Head Inside Mental Health
Todd Weatherly, Therapeutic Consultant and behavioral health expert hosts #Head-Inside Mental Health featuring conversations about mental health and substance use treatment with experts from across the country sharing their thoughts and insights on the world of behavioral health care.
Head Inside Mental Health
Empathic Psychotherapy with Yellowbrick Leadership Team
What if the most healing room in mental health is one where a team of doctors and professionals focus their full attention on a single person with warmth, precision, and zero pretense? We take you inside the Yellowbrick Treatment Program's “rounds,” an empathic approach to mental healthcare where hidden patterns surface, shame softens, and change becomes less about willpower and more about regulated choice. The team explains how focusing on core enactments, those repeating relational loops that drive distress, turns everyday interactions into a living, breathing lab for growth.
From there, we widen the lens to families. Connected autonomy becomes the north star: real independence rooted in internalized, trustworthy bonds. You’ll hear how sessions tackle hot‑button dynamics around boundaries, power, and resources, creating a space where parents and emerging adults practice new choices without losing agency. It’s deliberate exposure to what matters most, not staged exercises that fall apart outside the room.
On the brain‑health front, we dig into a multimodal approach that pairs meds, pharmacogenomic testing, and direct adherence data with neurofeedback, TMS, direct‑current stimulation, sleep hygiene, nutrition, chronotherapy, EMDR, and autonomic retraining. The team shares outcome highlights, including qEEG changes toward regulation and TMS response rates that outpace FDA trials—likely because stimulation is embedded in a rich daily ecology of skill‑building, community living, and attuned relationships. The takeaway is clear: no silver bullets, just converging vectors that nudge the brain past homeostasis so healthier circuits can take hold.
We close with a simple invitation: if you value science, humility, and care that fits real life, pull up a chair. Subscribe, share with someone who needs it, and leave a review with your biggest insight or question so we can keep the conversation moving.
Hello, folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substitute treatment with experts, advocates, and professionals from across the country sharing their thoughts and insights on the world of behavioral health care. Broadcasting on WPVM 1037, The Voice of Astral, independent commercial free radio. I'm Todd Weatherly, your host, therapeutic consultant, behavioral health expert. It is my privilege to be joined today by the power team at the Yellowbrick Treatment Center, a national leader and resource for the psychiatric treatment of emerging adults using a developmentally specialized research-based clinical model that integrates cutting-edge findings from neuroscience, innovative psychotherapies, strength-based life skills, and wellness medicine. There in Evanston, Illinois, outside Chicago, I have founder, CEO, and Chief Medical Officer, Dr. Jesse Viner, distinguished life fellow of the American Psychiatric Association, and co-editor of the book Minding the Brain, which he produced with his wife, Dr. Laura Viner, their director of research. Along with Dr. Viner are Dr. David Barron, Yellow Bricks Medical Director and American Board of Psychiatry and Neurology Distinguished Life Fellow, and Dr. Brynn Jessup, their Director of Family Services, and instructor at Northwestern University Feinberg School of Medicine, highly distinguished providers in their own right, as members of the Yellow Brick leadership team. I will link bios for everyone in our podcast webpage. I was there last month for their 19th annual conference liftoff, facilitating successful launch of for emerging adults, where they had a host of top minds from around the country talking about their research and work with emerging adults impeded by mental health and substance use conditions, including Dr. Viner, Dr. Jessup, and Dr. Baron. And I got to also do a deep dive with their team to learn about their treatment model. Dr. Barron, Dr. Jessup, Dr. Viner, thank you for being on the show today and welcome.
SPEAKER_05:Thanks for having us, Todd. Thank you, Todd.
SPEAKER_01:Our pleasure. Glad to have you. Well, and I I uh one of my favorite experiences while being there was getting to obviously my favorite experiences was getting to talk to the three of you individually about the program. Um, but a real highlight was getting to see you work uh and getting to do rounds. Uh rounds is something that the clients get to experience where they are being reviewed essentially for some of what's been going on for them and where they are in their treatment. And they are joined, however, by their entire team, people who serve on the on the residence side, all the doctors, including Dr. Jessup and Dr. Barron and Dr. Viner. Um, and I mean, I think that if you weren't used to it, and probably uh clients who walk in, you know, for their first time when they do rounds and they're sitting in a room, and half the room is they've got about 20 different doctoral degrees sitting in the room on one side, and they're all going, Hey, what about this? Um, and rounds is kind of an old model, is it not? It from it stems from way back in the psychoanalytic practices. Tell us about where it where this aspect of the program model came out of.
SPEAKER_02:Uh well, for the origins of it, uh, Dr. Viner might be able to speak to that, but the the idea of rounds comes from the medical uh tradition and uh psychoanalytic tradition had its origins in the US from that model. And rounds in a hospital means uh uh a gaggle of doctors and train doctors and training and medical students and sometimes nurses and other professionals walk around from room to room and gather around the bed of a sick patient and uh at best talk with the patient and at worst in some places talk at the patient or about the patient. Um but we we have a much more personal approach to it where we spend a half hour once a day uh with the entire professional staff, as you said, meeting with a single person who is here for treatment. Uh people tend to stay here a while. So, yes, that first encounter sometimes feels a bit intimidating to them. Um some of them continue to feel intimidated despite the uh you know what one of our uh one of the bases of our clinical model uh comes from uh a professional called Alan Shore. He's a internationally known psychoanalyst and uh researcher and author about the phenomenon of enactment, that is uh the emotional interchange between individuals that occurs all the time in our lives every day. We try to capture and harness that process of enactment as a therapeutic tool. We use a concept called core enactment where we help the patient identify what is their repeating pattern of engaging with others that has been turning out to be problematic for them and that often evokes a strong emotional reaction in the other person. So one of the things we use rounds for is to have a whole group of people, all of whom have different experiences of this individual, be in the room together, have an experience, have a conversation. It's open-ended. We start it off by asking the person, how's your treatment going? What's your experience lately? What do you feel the need to talk about? And what do you know about what you're learning about your core enactment, that pattern that's been problematic for you? And then we have the opportunity each to share our own emotional experience and for them to be able to get a window into different aspects of the more hidden parts of themselves. The parts that end up getting behaved or acted out rather than spoken about in their lives, and you know, often it's put them highly at risk. So uh we we surround them. And uh Dr. Shore, who came up with this concept of enactment, uh came to visit us and referred to that experience as an empathic field. Um it is really quite an empathic field. It's basically a person who's struggling and suffering steps into a room where everyone's undivided attention is on them uh in an effort to be helpful to them. Uh it can sometimes be provocative, sometimes we push them about things, but that's all in an effort to help them understand themselves and to uh engage in the really difficult process of change.
SPEAKER_01:My experience being a witness there was that it was intense, but highly compassionate. Like there's not a soul in that room that is not for the betterment of this person that doesn't hold them dearly uh in what they consider to be your care. And that they they only want the best for them. And in that way, it makes it truly inescapable. And I think that the there's there's no pulling the wool over anybody's eyes in this room when this is happening for someone, you know, that everything's on the table. Um we're n we may not pick it all up, but it's it's there and there's no escaping it. And so I, you know, while it may feel overwhelming, you know, for a person who has to sit on the outside for clients who might come into your care or anybody else's, what I know is that if they're going to get triggered by something, I want them to do it while they're surrounded by clinical professionals so that we we know where that trigger is, we know when it happens, and that when and when they transition from that environment, they've got an opportunity to really have a plan for how they manage and and work with that as they go out into independent life. Um and you you the empathic field, Dr. Viner, you and I we talked at great length about the empathic field. And it it I'd love to hear your thoughts about it because I think it's hard, it's hard to put your finger on. You know, it's hard, it's something that's very difficult to name. It's like, what is this thing, this you know, this this extra thing that happens in a room when people sync up. They they they sync up in their amygdala or in their limbic system and they start to generate uh a relationship that can translate to healing. Like t tell me a little bit about that, because I know that stands at a as a core foundation for the program at Yellow Blick, Yellow Brick, excuse me.
SPEAKER_05:Sure. Um, you know, the visitor who comes into rounds often will um themselves feel a bit anxious, like, aren't we intimidating the patient? Um, and isn't this a little too much for them? Um for um most of the individuals who come to us, the way we understand um the patient's anxiety in rounds, it's linked with um the uh sense of um empathic connection from so many people that because of their um you know hurts and vulnerabilities in life, they've come to protect themselves against what for them is the threat of connection. Um and uh the the feeling so cared about by up to 20 people all paying total attention to you in the most nuanced and you know um you know uh you know um precise kinds of ways. And part of the struggle in treatment is um how to create this kind of ecosystem of relationships that is going to invite this person and allow them unconsciously for the most part, to make the choice to be open to the attuned caring connection because the neurobiology research informs us that uh it is through that kind of attuned empathic connection that our brains, which are deregulated from trauma and other life stress circumstances, that the brains begin to uh calm down, uh the limbic system begins to reset, and it's only a regulated brain that can actually learn anything, whether that's a cognitive learning or an emotional learning of self-integration. Um and so uh rounds is kind of an iconic experience of uh what is on offer at Yellowbrick, which is an empathic ecosystem of relationships, inviting and offering connection that allows a person to make a choice to lean in, um, which is going to open up various kinds of healing possibilities for them. It's a fundamental um, you know, found foundational aspect of our model.
SPEAKER_01:And it's almost like a, you know, there's a there's a juxtaposition here where through treatment during the time that they stay there, they start to feel safe. You know, so they've kind of they've kind of addressed this bottom level of Maslow's hierarchy of needs, and it allows them to become vulnerable and and and participate in a in a process like rounds, while vulnerable, maybe intense, possibly even emotionally triggered, but not threatened. And that's it.
SPEAKER_05:What I would say, Todd, is the transformation that uh occurs in a treatment that is deepening is that the initial experience of um feeling unsafe from the outside, um, people begin to recognize that the true threats are actually living inside them. And that the work is about reconciling um those different parts of themselves that have become internalized from adverse life experiences.
SPEAKER_00:The attunement that my colleagues have been talking about that occurs in rounds really speaks to the foundational principles of contemporary interpersonal neurobiology, in that we all have aspects of our emotional experience that are walled off or in other ways hidden from us, that are nonetheless formative and uh they become the engines of what drives people, uh, particularly in problematic ways, uh, the people who come to us at Yellowbrick. So, what happens in rounds is that this attunement begins to bring forward those hidden or obscure aspects of self that become um objects of attention and care that would otherwise be hidden or um enacted in problematic behavioral ways. So uh the other experience that patients have over time in rounds is um initially everybody is scared to tackle rounds. And you know, you walk into the room, and as you point out, Todd, there are 20 people with advanced degrees who are all laser focused on you and everything you say and um everything about your presence in that moment. It can be quite intimidating. What people often say over weeks, um, and as treatment progresses, is rounds is not scary at all. It is, in fact, a safe place that they can bring forward parts of self that um are otherwise held back, either held back consciously intentionally because they're shame-ridden or embarrassed, or um not consciously at all, um, unconsciously held back, sealed off, walled off, obscured. And rounds becomes a place. Exactly. Rounds becomes a place where that can come forward and um shared.
unknown:Yeah.
SPEAKER_02:It's it's uh it's rare that a uh patient will engage with a visitor. Uh that was uh that was a unique, well, not entirely unique, but it was a very a very rare experience, and it was great. It was actually helpful to her treatment.
SPEAKER_01:I have that impact on people sometimes. Um and I you know I want to go in a couple of different directions here. One, Dr. Jessup, for you, obviously, you know, as the person proceeds through treatment, as they, you know, begin to identify in healthy ways their core enactment, and they they cultivate this kind of trusting attunement with their team. And it becomes this process that's not scary at all, that's really informative. How does that translate in your work with the families? We know that family work, you know, I think it's one of the things that there are treatment programs out there that really miss out on the level of family work that is involved. And these folks have got lots of complicated kinds of arrangements with family, namely parents, lots of enmeshment and other, you know, boundary patterns that are not serving this individual. And then they start to do this realization. How does that lean into some of the family work that you're doing with the families that are the clients there at Yellowbrick?
SPEAKER_00:Well, of course, the family process is a crucible for core enactment. And uh I think in terms of a family having a its own sort of systemic core enactment, these are transactional patterns around boundaries around power and authority and control around um allocation of resources, whether it's you know, budgeting or emotional resources in the family, those are all in play. What we try to do at Yellowbrick and what I try to do in family therapy sessions is recreate an environment that allows for a safe, uh a safer, more collaborative process that promotes understanding and acceptance of what previously has been either threatening to the family or otherwise problematic for them to deal with. So um we tend to lean in in family therapy to those aspects of family life that are most tension-filled, most um uh obvious arenas of struggle and concern. Um sometimes that means that the emerging adult sets the agenda for family therapy by saying, I want to talk about this that um I've never talked about before, or that I always try to talk about, but my parents can't deal with it in one way or another. That's the emerging adult's pitch. Um there are other sessions where the um parents have asked me, can you help steer our process together to address this one place where we always crash and burn? And we'd like to have that process unfold in a better way, but we don't know how to do it. We've we've tried every way from Sunday to make that happen. And um we tend to go down in flames. And can you help us do that?
SPEAKER_01:And I remember a case that you and I discussed where um, you know, the the individual had a particular issue, and but this issue was something the parents had a they they had a a way in which they approached it. Mom had a reaction, dad had a reaction, and they're like, look, we're not gonna do it this way. We're gonna say these things because I know my mom's gonna react. It was incredibly insightful on the part of the young adult, um, because he knew his family. And, you know, he directed kind of where they where you would tap the nerve, essentially, and that became an entry point for kind of the greater work that needed to occur for him to do this individuation process, which that he had struggled with. So um I you know, I really appreciate the sophistication and the nuance of it, and and that leads me to this other area where Dr. Barron might oh, Dr. Viner, please.
SPEAKER_05:I just wanted to add something about uh an organizing principle for our uh family work, but also our um staff relationships with patients. It's organized around a concept in the developmental psychology literature known as connected autonomy. And what that phrase um refers to is a paradox about human development, in that our capacity to function autonomously rests upon the internalization of our connections. And so uh we use this principle as a uh kind of a red thread in how we work with uh families and our own relationships uh with the patients, in that um we're we're always uh taking a position of um create facilitating uh um the patient using their own agency and authority to move into a space uh that allows for being able to make good use of us. The the the Winnicott concept of becoming a usable. Object for the individual in treatment. And this approach often allows families of emerging adults to not necessarily have to dive into the dark of whatever the family traumas have been, but to actually find a pathway out of some of the enmeshed kinds of complications that psychiatric illness and developmental injuries have caused the family to maladapt to. And it allows opening up new paths that can compensate for what previously have been dead ends for them and trying to solve emotional problems as a family system.
SPEAKER_01:This, you know, uh, if you will, interdependence that they have on their family. You're connected to your family. They're part of who you are. It's not something that goes away. Um so you have to figure out a healthy place for that stuff to live, especially if it's involved, you know, trauma and meshment and all these other patterns that we see. But, you know, the and what I was gonna, I mean, all of this, because we see it in mental health so often, and Dr. Barron, I hope you'll you probably have something to say about this, but the medications, you know, the uh it's very hard to engage in much of this process without a regulated brain. Medications play a huge role in that. Um, and so very often we we, especially in the outpatient world, we run into, you know, docs that aren't spending very much time. They definitely don't know much history in terms of what's going on. You, on the other hand, as medical director, get to sit on top of this, you know, brilliant model that reveals so much, you know, what's going on with the family, with the with the client, you know, how well they're sleeping at night, um, what they're coming up with and what they're you know, what's core for them in the rounds. And that goes into how you digest what is going to be a good medication regimen. Tell me a little bit about that. I mean, I sure, you know, if we could model that and give it to everybody else in the world, it'd be great. But please tell me your process around that.
SPEAKER_02:Well, uh working here has uh really brought home the fact that um just as a just as a starting baseline concept, people don't take their medications. And the the beauty of our model is we know when they don't take their medications. We don't force them to, we don't direct people. We have staff observing them taking meds uh who then report out and it's documented in a chart whether they're actually showing up and taking the meds, responding to reminders, doing it consistently or not, or just objecting, because sometimes they'll object through their actions and not come in and talk to their prescriber about it. But their prescriber has access to that information, and that's a huge advantage over an outpatient practice and and over a program that doesn't have a supportive residence, for instance, um, where you have to take somebody's word for it, or you just notice that it's been three months since they refilled the prescription you gave them that was only good for 30 days. Maybe they're not taking it, but that's all you've got to go on. So we have a tremendous uh access. This is just part of having access to everything they do while they're here. Uh Brown's is just a distillation of that. We also use genetic testing. We we recommend it for 100% of people coming here. If they haven't had it within the last year or two, we ask them to repeat it because the company's doing these genetic profiles. And this this is a genetic profile that's specifically focused on psychiatric pharmacology rather than um on ancestry or the other things. Very broad range. Can be fun to play with, but are not directly relevant to our work. Um, so those profiles are evolving. Every couple of years they add another few genes. But the other thing that changes about them is that if you had your genetic profile done, say five, six years ago, the research has been evolving about what these genes mean, what recommendations are based on the particular genetic configuration you have. And sometimes they change because new research is developed and occasionally they reverse. Uh that that's happened once or twice with just with the one company we've been dealing with the last five or six years. So we we get we try to get the most up-to-date version of the testing, we try to get the most up-to-date genetic profile that has all the relevant genes, and that is a tremendous uh help. It's it's not it's not what decides medication recommendations, but it is a significant influence on it. I've been practicing long enough that I was at this for 10 or 15 years before there was any such thing as genetic testing that could help us. And the difference between that time and now is really dramatic because if you have access to these tests, it can markedly shorten the time it takes to get to appropriate, tolerable, and effective medication. You know, most psychiatric meds take a while to work anyway, typically not any less than a few weeks and often uh a couple of months, depending on what you're treating with it, kinds of symptoms. So if you can get that down to one or two trials instead of four or five or six trials, you know, you're you're making a huge difference. So that's that's one aspect. Medication is not the only thing we do to help people with brain deregulation. Um in a certain sense, a great deal of what we do, whether it's uh, you know, it's yes, it's in that book, uh Minding the Brain. And uh the way we mind the brain with our patients is uh to yes, prescribe medications. We do something called neurofeedback, uh, which is self-brain regulation using electroencephalography data as the feedback format. Um, that's a whole conversation in itself. Uh not targeted at DSM diagnoses, but certainly targeted at brain regulation and quite effective for that. Uh uh, at least it's not it's not a one-to-one correlation with DSM diagnosis. Um the validity and and helpfulness of DSM diagnosis is another entire conversation, but just to say it's helpful but has its limitations. Um I like to say those methods allow you to cheat a little. Say again.
SPEAKER_01:I I say that you know, like neurofeedback and some of the brain-based methodologies allow you to cheat a little, things that you might spend very a lot of years doing psychotherapy over. You can get regular you can get some results with regard to emotional regulation much quicker.
SPEAKER_02:Yes, and in certain respects that's true. Although with the population who come to Yellowbrick, um it's it's gonna take the whole village full of people and techniques. So it's it's less a matter of, I get what you're saying, but it's less a matter of cheating than um, you know, bringing out all the troops and doing everything we possibly can because this person frequently is gonna be dead or disabled if something doesn't change. Those are the people who come to us, not not entirely, but a big majority of them.
SPEAKER_00:I was just gonna add that there's a synergy um between the psychopharmacological supports available here for self-regulation and all of the interpersonal uh supports for self-regulation. You know, the I guess an analogy would be an athlete who has a really excellent physical trainer is also going to benefit from nutritional coaching, from sleep hygiene improvements, so that everything is enhanced by the um therapeutic actions in those other ancillary or collateral arenas.
SPEAKER_01:Absolutely. Now I'm gonna ask a I'm gonna ask a hotbed question. Um and uh Dr. Barron may have something to say about this, and you all might have something to say. This is something that kind of lives in the topicality surrounding mental health. But when you when you're doing the genetic testing um and you see a person after a period of time, you know, you're seeing different results because the testing changes. Do you think you are seeing anything with regard to uh epigenetic? You know, do you see a person's not to say that they're cured, mind you, but do you see a person's responses, you know, level of medications and other kinds of things, do you think that there are epigenetic changes occurring as a result of a person becoming more regulated for longer periods of time?
SPEAKER_02:Well, there have to be. Um brains, yeah, yeah, brains don't change without rewiring, and rewiring doesn't happen without epigenetic change. Whether it's adverse change, like trauma, there's a there's a whole robust body of research on how those epigenetic changes occur in adverse circumstances. You know, children who even grow up in chaotic families who are abused, molested, all that, you know, you can measure it now. You can look at the methylation of their genes and see that it's much more prevalent uh and associated with adverse consequences. And the healing approaches and supportive environments and all the things that make a positive change have to be engendering epigenetic change as well, of a different kind, obviously. Uh otherwise, you know, basically if you if your brain doesn't rewire itself, meaningful change doesn't occur. And brain rewire, this is one of the problems with our current mental health system as a whole, is that it's focused primarily on uh crisis intervention in terms of what insurance will cover. Um, you know, it's very short-term focused. If you need a hospitalization, you better be out in three days, otherwise you're gonna go broke. And that's not how brains change. Brains take months to change, and that's when there's active effort going on, and all active effort has to swim upstream against the fact that brains don't want to change. It's not just people's stubbornness, it's our brains intrinsically are uh you could say wired or evolved to keep doing what they know how to do. It's an extra energy expenditure to change. So there's a there's an intrinsic resistance to any kind of change, and then that also is manifested through all kinds of interpersonal styles. Um we're always fighting against that.
SPEAKER_01:We need the brains don't change quote on a t-shirt, you know.
SPEAKER_02:Brains don't want to change for sure.
SPEAKER_01:Brains don't want to change, brains won't change without rewinding.
SPEAKER_05:We can we can demonstrate the value of our model and its power um you know through the neuroimaging um um that is available through quantitative EEG. And so uh over the last two decades, uh we've accumulated um you know hundreds of cases um that on admission were deregulated at three or more standard deviations within certain crucial networks and on transition uh from treatment uh have made one to two um standard deviation changes towards uh regulated patterns. These are uh um images uh of their neural networks compared to individuals who uh do not have histories of psychiatric uh or neurological illness. And you can't fake the quantitative EEG. And so we uh we you know can demonstrate that uh what's happening uh is uh um you know changing things at the most fundamental levels of neural networking. And that of course um is the downstream effect of changes uh in uh epigenetic uh transmission of RNA.
SPEAKER_01:You can't fake one to two standard deviations of change either.
SPEAKER_05:I mean it's uh no and the brain's the organ of the mind. That's that's a fundamental principle uh in our work. I think David um we we um left off uh without mentioning some of the other kinds of uh uh interventions that we do within our sister company, Synchrony Brain Health. That in addition to medications and uh neurofeedback, we have uh transcranial magnetic stimulation, which is FDA cleared for depression, depression with anxiety, OCD addictions, and often can be helpful for people with PTSD or chronic pain. Um we use direct current stimulators, we uh emphasize sleep hygiene, as uh Dr. Jessup was saying earlier, um, nutrition, exercise, uh, chronotherapy, EMDR, uh retraining of the autonomic nervous system through mind-body work and mindfulness training. Um, you know, and part of the concept there is, and I think we were touching on this a little bit earlier. It's not that we're uh searching for what's the silver bullet with any particular individual. It's we understand that brains are stubborn, all organic systems you know are premised on homeostasis. They don't want to change. And so it takes multiple converging vectors of stimulation to bring the default platform to a tipping point where um in order to actually function better, it has to be disrupted, you know, to then come together differently. And so we're we're you know, um shooting multiple arrows at the bullseye, you know, um to and landing as many as you can. And landing as many as we can.
SPEAKER_02:It's a great metaphor for it's a great metaphor for rounds because yeah, that's exactly what rounds does in an interpersonal way. You put all the all the archers in one room. And the target isn't the patient, the target is the troubles the patient has had.
SPEAKER_03:Yeah.
SPEAKER_02:The patient is an archer too.
SPEAKER_05:It's another way of which Yellowbrick is differentiated from many other programs in that you know, programs tend to hire good, you know, people who are well trained, and they say, go do your work. Um, and we hire well-trained good people too, but we say we we adhere to a certain kind of model here, and we want everybody to be aiming for the bullseye in the same, you know, um, you know, uh model of treatment. And um, you know, because treatment, even if it goes on for six to eight months, as it often does here, um, is a very short period of time compared to how long these complex problems have developed over the two decades of a person's lifetime. You know, and so we we gotta hit the bullseye as as as often as we can. And that means we all have to be uh working within the same conceptual model, uh, a developmental neurobiological model, as Dr. Jessup said earlier.
SPEAKER_01:The um and that, you know, bringing that up, uh especially um I enjoyed Dr. Potentut's uh talk on TMS when you were we were there for the conference. And I, you know, TMS is I wouldn't call it new, but I would be called I would call it very much more emergingly popular. It was approved by the FDA, suddenly you get insurance reimbursement. Now the world is starting to notice, and you're seeing it pop up in a lot of different places. You guys have been at it for a little while. What is your what is the success rate you're seeing using TMS with the clients who come to you? Because you've got a lot of folks who are suffering from pretty severe depression, um, which it's you know highly clinically indicated for that. Some people get good results, some people don't. Um, but I we're seeing a lot of really kind of miraculous results. What is, you know, from the broader behavioral uh standpoint, in your view, where does TMS sit in this profile of treatments of arrows being shot at the bullseye?
SPEAKER_02:We have uh we have data on that particular question, as it turns out.
SPEAKER_05:And I thought you might publish data in green simulation.
SPEAKER_02:Right. So uh if you look at the yellow brick population, all of whom access this service through synchrony our sister practice, we have roughly an 80 to 90 percent, 85 to 90 percent response rate. Uh just looking at major depressive symptoms and using what they call the H1 helmet from a company called Brains Way, um response to symptoms of major depression. So in the research trials for major depression on the brains weight helmet, the response they were celebrating because the response rate was around 60%, which is equal to equal to or better than most antidepressant medications, um, and significantly better than a sham treatment, which is the technological equivalent of a placebo. So the placebo 35-45%, the research trials 55-60 percent, yellow brick 85 to 90 percent, and the difference we we can't say with scientific certainty, but our best educated uh estimation uh I don't want to say we're guessing because we do have a lot of data behind this statement, but our our estimation is that the reason we have a better response rate is not because we do TMS better, because the protocols are fairly standardized, it's because we do all these other things at the same time. And TMS in particular is activating, and that particular helmet is activating the left frontal lobe, actually, the dorsolateral prefrontal cortex on the left on the left side, which is the seat of decision-making, executive functioning has a role in executive emotional functioning. Basically, it's your thinking brain talking to your emotional brain and saying, they're there, it's gonna be okay. Calm yourself.
SPEAKER_01:Everything that sits on top of the saguinal singular, right? Like everything that's written on it's it's right up here.
SPEAKER_02:Yeah. Don't keep doing those destructive things, you're gonna be okay. And um, when you activate that part of the brain, and then you spend the rest of the day interacting with people, learning new things, learning, learning some of the skill-based therapies, or for most of our patients, refreshing your learning that you had elsewhere of those skill-based therapies that didn't on their own help you enough. Um, and and living with people who are struggling to support each other and having rounds with all of us. Um starting your day, usually it's in the morning, with that activation of that key executive function circuit. Um, we think that accounts for the difference in response rate.
SPEAKER_05:But what's fascinating about that outcome data is um our patients tend to have anywhere between three, five, seven different diagnoses. The people in the FDA trials have one. And so our patients should do much worse just because their circumstances are so much more complicated. And our patients are doing as well or better than the people who simply have the single diagnosis of major depression. And I think that speaks very powerfully to the model itself, as Dr. Barron was just articulating, of the multiple converging interventions that promote PDNF, that promote um neuroplasticity, that produce inflammation, that gets the brain um talking to itself in more open ways. We can demonstrate on quantitative EEG when people come in that um there's roadblocks between the different networks that you know need to be able to talk to each other for people to function. The way the brain works is there are networks that have a role um in in functioning, but they can't do it without talking to other parts of the brain. And if there's roadblocks there, it's not going to happen. And we can demonstrate um what they call increased coherence um you know on transition um you know from um the the multiple different interventions. And so it's really a fascinating piece of data that our patients are doing as well or better um when you know legitimately they should they should not have as good an outcome given the complexity of their circumstance.
SPEAKER_01:It's kind of the you know as Americans we we all have the kind of pill-based model of care you know you have a symptom you take a pill you have a condition you get a treatment you take a pill and so you know the while pills have their function they obviously they obviously do the you're talking about an approach that I think that so many even even residential treatment programs kind of miss out on because one of the things that the will industry and programs we would see as an outcome measure is that they were really good at being in treatment but they weren't really good at being outside of treatment um because they had a lot of approaches um but I think that what you had was while you are a team of people aiming at one target, you would go into these programs and you had a bunch of people and they were aiming at the bullseye, but they were all different targets without connections to one another. And what you're supporting in this model, it occurs to me, is that you're supporting not just the regulation around a particular symptom or or piece that the person is dealing with, but you're supporting the forging new connections to create different behavior so that it can exist outside of the treatment environment. And that's something a lot of mental health is missing on even in like you know high cost profile kind of treatment centers where you're not seeing the results when a person comes outside, which is you know the idea that all of you are are joined together and in a way like you like each other too. It's not just that you guys are a good team is that you actually like each other you love your work you love the people that you work with you feel very connected. You've got most of the folks that are working for you been there for years on end. So you've got this really well established team that trusts one another you know we know that the therapy one of the biggest one of the biggest things that's going to prove an effective treatment methodology is the is the relationship between the provider and the and the person. Well I think that goes double for when you've got the relationship between the providers.
SPEAKER_00:Yeah it seems I was just going to say it it it it seems really self-evident because uh we see it in we see it in professional sports all the time the teams that are most successful are those teams that create an ecology that supports the efforts and ambitions of everybody on that team and all of the ancillary professionals involved with that team um you you know you can have a great player but if you don't have a great organization behind it there the ecology that supports that player and the teammates maximizing their potential is just not going to be there. So um similarly Todd when you mention um the sort of distinctively American enthusiasm for the quick fix or the pill that will magically transform somebody's mental illness magic bullet the magic bullet we understand that you know the brain like any other living system is embedded in an ecology of other living systems and the more coherence uh we can bring to that the better we we um we don't um believe in the asylum concept of treatment um so there's no such thing here as uh being a treatment and then going back to the real world um yellow brick is a community integrated program we do treatment in real time in the real world uh parents often ask do you do exposure response prevention to which we say no we can only do it while they're awake you know um that the brain doesn't change unless you have real choices uh available to you including the the bad choices uh but that you can't pump new new neural networks without a real choice and you can demonstrate this on fMRI um and so um treatment um you know has to involve real choice and that also um is what is again going to invite uh real agency motivation and initiative um you know from that uh emerging adult whose troubles often have caused them to uh suppress or dissociate you know their sense of authority and competence I don't know if you're familiar with this uh but a few years ago there were some studies about you know people were promoting the idea that well if you do a crossword every day it'll help prevent you from getting dementia and it turns out if you do a crossword every day you get a lot better at doing crosswords but it doesn't actually prevent you getting dementia so it's as as an example you know not to you know not to single out a particular sector but you were mentioning wilderness programs if you go out and be in the wilderness with with capable professionals for a couple of months you will probably get a lot better at being out in the wilderness and you may get somewhat better at the personal relationships you have with those folks in a wilderness setting but that it isn't necessarily going to translate when you return from the wilderness unless you plan to live there.
SPEAKER_02:And the wilderness here is this you know the city of Evanston half a block from the city of Chicago uh this Friday night the patients are going to a restaurant downtown and had a uh really robust discussion in our community meeting about can one of them pay extra over Yellowbrick's budget to take everyone out for a birthday. Um and it's fascinating we have this open model where we don't we don't pretend to exert authority over them and they kept looking at us to say is is it okay? Are you gonna let us do this and let us there was no there there was no answer.
SPEAKER_05:And eventually the answer was well you're not doing anything differently than we constructed in this model you know the budget involves the alabricks you know money so you're staying within the budget so why do you need to ask us have fun another element of that it's also a restaurant on a Friday night where there are going to be a lot of people drinking you know um and um we have you know um at least two thirds of our patient population you know have substance use problems and in the group that's gonna be going three or four of them are very severe life-threatening alcoholics and you talk about exposure response prevention part of the treatment experience is helping them how are you gonna plan to be in that setting you know and stay sober you know yeah and how are you gonna help each other as peers do that you know um so that's that's what I mean by real time.
SPEAKER_01:You know it's not a contrived you know um you know kind of as if experience it's a it's an authentic uh challenge um you can't you can't erp the or the the person who's an alcoholic the at a bar scenario in a group room you know the and before we run out of time uh one thing I want to bring up and and ask very quickly about is um the you're guys gonna love this that they did this study on chickens eggs and they you know they wanted to see whether or not you know what what was the what was the what was the chicken group that produced the most eggs. This was a leadership uh investigation essentially so they took all the highest performing chickens and they put them all together and and then they just took regular group of chickens with a kind of a highest producing chicken and a lot of what they referred to as support chickens. So the group that had you know a better relationship um and and the the high performing chicken group like they kept competing with one another and they underperformed so something we see I'm making a jump here something we see uh in in treatment a lot of times especially with you know fairly highly sophisticated clinical treatment assessment centers clinics things like that is that you end up with a phenomenon I refer to as top heavy you get a lot of docs in there and it gets a little siloed you know this doc knows a lot about this and this doc knows a lot about this but they don't talk to one another um or you know there's a lot of like well that happened before we look at what's going on now and we think we know better than who those guys, whoever they were what I notice about your team is is that you've got a lot of high profile leaders that really get along and respect each other's opinion. And it translates to an effect in programming that is far more supportive to an individual and a family and in everything else because the the ego's gone you guys are you you guys are if I ran into you the street I wouldn't know that you were a doc necessarily because you seem like a nice guy and you have good social skills. Nice guys who wear ties nice guys who wear ties you know um and I I like I know that you know Dr. Barron and Dr. Viner both came from like I was Dr. talking to Dr. John Santo preatro and he said yeah when you're a um distinguished life member of the Psychiatric association it means that you're old um and that means that you guys got a lot of years I know you had about a lot of years and all of you have been in psychiatric hospitals and and Dr. Viner created this model because he saw something that was a lack in the world. I think that also has something to say about how you pulled this team together.
SPEAKER_05:Speak to that just a little bit well um we've been really blessed and I've been honored by um the people that uh uh have come to to join in the mission at the Ellenberg and um we have a very deep bench of strong expert um professional staff who um I think it's because um they've been so accomplished in uh prior generations of their career um that um they're already on the other side of that curve and in fact um they actually have learned um from leadership positions um that where the action is is with the patients and with their families and um they you know really enjoy um what uh is available here because unlike other programs that have so many bureaucratic regulatory and insurance related constraints at Yellowbrick you can actually fully exercise your talents uh and expertise as a professional and you're supported in doing that um and I think that um you know we we've really been able to uh uh have patients and families benefit from um the experience that professionals have working here and um it's one of the things that's most rewarding to me you know is to be in a position to you know invite people into that mission.
SPEAKER_01:Yeah I think that um you know you see a lot of the field the mental health field and it's designed around being right. We know the right condition, we know the right signed about reading right being right, whereas you guys have aligned towards treating well.
SPEAKER_05:And what one of the ways that that in a very practical way that that gets um operationalized here is uh we talk to prior providers. Shocking we don't assume like they didn't know what they're doing and we're the best and all that um you know that um you know we really collect an enormous amount of information um and speak directly to to prior uh providers um and um you know really want to have the benefit of what um their their work has been with the patient and there is a kind of arrogance within medicine in general and I think psychiatry mental health in particular um you know there was a famous paper written back I think it was in the 90s which was about borderline patients who have you know like a dozen different um you know treatments and it's the last one that says you know you know we finally got it right you know um when actually this paper's you know premise was each program had a certain place in this person's ultimate recovery and what we certainly subscribe to that more humble perspective about it. And we feel humbled by the you know the privilege that we have to to work with these individuals uh in a really meaningful meaningful intimate way it's a little easier to be right about a case of generalized anxiety disorder who comes into your outpatient office and says what do I do and you have a whole toolbox of what you can offer them and you're you're more likely to be right.
SPEAKER_02:We have a case of John or Mary who is completely unique of course as is the person with generalized anxiety disorder who maybe maybe isn't as as much at risk um and for whom there is no protocolized research based unitary approach that everyone's tried out and we know is going to work. So you know to the idea that we have to be right is antithetical to what we're trying to do because it doesn't fit with who we're working.
SPEAKER_05:And it leaves out the patient a long time it leaves out the it leaves out the patient.
SPEAKER_01:Yeah you know we co we co-create the person's healing you know with them um and with their family that that needs to be on a t-shirt too we co-create the person's healing with them Dr. Viner Dr. Barron and Dr.
SPEAKER_04:Jessup thank you so much for being with us today and thanks for being on the show thanks for joining me it's been a real pleasure it was an honor to see you this past year when and I'll look forward to seeing you again when the conference comes around I plan on coming up to see you again and I'll be working with you all November 5th I'll bring my big coat you know thanks for thanks for offering us this opportunity Todd thank you thank you Todd it was a pleasure absolutely you b you folks be well happy new year to you and we'll see you soon beat the beat and off no peanut butter need to follow it all I want you so on the last in a need to fall away all if so only you lost in here to fall our way all we all I feel so lonely you lost in here to fall our way all our way all