The Data Gap: Why Neuroscience and Radical Humanism are the Future of Mental Health

Richard Zwicky: Everyone, it's Richard Zwicky with High on Healthy, the show where we know there's no one path to healthy, so we look at them all. If you haven't subscribed yet, please do so on Apple Podcast, Spotify, or your favorite podcast listening tool. Today, we're looking at the intersection of mental health, neuroscience, technology, and care delivery. And we tackle a problem that not enough people outside the field are talking about in clear terms, which is if we're trying to treat complex human behavior with incomplete and fragmented data, how do we get there? And my guest for this discussion is Dr. Justin Jack, who is a licensed professional counselor and founder of the human therapy group or human theory group, Dr. Duck has over 20 years experience working with children, teens, athletes, veterans, and high performing professionals. And he's now actually completing a advanced training in neuro feedback and psychedelic research through the California Institute of Integral Studies. Welcome aboard the show, Justin. Yeah,

Justin Jacques: Thank you I'm super excited to be here today.

Richard Zwicky: I'm looking forward to a really fascinating discussion and we're going to be getting into more and more of a series around the data and how do we use it in general on this show. We've been talking about lots of different therapeutic practices and challenges and theories. And one of the things that's arises with a lot of discussions that I've had with psychologists as I deal with so many on a ongoing basis through the show and through my business is the limits in self-reporting. And I know that's something from with your background what you've been looking at it's something that's a big concern because if you ask people how are you today the answers are inconsistent and in every area of business and our life we know you can't manage what you don't measure but if we're not measuring properly how do we measure so me and should jump to the question on that is mental Health relies so heavily on self-reporting, mood scale, symptoms, so on. But those are emotions. How do we deal with subjective terms when we're trying to get to standardization?

Justin Jacques: I think that's a great qu question I think it's really hard do people know themselves enough? Do they know their own vacasillations of emotions, And so I'm always using scaling questions, but it is self-report. It is inconsistent. And so I think as a field, we really don't have great tools to help us understand how somebody actually feels in any given moment. And so I think we are stuck in this kind of in between I either use one of my platforms and I send out a tool. My folks don't like to fill those out. They take a lot of time or I'm scaling in session which is what I commonly do, What's your depression? What's your anxiety? What's your stress? But there's humans are so complex that we're getting a lot of variability, And so if there was a solution where we could get something that's really objective that would be helpful. Maybe something like natural language processing ways to really measure people's self-report over time would be really helpful. And I don't know if that's a tool that's within my session and is observing right and kind of is noticing trends and how the person is reporting and then we could correlate that with how they're doing but I think we don't have a precise way of measuring this.

Richard Zwicky: Going to stop for a second. Can you get closer to the microphone?

Justin Jacques: Sorry about that.

Richard Zwicky: I don't if you have a headset or something you could use. You're just seem to be fading out a little.

Justin Jacques: I don't have a headset. I apologize.

Richard Zwicky: So, yeah, if you just stay closer to the computer, it'll help already noticeable. And we'll go back in a second with the next. So, on that point in your clinical experience where is self-reporting actually reliable and is it really that the value depends on the skill of the practitioner to decipher what the person means?

Justin Jacques: I think that's a great question, I think it does, how do you read people? Have you done the 10,000 hours being in the chair? It's going to make you better able to read. And also, I think this depends on who you're working with, If you have a specialty, you're probably going to be a little bit better at analyzing and understanding where somebody is at when they're reporting depression because, there's a lot of behavioral cues that you can be assessing for, right? We're looking at irritability, how irritable how, frustrated are you, right? These types of things can give us hints, especially with men, for example. So, I think we have some behavioral cues, but again, there's still a lot of subjectivity in there. So, I'm caught between using my tools, my scaling, and then kind of really assessing the whole person and

00:05:00

Justin Jacques: Making sure I'm listening for cues where I might be seeing trends. So, it's very imprecise in some ways.

Richard Zwicky: And one of the challenges that also depends and creates simultaneously silo data right which will affect diagnosis and treatment planning. And that challenge can be exacerbated where you've got your notes from therapy then medical records from the doctor. House somewhere else and you may or may not have access at certain points depending on what and then the patient is receiving data from wearable apps and also from digital tools which sometimes people Google a lot of things but Google is responding in a generic fashion and doesn't actually understand the full context of what you're dealing with how combating that's got to be frustrating

Justin Jacques: I think what happens is I really get incomplete non-connected data, So I got many people that I work with have whoops aura rings, So they're reporting that The question is that data correct? Right? There's some stuff that shows that maybe they're not with sleep, things like that. And then I have all these other providers that are not talking to each other. And what happens often is when I get stuck with a client, then I have to pull everybody together. Now I'm calling the physician. Now I'm, making sure that the right family therapy is happening, right? And so then I have to try to pull everybody together to make sure that everybody's on the same page. An example is this past week I have somebody going out for a neurosych val so now I'm talking to the psychologist but then now I'm self-reporting what I'm seeing in the session and then it's the clients self-reporting what they see they may not have good insight and awareness right and so it's a really complex picture to try to sort through all this to get to precise treatment if that makes sense Yeah,

Richard Zwicky: And on that we're talking about better data and as listeners know that's a passion of mine with my background analytics and the platform I'm building around one aspect of it. But when we talk about better data, what kinds of data do the neuroscientists and behavioral science actually need but aren't getting?

Justin Jacques: I think I want to know behavior change over time that is really precise. So, what I'm looking at is things like diet, exercise, nutrition, right? Things like that. Are you getting good sunlight in the morning? These are the types of points. I know that sounds like outside the box, but I think it's really important to know in terms of maximizing treatment is what is behaviorally happening, not just what's happening in the session itself. So, if I had that precise data, that would be extremely helpful to keep for accountability, right? And then help me adjust my treatment over time to be way more precise. So, I think a collection of holistic data from multiple data points that could even come from the psychiatrist, right? That could come from, if they're doing some sort of cognitive coaching which often happens in my group, if I had all those data points really precisely, I think it would make me an incredibly more efficient therapist in the moment when I'm working with my patients.

Richard Zwicky: As you went through your training with regards to neuro feedback and psychedelic research, can you explain how they overlapped and tie into this?

Justin Jacques: So another tool is neuro feedback. So you can do a QEG and then you can train somebody over time and then do another QEG. And so what that helps me do is notice whether their theta, alpha, beta or gamma waves are within the normal range for a standardized adult, right? And that can be another data point. So that can help potentiate the process.

Richard Zwicky: And what does it mean if it's within normal range or out of range?

Justin Jacques: So it means that you got to train it back into that range for the brain to work most efficiently or optimally. Now there is some variability. You're not going to love this. Brains are For different people. So we also have to take a lot of self-report, but we do have a better more precise map. Psychiatry, think about mental health. It's the only profession where we're not actually looking at the brain. We're treating just what somebody's reporting to us. So, it seems to be very imprecise. If you're like a radiologist, you're looking at the bone or you're looking at something that's broken, right? And then the cause for us we're guessing and so precision is super important and I think neuro feedbacks gives us another tool to actually look at the brain and what's happening 100%.

Richard Zwicky: I often I often use the ref referral point. You break your arm, they can set it in a cast and they can see it's what it is and what the wound is in the injury and deal with it. But when you have a injury inside your mind, trauma, abuse, or anything else, you can't see it. And doctors can treat what they see, but when they can't see it, we're working to figure it out, right? It's by observation. And that's not standardized, And that clinical perspective that's required to get greater accuracy, depends on the data, but a lot of it's unusable.

00:10:00

Richard Zwicky: What do we look at traditionally that maybe should be disregarded where people are actually self diagnosing using the wrong type of markers. Right.

Justin Jacques: I'm trying to think I guess a lot of people will just go online and read something go to chat GBT and they'll get some sort of description, The problem is that in mental health when you have one thing you often have four things right these things cluster over each other and the DSM is so imprecise right it's not based on science so then as a clinician we are kind of stuck in this matrix of trying to tease out and so somebody might get an idea about something and they come in and they really become that diagnosis in some ways right because they're convinced that they have it where it could maybe not be true so some of these tools or screeners online aren't always helpful. It might bring somebody to mental health treatment which is really good. It lowers like the boundary the barriers and increases helpseeking behavior which we like. But then trying to help somebody be precise about what's going on with them. Those can be confusing.

Richard Zwicky: One of the biggest challenges early on for somebody is to one admit there's something to deal with and the second is to be able to and it's incredibly difficult is to face what happened to them because those injuries they remain active inside of you until you're able to confront them and accept it happened in the past isn't happening today right so that adds a layer of the challenge but as I was listening to what you were saying just now the ruptures and repairs that arise through that process

Justin Jacques: It's awesome.

Richard Zwicky: How could we use and people self-describing people will go and they'll say I have anxiety but more often than not people who have anxiety actually have underlying depression right anxiety isn't a symptom of depression rather it is the challenge and people don't commonly understand it because they see the one in front of them and it's the easy one to understand how can data help detect this better so that even the layman who's saying I don't know why I'm struggling but I'm struggling can start if they're going to turn to a chat GPT or applaud or something else and ask a question how can they at least help themselves ask the right question so that they know what to talk to the therapist about more accurately or why they're going to the therapist

Justin Jacques: I think understanding how the diagnosis works right what are the components of it and then how they overlap with each other right because often when you have depression you're going to have anxiety too right you might even have a panic disorder as well right so I think understanding that these things are not just siloed diagnosis, but they're often so comorbid with each other. I think that's an important data point to know and then maybe expand on, okay, I could have that, and then maybe let's go to the therapist and let's tease this out a little bit more. He can maybe use some of his clinical judgment or maybe some other tools or looking at his QEG to more precisely come up with a hypothesis of what might be underlying a diagnosis, right? A secondary or coral weird piece of that diagnosis.

Richard Zwicky: And when we look at all of that it's really about personalizing the technology to help be a proper assistant right and it assists in that case it's assisting both the individual who the patient to help them understand themselves but also if it's done right is helping the professional by giving them more clues about directionally how to approach the individual. Where do you see the biggest opportunity in that personalization and what's missing? Right.

Justin Jacques: I think what I haven't talked about which is super important is where's the person in the stages of change, are they invested in their treatment? I find that people that find me that are really invested and really want to know themselves are going to be able to use those tools more effectively. Right? If somebody comes to me and they have an aura ring, they've got all the things and they love data, that's the person I love to work with because we're going to work as a team together to really fine-tune which tools are the best to use when and how we can get at the issue more quickly and effectively. If I've got somebody who's very not ready for therapy, some of these ideas are just not going to be something they're interested in, right?

00:15:00

Justin Jacques: And they're going to be apathetic. And think about depression, anxiety. Often that's going to be a barrier to using these tools that would actually be very helpful in the treatment to be more precise.

Richard Zwicky: I mean any opportunity for personalization I look at as long as it's accurate is a step forward. And one of the things it also allows is for us to confront ourselves in better ways. And confront isn't a negative. It's actually as you talked about self-awareness, understanding oneself and how we present ourselves in the world. But that sort of data should allow us to help with relapse prevention. How in your studies, how have you looked at that?

Justin Jacques: I feel like I describe it this way putting those mental health guide rails on in your life are so important, So I have somebody that I just met with this morning who's sober over a year which is just fantastic. But now what we're doing is making sure those guide rails for mental health. So having those datainformed tools that's like Am I connecting with my partner? Am I doing those things that are going to keep me on the path is so important for relap prevention. Right? It may happen. But if you have those guide rails in place, that holistic picture that's going to really help with having less chance of having those types of relapses.

Richard Zwicky: And to those guardrails are critical and they depend on good data, objective data and enough data. A lot of tools, the app marketplace around mental health, there's a lot of tools out there and coming I'm looking at stuff from an analytics perspective and so much of it looks like whack-a-ole to me. I'm going to get this tool. We're self diagnosing and not helping ourselves in that way because we don't know what the right tool is for the situation we're dealing with because we don't have that visibility. It's scary when we're building powerful tools on weaker and complete data and behavioral. What would responsible integration of AI tools and data into mental health actually look like from your perspective?

Justin Jacques: I think That's a great question I think there's so many new things out there, it's hard to know what to trust, I mentioned sometimes maybe an aura ring or even like a Whoop could be a little bit off in terms of some ways. So, I think having technology that has studies behind it that has worked for years and I think it's hard to do that right now because things are coming out so fast. However, I would go back to my earlier comment that I have a number of people that really love certain apps and tools because it works for them and then it's something that they'll use, And I think that's a key component to it. Whether the data behind it, I'm not sure, You'd hope that there was really solid data that these tools work, but I think a lot of that is a black box to us therapists too as well as the clients that we work with. We have to trust that they've done the studies, they've looked at this, and this is effective. But like you said, we're trusting right in some ways. Yes.

Richard Zwicky: It's not and when I say about whack-a-ole it isn't that the tools are bad it's that matching the right tool to the right challenge is tough, a lot of the tools spend a lot of money and invest heavily in how do you treat, let's say anxiety since we've talked about that or anything else there. If you have that challenge it helps you through that moment. But getting to the underlying issue is a different piece because it's not just helping you manage in the moment. Just helping you get to the point of being able to address it and overcome it permanently. And how do we balance measurement and meaning with so data without dehumanization in that context, right?

Justin Jacques: I mean I think it's a both and, the data is extremely helpful but I call myself a radical humanist therapist right like the human experience is crucial so for them to be seen and heard and to be validated and challenged is a very fine line to so I'm bringing the data in because I want to be efficient I want to be effective I want to be doing evidence-based practice but I also have to realize that my understanding their lived experience is essential with change I thought about it this morning I was talking to somebody and I went to solving too fast, They needed to be heard for a while.

Richard Zwicky: I do that all the time. My kids and get annoyed. Yeah.

Justin Jacques: It happens. It's so natural that as humans, we want to problem solve, but often they need to be listened to first. So, in order to use data effectively, the person still has to be heard. What is that anxiety about? Let them talk it out. There's some much catharsis. Putting your thoughts, feelings, and emotions just into words and holding that space is a sacred thing that sometimes data doesn't actually get to. Maybe. I'm not sure.

00:20:00

Richard Zwicky: And it's a challenge because the ACE study which is the study to adverse childhood experiences has 10 questions with regards to trauma abuse you may have suffered before but in your formative years. But you add in gender and age and two other factors. You can choose orientation. You can use ethnicity. You can use any number of things. Language spoken and you get to 14. You can combine that 265 billion different ways for one individual. That person's experience leading up to that moment. That's too much data for one person to process. And yet a therapist is sitting there looking for the clues to untangle those threads to understand here's where the person is. But you're trying to coax the person at the same time to open up and explore while you're trying to unbundle. How do they think? Because that's just 10 factors. We have all the other factors, the hundreds of different ways we can ask and build those questions. That skill level of a therapist to be able to listen and unravel the individual. What's the data that could help you and as a clinician get there faster? What could if somebody were sitting down with a therapist, they've gone to therapy, it hasn't really worked or they're thinking about trying for the first time, they don't know how to make it more effective. What are the sorts of things you think you wish patients would talk to faster? Not about the trauma, abuse they experienced, about them.

Justin Jacques: I think the first thing I would say therapy is weird in that we have the presenting issue that we start with right and they come to so it's about me reacting to that but also knowing what's around that and then what is the sequence going forward right so I think if I knew that there was a particular sequence of solving the problems in an order that would be most effective I think that could be really helpful because often we think about the goal the task in the bond, So, what's the goal of the therapy? What's the task that we're doing in the session? And I'm always working on the bond, right? I'm building that bond,

Richard Zwicky: Why is that?

Justin Jacques: But it's not always efficient, So, it can be a meandering stream. And the other piece that I would love to know is when ruptures occur. My research for my dissertation was in ruptures and repair in the counseling relationship. So, therapists are really bad at knowing when ruptures happen, And so, sometimes because that's a great question. I think it's because we just don't notice. We want to have a positive relationship, but it can be really subtle. A withdrawal rupture can be extremely subtle and people don't catch it, right? Confrontation rupture is a little bit easier because somebody gets mad or they say something, but therapists that are really effective, they can attend to a rupture and help repair it and that makes the therapy way more effective. So what we're seeing is often in training and things like that, people don't recognize ruptures. And that can mean that and this happens to me all the time when people come and they shop therapists, they come to me and they say, "Justin, I saw this three people and they were not good. They just said the same thing back to me that I said to them, right? They were a parent." And I say that's probably because the therapist was not recognizing withdrawal ruptures and other types of things that then wastes a lot of time, energy, and money." So, I think a tool that would be helpful would be one that recognizes those types of events in a session.

Richard Zwicky: That would be it because the therapist is so focused on what the patient's saying in the moment. There's the subtleties of the interpersonal relationship with that individual that sometimes get overlooked. Not because they're not important, but the focus is elsewhere.

Justin Jacques: That's right. As a therapist, we're juggling processing content all the time. It's really hard to be in the process and then you're thinking about What's the theme that's leading me to the most effective approach? So managing those two is really hard. It gets better, but then you can miss things like ruptures if that makes sense.

Richard Zwicky: No, it makes absolute sense and that goes also to the fundamental issue with self-reporting because not that the therapist is not self-reporting it's the patient self-reporting isn't saying hey this isn't working for me and this is why right people feel they start building the walls and the barriers which gets them back into the negative cycle again which is unfortunate all around Yeah.

Justin Jacques: And I think that's really I don't mean to interrupt you but I think it's really hard with men. I mean, I find that often with men, the first 10 sessions is just getting comfortable enough to actually get to the issue. Does that make sense? It's just not a men do life side by side.

00:25:00

Richard Zwicky: We're men are trained to suck it up,

Justin Jacques: We don't do it. Yeah, that's right.

Richard Zwicky: Right? Hide it.

Justin Jacques: Men do life side to side. We fish together, things like that. We don't sit in a session like this with each other. So, it often takes a long time to get that wall down. I've had some people six months, especially some of the more hyper masculine men where I've just had to wait it out. And that's not efficient because we're not getting to the issue.

Richard Zwicky: But it speaks to the challenge that is still more than 50% of men don't have a close friend to talk to. And when you don't have a close friend to talk to, you don't even know where to begin. And how do you then open up to somebody who's effectively a stranger who you're going to for help, but you don't know them well enough to understand they're not judging you And that is fundamentally the issue. You think you're being judged and you start building the walls.

Justin Jacques: And we have a culture where we men don't talk about feelings, And so we're always oneupping. So to be vulnerable, that's scary. And this is a stranger that you have to be vulnerable with. Wait, I got it's going to take a while.

Richard Zwicky: And that's why it takes a while to build those relationships in the first place. And unfortunately, those walls can pop back up quickly. And it's different for women.

Justin Jacques: I would say yes. I'd say that in some ways women are a little bit more open and kind of come to session. This is just my lived experience as a therapist, but yeah, often they are a little bit more open initially and it doesn't take as long to get to the work as I call it the actual core issue.

Richard Zwicky: I mean, women are not trained to hide their emotions the same way from childhood, but there still is a there's so much misogyny in the world. There's that fear which is hard to overcome.

Justin Jacques: So, I mean, I think it also matters who the therapist is, are you open? Are you pleasant? What's your voice, tone, and intonation? All of that stuff matters when you're working with somebody of the opposite gender.

Richard Zwicky: And some of that is subliminal. It isn't conscious, which is a hard part, right? And that's if you're not clicking with your therapist, you should have that open conversation because they want to help you find the right one. Yeah.

Justin Jacques: But as a therapist that's terrifying sometimes, you have to really be brave and come out and say, "I'm noticing this isn't going well or I'm noticing this hesitation right now. You have to really take a risk and put something out in the room, risk for the mill, as they say in psychotherapy. And that can be really scary for the therapist. So often they don't address it right away. And I think that's another way therapy could be from a data perspective more effective is helping therapists address issues Instead of letting them sit.

Richard Zwicky: Justin, we are running out of time for today, but people want to learn more about the human theor theory group and your own practice and reach out. How can they do so and how can they learn more?

Justin Jacques: My website is www.human theorygroup.com. You can reach me on there. I also have a psychology today but yeah, I'm always interested in talking to people. So please reach out. I have a research line. I do corpus linguistics research. Again, as I mentioned, my research is on ruptures and repairs and the counseling relationship. I'd love to talk to anyone who's interested in that line of research.

Richard Zwicky: And I'm sure that also is a great opportunity for other therapists to speak to somebody to help them understand ways to repair or

Justin Jacques: Awesome.

Richard Zwicky: When they're stuck and wondering about is something going sideways. There's a lot of So, thanks for joining us today on the show, Just it was excellent.

Justin Jacques: Thank you so much, Richard, for having me. This was a really fun conversation.

Richard Zwicky: And thanks to everybody for listening. I'm Richard Wiki with High on Unhealthy and we'll be back again with you soon.