Paul Conti, MD — How Trauma Works and How to Heal From It (#533)

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“We can feel helpless and the world can seem hopeless. And that’s not the case.”

— Paul Conti, MD

Paul Conti, MD is a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident and then served on the medical faculty before moving to Portland and founding a clinic.

Dr. Conti specializes in complex assessment and problem-solving, as well as both health and performance optimization, serving patients and clients throughout the United States and internationally, including the executive leadership of large corporations. His new book is Trauma: the Invisible Epidemic: How Trauma Works and How We Can Heal From It.

Please enjoy!

Listen to the episode on Apple Podcasts, Spotify, Overcast, Podcast Addict, Pocket Casts, Stitcher, Castbox, Google Podcasts, Amazon Musicor on your favorite podcast platform.

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#533: Paul Conti, MD — How Trauma Works and How to Heal From It


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What was your favorite quote or lesson from this episode? Please let me know in the comments.


Want to hear another episode that outlines effective paradigms for dealing with trauma and addiction? Listen to my conversation with Dr. Gabor Maté, in which we discuss investigating the causes rather than the consequences of addiction, the therapeutic value of psychedelics (including the right way and the wrong way to experience ayahuasca), why some powerful modalities aren’t for everyone, and much more.

#298: Dr. Gabor Maté — New Paradigms, Ayahuasca, and Redefining Addiction



  • Connect with Dr. Paul Conti:



  • How did Paul end up in psychiatry? [06:29]
  • Who wrote the foreword to Trauma: The Invisible Epidemic? [10:18]
  • What is Paul’s personal history with trauma? [11:07]
  • How does Paul suggest people think about and define the word “trauma?” How do certain subsets of trauma differ from one another? [16:54]
  • How might someone take the first step in dealing with trauma that places itself in the forefront and makes it difficult to focus on anything else? [19:20]
  • What does Paul think of the current state of trauma treatment? In what ways does it fail, and how can it be improved? [26:16]
  • If we’re not doing a good job in the US, where can the most effective trauma treatment be found? [28:39]
  • What does it take to really unearth the causes (and ideal treatment) of trauma beyond applying the imperfect trauma symptom inventory? [30:08]
  • The good, the bad, and the ugly within the skill set of treating trauma. [32:45]
  • “We shouldn’t ask why the addiction, we should ask why the pain.” -Dr. Gabor Maté [38:36]
  • Modalities, frameworks, and tools that Paul has found to be particularly helpful in working with individuals who have trauma in their background. [41:29]
  • Antidotes for hypervigilance. [46:34]
  • What most helped Paul come to terms with his brother’s death by suicide, and how did it set the course for him to start medical school at age 25? [54:42]
  • What is the basic structure of Trauma: The Invisible Epidemic? [1:00:09]
  • Paul shares his favorite story from the book. [1:04:00]
  • What is selective abstraction? [1:07:01]
  • How might trauma promote learned helplessness that can push someone toward further trauma and even death? [1:09:47]
  • What does Paul think about the use (and potential for abuse) of psychedelics in treating trauma? [1:12:39]
  • With a number of arrows in the quiver, as Paul says, how does he prioritize options when treating someone for trauma? Might empathogens be included among these options? [1:19:12]
  • An instance when Paul might prescribe an anti-psychotic (and what he finds objectionable about this name). [1:26:31]
  • How can chlorpromazine (Thorazine) be helpful in these cases? [1:29:34]
  • The most helpful way to approach lithium as a treatment. [1:33:11]
  • What about trazodone? Does it carry any addictive or psychological risks? [1:37:21]
  • Dopamine as a currency of distress. [1:40:09]
  • What is a diathesis–stress model? [1:40:47]
  • Credible resources recommended for listeners interested in learning more about trauma. [1:43:09]
  • Parting thoughts. [1:45:25]


“Dopamine is like a currency. People say, ‘What does dopamine do?’ It’s like saying, ‘What does a dollar do?’ It depends on where we’re spending it.”
— Dr. Paul Conti

“We can feel helpless and the world can seem hopeless. And that’s not the case.”
— Dr. Paul Conti

“If you’re not getting help the first, second, third time, keep trying. There’s help there to be had.”
— Dr. Paul Conti

“Vicarious trauma comes from really this wonderful fact that we can be empathic and empathically attuned to other people and we can feel what they’re feeling. That’s a wonderful thing that we can do that for one another, but it also makes us so susceptible to other people’s suffering and pain.”
— Dr. Paul Conti

“We’ve evolved a system that purveys mental healthcare largely without attention to the actual human being. And this is a huge problem.”
— Dr. Paul Conti

“If we just take symptoms, we will get it wrong.”
— Dr. Paul Conti

“A person should be able to talk about what’s going on inside of them because it’s burying those unhealthy seeds, so to speak, that then compounds original trauma into something that can end up being far, far worse with a whole cascade of problems.”
— Dr. Paul Conti

“There’s so much that gets compounded when the original trauma gets pushed outside of consciousness and outside of communication.”
— Dr. Paul Conti

“More pain and suffering means people are more likely to repeat maladaptive patterns that lead them to more trauma.”
— Dr. Paul Conti

“If trauma arouses shame, then the trauma itself immediately alters our perception mechanisms that we can use to understand the trauma and navigate our way through it.”
— Dr. Paul Conti