Neuroscience, the Habenula, and the Future of Mental Health

Richard Zwicky: Hi everyone, it's Richard Zwicky with High on Healthy, the show where we know there's no one path to healthy, so we explore them all. If you haven't subscribed yet, please do so on Apple Podcast, Spotify, or your favorite podcast listening tool. Today, we're exploring a fascinating paradox. We can map neural circuits with incredible precision. Track sleep, heart rates, movement, everything with wearable devices. Build incredible AI tools that allow us to analyze data at massive scales. And yet, when it comes to mental health treatment, progress is often measured through short intake forms, subjective interviews, and symptoms checklists, which again is all subjective and really doesn't help you understand in a standardized way what is progress. So the question is the problem really a lack of brain science or is it a lack of usable data and data infrastructure? Joining me for the discussion is Kairo Babinette, a physician, public health leader, and behavioral change designer, who's also the author of the best-selling book,

Kyra Bobinet: Thank you so much.

Richard Zwicky: The Unstoppable Brain, which explores how modern neuroscience can help us overcome the failure loops and build lasting change. Welcome to the show, Kyra. So, before we jump in, I know it was in your briefing note, but for many listeners, I've spent the last few years building a predictive analytics platform called Sparks Health, which is focused on understanding the data that underlies how do we address the mental health dilemma and patterns. But the question is always what data should we actually measuring? And that's something I spend a lot of time thinking about because it's professionals like you who need that data to be able to take the next step. And let's start there and where we can map that data and we can map people's responses with incredible pre precision. We're still guided by as I alluded to in the opener those short form questionnaires. Where's the disconnect? Where the rest of the world operates to, you can't manage what you don't measure. And yet in this area, we haven't been measuring effectively, right?

Kyra Bobinet: I mean I think that it depends on the mental model of what you think is going on in the brain, So some people who are fans of those kinds of questionnaires they probably haven't thought about this actually, Richard, but I think that my projection on to them is that they think that by taking that sample of that moment of that brain where that person thinks it's at, So that's a whole other thing. And getting that's stable data. And what I think you and I probably share with this is the first time we're meeting, but what I'm surmising that we share is that the brain acts more like an electron cloud. Meaning that the electron could be anywhere in the cloud at any point. And sometimes if you do quantum physics, all places at once, right? And so what is stable and what is temporary is the question. What is from a science perspective what is being primed by the question itself. If I ask you what's your best moment of the day? You're going to answer that differently than me saying how are you feeling in this moment? And then how long does that answer last? Is the next moment going to be primed by you had lunch, you feel better now, cuz you were hungry and those kinds of relationships. And so these questionnaires that you're talking about, I think we can safely say that they're subjective to sampling error, which means how often you sample changes the answer, because we feel differently throughout the day. I woke up differently than I feel right now, and so that kind of, wave pattern, we're catching a particular point and we're not saying things on average. So the questions that are more valid are on average or in the last week and then you have recall bias. So there's all these biases that these questions are trying to navigate about how the human brain perceives of itself and reports on itself, right? And so I think I'm really in support of what you're talking about there that's so vulnerable to inaccuracy to maybe un lack of predictability or you can't really build something on that when it's such an ephemeral fleeting signal that you're trying to for us.

Richard Zwicky: It isn't. Brain science and brain health is really longitudinal nature. So taking those snapshots, it's a moment in time picture, but it doesn't reflect where you'll be 20 minutes or 20 years from now. And doing the work means you're changing the outcomes. Also, one thing I recognized early on is if I ask you, how are you today?

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Richard Zwicky: And you go, I'm great. And somebody else goes, I'm good. Those might both be fives. It just depends on the person's perspective on how they respond. But from a neuroscience perspective, that data gap is something that it appears most clinicians still misunderstand. Why do we not have that stabil stable and standardized perspective taught right from the start?

Kyra Bobinet: I mean we have not begun to grapple with the level of subjectivity in the data of modern mental health practice. It's almost in the art rather than the science category, So we got the art of it kind of down. But the precision is really not available to people. And then if you look at the tools for measuring their brains, there's this guy Dr. Aean Clinics who is the neur neurologist to the stars or psychiatrist to the stars right and even recently Kim Kardashian was like I failed the bar exam look on my Aean scan I have an aneurysm a malfformation or whatever like implying that maybe that hurt my chances of passing the bar I don't know I think the bar exam is such a beast anyway so What's that?

Richard Zwicky: I always say what is it? People get so obsessed about their marks, but there is what do you call somebody who graduates 99th in their class? A lawyer. No different than the one who graduates first. Right.

Kyra Bobinet: There you go.

Richard Zwicky: The bar exam it becomes an artificial marker at certain point.

Kyra Bobinet: So we don't have the tools yet and I think that the technology needs to catch up to what I think your aspiration or your vision is for us, which is, we have mostly 3T MRIs. They're only for the wealthy. They're only for the life-threatening illnesses because they're so expensive to run, they're expensive machines. And then there's the 70s which are these researchonly instruments and that's the only instrument that's able to really measure the human habenula which is sort of my area of expertise and focus and I think the most important thing that we should be bringing into the conversation right now to kind of change the conversation as to what to focus on. So I think we're still, ways out to being able to really nail the operator within the brain that could be the most precise tell of how a person not only is feeling right now, but more importantly, the average propensity of their brain to be reactive or non-reactive to certain things, certain situations that would trigger depressive symptoms, trigger anxiety, press, trigger addiction loops, those kinds of things. So, that's really on a clinical side of things, all we really want to know is how much propensity does this brain versus that brain have? And that's more telling than knowing your genetics. If I know that genetically you have depression in your family, I would rather know mechanistically how hyper sensitive this area of your brain is, the habenula, because that will tell me more than I need to know about the risk level of you. Or for example, if you are somebody who is specifically suffering really high levels of withdraw symptoms because of the way that your brain is wired in that area of the brain, the habanula versus somebody else, I know that you're at for relapse. I know that you're at greater risk for suffering during your withdrawal. So those kinds of things I think are dependent on either the technology being more widespread, widely used or a proxy on the subject. Ive side that would get at that and that's kind of where my cutting edge is right now in my research and in my work is trying to get at that cutting edge like what signals do we need that are kind of indic indicators of the habenula given that measuring everybody's habenula my fantasy with a 17 MRI is a little ways out

Richard Zwicky: And you speak to some of that aspect in your book the unstoppable brain describing how traditional willpower models fail.

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Richard Zwicky: And part of what when I was looking through it and considering it's part of is self-awareness and awareness of truly how the triggers affect us because we can't understand how our willpower fails if we're not aware of ourselves properly. But what else does neur modern neuroscience tell us about why those habits and behaviors really are difficult to change? Is it because of the pain or is it because we don't understand the benefit in the end? Right?

Kyra Bobinet: So I'm going to get to the second part of your question and I might ask you to remember it for me because the first part I wanted to set a little bit of a different context there which is that absolutely for a certain percentage of people and I don't know what percent of a hundred are like this but I think there's two main segments of people that I've seen in my research. One segment is really in self-aware and that self-awareness that you talked about helps them to be free from some of the wrong thinking around willpower. And so they free themselves that way, by saying that doesn't matter, that I and they give themselves grace or they try. It doesn't impede their effort, it doesn't hit their habenula and cause them to lose motivation. So, that's one mechanism to be free of your habenula, being the motivation killer. The other group that I've seen, and this is mostly men that I've seen in my research, I haven't counted it up, are people that if they fail with their willpower or whatever, they just start iterating almost automatically without knowing what happened. They don't want to analyze. They don't want to be aware of what happened. They don't care what happened that went wrong. They start fixing it. They're more solving forward kind of people so I just wanted to point that out that, some people are more introspective and more self-aware and more contemplative and other people don't bother with that step. It's just blunt force try to solve it.

Richard Zwicky: And that is also part of how children are raised right? The culture the dynamics around the individuals and how you're supposed to show up affects how you handle setbacks later in life.

Kyra Bobinet: And did you get the proper instructions to work with your brain instead of against it? And I would argue that, we're really in this deep hole right now of being performative for ourselves and for one another and all kinds of sort of secondary knockoff effects of that. So going back to your other question I'm sorry I forgot it already.

Richard Zwicky: I mean, nope. That's good. So yeah I was going to say that's almost describing is when you're a child some of us are taught if you fail at first you don't succeed try again not taught figure out why right it's not take the moment to think about why and then it's just try again and so that is part of the aspect the second part of the question is basically if is it the benefits are misunderstood or the pain of change blocks people

Kyra Bobinet: Why they don't change or with respect to their effort.

Richard Zwicky: With respect to why traditional willpower models fail. Mhm.

Kyra Bobinet: So yeah, willpower models I think are failing primarily because we don't know that we have a habenula and they are therefore performative. That they're not taking into account that no matter what we think we might try to do we may meet with reality and then we have to change things as opposed to willpower would say, " I had the perfect prediction of what I was going to do and I just need to execute on it rigidly without any creativity, without any adaptability, right?" And so that just sets up a win or lose kind of scenario for us that I did or did not do it perfectly being defined as my, prediction that I was going to do it that way or I was going to lose 10 pounds in, 5 weeks or whatever the case may be.

Richard Zwicky: And that is a constant challenge for people because if you set absolute goals, you do set yourself up to fail because more often than not sometimes you'll succeed, but more often than not, things aren't perfect. And, we see it with people who go through relapses and, don't understand they're going to take steps forward and steps back, but it's what you learn along the way. Which makes you question is the biggest limitation on

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Richard Zwicky: How we address these things knowledge or infrastructure.

Kyra Bobinet: I think it's expectation. Just writing off of what you just said, if I know that the game I'm playing has a 1% chance or less of turning out exactly as I predict, then when things start to deviate from my prediction, my smart goal or whatever the case may be, then I don't expect to just power with willpower. I don't expect to just tip dip into that. That's one option. But I expect to adapt and have a plan B, C, D, E, all the way down to Z maybe. And I meet life where life is. And I have realistic expectations about what this is. I think the artificial layer is what's hurting people. The sort of you can totally do 75 hard and you can do, whole 30 and you can do all these things by just powering through, by just doing it, and it misleads people as to what the brain needs and also how to get out of any ruts or any challenges that they face. And so they're brittle to the challenges. They break immediately. Feel bad and give up and are spiraling into all kinds of coping usually negative.

Richard Zwicky: Unfortunately that's the trend, isn't it? That's part of the problem is our coping mechanisms are not healthy. And one of the challenges is to learn the appropriate coping mechanisms. We've had a number of discussion on this show about the fact that our brain is still primal and the technology in the world around us isn't and we're struggling to keep up and catch up. One of the things that comes out of that is our physical health and biomarkers are indicative of the challenges but we don't know to measure to understand what are the meaningful biomarkers that are physical that we could use to predict not just our current mental health but paths to healing. Do you think wearables and digital health center sensors will help with this or just create too much data that people aren't making sense of

Kyra Bobinet: That's a really good question because there is such a micro environment with the nerves that matter, right? There's the reward center, there's the prefrontal cortex, there's all these networks that work together, I could name more esoteric ones as well, but without being able to sample what's going on in that conversation, without having a probe to even be able to disrupt or change that conversation, then everything else is very phenotypical surface level observational, but I do think that observations that crack right into the core of that mechanism can be created. And one of my fantasies that I want to have the world get good at is really creating an infrastructure around detecting and neutralizing all kinds of habanula activity. Whether that is addiction loops that addiction behaviors that we see, our phones, that kind of thing. But also negative emotional veillances failure being a big one, frustration, disappointment, helplessness those kinds of things because those are absolutely strong indicators this habenular complex that the anti-reward pathway is active right now and that you are subject to if not right now very soon motivation loss and you can't get done what you want to get done in your life as a result. And so oftentimes right now as in a clinical setting, you're catching people too late. You're seeing them after they've had real world consequences to their relationships, to their career, to their own but I think that there's an opportunity to catch it at the beginning. Even this morning, I was using my phone too much and the YouTube algorithm that I use sometimes just draws real negative. I don't know if you've noticed this, but it just draws me into this doom and

Richard Zwicky: It does.

Kyra Bobinet: Gloom and I'm like, "Hey, let me find some of my subscriptions that are a little lighter. Let me look at the bald eagles sitting on their nest. Let me counteract like comedians help me." because it just starts to collapse on itself into this negativity and that's all habenular triggers for me for my brain and so I started to feel less well I started in real time I talk about the self-awareness I started to notice that my brain was not feeling strong or good positive or optimistic and I'm not a polyiana person I'm not saying that but I have this ability because I have a meditation practice for so long

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Kyra Bobinet: To really see what I'm seeing or see my thinking, so I was able to kind of pull myself out of that downward spiral and say, I need a different input here. I need different. So I stood outside. I live in the beautiful mountains. I sat in the sun for, minutes and played with my dog, watched the hummingbirds feeding, things like that to kind of counteract that problem. Otherwise, if I just let that fire burn, I'm absolutely confident that I would feel unmotivated today, that I wouldn't get anything done, that I'd have all kinds of no do gaps and the like. And so I think that what I want practice to evolve to is getting good at picking up in the first beginning stages where your brain starts to get triggered by hopelessness, helplessness, powerlessness demoralization, negativity, all those, family of emotions. How can you notice it and then intervene on at that level?

Richard Zwicky: Boy, we'll have to have a separate conversation offline because I don't want to go into the depth. Just something but you talked about people going outside and sitting down in the sunlight may or may not have a coffee or tea watching the hummingbirds played with your dogs. These are a way that you can take control of your emotions and apply and use the environment or other people sometimes to affect the context of what's going on around you to shape your own mental health and to shape your and it's shortterm, but it also is long-term in a compound way. What are the biggest mistakes people actually make when they're trying to change their habits? Because everybody's going to find a different place to enjoy the moment in the sun. You have to find the one that matters to you. But people grasp it. That worked for somebody else. Will it work for me? What are the mistakes they make when trying to change their habits? And to know when to actually do it.

Kyra Bobinet: There's only one mistake that I see which is trying different things. Giving up on iterating because my belief and my observation of people is that there's only two kinds of people. There's people who are continuing to try and I mean iterate meaning you said before you apply knowledge of what didn't work before to try something a little different how about if we do this or could it work to do that kind of experimentation creativity that adaptation kind of thinking and then people who just have some story that causes them to not do that this isn't working out for me. I've been there, done that. All the failure diseases that I list in my book and more because I've actually found a couple others since then that are add to the list, and readers have told me what their experience is as well. So I think that it's this fundamental can you neutralize failure thinking and can you iterate and that seems to be the separation path between people who do and do not build habits. Absolutely.

Richard Zwicky: In that you mentioned about the different people and the things you've come across. But of course one easy thing or not easy to resolve but easy to identify challenge for people is people who have severe attachment issues. And their brain is fighting against them out of fear, telling them to run away from situations that could be good. How can they begin to work with their brain instead of against it? Because they're fighting everything they've learned.

Kyra Bobinet: And I would say little by little, my daughter is going through this right now. And I don't think she would mind me telling you that my first husband, her dad has a very avoidant attachment style. And the girls didn't get the attention they wanted from their dad. And so they learn to be performative, be exciting, be dramatic or whatever to get his attention because he would just ignore them otherwise. And so when it comes to dating, it is so hard for her because she also had a trauma as a junior high student where she was texting a boy as a 13-year-old. She liked him, and then one day he said, "Haha, I've been pretending like I like you for months now, and I've been showing all your texts to my friends." And so she,

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Kyra Bobinet: You talked about the defense mechanism, she shut down. She doesn't want to text anybody ever again. She really has anx anxiety when it comes to texting back, even her mom, and so let alone a boy. And so what she's been working through is just how can I take it a little baby step where I'm outside my comfort zone and realize that I didn't die and then go one more inch and realize I didn't die. And still though the spectre is out there that at any point you can't guarantee that this is going to work out for you and so it is such a journey of courage and risk-taking and reassurance and integrating and self-regulating in between. I mean it is hard work. I'm watching it moment by moment.

Richard Zwicky: It is hard work and when you're in your position trying wishing you could intervene and help but you can't get inside their mind to actually help them. You can only model better paths forward or different paths forward.

Kyra Bobinet: I think the thing that I would say that she has picked up for me though is the figure it out iterative mindset I'm going to iterate here I'm going to figure out how to get myself to be brave. She kind of has that knowing of that and she also knows that when she feels anxious, it is herenula. So you talked about how do we work with our brains when we have these attachment challenges. She has a mental model that empowers her to realize it's her habenula that is trying to protect her. And that depersonalization gives her some space to be brave.

Richard Zwicky: Where we started in the conversation, how would you proposed to collect longitudinal data to help her see where she was and where she is today to understand and that you could talk about the changes that have been made and how it's affecting her. So she could look at it and say, "Based on that, here's where I'm going." How would that help?

Kyra Bobinet: I really Yeah. Yeah. I really like the work of Dr. And Laura Lump. Because I think that gets into experimental design and then also results of each experiment somehow feedback looping into directionally what to do next, and how to apply that for your next iteration. And I really like some of her tools that she offers in her book tiny experiments. And yeah, I think those kinds of tools, if you were to look at that and say, how can I create a quiz a tool that would help guide that process? I think that would be really help. I don't know if you're asking about that, but I immediately go to you build something like that.

Richard Zwicky: What would you want how would that as a practitioner benefit from that type of data.

Kyra Bobinet: I think practitioners have so much on their plate and are so locked into somebody once told me that especially with MDs that people don't change their practice patterns after residency they're kind of locked in and so change management is its own journey w with the clinical body right

Richard Zwicky: It is its own journey. Yeah.

Kyra Bobinet: But I did do a training recently with people on neuroscience of trauma And there's such a hunger out there in the mental health community for new tools for these sort of vexing problems of things that you feel like you don't have the right tools for. And they really appreciated knowing the science of the habenula so that they could really have the right view on what's going on inside of my patient or client's mind that's killing their motivation that's causing them to not form new habits even

Richard Zwicky: Heat.

Kyra Bobinet: Though we keep agreeing on what should be done right it doesn't get done and so how do I close that gap between that knowing and that doing for each of my clients and that to me goes back to that whole thing of the one-two punch or the onetwo medicine of turning off the habenula, neutralizing all failure and negative emotions that you can with releasing it, and then resuming or iterating your way out of the darkness iterating your way out of the hopelessness and being iteration coaches, if you will. Mhm.

Richard Zwicky: And we are running short of time.

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Richard Zwicky: So people want to learn more about how to become an iteration coach for themselves but also how to identify who they should work with from this scientific back perspective. They want to learn more through reading your book or learning more about you. How can they do so?

Kyra Bobinet: If you want to stay up to date on what I'm doing because this is the direction I'm going in terms of creating a community around this, so that when people invent new things they can be disseminated among clinicians and the clinician body but also people who are not clinicians but who are working on themselves my website is dr kyra babinet.com again the book is unstoppable brain I just invite people to stay in touch and this is all evolving you're on a path we're all on paths and we just need to kind of stay in communication and support one another through it Because we're all inventing and innovating in the right direction, I believe.

Richard Zwicky: And all the work supports each other because we learn from each other.

Kyra Bobinet: Amen.

Richard Zwicky: And quite honestly, everybody who has a breakthrough and shares it also helps others. And I think that's one thing that I've noticed is so powerful in mental health is people do share their stories to help others not go through the same pain. Kyra, thanks so much for joining us today on High on Healthy. Was a really fascinating conversation.

Kyra Bobinet: I'm so glad to be here with you.

Richard Zwicky: I look forward to continuing and thanks to everybody for listening. I'm Richard Zwicky and be back again with you soon.