Dr. Mark Aoyagi Trains the Carrara Clinical Team on Mental Health as a Trainable Skill

0:00 All right, so everyone, we're pleased today to have Dr. Mark get me right on this. Aoyagi. Aoyagi. Aoyagi. Okay, from the University of Denver, who is a sports psychologist who has a practice of working with elite athletes on high performance. And so he's going to speak to us today about the psychological elements of his art and craft. I'll turn it over to you, Dr. All right. Well, thank you, Patricia. And first of all, Mark is fine. I know we're all, we're all clinicians here of some way, shape, or form. Well, I want to say a couple things first, just by way of introduction. You know, identity is always, I know it's something that's key to all of our work and it's something that, you know, it's funny, the ways that we introduce ourselves and how we sort of identify in these types of professional settings. But I always like to start with, I'm a father, first and foremost, I've got two daughters that are 10 and 13 and you know, kind of my literally my life revolves around them because I'm their uber driver so That that's that's the most important part of my identity and and really where I'm striving to be the best in my life right now and In the context of performance. I think that's an important thing to have is what are your priorities?

1:16 What are your values and you know, what's what's kind of your true north to be able to understand? Where you're going in if you get there, so So I'll start with that. And then as Patricia said, I have a role at the University of Denver where I'm a professor. We have a master's program in sport and performance psychology. I actually founded that program almost 20 years ago now, which is kind of odd and scary and probably a lot of other things. And then I also have a practice where I think Patricia mentioned that work with the Los Angeles Dodgers. And that was kind of the main reason that Richard reached out to me was my understanding. And so I kind of structured this presentation around my work with them. Given that we have a relatively small number, what I was really hoping for is to have it be more of a conversation than a presentation. So, you know, I've got way too much information actually to share, so I'm gonna pick and choose a little bit as we go, but please, if you have questions, if you wanna slow me down or speed me up, you know, there's gonna be things that I'm gonna cover that obviously you'll know as much about as I do.

2:20 But really encourage you and invite you to make this as interactive as you can through, you know, just feel free to pop on with a question or raise your hand or whatever Zoom techniques you want to use to enter into the conversation. With that, I think I'll share my screen here. You can see my screen okay. Yes. Okay, great. All right. So, I'm going to start with a story here, and you all, I assume, already know the ending of this story. Um, which is the Dodgers won the World Series. I'll take you back in time a little bit here to game three. So if you recall game games, one and two were up in Toronto. Um, Dodgers lost the first one, one, the second one, which is what you're hoping to do in that situation is basically get a split. So game three is first game in Dodger stadium. Um, Dodgers are a great organization. So they, they, um, give all their, uh, staff and employees the opportunity to go to the World Series games, the home games.

3:20 So I was there for this 18-inning, six-hour-39-minute game. And I mean, we were all, so the staff kind of sit together, and we were all basically speculating that whoever won that game would win the series, because just the way that it was lined up after that and how long the game was going and so forth. So Dodgers end up winning that game. You can see, if you don't recall, how crazy that game was. And then, for game four, we have this guy named Shohei Ohtani scheduled to start. Which was among the reasons why we figured if we won game three, we would be in pretty good position to win the World Series. As you likely know, that did not happen. At least we didn't win game four. No problem. Game five, we've got Blake Snell on the mound. I think at that point he had like a .7 ERA or something during the playoffs had been pretty much untouchable. And then, oops, we lose game five as well.

4:24 So now in a seven game series, you can see that Blue Jays are feeling pretty smug at that point in time and Dodgers were not feeling so great at that point in time. So I'd like to take you into the clubhouse after game five. I would just ask you to reflect on what do you think was the mood in the clubhouse after game five? And if there's enough of you here, feel free to share. I'll just put a few questions up here. What were the players thinking and feeling? And how confident do you think they were going into the remainder of the World Series here? Well, a little shaky intense, I would say. So I'll share one kind of behind the curtain secret with you, which may not be that much of a secret. But the reality is working in professional sport, for the most part, fans take wins and losses a lot harder than the players actually do. And one of the reasons for that is, especially in baseball, the players know there's another one tomorrow.

5:28 Whereas the fans don't necessarily have that perspective and haven't had that experience throughout their life if they have not been that type of a performer in their life. So one thing is, of course the World Series, there's a little bit more on the line there. It's a little bit more of an event, if you will. There's a bit of a debate in the sports psychology world whether you should approach something like the World Series or the Super Bowl as just another game or as like the big game. And I won't get into that for now, but just know that that's out there. But the common narrative is this idea of the best athletes, the champions, the gold medalists, they always believe they're never down on themselves, they're always positive, yada, yada, yada. Well, I can tell you, after game five, of course there was dejection from the immediate aftermath of the game. That's normal. That usually goes away pretty quickly. But they're recognizing that they're down 3-2 and they're going back to Toronto for the last two games of the World Series.

6:29 So in terms of how confident they were that they would win the World Series, not at all. There was not a person in that clubhouse that would look you with a straight face and say, yes, we're gonna win the World Series right now. They pretty much figured that they had lost it. So I'm assuming that this may be a different idea than what many of you might have thought would have been the case in that clubhouse and what I might be sharing with you as a sport and performance psychologist about the psychology of high performance. But it takes a radical honesty to be an elite performer. And the players and the staff in that clubhouse, if nothing else, they're honest with themselves and they recognize that they were not in a good situation. They were not in a good position to win the World Series. And they were honest about that. So I think you can probably see the next questions I have there. What do you think they needed or would have benefited from at that time? And what would you have done? And again, this is for people and you all being clinicians, you may have a little bit better idea of where I might go with this. But the answer is nothing.

7:33 They didn't need anything in that moment because they're prepared. So what they had in that moment, they didn't feel great, they didn't have confidence, they didn't have a feeling, a belief that things were gonna work out the way that they wanted beyond a general optimistic framework. But for this specific scenario, they were not thinking that they were gonna win World Series. What they did have were championship habits. The quote here that I have up is, we don't rise to the level of our expectations. We fall to the level of our training. What I want to emphasize throughout the rest of this presentation is the idea that mental health is a skill, just the same as the physical skills that they use on the baseball field are. And in order to have the skills be ready for us when we need them and when we want to use them, we have to train them on a regular basis and develop that skill. So what I'm going to spend most of the rest of my time talking and presenting on is how I teach mental health to the Dodgers. So literally next week, actually literally a week from today, I'll be down in Phoenix with our, if you follow baseball, they just had the amateur draft. And so we've got our new draft picks that are that'll be coming into what we call draft camp down in Phoenix next week. And so what I'm going to share with you now is literally the presentation that I share with our new draft picks to orient them to introduce them to how we do mental health in the Dodgers organization. And again what I what I hope you'll take away from this and hopefully will be useful for you in your work with your clients is this idea of mental health being a skill. And while I think that probably resonates with you all and maybe you already do some of this in your approach to treatment and support.

9:20 Hopefully, the way that I introduce it and the examples and references and reinforcement that I give for this idea will have some utility for you all. I was going to do this thing on mental routines, superstitions, rituals and routines. There's a lot of all of these in professional sport. The short version is superstitions are things that we think help us perform better but actually don't have any direct impact on performance. And then the other way that we say it is that superstitions control us rather than us controlling the superstition. Rituals are just a sequenced series of actions that you engage in. So, you know, taking a shower, you probably do the same thing each time you get in there. It's helpful in that it frees up mental space to be able to focus on different things. So basically what a ritual does is it takes the need for cognitive effort out of that series of actions, but it doesn't necessarily make us better at those actions. A routine, as you can probably guess at this point, is something that actually does make you better prepared to perform whatever the task is at hand.

10:28 So again, if we look at that control dimension, a routine is something that the player controls rather than the routine controlling them as the superstition does. So all that is to say that what we want to build, what my goal is with the Dodgers and I think what you, again, may already do, but hopefully might have some more incentive to do with your clients is to help them build mental health routines that actually equip them with daily actions to get better at the skill of mental health. Okay, so this is what I present to the Dodgers right off the bat. New draft picks, kind of their first introduction to the team, what we're all about, and our culture around mental health. So I start out with first principles. What are the first principles of mental health? First one, relationships are the most important aspect of mental health. Relationships are the most important aspect of mental health. And so I get into, this is where I would introduce myself to the team, my background, personal background, professional background, some of the teams I've worked with and so forth. I won't bore you with all of that. But then I want to go get straight into this idea that mental health is a trainable skill. And so, introduce them to the idea. So, just for context, as you can probably imagine, these are all young men. They're very physically oriented. They're action oriented. They're doers. They don't spend a lot of time pondering the meaning of life.

11:56 You know, they don't have a great, and obviously I'm painting with broad brushstrokes here. But again, they're physically oriented. They're not as mentally and emotionally oriented as some might be. And so what I'm trying to do is appeal to that, right? To make this parallel between the way that they got here, physically, and the training that they did physically applies to the mental and emotional realms as well. So we talked about, there's only three things that you can train. You can train your craft. We've been doing that for about 100 years, learning how to be better at what the things are that we do, our craftsmanship. Second thing is you can train your body for about the past 50 years or so, exercise, physiology, biomechanics, and so forth have helped us to understand how to get better at training our physical body and our physical craft. And then for about the past 10 years or so, we've understood how to train our minds. And we used to talk about training your mind was a competitive advantage because people weren't investing as much in that area.

12:59 What we now know is that, again, at the elite professional sport level, if you're not training your mind, you're falling behind. So it's no longer a competitive advantage so much as it is a necessity. And now, I like to get right into giving them, again, these are physically oriented doers. So I like to give them examples of in the moment, how can they work with their mental health? So pop quiz, what everybody loves. Let's see if this will work. I need to do the presentation here to get the animation going. So, you have this experience. Your heart rate and breathing are getting faster. Your palms are a little sweaty. Your body temperature is rising. You need to go to the bathroom. So, pop quiz.

14:00 What do you call this? What is this state or what is it that you're experiencing? Anxiety. Anxiety, yep. Most common answer. I know there are a lot of other people, at least on video, but Oscar, do you have any ideas of what you might call that? Sorry, what was that? This state where, I don't know if you can see the animation on the screen. But yeah, your heart rate and breathing getting faster, palms sweaty, body temperature is rising, you need to go to the bathroom. What do you call this when you experience that? Stress or anxiety, basically, right? Yeah, Rachel. I was gonna say fight or flight. Yeah, okay. So yeah, this is all where the common answers that people give to this question. How about excitement? So physiologically, which these are all physiological symptoms, right? Physiologically, anxiety and excitement are exactly the same.

15:04 However, it makes a huge difference on if we label it, anxiety or excitement. So the way that we talk about this in performance context is challenge versus threat. So the important thing, well, among other important things here is how we define challenge versus threat. So a threat state is when our perceived demands exceed our perceived resources. That's the threat. And what happens in a threat state is downstream from that. So downstream from that psychological understanding of are the perceived demands greater than our perceived resources. If we go into that state, then anxiety increases, heart rate increases, heart rate variability. If you're not familiar with that, you can think of it as kind of like efficiency. So how efficiently your body is using the blood flow goes down.

16:06 So heart rate goes up, efficiency goes down. Our vaso, so we get peripheral vasoconstriction, so that means peripherally, like in our arms and legs, those, that vasculature constricts. And so basically what it's doing is it's shunting all of that blood back to our primary organs. It's preparing us for an injury. And that's where, if you've ever had that feeling of your pulse pounding in your head, that's what's going on there, is you're getting that constriction of this rush of blood. Okay, so that's what happens in a threat state if we perceive that the external demands exceed our personal resources. Now, on the flip side, if we perceive that our personal resources exceed the situational demands, we go into a challenge state. In a challenge state, our cardiac output increases, so heart rate increases even more than in a threat state, But now our heart rate variability increases. So now, and we get peripheral dilation.

17:08 So now the blood is rushing to our limbs, it's preparing us for action. So rather than going into a threat state and preparing for injury, we're now preparing for action to take on the obstacle or the challenge that's in front of us. We're better able to focus testosterone increases. There's all sorts of stuff about testosterone, but from this perspective, just think of it as it's a moving towards, right? It's a preparing to do something. So, what, so this choice of, and again, I'm emphasizing choice and perception, right? This choice of whether we view the thing in front of us as a challenge or a threat has a huge impact on how we're actually able to respond to that challenge or threat. In a threat state, we shut down, we protect ourselves. In a challenge state, we get big and we approach the thing. So the kind of the pithy way to say that is our psychology drives our physiology. The choice that we make with our psychology drives our ability to respond to the situation. Now I'm hammering you all with this from like this physical perspective, but what I would argue and again, you tell me how you feel about this.

18:11 I'm actually really curious how you feel about this. But if we look at the key mechanism in all of this is our perception of our personal resources versus our perception of what the situational demands are, right? There's no objective truth here. There's no objective truth here. It's how we perceive our resources versus how we perceive the situational demands. I would hypothesize, again, I'm curious what you all think about this, but I would hypothesize that a big driver of addiction and substance abuse behavior would be not perceiving the personal resources to meet the situational demands. Therefore, substance use becomes a coping mechanism. I'll let that hang out there if anybody has any thoughts. I like to call it a lethal lack of imagination. An impairment in imagining what are my other options or resources. Yeah, completely. Jack, yes, I can come on.

19:16 I was just thinking reservations, you know. Say more, what do you mean by reservations? When patients come in with reservations, you know, they're not coming in with that perception of themselves is maybe tainted by something that they're caring that isn't true. Yeah, oh, I see. Reservations are doubts about themselves. Yes. Gotcha. Yes, absolutely. Yeah. Now, and I said there is no objective truth to this, which is true, right? Perceptions are our choice. That being said, it's more helpful if they're grounded in some reality, right? We talk about you have to earn the right to be confident, meaning that you have to to engage in the actions to build your competence so that then your feeling of confidence is connected to something real. So there is that side of it, but again, perception is our choice. Okay. So the next thing I talk about is then what are the characteristics of elite performers?

20:16 What are the kind of the psychological and personality characteristics of elite performers? And I give the caveat here, right? None of this is diagnostic. I'm not diagnosing or using any of these terms in the clinical sense, but as we all know, these behaviors occur on a continuum, right? And so elite performers tend to have just enough anxiety, just enough OCD, I know you all know what these mean, so I would kind of define and describe these terms for the players, but I won't do that with you all. So just enough anxiety, just enough OCD, just enough perfectionism, just enough narcissism, to be the top 1%. So it's It's a volatile cocktail, right? When they get it right, they perform great. But as you might recognize with a lot of the photos of the athletes here on the screen, a lot of times their life outside of their performance domain has a lot of chaos involved, as you could imagine, from these sort of personality and characterological traits.

21:19 So I share this with with our athletes and I'm guessing that you see a lot of these same traits in substance abusers, right? Because these are the traits of people that are trying to get after it. And they have an addictive quality to them, right? I would argue that elite performers are addicted to something that is maybe sort of healthy or at least functional or probably the best way to say it is that at least they get rewarded for doing it. But as I said, a lot of times their lives outside of that thing are not very healthy and you can see why from this cocktail. Does this sound familiar to the folks that you all work with, these traits, these characteristics? Yeah, and that would be my assumption. I did, I meant to say this in the beginning, I did work in, during my doctoral program, I did a year at an inpatient substance abuse treatment in rural Missouri, right, it kind of the, wasn't the height, I wouldn't say, I would say it was the early adopters of the opioid crisis. So, but yeah, you know, saw a lot of this as well, not in the depth that you all do.

22:26 Okay, so what does that mean? So from here I go to how do we define mental health? You know, going back to, you know, kind of how I started this with talking about identity, how you think about the thing makes a big difference on how you experience the thing. And so if we don't know what we're talking about with mental health, it's hard to know where we're going and how to get there. So, and I'll go through this pretty quick with you all, because again, I think probably we're on the same page here. There's probably some nuance to how I do it that I would assume is a little bit different than how you talk about it with your folks. So, is mental health the absence of mental illness? Hopefully you're all nodding your head and saying, nope, that doesn't capture it, right? There's more to it than that. So then, is it about happiness? Is it about feeling good? This can be a provocative one, right? But I would argue that if, and really what we know now from psychological science is the more that you pursue happiness, the less likely you are to get there. And so I would argue that, well, happiness, satisfaction, meaning those are probably wrapped up in mental health to view those as the definition or the objective of mental health, I think is problematic.

23:36 So I'm gonna scratch that one off the list as well. I just said satisfaction for the same reasons. I would cross off satisfaction. So then what is it that we're going after? Again, here's how I define it for the, you know, call it 20-year-old men that I'm working with just to give them something that they can relate to. And I call it the capacity to get after it, whatever it is for them, right? To have the energy, the resources, the confidence, the capabilities, to do what the things that are important to you, the things that you value. So importantly, along with that, is it is not about feeling good all the time. And in fact, the more that you are going after it, the more that you are trying to accomplish, achieve, push for, strive for in your life, the more quote unquote negative emotions you'll feel because you're putting yourself out there, right? You're being vulnerable. You're taking risks. You're putting yourself into the arena in that, you know, that famous, well, Brené Brown didn't have the quote, but Brené Brown kind of made the quote famous, right?

24:40 the person in the arena. And you'll notice here I have negative emotions in quotes because one of the things that we'll get to later on is that what we really want to be able to do is work skillfully with all of our emotions. So the idea of labeling emotions as positive or negative to me is not helpful and in fact gets in the way. I would, again, imagine that we're on the same page here but I like to use the language of workability rather than positive or negative. So is this emotion helpful right now? If you have a lot of anxiety and you're just kind of going about your everyday life, maybe that's not so helpful. If you have a lot of anxiety and you're walking in the woods for the first time and you don't have any navigational skills or anything like that, anxiety is probably a pretty helpful thing to be feeling at that point. So anyways, all that is to say that this idea of positive and negative I think is not helpful. Okay. So, mental health is a skill. I got to see if this will play. Practice?

25:41 We're talking about practice, man. We're talking about practice. We're talking about practice. We ain't talking about the game. We're talking about practice, man. So my references are getting a little old and dated, but famous clip from Allen Iverson emphasizing practice. But again, this is trying to speak the language of the audience that I'm speaking to, right? So they understand what physical practice looks like. It's daily, it's intentional, and it's structured. And so I'm gonna make the case that mental health is exactly, it works exactly the same way. To develop the skill of mental health, you need to have daily practices for mental health that are intentional and that are structured. And then I offer them a framework for that. So the second, first principle, first principle, relationships. Second, first principle, mental health is a daily action. All right, what does that look like? So mental health practices, sleep, exercise, eating, recovery, meaningful relationships, gratitude, purpose.

26:45 Obviously you could add a lot of other things onto here, but these are the ones that I emphasize as kind of the foundation for our folks. On sleeping, exercise, and eating, I go through this pretty quick with them because they have nutritionists and physiologists and things like this. But basically, in terms of sleep, trying to go to sleep and wake up at the same time each day, having some consistency in your sleep-wake cycles obviously is very beneficial for your mental health. With them I don't emphasize the time of it because they have pretty structured parameters around what they're doing there but as you all likely know it's somewhere in the window of seven to nine hours on a consistent basis. Exercise again I don't need to emphasize this too much they have strength and conditioning coaches and so forth, but the big time where the most frequent or common time when they're experienced mental health situations is when they're injured. And one of the reasons for that is because a lot of times their ability to physically exercise and move their body can be limited or taken away from them.

27:54 So I emphasize that time period with them, but again, as you all know, and as I'm sure you emphasize in your work, if physiologically, biologically, you're not right and meaning that you don't have a foundational exercise practice of movement, it's really hard to get your mental health right. So foundational piece of mental health there. And then eating, again, they have nutritionists and so forth, but just the idea of garbage in garbage out. If you put crap into your body, you're probably going to perform like crap. If you put better stuff into your body, you're probably going to perform better. And you know, we don't need to get into that a whole lot. I mean, we can if you want, but okay. So the one that I spend the most time on with them is this recovery aspect. And again, these are people that physically, they know how to get after it. They're doers, right? And so I give them this equation, stress times rest equals growth. So they get the stress piece, right? And part of this here is also reframing the word stress, because we think about mental stress and with that, we often think of anxiety and with that, we think of negative consequences.

28:54 There's some, and you all are probably familiar with this, but just to share with you more of this performance perspective that I come from, there's some really fascinating research around how we perceive stress, so there's that word again, right, perception. How we perceive stress is the driver of what the outcomes are that we get from stress. So athletes get this on the physical side, right? They understand that when they're in the weight room, when they're working out, they're physically stressing their body. And they understand that that's a good thing. That's a helpful thing if they get the rest in, right? If they don't get the rest in, they don't get the growth. They don't get the development. But I think a lot of times, and I think our field is guilty of this as well, is that a lot of times we view mental stress or emotional stress as inherently bad. And again, I'm probably preaching to the choir here, but the reality is what the research shows is that if we view, if we perceive mental or emotional stress as negative, then yes, we get negative outcomes.

29:56 We get sick more. We have immune system dysregulation. We have an increased chance of mortality, like literally dying. However, if we perceive, again, it's just a perception, if we perceive mental and emotional stress as beneficial, then we see the flip of that. We actually see less lost work days, better immune system functioning, and actually in a longitudinal study, they actually had lower mortality. So the lowest mortality, it was one of those quartile, so one axis was stress, high or low, and then the other axis was perception of stress, negative or positive. So if you were in the high stress, but positive perception of stress group, they had the best outcomes across the board, better than the low stress positive perception of stress. So what we see here is if we perceive mental and emotional stress and physical stress as helpful, we get benefits from it.

30:59 Same as this equation, stress times rest equals growth. Okay, so the outcropping from this is they're going to get the stress in the professional sport environment and in the lives that the folks that you work with lead. They're going to get the stress. The question is, are they going to get the rest and do they know what rest is? So I kind of flipped through this real quick and again, I'll just go through it with you quickly. And I just have them say, you know, is this recovery or not sleep? Pretty obvious one. Yes. All right. Here we go. Using alcohol or other substances to unwind. Hopefully you're all saying, nope, not recovery. All right. Gaming video games. Again, I work with them. Now here we can start to get a little bit more nuanced, right, in terms of what type of recovery do they need. If we're talking about physical recovery, yeah, maybe they're getting some decent physical recovery with video games.

32:00 Are they getting mental or emotional recovery? Not a chance, right? Overstimulated in that regard. Social media, same deal, right? Maybe some physical, although we see some pretty extreme cortisol and other responses so probably not a good recovery along any dimension. Marijuana, most common substance, you could probably guess that our players and staff for that matter use marijuana. They'll espouse the recovery benefits of it. We have sleep specialists that come in and all that. What we know is that THC impairs the sleep architecture, so you might be unconscious, but you don't get the benefits of sleep. CBD, there's a lot of, it just hasn't been really well studied. The best that we can tell is CBD does not harm sleep. For some people, maybe there's some benefits, but it's really hard to say for sure.

33:01 It's also really hard to find a pure source of CBD that doesn't have the THC with it because anyways. Y'all probably know this better than I do. Okay, again, remember my demographic. These are young men. So we've got to cover all the bases. So we get, you know, I got to make sure that they're awake as well. Sex, you know, okay. Other thing they love to do is gamble, play cards. Again, mental and emotionally, not at all. Physically, maybe some. Netflix and chill, they're wise enough to know that the ice cream part of this isn't great for them with their nutritional habits. But again, screen time, maybe, maybe not. If we take out the ice cream, is just Netflix okay? Maybe, you know, depending on what you're watching. But is it the best? No, not really. Okay, so what's better? Listen to some quality music, music that, you know, you relate to. It doesn't necessarily need to be quote unquote relaxing music, but just something that sort of gets you out of your head and into a different state of mind and into a different experience.

34:10 Obviously connecting with family, friends, loved ones, great recovery activity, prayer, meditation, mindfulness, great options. So again, just a quick summary of what's recovery, what's not, yes to sleep, mindfulness meditation, prayer, music connection, no to alcohol, marijuana, video games, social media, gambling. This is just the populations that I work with and where they're at in regard to these dimensions. Okay, relationships, gratitude, and purpose. I don't think I need to say much about that with you all. Just the idea of having people that you can actually talk to and have a real conversation with about the hard stuff. Gratitude, I'll talk about that more in just a second with some of our routines that we talk about with them. Purpose, having a cause bigger than yourself. A lot of times, again, with young men in particular, they just identify. One of the questions I'll ask them a lot of times is, are you a baseball player. And if their identity is baseball player, my response is careful, careful. If you don't have more than that to live for, then it can become too heavy of a weight, too big of a burden. One of the cliches that we talk about is, especially with the new draft picks, is what got them here won't get them where they want to go, meaning that They probably had some obsessive focus on baseball.

35:35 They get to that point, and that's helpful to a point. But if they continue on with that through their 20s into their 30s, well, they're not going to get to their 30s if they continue on with that. I don't mean they're not going to live to their 30s, but they're not going to be in baseball to their 30s. The point is that we need to go through and overload a specialization phase, but it's a phase. And that's where coaches and so forth can help them understand, OK, time to zoom out. Let's figure out some hobbies. Let's figure out something that puts the game in perspective. And that's where values come into play. How do you want to show up in the world? OK. So in terms of practices, like I said, I always want to give them something concrete. So a morning routine, I've been yammering at you for a while now, so I would invite you all to let's just do this together as a practice rather than me just talking about it. So this is 60 seconds, right? When your eyes pop open in the morning, well, hopefully they don't pop open, when your eyes gently open in the morning, you can just do this 60 seconds, or you can do it for 20 minutes. Whatever works for you. But I encourage people to start small, and again, build the habit, right?

36:36 Build the routine. Make sure that that becomes the foundation for the practice. So just a breath, right? And what I encourage them to do is a nice, slow inhale. Again, if you're willing, we can all do this together. And then a focus on the exhalation. And again, as you all likely know, when we focus on the exhalation, that activates the parasympathetic nervous system, The rest and digest, feelings of safety, feelings of calm. So just starting our day off, just letting our nervous system know, we're good, we're safe. Of course, that's not always the case for everybody all the time, but in general, that's the habit that we wanna build. Okay, second piece, gratitude. So just calling to mind one thing that you're grateful for right now in this moment. And the key thing here, and again, you all are probably familiar with this, but the key thing here is to feel, to have the felt sensation of gratitude. not just not the cognitive expression of gratitude but the felt sensation of something that you're grateful for.

37:42 Alright and what we're doing there is we're just priming the brain to find the good. Again you all know the brain has this negativity bias it's always looking for what's going to go wrong and looking to keep us safe. So again this is just a practice first thing in the morning to let the brain know hey we can look for the good as well here. Ok and then an intention how do you want to be throughout the day? Not what you want to do but how do you want to be? How do you want to show up and just take a moment to set that and lock that in. And then at this point, you know, you might feel like kicking off the covers and getting out of bed. And so I'm just taking a moment to literally be where your feet are. So a cue that I give the athletes I work with a lot of times is just feel your feet on the ground. And again, you all probably done this some of your clinical work that if you if you literally can feel your feet on the ground, you know, I'll ask my clients this all the time, what happens in your head when you literally feel your feet on the ground?

38:47 Oh, it clears up or it slows down or the thinking goes away or, you know, different things that they say. The reality is if we can literally be in our kinesthetic sense, right? And there's nothing special about the feet. You can rub your fingertips together, you can feel the breeze on your face, whatever, hear a sound, right? But anytime that we're in our senses, then necessarily we're in the present moment and we're out of our mind, right? Literally not focused on the dialogue, dialogue, whatever it is that's going on in our head. And those are the moments when we perform our best, right? When we're present and when we're embodied rather than in cognitive mode. So that's just a little morning routine that I offer to the players that they work with just to build this foundational practice of mental health. Other key time of the day is the nighttime. So nighttime, they're usually pretty exhausted, so try and simplify it even more. Just having a practice of gratitude.

39:49 So whether they write it down or again, whether they just feel it, but the point here is again, to embody it, to feel the sense of gratitude. It doesn't need to be anything grandiose, right? It can be something big and grandiose, but it can also just be, hey, I'm grateful that my physical body got me through the day today. Or something as simple as, I'm glad I can see, I'm glad I can feel, I have loved ones in my life, whatever the case may be. But feeling those things, right? And then as part of their sort of wind down and transition into sleep, whatever practice makes the most sense to them, whether it's meditation, whether it's prayer, whether it's visualization, just something that they can do on a nightly basis to encourage that transition from the tasks of the day towards sleep. All right, so the third and last first principle here is that actions come first, emotions follow, right? So I've just offered a bunch of actions to support mental health as a daily practice.

40:54 And then this idea of, okay, so how do emotions fit into this? I already talked about there's no positive or negative emotions, happiness isn't necessarily the right goal, although of course we would all like to feel pleasant emotions more frequently. But the idea that actions come first and emotions follow. So this is something that some colleagues of mine in Denmark shared with me. It's a really great structure. So this on the left side of the screen is a worksheet that I'm happy to share with you all, if you're interested. And then the second side is kind of an example of how to use that. But the bottom line is, and hopefully you can see this. It's probably a little bit small on your screen. But if you follow the numbers, number one is to identify your values and game plan and the actions associated with that. So in this example on the right, this is from a sailor. This is Denmark again, surrounded by water. So sailing is a big thing there. I know nothing about sailing, so if you know more about this than I do, help me out. But what this athlete said, and this is an actual gold medal athlete that these folks worked with, that she obviously gave permission for them to share her story.

42:05 that her value was courage. And the action associated that is staying and fighting. So my understanding is that in the sailing, they line up along this start line and somewhere in the middle of the start line is the ideal wind position. And so all the boats are floating, fighting to get into this middle position. But of course, it's more comfortable to be outside of that, right? Outside of the scrum and feel like you have open water and all that. So for this athlete, that was her challenge. She wanted to be courageous, which meant staying and fighting in the middle of the pack. So then if you go down to number two, you have the difficult situation. So for her, that was the start line, the crowding in the middle of the start line. And then three is you have the thoughts and feelings that come up around that. And what almost always happens as a result of a difficult situation is unpleasant thoughts and emotions. And so here we see the first fork in the road off to the right, is that if we go the emotion-driven way, the emotion-driven way being, I feel these unpleasant, negative, uncomfortable emotions, I wanna get away from them.

43:12 And so the action there, in her case, the action is to escape down the line, to get out of the middle, to get to space, right? And then the short-term reward is relief, right? Those negative, unpleasant emotions go away, or at least are lessened, right? But there's a long-term price or consequence, is now that she has a bad start and isn't engaging in this work consistently and true to her values. Right? And this is, again, this is one specific example, but I'm sure you all can see that this is the pattern everywhere we go, right? Anytime we encounter a difficult situation, if we follow the emotion-driven way, we get a short-term reward, right? A short-term relief, but a long-term price or consequence. Whereas, if we follow the values-driven path, what we see is that now we get a short-term consequence. So, the short-term consequence, the immediate result is the negative, unpleasant, uncomfortable thoughts and emotions stay.

44:13 But if we're able to stay with that and if we have the tools to work with that, now we get a long-term reward of being true to our values and having a chance to, again, in this athlete's case, have the race that she wants based on the values that she has of courage and the game plan that she has of trying to maximize the wind, right? So do y'all see that pattern? I mean, again, I think this sits right at the heart of like really all of the problems that we experience as humans, but I would specifically say in addiction and substance abuse situations, right? Is this idea of, am I going to experience a short term consequence, negative unpleasant thoughts and emotions, maybe even beliefs, in service of a long-term reward, or am I going to follow the emotion-driven way, experience short-term relief, but a long-term consequence? Y'all relate to this pattern? Is this something you see a lot with your folks? Yeah.

45:15 Yeah. Definitely. But I couldn't agree with you more. I appreciate that. Okay, getting close to wrapping up here. Again, this stuff I'll just kind of fly through, but just, you know, common stressors. These are all things that the folks that I'm working with are experiencing right then, right? So the point is that they're under stress. And again, stress doesn't have to be bad. It depends on our perception of it. But the more stress we have, the more important recovery begins or becomes, sorry, that's the point here. Obviously, along with recovery, we need coping strategies. So again, listing out here, what are their common coping strategies, alcohol, marijuana, substances, doom scrolling, excessive video gaming, excessive porn, eating, not necessarily the healthiest coping strategies. And then we get down to meditation and prayer, investing in relationships, journaling, sleeping. OK. I do a piece about recognizing mental health issues just because it's not something that a lot of them are familiar with. You all are very familiar with this, so nothing there. And then just a review of the first principles, relationships, mental health is a daily action, actions come first, emotions follow, and hopefully they feel like they've now got some actions, some practices to be able to incorporate into their daily routines. So now again, here, I'd love to hear your thoughts about this. But if I tie this into the world of addiction, I would argue, and again, I recognize this is way oversimplified, right? There's a lot more going on here than just this, but I would argue that one component of addiction is that addiction is actually a symptom of the self-help section of our bookstore. So the self-help section of our bookstore is going to tell us, pick yourself up by your bootstraps, right? It's on you. Think positive thoughts. Stop the negative thoughts. Think positive thoughts. Replace them, and and then feel great all the time, right?

47:16 Now these might not be the exact messages that these are books and the self-help gurus are portraying, but it's kind of a this is the flavor, right? And so what I would offer is that rather than picking yourself up by your bootstraps, picking yourself up by your bootstraps, right? Invest in your relationships, double down on support, reach out to or reconnect with loved ones. Or, you know, and if you don't have those in your life, get a pet, you know, any sort of relationship here that again, gets you outside of the tyranny of your skull. Right? Thinking positive thoughts. Yeah, of course. If you can choose positive thoughts, great. But what I'm more interested in, again, as you've seen throughout this presentation, What are your actions? What are the actions? And so engaging in mental health as a daily action.

48:17 And then finally, this idea of feeling great all the time. Again, we go back to emotions follow actions. These are the three first principles that I shared. And the point here, and again, going back to one of the first points that I made about when you're getting after it, when you want to be a high performer, you're going to experience more unpleasant emotions, not less. And so the task, the job, the skill here is to get skilled at working with the full range of emotions. And that's the pathway to a rich and fulfilling life. It's not trying to blunt or narrow or only experience, quote unquote, positive emotions. It's being able to work skillfully with all of our emotions. And that's what's going to lead not only to the greatest outcomes, but also to the most fulfilling life. I'm conscious of time. We're the last few minutes here. So, would love to invite questions, reflection. I've also got a few FAQ things here that I found to be useful in addressing some of the common concerns that come up, particularly again around the young male population that I work with.

49:30 But I'd love to pause and see just what reflections, thoughts, or questions you all have at this point. Well, it's so analogous to the emotional musculature that we're always trying to build here. So it's all the same principle, but the emotions are the physiology, so to be able to build that distress tolerance. And I like the idea of orienting outward, family prayer, meditation, diet, et cetera, rather than just this individualistic approach of like, I'll pull myself up on my bootstraps. No, it's through the community that we find ourselves. And just remembering to use those tools as we build our emotional musculature. I just love the confluence of terminology in both fields. Is that a phrase y'all use, emotional muscularity? It's one I used. Yeah, I love that. This is fantastic.

50:31 Thank you. I know you have some more heavy cues, but this has been really enlightening. Thank you so much. Well, I hope it's hitting on something that's both of interest and of use. Yeah. Were there any other thoughts or questions, reflections? Rachel? No, I was just turning on my audio to say thank you. That was fascinating. Some things it was like, yes, absolutely. Another thing was like, oh, wow, that's new. Oh, good. Well, I'm glad some of it was new. I'm always a little hesitant speaking to colleagues, because I live in kind of this sectioned off world where all of this is very new, and so I have to be fairly basic with the folks that I normally speak with. So I'm always a little leery talking with people that are colleagues. I thank you very much. Speak the same language that we do. The language of the heart, yes. Yeah, thank you. And again, I hope along with that, there was something that was useful as well. Oh, absolutely. We don't want to bring up your last two.

51:32 Did you have a couple more slides that you wanted to go over? Sorry. I mean, like I said, I've got way more than the time we're allowed for. So yeah, I think Oscar may have wanted to share something. Yeah, I just wanted to mention that it's exciting to me that you frame mental health as a skill and a routine and the ritual and the repetitive aspect of it. It's like it breaks it down. So it's not some just like amorphous unicorn. And it's just more like, hey, like we're going to do an oil change in the car. We're going to do, it's more, it's more, um, it's less intimidating, I guess. And that's just, I just really, that's something I'm trying to implement in my, in the way I frame it as well. Um, but the way you articulate it was just really cool. So I'm just, I'm just grateful for that. That was cool. Thank you. I appreciate that. It's funny. You say oil change. That's actually an image I use in one of my slide decks is I'm trying to move mental health from the idea. I show like a wrecked car first, right, and trying to move it from the idea of like this is mental health to the idea of like, yeah, it's a it's routine maintenance, you know, I guess I missed that one if it was on.

52:41 I didn't do it here. No, okay. Okay. Very cool. Yeah. But I mean, one of the reasons I do what I do is because the generation that I grew up in, and I would assume some of you as well, is mental health was it wasn't something I was taught. It wasn't even something directly selected for, but what it really was, is it was deselected for. It was sort of like if you didn't have the mental and emotional skills to get to the next level, you were just cut. It wasn't seen as something that actually could be developed. That's where this idea of it being a skill and why for me it's so important to teach people this skill is because I've just seen, in my superficial world, it's talent wasted in the real world that you all work in, it's lives wasted, right? Because they don't recognize that this stuff is a skill that they can be taught and they can learn and they can develop. And they just think that, again, in my superficial world, they've been deselected. Or in your world, it's like they've just been like life has passed them by and they just don't feel like they can compete in life. And what they don't recognize is like, hey, I mean, some people were lucky, lucky and either had a predisposition or or a supportive family or whatever that help them develop these skills implicitly.

53:59 But hopefully what people are now recognizing is that these are explicit skills that can be intentionally taught and developed. But I think most of our fellow humans are walking through the earth not knowing that. Very crucial. I love how you bring it all home. Very grounded, very material, very doable with just basic skills which build. So thank you so much, Mark. This has been delightful. Learned a lot. And loved hearing more about the Dodger stats. I wasn't aware of all the beginning. I appreciate all that. And I appreciate y'all sharing your time with me. You guys are doing great work. And I know that there's not a lot of, I know it can be internally rewarding, but there's not a lot of times external validation for the work that y'all do. So just want to say that myself, I appreciate it. I refer folks to, I refer people to folks like you a lot. So I'm glad that you're there and I know that you're doing really hard, but really meaningful work.

55:00 Thank you. Thank you, Roger. Thank you for your work with our Dodgers. Keep them champions. Thank you again. All right, everybody. Thank you all. Thank you. Thank you so much.