An Integrative Approach to Brain Health with Elumind’s Dr. Edalati

Dr. Kourosh Edalati: So, one of the anxiety stories I have is about this young man who came from another country. And he basically had been a child soldier in his own country, and when he saw the centre, it started triggering him right away to the extent that he could not think. It’s a typical panic reaction, I suppose you can call it. He couldn’t think, he was breathing fast, his heart rate was going 200 miles an hour. And I was just very curious because our centre is actually very serene, very zen. And so I was asking myself, “Well how is this young man getting triggered like this?”

And what I discovered was that he had been told what to do. And so the person, or the family who was with him, I think it was actually a family friend, was trying to get him into the office to be interviewed by me.

John Bateman: Oh, I see.

Dr. Kourosh Edalati: And just that small little thing, to most people, it’s so basic, it’s so small. But for him it was so immensely triggering.

And so anyways, we proceeded to calm him down, and he saw that we are not here to recruit him into going and doing anything bad, rather just trying to help him. But that’s just an example of what anxiety can do to a person. And then obviously he has background of trauma, background of post traumatic stress disorder, and that trauma has many triggers, and the triggers are easily, I guess, picked up by the nervous system of this young man. And he just goes off.

It’s just like a fight or flight response really. But the anxiety reaction, it’s in everybody. Every one of us has it, every one of us has triggers. Every one of us has resilience to deal with it at times, and at times we don’t have that. So, we start having panic reactions, we start feeling stressed out. And it was no different in this young man.
And that story, that stood out for me just because of the really subtle response to his environment.

John Bateman: Yeah, I mean, just to quickly cover that, could you detect that something was happening with him, and what exactly did that look like? And then, you said that you calmed him down, what did that look like too? Just to kind of brush over that. Because that’s kind of important if somebody finds himself in that situation.

Dr. Kourosh Edalati: So, seeing his body react first. So usually anxiety, when somebody’s having a panic attack such as that, you see the body tensing up, you see the face sometimes flushing. And I could see him tensing up, I could see that anxiety rising up. And then of course he went to a full-blown panic attack.

It’s not always like that. Sometimes anxiety is very subtle, when someone just has their mind running commentaries and worries. The what-if situations. Sometimes the anxiety could be about being in a public place, such as social anxiety. So, it could be subtle or it could be extreme. Like this panic reaction is usually an extreme anxiety reaction.

And so for me, the biggest thing was to identify why he was being triggered. And of course, when the person is in a panic reaction or in such a big anxiety attack, the breaks of the brain are off. So we call those the prefrontal cortex brain. So, the person is going right to their amygdala, which are the heightened emotion centres of the brain, and they’re off to the races. So, it’s very difficult to bring them from here down to a logical rational level.

So, what we do is usually we start with a physiological calming down before we go to talk to them. We just focus on physiology. And of course, breathing is a very big component of reducing anxiety and improving the physiological states that we want them to be in before we can engage them in a conversation. And this is exactly what we did with him. Just have him breathe, have some water. You also start using your voice a little bit because you want really [to] reduce that anxiety by having a very calm, kind of settling down, I guess tone of voice if you want to call it. And that really helped him. He calmed down. And then we could just have a conversation.
Of course, you have to know some of these techniques.

That’s why you do psychiatry or you go to medical school. But even if the average person is having this reaction, breath work is always a very fantastic way of calming the anxiety down.

John Bateman: So, you are a psychiatrist.

Dr. Kourosh Edalati: Yes.

John Bateman: And so, you learned… I guess an interesting question that pops up, before we move on to what you do at your treatment centre, but it’s just an interesting point that you are educated formally on this, and given this is what anxiety looks like, this is what to look for, this is what you can do.

Do you find that those kind of universally apply or do you find that you’ve had to develop your own techniques for dealing with people as you go? That is to say, have there been any surprises for you in terms of how to deal with people? Have you found things that you thought might work but didn’t work, or that you found worked that you didn’t even talk about when you were going through education?

Dr. Kourosh Edalati: I think education is a way of learning the rules and then learning how to bend the rules.

John Bateman: Yeah, yeah, yeah.

Dr. Kourosh Edalati: All the techniques that are taught, all the treatment modalities, they work on some people and do not work on others. And so there’s a science to it, but there’s also an art to it. Meaning that you take the technique, and you use it when you see there is a receptive person for that technique. So, you have to read the person very well. And I think rapport, which oftentimes, we don’t spend enough time on it because you’re so busy as a mental health professional. It’s just go, go, go, go. The sheer volume of the patients you get to see doesn’t give you that.

But I find that if you took the time and build that rapport and read the person, then you can use the techniques more accurately. Because you have a toolbox of techniques that you have. Cognitive behavioural therapy, DBT, hypnosis, EMDR, you name it. I mean there’s ACT. So, we have all these things that we learn in psychiatry or psychology. But then if you don’t read the person and you just try to force it, it really doesn’t end up well. The person keeps coming and then after what you become disillusioned, and then the person becomes disillusioned, and the therapy basically fails. And then you feel like a failure as a therapist. So your anxiety rises up next time you see someone.

John Bateman: Well, that’s something, it’s important for people to know, that that therapists get anxiety too.

Dr. Kourosh Edalati: Absolutely, absolutely.

John Bateman: Not impervious to life for sure. It’s not life proof that way. Just to quickly touch on it, you know are a psychiatrist and so you have the ability to prescribe. And I always have curiosity about medication and how you approach that within your discipline. I assume it’s something that you would use when needed, but I’m just curious about what that approach looks like for you.

Dr. Kourosh Edalati: Exactly what you said. You need to look at the situation. Sometimes medications help a lot, and they can really help a person get out of a funk. And sometimes they just don’t. The person’s body doesn’t accept medication. I’ve had people who have been very sensitive to medications, and the body just rejects it. It had severe reactions to it. Some people, they don’t reject it, but they just don’t respond, so that you just pile up side effects. And then some people really respond beautifully.

Sometimes you want to do psychotherapy, and everybody talks about talk therapy, counselling. And they’re wonderful tools. But if the person has so much anxiety, it is impossible to put them through that counselling session. You need to have medications on board. Or if some kid has deficiency in terms of serotonin in their brain, you can sit down and talk about techniques until the cows come home. You’re not going to go anywhere with that because you have to have the serotonin in the brain, and regulated serotonin, which is oftentimes what we need in anxiety management.

So, I think everything has its place, but it has to be an integrated approach to mental and brain health. And this is what Elumind is unique at.

John Bateman: Yeah, that’s what I wanted to get into because what you do is something that is very unique. And I would love to hear what you do at the Elumind Centres, how you approach anxiety and different mental health issues.

Dr. Kourosh Edalati: So, the first thing we do, with respect to any client that walks in, is we do a full assessment because we want to really understand the person. A full assessment really involves not just the brain health of the person and the mental health of the person, but also looking at the body. Oftentimes, people forget that the chemicals in our brain are made up of certain ingredients, and these ingredients come from the food that we eat. And if you are eating the right foods, we are getting those chemicals produced in our brain. However, what if we eat the right foods but it’s not absorbed into our bloodstream. We are taking all these very expensive supplements, but it’s not going anywhere.

So, we look at the person from both mind and body perspective when we do the assessment. We look at their physical health, like their lungs, their heart, their digestive tract, and also their brain, and also their kidneys.
And then once we have a full assessment psychologically, and I guess medically, then we proceed to the next step, which is formulating a treatment plan for them. And that treatment plan needs to involve the brain, the mind, and the chemicals that draw on the brain. So, we kind of use a model called roads, cars, and drivers’ model, where we look at the roads as the neuro pathways in the brain, the cars as the chemicals. And the driver is the psychology of the person or the habits of the person.

So, when somebody is giving that formulation, that treatment formulation, say, “Okay, how’s this person’s brain working out? The neuro pathways, are they connected? Is their under-connectivity? Is there over-connectivity?” And we look at that through something called a brain map, a qEEG brain map. And we use that as a suggestive tool. And together with the assessment, we see, okay, does this person really suffer from anxiety and are the pathways in the brain highlighting that? And then the next step of course is looking at the chemicals in the brain. So, for that–

John Bateman: Sorry to interrupt, but when you talk about looking at the pathway of the brain, are those pathways you’re looking at, is that a build that you’re just doing through interaction with the person, or are you actually imaging in ways?

Dr. Kourosh Edalati: No, they’re actually… So, what we do is called a qEEG or quantitative EEG. And what it is, basically it’s electrical activities of the brain are represented by different waves. This is like five different waves. Alpha, delta, theta, beta and gamma. And the amount of these waves and the location of where they occur are inferring to us as to whether this person is showing anxiety or showing depression, showing autism, et cetera.

John Bateman: Right, interesting.

Dr. Kourosh Edalati: So, it’s not diagnostic, but it’s an inference tool. It gives us that kind of clue, and together we take the assessment and combine the two, and that gives us a very good diagnostic tool as a combination.
John Bateman: Right, I got it. So, moving on, then you say you go to a different step.

Dr. Kourosh Edalati: So, the next thing we look at is the chemicals in the brain. So, we talk about neurotransmitters. Serotonin for example, where the medications, SSRIs that oftentimes are prescribed for anxiety, can be helpful or not helpful depending on the person.

So, the next step is of course looking at the neurotransmitters in the brain. And how we do this is there some basically kits that we use, they’re from third party, they test the neurotransmitter levels in the brain. And it’s not necessarily a hundred percent accurate, but it gives us an idea of, okay, is this person really, really, really low on dopamine, for example? Or is this person really low on norepinephrine or serotonin? So, we get an idea of the chemicals.

And the last step of course is looking at the psychology of the person. What are the core beliefs of this person about themselves, about the world around them? Like the person I talked about earlier, the core belief about the world outside was it’s a menacing world. Or if somebody has very low-grade anxiety, they feel quite often invalidated, judged, they worry about things that things can go south.

So, there’s a core belief about everything that we are and everything that’s around us. And that determines a lot of what this person’s ability is to deal with anxiety-provoking situations, because we all have stress in life, but it’s how we deal with it that determines whether we have a high level of anxiety or not. So that is one aspect of it.
The other aspect of it is habits of a person. I oftentimes tell people that we are creatures of habits. And many times, people put themselves in stressful situations by having habits that are not serving them. And so, we identify those habits as well.

For example, I’ll give you an example, someone overeating or carb craving when they’re very anxious or they’re stressed out. I mean, how many times have we all had that situation happen to us?

John Bateman: Yeah, today. But yes.

Dr. Kourosh Edalati: Yeah, often times. But recognizing that and seeing that it can lead to more problems down the road is the key and seeing what we can do to change it.

So again, we looked at the roads, we looked at the cars, which are the chemicals, and the driver, which is the person’s mind, psychology, habits. And the way I would tell people is that if you had the perfect road, let’s say you have a German autobahn, and you have the Ferrari, but you’re a bad driver, you’re going to smash it against the first 300 kilometres.

So, you have to take care of all three components, and that’s what makes Elumind very unique. It’s an integrated approach to mental and brain health. And obviously for each of those three categories, we use different treatments. So, for example, for difficulties with the roads, we use neurofeedback or neuro-therapy. And it’s a long story to tell you all about neurofeedback. Basically, it’s an operant learning modality, uses basically technology to train the brain in certain areas that need training.

John Bateman: So, is this an interactive process with the person?

Dr. Kourosh Edalati: It is.

John Bateman: Okay, gotcha.

Dr. Kourosh Edalati: With the person, right. And then for example, for the cars, nutrition is one aspect, medication is another aspect. Obviously, we look at the person’s gut health so that we make sure that they’re absorbing well. Their detoxification centre of the body, which is the liver and also the kidneys, they’re working well. So those are the parts that go to for the cars. So, we want to make sure that they get enough chemicals in their brain.

And you would be surprised how many studies have been done on how the impact of poor nutrition and changing of it can really change up a society, where basically you can look at how individuals behave differently, feel differently by just changing their nutrition. Or sometimes giving them medications, same thing. So, it has to be a balanced approach.

And then finally, counselling, psychotherapy. We use all these different wonderful techniques that we learn in psychiatry and psychology and help them as they need to build a stronger mind, stronger spirit, stronger psychology so that they can deal with the issues that arise in life.

John Bateman: Yeah, it sounds like a really… It’s great to hear of a place that has that integrated approach. What I’m really enjoying about talking to you today is your scientific approach. Because so often I think people think that anxiety and depression and all these things are strictly caused by just trauma or something bad happened to me in the past, therefore if I uncover it, I’ll be cured. When what you’re talking about is a much more integrated process that happens that brings us to these states in our lives, that of being chronic anxiety or chronic depression.

Dr. Kourosh Edalati: Absolutely. And John, people forget about their genes.

John Bateman: Yeah, yeah.

Dr. Kourosh Edalati: We love our parents, but sometimes they don’t give us the good stuff. So, the genes play a big role. If your parents have anxiety, you probably develop some of it as well. And so, you’ve been given a card, deck of cards that maybe are not the most favorable for you, but you can turn it around. There’s hope for that too. So, if the genes are not giving us the right neurotransmitters that we need for combating anxiety, then science, the modern medical science can help us with that, whether it’s medications or nutrition, either one, or combination of can help us with that.

So, you’re absolutely right, everything is really science-based, and I think people have to recognize that we are in a very exciting era for our lives where we can use technology to our advantage. And really some of the stuff was never available 20, 30 years ago when I was just a boy running around. So, I’m just looking at it, I’m like, wow, this is cool.

John Bateman: Yeah, and I think the interesting thing about your treatment approach is that it comes from that point of education. And you have a wide array of skill sets in terms of diagnosing and then integrating a system to help people. Just curious, quickly, do people come in for set periods of time? Do you treat them as they need to be treated? How does it work like that at the clinic… clinics, I should say.

Dr. Kourosh Edalati: So, what we do is we get people to go to the assessment, once we determine the level of, I guess, anxiety that they have and the root causes of it as well. Obviously, if someone has trauma, it’s not just anxiety, but they also have background of trauma. So, we have to work on getting rid of the symptoms. But we also have to look at, okay, how can we help this individual process some of their trauma?

And we create a roadmap for them. We create the number of sessions that would take to the different modalities that I mentioned. And these are just a few of them. There are others as well. But we just want to make sure that it’s custom made, personalized medicine for that individual. So, when the person comes in, they walk out with a roadmap, they know how many sessions they’re going to be doing.

And sometimes people come in, they do a few sessions and then they have to take a break because either family reasons, job reasons, money reasons, whatever the reason is, and they can come back and complete it too. But it gives them a break from the suffering. They get a little bit better, they go, they come back, and they complete it.

So, it varies. That’s what I’m trying to say. But it’s very much custom designed based on the individual.

John Bateman: Well, I mean, thank goodness. When I first started experiencing anxiety and depression, I was quite young. And my first real bout of depression, I was probably, oh, it was like 35 years ago. And you know what? Then, it took me a long time to get a diagnosis, first of all. And the second thing is it was basically Prozac and counselling.

And so, it’s just so heartening to see that somebody like you has taken such a multi-prong approach and put it into one spot and are able to help people now. I would’ve loved to have had that back then, but what you’re doing is amazing work and I really appreciate you taking the time to talk to me.

Before I sign off, I want to let everybody know that it’s elumind.com, elumind.com. E-L-U-M-I-N-d.com is your webpage. Dr. Edalati, thank you so much for taking the time to talk to me today.

Dr. Kourosh Edalati: Absolutely. My pleasure, John. Any time.

John Bateman: Okay. I look forward to talking to you again in the future.

Dr. Kourosh Edalati: Thank you.

John Bateman: You take care.

Dr. Kourosh Edalati: Thank you. Take care. Bye-bye.

Outro: Thank you for listening to #OurAnxietyStories. If you’d like to support this podcast or Anxiety Canada, go to AnxietyCanada.com.