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. You can also watch the interview on YouTube.

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The transcript of this episode can be found here. Transcripts of all episodes can be found here.

#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

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


The Tim Ferriss Show is one of the most popular podcasts in the world with more than 900 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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14 Replies to “Paul Conti, MD — How Trauma Works and How to Heal from It (#533)”

  1. Tim, facing, healing and preventing personal and war trauma is what feminists have been railing about for all these years. Andrea Dworkin, the feminist nobody reads but everybody loves to hate called this :The shitwork of feminism in her book “Letters from a Warzone”. The metaphor of all interaction being subjugation in an unfree environment might be taken too far but the epidemic of trauma is the daily reality of women, children, refugees, etc.

    1. From studying the G.I. Gurdjieff system, which led me to studying the mechanisms of trauma, and reducing my own traumatic repercussions, I have now been able to see with less blinders and not through a broken, cloudy lens, and as such I have recently come to the same conclusion that humanity is controlled by a web of trauma and we are experiencing heavy triggering of that web right now.

      That said, I’m ecstatic that someone else (who is also a medical professional) came up with the same conclusion, so I am ordering Dr. Paul’s book now.

      I would say that this web of trauma is the same thing Gurdjieff described as the majority living as mechanical humans or in “waking sleep”, because we are reactively being controlled from outside influences by our own stored traumas from childhood and beyond.

      1. Reading The Caliban and the Witch by Silvia Federici, a book ostensibly about how the witch trials in Europe helped establish capitalism as the dominant economic paradigm, really shows how 99% of current Western political discourse is just people possessed by the ideology of *medieval Europeans* y’all! Like zombies echoing a pre-installed set of beliefs.

    2. Finally, one possible suggestion to Tim for why the news of that car accident had so much impact on him.

      NOTE: This is based on my opinions, my experiences with my own traumas, and my understandings of the mechanisms of trauma. As you (Tim) have frequently said, I’m not a doctor and not playing one on the Internet:

      You mentioned being frustrated that your friend was coming to you as if you could help and you felt powerless to help in the situation. I would suggest that this itself triggered some trauma within you, so that the news itself, because it suggested a new existential threat, got inadvertently tacked onto your existing trauma.

      In short, you were vulnerable at the time because your animal brain, your center for trauma, or whatever, was open and receptive to danger due to this trigger. And because trauma is stored based on similar situations/sensual information, it stored the idea of driving as just as likely a trigger/immediate cause of death as whatever originally happened to you that made you feel powerless to help someone in pain.

      Hypothetically, ridding yourself of the original trauma would clear out any connected traumas.

  2. I am worried about microplastics in the environment which makes me concerned about your choice of sponsor Vuori Clothing. Looking at the fabric detail of many of their items, there is a lot of polyester and elastics which are known to shed microplastics into the environment. This also happens with recycled polyester. Not good for any of us or the world. This is a difficult nut to crack for spots clothing. You may have already researched this but perhaps worth engaging with them on this?

  3. Trauma lives in the body and it doesn’t age in the body until it is confronted in a holistic way. Conti is brilliant, but given my recent experience with trauma (my son attempted suicide four days after revealing that my father sexually abused him as a child), it can be more precisely and constructively described in physiological terms rather than with humanistic psychology (i.e, Paul’s frequent references to “narrative” and emotion). Sabino Treatment Center (dual diagnosis for substance/trauma residential facility in Tucson) saved my son’s life. They start with the premise that trauma doesn’t age — one typically responds to post-trauma triggers the same way as the initial trauma event(s) — fight, flight, or freeze. Those responses did not prevent the trauma then, and they are unable to help the body/mind during triggering episodes. Our son is doing so much better, and that recovery started in the body — inviting him to process the trauma in a safe environment where methods like EMDR were used to deactivate the nervous system during the triggers. I was taught a great formula by his therapist — T – 1 where T is “Trauma” and -1 is a unit in time before the body allows itself to truly process the trauma. Trauma victims plagued by triggers usually “freeze, flee, or fight” as a response to memories and other experiential triggers that prevents the person from getting the other side of the trauma. My son needed 60 days to get to T +1=the ability to process the trauma and get to the other side of it — to deactivate the body and remain calm and feel safe when those triggers/memories emerge and not fall back on the “freeze” response that he used during the initial trauma. In sum, I think Conti’s explanations to listeners could be more helpful if he talked more about the body’s response to trauma as well as one’s initial freeze/flight/fight response and how that continues to define one’s response to subsequent memories of trauma as well as experiential triggers.

    1. I agree with you, Chris. I think the chemical interactions are fascinating and all, but I feel too many people discuss the outward indications of trauma (as even discussed in this episode) but very little about the mechanisms that cause it, the cycles that perpetuate it, and the in-the-moment causes/reactions to a retriggering of it.

      I had to teach myself the mechanisms from years of study and self observation and have only begun to clear out my own traumas in the past couple of years, which has been an amazing relief.

      But it’s not only difficult to find people talking about the practical cause and solution to traumas, but it’s virtually impossible to tell anyone about it. Our society seems hell bent on finding some external solution like medication versus really exploring the internal world that these experiences distort and where they can be healed.

      1. I believe i share a somewhat similar response as you spoke of re your acquaintance whose daughter died in a crash. I’ve heard the person you spoke of interviewed in person and their house is on a weekly dog walk. I looked at aerial maps of where the accident happened. mainly i wonder what life would possibly be like inside their home. I appreciate whenever you personalize things with the person you’re speaking with.

  4. Re;22:29 anxiety during driving after friend’s daughters death. After 40 years of anxiety & driving, I finally got over it using NLP and changing the thought pattern. Please try it now before your thoughts get more ingrained and harder to break.

  5. Regarding anxiety and driving:
    I had a similar experience, and if I were you, I would contact your friend Tony Robbins ASAP for NLP – I think you may have developed something similar to a simple phobia. Best to get it treated before it lodges itself more deeply.

  6. As someone with an ACE score of 10, I have spent decades in therapy and have been on many ant- depressants and anti-anxiety prescriptions. I have also self medicated, tried pyslocibin, and tried alternative techniques such as EMDR, EFT, exercise, meditation etc. However one thing that doesn’t seem to be discussed much but has helped me with depression more than any single treatment has been FDA approved Transcranial Magnetic Stimulation (TMS). Just sharing for others who have treatment resistance depression. Like all tools, it is not a panacea, but simply another option for people to explore.

  7. It’s impossible to determine what harm is “bad enough” to cause trauma. An event that could constitute a traumatic event is a close encounter with death, like a car accident. Neglect or abuse are examples of traumatic events that are complex and ongoing.

    1. I would agree. I would say a save definition would be anything that a person in the experience interprets (internally, not consciously) as a threat to their life. A car accident is an obvious threat, but a person yelling at you may not be. But if the same yelling occurs as a young child, it would feel like a threat, and if someone already has that traumatic experience when young that they haven’t internally resolved then their threshold would be lower or repeated similar episodes would also feel like a threat, and would compound that stored trauma, even if rationally they wouldn’t seem to be threatening.