan is the quality of life that you have. And we know that there's a health span, life span gap. And so the question is, what are all of these exposures throughout your entire lifehood leading to? And, you know, over time, what we're seeing is that, you know, this is based off of the NFL longitudinal players study, you know, that was led by Dr. Ross Siffant, who was the ⁓ original, one of the original plank holders at Home Base, but also the president of Spalding. rehab where the chair of Spalding Rehab. And he noted that ⁓ for professional football players, if you look at their body and their coronary artery disease, their weight, their diabetes, high blood pressure, someone who is 40 years old looks more like they're 50. So there's a 10 year health span, lifespan gap. So what we have done within Homebase is really taken that model on and looking not only just at the invisible mental health impacts of PTSD or TBI, but also the potential invisible physical impacts in their relation to each other. Because I think where psychiatry needs to go is to incorporate all of that. So making sure that you're thinking about the person holistically. I think some of the other things that have really had a positive impact on this recently are the medications like the GLP-1 ⁓ class of medications. We're thinking differently about overweight and obesity, but then also the impact of these amazing, wonderful molecules and the potential to improve health span. But also, ⁓ there might be an improvement in alcohol and substance use disorders. So NIDA leaning in on that and doing their research now. knowing that it can decrease cravings and desire for substances as well.

Dr. Sulman Aziz Mirza (35:52) Yeah, and I think it kind of ties back in with this idea that us as psychiatrists have to think outside the brain, right? And think outside of like what we have traditionally maybe learned psychiatry to be. And you're like, you're using holistically and like the way that's meant to be used and not the gimmicky version online that we see, which is like, ⁓ get off of all your meds and do a, you know, and just do some yoga and everything will be great. Not to say that yoga is great, not great, but you know, but it doesn't cure everything. But the idea that like, yeah, I mean, there's more than just, you know, our bread and butter SSRIs and anti-psychotics, that there's more than just the DSM that, you know, it extends beyond that, they are our physical health and our mental health. Again, like all quality clinicians should know is like these things are tied together. You know, the, I'm, prescribing the GLPs and in my practice, like I'm jumping to that like a lot sooner than when I was maybe six months ago to a year ago. And as we get more experienced and seeing that like these are doing a lot of things for like you mentioned with, with alcohol and substances is just knocking those out, right. And the impact that we see, like when we treat the obesity and what that does to the mental health, right. just dramatically improves everything. ⁓ I haven't seen much with the GLPs and like trauma stuff, but at the same time, like, you know, maybe, you know, maybe there'll be some more research out there about that. But, you know, it's that idea that we have to be doing, doing a little bit more, right?

Dr. Sofia Matta (37:32) So I'd also like to tie it to hope. So I think it's really important to give our patients and our community hope as well too. So as a positive psychiatry construct, we need to focus not only on the negative aspects of, know, moral injury or burnout or the impact of the exposure to all of these things. So I like thinking about resiliency, heartiness and grit. You know, so these are several concepts that you need to promote in people as well. And anything that you can do to help someone feel better can change their trajectory, whether it's their physical health or their mental health, and it's all tied together.

Dr. Sulman Aziz Mirza (38:16) Yeah, no, absolutely. So you talked about burnout. What are some things that we're wrapping up a little bit, like burnout, some things that you do for yourself to kind of prevent the burnout? Because I know it's important for all of us to kind of make sure that we're keep going and going.

Dr. Sofia Matta (38:32) That's a great question. So I'm an acupuncturist as well too. So I lead acupuncture services at Homebase. it seems like something you mentioned yoga as well too. So I think that what we need to focus on is our own ⁓ sort of vital energy is what it's called in an acupuncture or Qi. And we know that it can be impacted or it can be drained. And I make sure that I exercise regularly. And that can mean anything. After COVID, everyone's lives changed. Providers, we were separated, we were disconnected from people. And some of the things that really kept me going were the monthly Zoom calls that I had with friends, and we're just going outside and walking. You know, it can be adapted to whatever it is that that are your limitations. You know, we know that there are tens of thousands of ⁓ civilians and service members in Ukraine who are, you know, having ⁓ they have amputations now and we know people ⁓ may need to engage in adaptive sports or other things. You know, yoga is something that you can do, you know, even with loss of them, you know, and making sure that you take care of yourself with whatever works for you. We do art sessions as well, too, therapeutic art, and we have the patients make these masks. And you never know what someone is going to really lean into. So having many different things that could be your go-to, you know, is really important. But so for me, really, like exercise is probably the biggest.

Dr. Sulman Aziz Mirza (40:23) Great. No, no, it's, it's yeah. Again, we get asked all the time, Clintus is wise is like, you know, what can I do for coping skills? And was like, I can give you a list of a hundred coping skills or, you know, chat, you'd be taking, give you a list of a thousand coping skills was like, got to go out and try this stuff and see what works for you. And then the best coping skill is the one that you'll do and the one that you feel is effective. Right. So exercise is great. Big advocate for exercise and you know, getting out and connecting is huge. Right. So. having that connection with others.

Dr. Sofia Matta (40:53) Creed.

Dr. Sulman Aziz Mirza (40:55) Any kind of like parting words or things that we did not mention that you want to kind of like bring up or discuss or plugs for yourself.

Dr. Sofia Matta (41:04) Well, I mean, I think I would like to end on a positive note, just because I think that that's how I am. And I think that there are a lot of opportunities for where the field is heading. And I think that the most recent iteration of the DSM is ⁓ a definite step in the right direction to include things like biomarkers and then also genetic aspects, but then also know, a treatment aspects as well. But I think that, you know, the movement of the needle and the pendulum in the right direction is happening. We know that the future of psychiatry is coming. know, the neuromodulation accelerated, you know, transcranial magnetic stimulation, you know, these molecules, the psychedelics, ketamine, know, ibogaine, psilocybin, MDMA. they all offer hope for people who have been treatment resistant. And that means fail multiple different trials, but it almost is almost a judgment call on them. Like, well, what is it about you that you didn't respond? And I think that we need to also change the wording for that and decrease stigma and just realize that I think that these events impact us all, not just patients, but also us as providers, as psychiatrists within the field, and to recognize that and to label it so that people understand that we're all living in this and through it.

Dr. Sulman Aziz Mirza (42:42) Yeah, it's, think of all of these podcasts, I've done, think four or five of them. It's, I've talked about how much I hate the treatment resistant term. It's this like terrible, terrible term that is, needs to be just thrown away. And, you know, I have my Wednesday night clinic, I have people I was talking with last night about like, you know, stuff going on in the world. And I'm just like, we're all in this, you know? I was like, I used to be able to give you answers maybe like a couple of years ago, but like right now I'm like, can't, I can't give you the reassurance. can't just say like everything is gonna be great. I can't, it's hard for us. And I think we have to accept that and understand that like it's tough times right now. like, but you know, getting through it together and having again, those connections, those coping skills, whatever else it does out there, that's what's gonna get us through to the other side. I agree. mean, I think that the future of the field is moving in the right direction. Again, getting away from just reliance on medication and, you know, six weeks of CBT and, you know, it's a little bit more complicated than that. but that's okay. As long as we have that, again, the holistic approach and incorporate all these different interventions, people have really good outcomes or can have great outcomes.

Dr. Sofia Matta (44:03) And I think also, you know, we spoke a lot about artificial intelligence in a negative way, you know, in terms of like the drone swarms. But I also want to point out the potential that's there in terms of machine learning and large language models and the positive impact that that's having in terms of precision medicine and personalized care. You know, the AI can detect signals where a lot of people wouldn't necessarily see them. And, you know, using that to inform precision models to determine who might, you know, benefit from an intervention. You know, the fact that it can pick out people who might be at increased risk for suicide or also who might respond better to one treatment versus another. You know, the use of genome-wide association studies, know, ⁓ Dr. Jordan Smaller just had the recent, you know, landmark paper on the 14 different, you know, ⁓ psychiatric diseases that have been scoped throughout the genome and how we're getting there because of these huge data, just sort of crunching it in the system and seeing what happens. So I really have a lot of hope for where the field is heading, not just in terms of interventions, but then also in terms of data.

Dr. Sulman Aziz Mirza (45:27) And I know, I mean, I was like, another thing with the AI stuff, as much as people are scared of AI, think, again, there are some good uses. think I've had my previous podcast talk with Dr. Arash Chhabrabang, I can't remember his last name exactly, but he's done a lot of like that AI exposure for trauma, like that, like the VR kind of style AI exposure to trauma. And with that, and it's like, That's a great use case for these technologies as much as we're moving towards that Terminator future slowly bit by bit.

Dr. Sofia Matta (46:01) Sure. building a better AI that includes, you know, ⁓ being able to detect concerns where there is suicide, you know, risk and, you know, working with, you know, different AI companies or, you know, Dr. Kelly Posner, Gerstenhofer, who developed the Columbia Suicide Severity Rating Scale, you know, being able to say, there's a way to build a better system because we may only be available for an hour. ⁓ for a patient, but they might be having a problem in talking to an AI bot that could provide some form of safety net that exists between the boundary of no care and mental health care.

Dr. Sulman Aziz Mirza (46:51) I was like, we'll save that topic for another day. ⁓ No, Dr. Mata, thank you for your time with us. And then everybody else, make sure to check out the article in the May edition of Psychiatric News. It is our special report. Again, the topic. or the title is, ⁓ Conflict, Disaster, and Psychiatry of Displacement. So that is the main issue and make sure to check that one out.

Dr. Sofia Matta (47:23) you