#12 - How Psychotherapy Can Become Mainstream - Dr. Cameron Sepah

I had the most educational, and enlightening conversation with Dr. Cameron Sepah and I’m lucky that I captured it digitally and can share it with everyone! 

We talked about a range of topics from his education at Harvard and UCLA, to his time growing a digital health tech startup from 6 to 300 employees and now his efforts running his own private practice while advising multiple venture capital funds on their investment strategies in and around digital health investing.

Dr. Sepah is a venture capitalist, an investor, an executive psychologist, an assistant clinical professor at UCSF Medical School, he’s a founder, a CEO and someone whose public commentary on mental health, and human performance to be very educational and insightful.

In his private practice, he helps CEOs, and VCs optimize for health and performance using evidence-based approaches.  We had an incredible conversation about evidence-based treatment, stigma, and psychotherapy will have to evolve in order to become mainstream (just like jogging or physical fitness).  The answer is in and around the idea of how we select our sexual partners and goes back to Natural Selection.

You can connect with Dr. Cameron Sepah directly via his Twitter and LinkedIn, and keep up to date on his work via his newsletter which I highly recommend.

HERE ARE SOME OF THE THINGS WE DISCUSSED:

Dr. Cameron Sepah talks with us about growing up in San Diego, then attending Harvard for his undergraduate degree and UCLA for his Ph.D in Clinical Psychology (Psychoneuroimmunology).  We talked about his love of people and passion for understanding them from a very early age and how that drove him toward his educational focus and profession of choice because he wanted to apply his learnings to helping people.


While in college at Harvard, he worked in a cognitive neuroscience lab doing research with Stephen Kosslyn.  Their research included looking at how Buddhist monks can control their emotions, one of them to the point where he could avoid reaction to a gunshot next to his ear.  We talked about this study of learned emotional responses in our conversation in this episode.
While in graduate school at UCLA he focused on several areas including anxiety disorders, and behavioral medicine/health psychology.  He did a lot of work around using behavioral interventions to manage chronic illnesses including obesity and diabetes.  We talked a lot about some worrisome and fascinating statistics and facts around these diseases including:

a.  Only 12% of people have zero metabolic issues (blood sugar issues, diabetes, obesity, etc.).

b.  This is the first time in history that most adults have abnormal blood sugar levels.

c.  We live in a profoundly sick society.


Diseases of lifestyle kill more people now than diseases of infection do. We as humans are dying mostly from diseases of excess.  We talk about why, and how this is relevant to the mental health struggles of many people who Dr. Sepah has treated over the years.


Individual or group therapy isn’t set up to solve the breadth of the mental health problem set in society.  It’s not that it isn’t effective, but most people can’t afford it, don’t have the time, or don’t have the energy or resources to show up in person and do what they need to do.  So why should providers expect people to come to them, when providers could come to patients, digitally and conveniently?  We talk about the emergence of digital access to care at length and Dr. Sepah’s contribution to developments in that space.


Dr. Sepah moved to Silicon Valley right after getting his license to practice.  He wanted to help people with metabolic diseases, so he joined the founding team of Omada Health where he was able to help far more people than he could in an individual practice.  Their business helped over 250,000 people lose over 2,500,000 pounds while he was there.


We talked about the mental health crisis in the university school systems and how colleges are not prepared to handle it or deal with it.  Even at his college, Harvard, where he was surrounded by wealthy kids with tremendous privilege, there were many mental health issues and struggles.  He estimates that at least half of the students there struggled in some way with mental health.


What contributes to human flourishing?  If you go to your doctor for a check-up and the “check engine light” says you’re ok, are you really?  Is there really nothing you can do to improve?  Is the absence of illness necessarily the presence of health?  We dig into this from a mental health perspective.


When will psychotherapy be mainstream, like jogging or going to the gym?  You must look at it from a sexual mate selection perspective.  Let’s look at fitness as an example.  Fitness is a growing market, and it hasn’t always been that way.  50 years ago, fitness was not a big thing.  It wasn’t that long ago that the only people who jogged, were athletes almost exclusively.  Fitness is a relatively recent phenomenon as it has become a status symbol, or a signal for sexual partner attractiveness.  On the contrary, therapy and mental fitness efforts signal that you are mentally ill or a potentially unstable partner to potential mates.  Mental health will never be at the same place as physical fitness until it enhances your potential value as a partner to other people.   This will require stigma reduction.


How do we de-stigmatize psychotherapy?  We have to re-brand it all together.  The term “therapy” has too much cultural baggage for us to reclaim it.   We talked about the need to move away from pathology and stigma toward performance and prestige.  Take having a personal trainer or personal chef for example – they are status symbols indicating that you prioritize nutrition and fitness.  We must find a way to re-brand psychotherapy so that people can view it as a positive tool in your life.


Calm and Headspace have nailed the consumer marketing aspects of mental health.  They brand themselves as sleep aids or meditation apps, but when you look at the reviews of the apps, people are using these apps to improve their mental health.  The best mental health companies don’t use the words “mental health” to brand themselves or what they do. 


The best athletes in the world, have coaches, they could probably coach themselves.  They know that playing is not the same as coaching.  There is unique value in someone who is focused on theory and strategy on your behalf.  You also need clear objectivity from an outside observer when you train as an athlete.  Finally, you need someone who curates all the potential techniques and approaches to help you decide what’s best for you.  Coaches help athletes with these things so the athlete can focus on execution.  We need this in our lives from mental health professionals.  The term “life coach” or “executive coach” hasn’t taken off because of how the non-licensed life or executive coaches have treated the industry.  It all comes down to tracking and ranking performance outcomes.  This works in physical training and needs to be applied to mental health and wellness.


How do we reduce stigma around therapy?  If therapy is always associated with coping with job loss or coping with a breakup or coping with low self-esteem, then it’s always going to have stigma associated with it.  Maybe we should re-brand it as “performance psychology” and focus on what people want such as making more money, attractiveness to potential or current partners and increased confidence. 


We should be more focused on the positive.  Focus on producing outcomes that people want and things that make you an optimal person or partner in every way. How do I find a therapist or a performance coach? We talked about who to look for, what to look for and how to do it.  Dr. Sepah emphasizes that you should find someone who is licensed to do this kind of work (there are many “life coaches” and others out there who have no licensing or very minimal training). We talked about resources for finding therapists and some things to watch out for in how providers describe themselves and their areas of expertise (too many therapists list their expertise too broadly).


We talked about the mediums over which therapy can be delivered from texting, phone calls, video calls, and in-person meetings.  Dr. Sepah talks about the effectiveness of each way of meeting with people and which ones are effective in his opinion as well as how each of those methods can be used in a holistic treatment plan where continuity of care is important.

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