Kevin Majeres, MD, teaches cognitive behavioral therapy (CBT) at Harvard Medical School. CBT is the gold standard to treat mental health conditions without drugs. CBT can also help with workplace issues such as burnout or anxiety. Dr. Majeres (pronounced Majors) has built a digital platform, Optimal Work, to improve the quality of work life. I learned really useful things from this interview.
Highlights:
Sal Daher Introduces Dr. Kevin Majeres
What OptimalWork is Solving
"... what we are doing is bringing the insights of cognitive behavioral therapy out of the normal context, which is working with the cognitive behavioral therapist. We're bringing that to people in the setting of their work..."
"... In fact, everything with regard to eating behaviors, there's abundant evidence that cognitive behavioral therapy works. At one level, you could see that the more someone was afraid of hunger, the more likely they would be to act on it..."
"... This is why I think anxiety is the most central emotion to understand because anxiety is the urge to avoid challenge as challenge..."
"... Cognitive behavioral therapy, I should say, it also tends to focus on what's happening right now. What are the emotions showing up right now? Where's the avoidance right now? Where does the reframing have to take place right now?"
"... I think that we need more and more things like Endeavor OTC that are helping to identify what are the particular mental muscles that can be worked out, and whether these things are going to be universally applicable, or maybe there are certain subpopulations that that's exactly the workout that they need..."
"... How would you compliment this Cybex machine for the mind with cognitive behavioral therapy?"
"... That in a sense is like what we teach people at The Golden Hour, is how to just briefly strategize what you're about to do, lay out the steps in advance, think of how you want to be stretching yourself in these steps, calm your mind down for a moment, and then launch into it. Then you're going to have full traction, and then you get momentum. Flow is really just momentum in work..."
Dr. Majeres' Psychiatry Journey
"... anxiety is adrenaline waiting to be reframed..."
Advice to the Audience
ANGEL INVEST BOSTON IS SPONSORED BY:
Transcript of “Joy at Work”
Guest: Kevin Majeres, MD
Sal Daher: Hey, this is Sal Daher. I'm delighted you found the Angel Invest Boston podcast in which I interview people who know a lot about building technology startups. I now have a substack about losing and keeping off 100 pounds of body weight in my 60s. It's called AgingFit, and my goal is to build a community of people interested in keeping fit as they age. Look for Sal Daher on substack.com. Daher, by the way, is spelled Delta, Alpha, Hotel, Echo, Romeo. Enjoy the podcast.
Sal Daher Introduces Dr. Kevin Majeres
Welcome to Angel Invest Boston, conversations with Boston's most interesting angels and founders. Today, we are having a conversation with Kevin Majeres, M.D. Kevin is a psychiatrist who teaches cognitive behavioral therapy to residents at Harvard Medical School. He is someone that I've connected with via some friends here in Cambridge. Only the second psychiatrist I've had on, Jacqueline Olds, is also a psychiatrist who has been on the podcast before to talk about connectedness. Kevin is here to talk about his approach to OptimalWork. Welcome, Kevin.
Dr. Kevin Majeres: Thank you, Sal. It's great to be here with you.
Sal Daher: By the way, for the transcriber, Majeres is spelled M-A-J-E-R-E-S. You're a faculty member. You teach at Harvard Medical School, but then you also have your own practice. Some of that is expressed in the website, optimalwork.com. What's that all about? What problem are you solving with optimalwork.com?
What OptimalWork is Solving
Dr. Kevin Majeres: Yes, OptimalWork has as its mission, helping people to challenge themselves according to their highest ideals in each hour of work. In many cases, we find that the way people work isn't really bringing out their best. They feel maybe anxious and burnt out, or they feel distracted and overwhelmed. Now, for my perspective, all of that has to do with a particular relationship that we form with challenge in our life. Namely, that we see challenge as the obstacle, instead of seeing challenge as the opportunity for learning, growth, and practice.
What OptimalWork does is it helps people to take a fresh view of their work to see ways that they can do whatever task they're about to do in a new and better way, to unlock the possibilities for growth that actually every hour of work is affording us.
Sal Daher: This is really powerful because as a grandfather, I understand that reframing situations is extremely powerful when dealing with kids. This is just from knocking my head against walls that I've learned this. I have no academic training like you do. This idea of people getting stuck in certain modes of behavior, and I see this with founders, I see this with even angel investors or people working in different levels, they're caught up in this never-ending swirl. We are way too busy. We're involved in too many things and we don't take the opportunity to master, to create a more efficient and effective and satisfying way of dealing with that around us. What's the evidence that your approach works?
"... what we are doing is bringing the insights of cognitive behavioral therapy out of the normal context, which is working with the cognitive behavioral therapist. We're bringing that to people in the setting of their work..."
Dr. Kevin Majeres: Yes, so what we are doing is bringing the insights of cognitive behavioral therapy out of the normal context, which is working with the cognitive behavioral therapist. We're bringing that to people in the setting of their work.
Sal Daher: Kevin, before we get into that, why don't you describe what cognitive behavioral therapy is versus what people usually associate what psychiatrists do? Which is that Freudian kind of approach.
Dr. Kevin Majeres: There's a lot of different approaches. Cognitive behavioral therapy, and I think you can say maybe it started with Viktor Frankl but certainly Aaron Beck is one of the leading figures in developing cognitive therapy. The original idea was that all disorders of mood are first disorders of thought. If you fast forward, what Beck ended up seeing is that what's essential in cognitive therapy is what is called reframing or cognitive restructuring, which is that there is a way that you can widen your view of a challenge so that now you can see possibilities that it's giving you. Something that could have just been purely negative, now actually you see as containing the seeds of growth.
It's a little bit like when people are starting to exercise and they might dread the feeling of soreness that they get, because they just see the soreness as an obstacle, as a limit to their ability to work out. I think the real reframe of soreness is that no, that actually is the growth taking place and your ability to welcome the soreness is how you make progress. The soreness is the strength developing in you. We learned then what cognitive behavioral therapy did extremely well is to help people then shape their behavior, particularly with regard to anxiety, so that they would approach the situations that would usually make them afraid rather than avoiding them.
Now in general, where the theory has gone is that every vicious cycle comes from avoiding negative emotion and it's the unwillingness people have to experience a negative emotion that in fact makes it come back again and again. Let's say people get nervous with taking tests or public speaking or, okay, well if they start to avoid those things, their system learns that these in fact are real threats and the next time those things come up, they're going to feel even more afraid. If they keep avoiding, that's the vicious cycle, they get more and more afraid. What behavioral therapy then did was help people come up with a plan for welcoming the sounding of their alarm in safe ways so that they could retrain themselves.
That's called exposure therapy, but really, it just means that the sounding of the alarm, in fact, is the goal, not the obstacle. That's when the retraining takes place. It's the same with, say, cravings. CBT is the top treatment for anxiety disorders, but also for addictions. There you can see that when people have cravings, they're acting on the craving in the moment, only to the extent that they're unwilling to feel the craving.
If you had someone who's struggling with alcohol and they're going by their favorite bar, if they really hated the feeling of the craving, they'd be more likely to give in in that moment. If they could welcome that feeling as being the road of freedom, this is how the brain reprograms itself, is to have the craving and for them not to give into it. That's how you shape the craving. Now, there's just extremely abundant evidence that these dynamics are always at work.
On the one hand, you're habituating the negative emotion by not giving into it precisely by being willing to feel it. Also, you're developing a strength, a fortitude, a temperance that gets stronger and stronger and stronger as you develop momentum with the new behaviors. Those are called virtuous cycles. In a way, that's a summary of CBT. It's about understanding, reframing, and then also how it fits into these developing virtuous cycles.
Sal Daher: Excellent. It's like turning down the impact of the negative emotions and then doing a jiu-jitsu trick and turning them into a way to reprogram your behavior so that you reinforce, you create habits that reinforce the new behavior, which take you in a positive direction, the goal that you're trying to achieve. Now, one thing that I deal with constantly is because I'm keeping off 100 pounds of body weight. It's very conscious. I have to be very conscious. I keep track of my calories. I do a lot of exercise.
I also make an effort to enjoy eating the things that I can eat and not put on weight because I can't be eating a sleeve of chocolate chip cookies every day and not put on weight. I will sometimes have a little piece of cookie or something, but most of the time I satisfy myself with things that are far less caloric. This didn't come about all at once. I mean, it came about very slowly through a lot of habit building like blind, banging my head against the wall. I wonder if cognitive behavioral therapy could be helpful in that context.
"... In fact, everything with regard to eating behaviors, there's abundant evidence that cognitive behavioral therapy works. At one level, you could see that the more someone was afraid of hunger, the more likely they would be to act on it..."
Dr. Kevin Majeres: Yes, absolutely. In fact, everything with regard to eating behaviors, there's abundant evidence that cognitive behavioral therapy works. At one level, you could see that the more someone was afraid of hunger, the more likely they would be to act on it.
Sal Daher: Ah, okay. This is really important. Fear of hunger. I'm writing this down here with exclamation point, because this is very true. You psych yourself out with this-- I know people who do this, I do it myself. I know people who do it even more than I do. They're not really hungry. It's the fear of hunger that gets them, that breaks them down. The reality is on a proper diet, which is what I try not to be hungry. I may be a little hungry, but never voraciously hungry to the point-- so I eat a little bit all the time. Six meals a day, so to speak. Smaller meals so that I never get voraciously hungry and that fear doesn't get triggered. This is so empowering.
Dr. Kevin Majeres: Exactly. That's one important way of approaching it. There's no one size fits all rule for how to help people with eating. The same with everything else in psychiatry. We try to find what works for individuals. In the end, you want everything tailored to the person in their life. On the one hand, also, you could say it's like soreness is for building muscle strength. Well, hunger it is I think you could say, simplifying, but you could say hunger is really a hormone called ghrelin. Ghrelin has a lot of benefits. Has benefits even for the brain and for your ability to remember things. It's like, hungry squirrels can remember better where they hid their acorns.
Sal Daher: [laughs] That's right.
Dr. Kevin Majeres: Because sometimes people think they can't function mentally while they're hungry. In fact, you might be able to function even better.
Sal Daher: That's how you're sharper.
Dr. Kevin Majeres: It can make you sharper. I think in all these things, maybe the goal is then that the person becomes a little more flexible. They let themselves feel the hunger, they welcome it, but that doesn't mean that they have to subject themselves to it constantly either so that you don't have to go overboard one way or another. I think a similar thing is--
Sal Daher: It's like cutting off the peaks. You don't want to get to the end of the day to where you're voraciously hungry and you overeat. That's the problem. It's not being a little bit hungry. The problem is being voraciously hungry, feeling weak because your sugar balance is low and so forth at the end of the day. Then in my experience, that's when overeating happens. Then your ghrelin is raging, your leptin is down and most people overeat in the evening.
Dr. Kevin Majeres: That's exactly right.
Sal Daher: Nobody puts on weight from what they eat at breakfast usually, it's the evening eating that gets them. That's an excellent thought that learning to live with your state of hunger is also a very powerful aspect of it, because it is conducive to health and to sharpness of the mental memory.
Dr. Kevin Majeres: The metabolic flexibility. That if you never let yourself experience hunger, then it may be the case, not necessarily, but may be the case that your body is then less able to quickly do lipolysis, for instance. There can be a goal of people developing metabolic flexibility.
Sal Daher: Lipolysis is the--
Dr. Kevin Majeres: Breakdown of fat.
Sal Daher: Breakdown of fat. Interesting. Because there is growing evidence that metabolic flexibility is very powerful. For example, there are athletes Zone 2 Training, to be able to power their muscles both with lipids, fats, and with sugar. I do a lot of Zone 2 Training, walking fast all the time, and I walk pretty fast. I find that that really also helps control my weight because if there are excess calories around if they're in fat form, they can be turned into fuel for my muscles when I'm walking, instead of just sugar.
Dr. Kevin Majeres: Yes. Your muscles even have a non-insulin-dependent way of taking up glucose from the blood when you're exercising.
Sal Daher: Exactly. Non-insulin-dependent, meaning. Think of insulin as this is a Peter Attia, he's a primary care physician and you've heard of--
Dr. Kevin Majeres: I'm a big fan of his.
Sal Daher: He talks about a straw, that insulin is a straw to let sugar into the cells so it can be turned into ATP which is what powers the cells. If you can power your muscles with less sugar, all the better.
Dr. Kevin Majeres: Exactly.
Sal Daher: This is tremendous.
Dr. Kevin Majeres: There's also on top of that then, because I think that most of the problems people have with eating have more to do with cravings than with hunger. It's interesting, hunger being what classically was called a natural appetite, which means it's just there. It's not specified by the thought of any particular food, although maybe you do have salt cravings. Craving is properly understood as regarding food tends to be always specified to one particular food you really want to have right now. The chocolate chip cookies.
Sal Daher: Right. Nobody craves kale.
Dr. Kevin Majeres: Exactly.
Sal Daher: Maybe some people do, but if they're in a kale-deprived state or something. Maybe if they're an all-meat diet, they might be craving kale. Normally, people they're not going to crave kale, they're going to crave these things that give them a rush, a kick. You're right. The distinction between craving and hunger is really very important.
"... This is why I think anxiety is the most central emotion to understand because anxiety is the urge to avoid challenge as challenge..."
Dr. Kevin Majeres: It turns really on the idea of challenge. There are particular challenges like hunger, cravings, anxiety. This is why I think anxiety is the most central emotion to understand because anxiety is the urge to avoid challenge as challenge. That is what generates the secondary emotional responses. If you think of addictions as a phobia of cravings, it's because cravings are now the challenge and that's the challenge that they're struggling with. They then keep avoiding them by giving into them, and they develop a phobia of them.
This is like a third wave cognitive behavioral way of thinking. Third wave just means it's the most recent. What it looks at is in general, the tendency people have to avoid these negative feelings. Avoidance is the dynamic that produces anxiety. It's called threat learning or sensitization. If you avoid anything, be it a feeling like hunger or craving, or even a difficult person in your life, the more you avoid them, the more threatening they become for a part of your nervous system. You're going to be more and more on alert for them or for the situation and it's going to be less capable of bringing out your best, because it's going to make you react more automatically.
Now take that as just a sign of what it's like when people normally sit down to start their day's work. They just sit down and then they launch in trying to get it done as efficiently as they can. Which is totally understandable but I think that that actually is where most of the missed opportunities are, that it only takes a moment to deliberately craft what you're about to do in a way that it actually can bring out your best because you've thought in advance of what that would look like.
Sal Daher: Okay. That is very, very powerful. At my stage of life, I have the luxury of laying off work to other people, curtailing activities I'm involved with, semi-retired, I have income and so I have a lot of flexibility in my life. I can imagine someone who's in mid-career, has a lot of commitments, they cannot lay off. This is really, really powerful. To be strategic about your work, don't slog through your work. There is a way to transcend the anxiety and fears brought on by all the stuff that's happening in your work. Do that jiu-jitsu trick and then get really effective.
Dr. Kevin Majeres: That's exactly right.
Sal Daher: Let's get back then to, in general, what is the scientific evidence for cognitive behavioral therapy? Which is generally regarded as highly effective.
"... Cognitive behavioral therapy, I should say, it also tends to focus on what's happening right now. What are the emotions showing up right now? Where's the avoidance right now? Where does the reframing have to take place right now?..."
Dr. Kevin Majeres: Yes, it's considered the gold standard. Cognitive behavioral therapy, I should say, it also tends to focus on what's happening right now. What are the emotions showing up right now? Where's the avoidance right now? Where does the reframing have to take place right now? That generally distinguishes it from what's called psychodynamic, which is more looking at the past, where the therapist then, in a sense, reparents the person through a transplants reaction.
Sal Daher: The Freudian way. Yes, the doctor is saying you're the person, the doctor with the Austrian accent.
Dr. Kevin Majeres: A lot of my friends are Freudian therapists. If you have an expert therapist and you have a lot of time, it can be liberating in a lot of ways. I think in the end though, what's liberating about it is it allows people to approach whatever shows up with a sense of curiosity like, "Oh, where's this coming from?" They try to be more understanding with themselves. Well, I think what cognitive behavioral therapy would do is, will just directly be helping people to look for ways to practice, being curious with whatever shows up, being understanding with themselves, being understanding with others, focusing on these ideals.
At the centerpiece of modern behavioral therapy is the concept of an ideal, which is a quality that is basically like a virtue that you aim to practice, but you'll never fully attain. It's really important because as you make progress, so let's say everyone responds I think differently to talking about ideals, though my favorite way of getting at what are people's deepest ideals is just take the most important relationship in your life and imagine that that person is talking about you to someone that has never met you.
Let's say you can overhear the conversation and they're bragging about how wonderfully well you treat them. What words would make you happiest to hear them say about how well you treat them? In OptimalWork, we do this as an exercise. At one point we looked at our results because we had asked this of something like 2,500 people. Some of the most common answers people gave is they would love to be described as loving, as encouraging, as caring or thoughtful, reliable, understanding, patient. Those are all beautiful qualities.
That it's enough that a person has one of the quality in their mind that's like this. That they would love to practice in this next hour of work. That gives them the intrinsic motivation that brings out their best energies. All of the adrenaline they may be feeling about pressures and deadlines, in fact, is waiting for a positive goal like this, and they can click into place. It's like putting a car in drive. Many people are stuck in neutral and revving the engine. You need these kinds of ideals. Ideals are different than outcomes because outcomes once you attain them, the dopamine has gone.
Sal Daher: Right.
Dr. Kevin Majeres: Ideals, you get endless dopamine as you make progress and living them.
Sal Daher: Dopamine for the software people in the [laughs] audience is a chemical in the body that creates a sense of anticipation, and it drives us. Everything, all our sense of dopaminergic system is what motivates us to do everything in anticipation and since it's all about anticipation and not satisfaction, when we do something, then we achieve our goal that frequently we feel let down.
Dr. Kevin Majeres: Yes.
Sal Daher: Jacqueline Olds talked about the dopaminergic system and how to deal with that. You can recap that here as well. There's no satisfaction chemical system in our body. There's only this motivation for anticipation. Therefore, it is necessary for us to have unachievable goals to reach for the unreachable star. Listen to Man of La Mancha. We've been playing Man of La Mancha here this week for the kids, and to reach for the unreachable star. You have to have that unreachable star because we don't have any satisfaction chemicals in our bodies, we only have striving chemicals.
Dr. Kevin Majeres: The three things that would give the most dopamine are growth and mastery. Any kind of growth in skills and knowledge, and growth, and mastery is inherently rewarding. Another is ideals. These are the positive qualities I was just mentioning. The higher you get in ideals, the more it's directly about being loving. That points to the third source, which is bonds. You're connectedness to others. Skills, ideals, and bonds, those are actually the content of reframing.
You can always ask yourself, in this next time of work, is there some skill I can practice and do in a new and better way? The problem is though, when people get into just focus on getting things done, an outcome mentality, that mentality shuts off innovation. Just trying to be productive and efficient can have its moments in our life and sometimes we need to. If that's all we do, if that's the only way we challenge ourselves, in fact, then we start to stagnate because you're not doing things in new and better ways.
In OptimalWork, we talk a lot about the difference between a quantity challenge and a quality challenge. The importance of setting these quality challenges so that mastery and ideals and bonds are actually the thing you're looking to grow. Growing in those things is, in a way, deeply lasting. You've changed yourself permanently through mastery and ideals and through bonds. That's actually something that can't be threatened by any loss. Those things, those are everlasting. They remain.
In fact, if you're wanting to, for instance, be very generous in helping someone, you're going to set little goals for yourself in the task, and so that's important. You do want things you can check off, but what's important is that that's serving something higher, a deeper way of growing. In a way, this is behaviorism 3.0, which is that the ultimate positive reinforcer these things that are inherently reinforcing. Growing and mastery, deepening the ideals that you're possessing, deepening your bonds, those are the ultimate positive reinforcers and they produce a momentum in life.
Sal Daher: Sorry to interrupt with a stupid comment, but you said behaviorism 3.0. Behaviorism 1.0 was BF Skinner in the Skinner box and experimenting on his children giving -- [laughs]
Dr. Kevin Majeres: I know.
Sal Daher: I think we've come a long way. Scientists do crazy things. My daughter went to medical school at the University of Vermont where they did a lot of early work with X-rays. These physicians were very motivated. They were X-raying their body parts, and so they ended up having to have their hands amputated. It was horrific.
Dr. Kevin Majeres: Exactly.
Sal Daher: I've seen this over and over, scientists experimenting on themselves and their own families because there's so much conviction, so much ideal, and not a lot of sense here. I think a little bit of self-knowledge is necessary. Behaviorism 3.0, so please continue.
Dr. Kevin Majeres: The old saying is that virtue is its own reward, and that sums it up pretty well. The ideals in behavioral therapy are virtues used not to measure how much you have of a certain quantity, which is probably unknowable, but are you consciously stretching yourself in this direction? It is like a star that you aim for. It can guide your current steps, but you'll never attain it. That's the modern sense of ideals.
Sal Daher: Wow. That is extremely, extremely powerful. Now, Kevin, recently I interviewed Eddie Martucci who is the founder of Akili Interactive, which is a company that has a digital therapy. It's a video game delivered via an app, iPhone. It's also on the Android platform. Basically, it's a driving game with obstacles. You have to hit these power zones at the same time that you're trying to hit the power zones. You can't drive off the road, but you also have to catch these things that are coming at you from the front, things that are coming back from the rear, the things that come from the front of one color, the rear is another one.
There are things of different colors you have to distinguish between, so there's a lot of different circuits of attention that are engaged and when you're doing this, and that's extremely challenging, and you can get it to flow that you discuss in some of your videos and podcasts. By the way, Kevin has a podcast called OptimalWork.
Dr. Kevin Majeres: Yes. The Golden Hour of OptimalWork.
Sal Daher: The Golden Hour of OptimalWork. I've been doing this and I feel that I really have improved my cognitive function, my ability to focus my attention, to silence distractions, and so forth. I'm just curious because I know that cognitive behavioral therapy is also used for helping people with attention problems. As a matter of fact, in your practice, you do this. I'm just curious to hear your thoughts on this.
"... I think that we need more and more things like Endeavor OTC that are helping to identify what are the particular mental muscles that can be worked out, and whether these things are going to be universally applicable, or maybe there are certain subpopulations that that's exactly the workout that they need..."
Dr. Kevin Majeres: I think that we need more and more things like Endeavor OTC that are helping to identify what are the particular mental muscles that can be worked out, and whether these things are going to be universally applicable, or maybe there are certain subpopulations that that's exactly the workout that they need.
I think that having something like a game makes it easier to study because you can tell if people are doing this. Yes, I look forward to seeing more of the research coming out. I think there's a lot of positive signals that this is helping people. I love thinking of the mind as a muscle. In fact, I even think intelligence itself is like a muscle and the more people are stretching themselves in these ways, I think that it just makes us sharper.
It makes sense to me that practice builds a kind of strength and that the game which I have played, it certainly is teaching people to inhibit impulses, to identify and inhibit impulses that they have. If you just took it at the level of that, would getting better at doing that help people to focus? It's believable. This is a way of training and seeing how much are you improving people. I think that these are like the entrepreneurs of the mind looking to see how do you get people stronger in these various ways.
Sal Daher: Through trial and error. I think that there's a lot of potential, I think, for layering different approaches because I suspect that what the app does is it engages certain very fundamental cognitive functions and it trains them and other than the visual-spatial stuff. It doesn't to have some effect in the zones which are involved with attention. I know in the app itself, it's coming up with behavioral suggestions for people to help concentrate their minds, show up earlier, have a checklist of things, and things of that nature.
Dr. Kevin Majeres: Nudges.
Sal Daher: Nudges, because the brain is extremely, I mean, our minds are extremely complex things and I suspect they initially tested this on 8 to 12-year-olds. It was cleared, got FDA approval for 8 to 12-year-olds. It helped them, I think, modestly, both in conjunction with the drug therapy, drug treatments and also by itself it had an objective effect and the FDA allowed them to make a claim that it can be used to treat ADHD.
I suspect that what the real sweet spot for them is going to be with older people where they're training some of these circuits that are degrading because of physical biological decline over time. It becomes more important. Put it this way. I mean, the analog that I have is my eccentric, I go down the stairs backwards. I call that eccentric stair walking. Why is it eccentric? Because, I'm trying to address the eccentric muscles in the body, which are for unloading weight versus the concentric muscles in the legs that are for loading weight, for pushing yourself up. You're a physician, and you know this very well, you're kind of giggling. For me, I found that it really helps my balance to go downstairs backwards because normally I wouldn't exercise those. A young person doesn't have to do that. They have a sense of balance. Their hormones and everything are building muscles. As you age, if you don't use a muscle a little bit, it's gone. It goes really quickly. That process of-
Dr. Kevin Majeres: Atrophy. Yes.
Sal Daher: -atrophy. No, no. There's a word for muscle loss, sarcopenia, which is I guess a pathological situation. That tendency towards losing muscle as you age is very, very-- so you have to concentrate specifically. Just as I'm doing these exercises to maintain balance, I suspect that they're going to discover that these very targeted, focused approaches with apps are very useful for older people. They have to do weights. If you're younger you can actually go out and just do the sport and you will build muscle. In order for older people to build muscle, they have to do very, very, very focused muscle building exercises.
Dr. Kevin Majeres: Yes. I think a lot of these apps are using particular machines in a gym where it guides you through the correct form so that you practice the right form again and again. I think that definitely has its place and its function.
"... How would you compliment this Cybex machine for the mind with cognitive behavioral therapy?..."
Sal Daher: Okay. Just let's speculate a little bit. Maybe you say that would be unprofessional and that you're not comfortable doing that. How would you compliment this Cybex machine for the mind with cognitive behavioral therapy?
Dr. Kevin Majeres: Yes. In OptimalWork, we talk about doing a golden hour. A golden hour is designed that if you follow the three steps, you will go into flow more and more at will. Because flow is something that you cannot make happen directly, but you can set the stage for it. The way you set the stage for it are three basically neurological steps. The first step is reframing, and that gets you out of what we call threat mode. When you're feeling overwhelmed and threatened and you now start to see the opportunity and the challenge in front of you, okay, that activates your ventral medial prefrontal cortex.
That's the key to being able to go into flow. It's just the first step. The second is mindfulness. Mindfulness is the activation of task attention, which I think this is what Endeavor OTC's research is showing is that they're able to selectively activate task attention similar to how mindfulness does it actually. Mindfulness is the technology freeway of selectively activating task attention to turn it on, and you do that by doing a task that has no steps. The only step is attending to something in the present moment and then returning your attention there as often as you need.
Sal Daher: Highly abstracted, totally focused.
Dr. Kevin Majeres: Like the sensation of the breath is something very basic. Then your thoughts come and you let go of them, and then re-anchor yourself on the breath. Mindfulness always has these three movements, detecting an intruding thought, letting go of it and re-anchoring on something in the present moment. That's the second necessary thing. Reframing actually sets the stage for mindfulness, because now that you're out of threat mode, you can actually become mindful. Mindfulness on its own isn't flow, but it's a state of readiness. What it's ready for is just the right challenge. That's the third step. You need a challenge within the task you're about to do, that positive challenge is what pushes you then into flow.
In fact, these steps of reframing the challenge, being mindful and fully present, and then stretching yourself in it, these come from behavioral therapy 2.0, which is, if you want to get someone-- This is a little bit of a digression, but just this, if you want to get someone over a phobia as quickly as possible, these are the three steps they do. Say a person is afraid of heights. My office has a very high balcony. If I were to have the person go on my balcony, at first I'd want them to reframe this, that this is exactly the kind of safety learning that they need to do to overcome their fear of heights so they can say bring it on, the more the better.
Sal Daher: Ah. Okay.
Dr. Kevin Majeres: You've reframed something, because you can say, "Now, bring it on. This is what I need." Then I would teach them to be mindful of the sensation of anxiety in their body to welcome it as fully as they can. Then the third is to lean into it, maybe going to the railing, not hugging the door. Now as they do those things, the whole exposure could go as rapidly as 90 seconds, because reframing and mindfulness challenge together are how you give the clearest signals to your system that this is actually safe.
But those same things can apply in any kind of work. Just thinking of like, in this task I'm about to do, is there anything here I'm dreading? Anything I would tend to complain about? I think it's so important that this idea of we only complain about challenges, and yet challenges are the only way we grow. We flip the complaint around so that now we can get enthused about engaging this. I think when you're talking about how CBT compliment, something that's focused only on a task attention for many people might be the missing ingredient, and now they can actually go into flow much more easily.
It'd be great for us to know more about how these things work, and then we can see how do we recommend. Now that we have thousands of people using OptimalWork, it'd be great if we could identify the people that this would help the most, and then recommend it to them as a particular exercise.
Sal Daher: I have a theory. [laughs] It's the older population. [laughs] I have a theory. The response seems to be much higher in older people. Okay.
Dr. Kevin Majeres: That's fascinating.
Sal Daher: You would expect the response, older people to be responding less, right?
Dr. Kevin Majeres: Yes.
Sal Daher: The younger people that have all these hormones and all this stuff, so they would respond, but the response among the older, the effect is 10 times greater in older people than it is in younger people. They don't really have an explanation for it and I suspect it's just because there is biological decay, degradation of function in the elderly in the older people. In the young, it's the opposite, the dynamic is growth. I see you're making possible very mundane things. Then people get involved with they socialize more, they plan more, they do higher functions.
"... That in a sense is like what we teach people at The Golden Hour, is how to just briefly strategize what you're about to do, lay out the steps in advance, think of how you want to be stretching yourself in these steps, calm your mind down for a moment, and then launch into it. Then you're going to have full traction, and then you get momentum. Flow is really just momentum in work..."
Dr. Kevin Majeres: I think that we have to be creative and flexible in helping people make their own strategies, but a good strategy will give you traction. You start to feel like you're making progress and then traction gives you momentum. That in a sense is like what we teach people at The Golden Hour, is how to just briefly strategize what you're about to do, lay out the steps in advance, think of how you want to be stretching yourself in these steps, calm your mind down for a moment, and then launch into it. Then you're going to have full traction, and then you get momentum. Flow is really just momentum in work.
Sal Daher: I'm going to make time in my life to examine your work more closely, Dr. Kevin Majeres, because [laughs] this is extremely promising. Particularly, I want to explore with you one-on-one just utilizing these aids as a help to people who are aging, because there is neuroplasticity in the elderly. We all know that, but I think it's very different because of the dynamic. It probably responds very strongly to stimulus because there is no natural biological stimulus that's applied to these things.
Anyway. At this point, what I'd like to do is I'd like to do a very brief promo for the podcast, and then I'd like to go into how you got into this, how you decided to become a psychiatrist. What attracted you to this a little bit, as a help for people who are trying to discern their careers, discern the direction in life, and so I find that's very useful. If you are finding this podcast useful and you want more people to listen, the best way you can do this is first following us on whatever app you listen to, and then leaving a review and a rating. A written review, it doesn't have to be much, but the algorithm sees if someone took the trouble to write a few sentences.
It privileges that episode over other episodes that are launching on the same date. This is a very powerful way to get a particular episode seen by more people, is to do a review as soon as it launches. I ask the audience if you've gotten some benefit from this conversation, a very powerful conversation with the psychiatrist, Dr. Kevin Majeres. I would really appreciate your help in this. Kevin, let's step back. When is it that you decided that you wanted to go into psychiatry? What brought that into your head?
Dr. Majeres' Psychiatry Journey
Dr. Kevin Majeres: Let's see. I guess it would go back to my undergrad days and reading Viktor Frankl, Man's Search for Meaning. I was interested in medicine since I was very young, and I always wanted to be a surgeon. I always told people growing up that I want to be a cardiothoracic surgeon. I started reading a lot more philosophy starting in high school. When, as a sophomore, I discovered this medieval text, The Summa Theologica of Thomas Aquinas, I started reading it every day. I've been, in fact, reading him every day since then. It's been almost without fail.
Sal Daher: Requires a very, very great deal of the ability to focus your attention.
Dr. Kevin Majeres: Yes, I think that was my jam when I was in high school. I went to a great high school, and it certainly challenged me, but this is a unique kind of challenging, you think through things in a deeper way. When I got to college, I was looking for a way, like, "Okay, I have this love of philosophy and the understanding of how the mind works." That's when I then was exposed to Viktor Frankl, and at the same time, started hearing about cognitive behavioral therapy.
To me, I thought, "That sounds like Aquinas and Aristotle," because they saw that the intellect and the will is being the two powers in the mind that direct the person, and so cognitive behavioral. That always was there in my mind, is okay, "I need to learn more about this," but it wasn't then, I went to med school. I never took a psychology class in undergrad. I went to UT Southwestern for Med School, which I loved, it's a fantastic school, and I stayed there for residency.
I think that it just grew on me that I wanted to practice a form of medicine that would help people to grow in the most important ways. It was really this idea, seeing that psychiatry is about helping people thrive, that yes, it's defined negatively, but at the same time, I saw so many beautiful cases of people turning their life around, and that's-- so I little by little in med school decided, okay, psychiatry is for me. Then I stayed there for residency at UT Southwestern and the residency director Paul Mohl and the faculty were super supportive of me and my interest in CBT. They even did something unheard of which is they paid for me--
Sal Daher: You said, Paul?
Dr. Kevin Majeres: Yes Paul Mohl, Dr. Paul Mohl. He was the residency director when I was there.
Sal Daher: M-O-H-L.
Dr. Kevin Majeres: H-L yes.
Sal Daher: M-O-H-L for the transcribers. Okay.
"... anxiety is adrenaline waiting to be reframed..."
Dr. Kevin Majeres: Yes. They were very supportive of me becoming Southwestern's expert on anxiety. To do that, they supported me going to the Beck Institute in Philadelphia, and so I had a fellowship with Beck Institute where I got trained by Aaron Beck himself and by Judith Beck, and Leslie Sokol was my one-on-one supervisor. I got fantastic training in helping people with anxiety. In my practice then, in my private practice, I ended up becoming really good at helping people with anxiety, so that in some cases it took one or two sessions to flip everything around.
Now, the best thing about anxiety is that at its core it's really adrenaline, and the more people welcome the adrenaline as the ultimate performance enhancer, the more adrenaline itself shifts its effects to now just give them an IQ boost. Now they're more verbally fluent, they can remember things better, they have greater clarity of thought, they can speak better, they can connect to people more. Adrenaline is this universal enhancer for every measurable function of the brain and anxiety is adrenaline waiting to be reframed.
When it's not reframed, then is the fight or flight response. Its primary effect is going to be in the periphery of the body, and it's going to make their heart go faster, and their palms get sweaty, and maybe they flush or blush, and all the symptoms of high adrenaline. I found that the more I could help people reframe adrenaline as the very thing they're aiming to bring on, then we could do ultra efficient exposure exercises. That was my like initial expertise was using reframing mindfulness and leaning into the challenge to produce these incredible responses through exposure therapy.
Then when I got to Harvard, I got some training with Dan Brown who is a PhD psychologist here in visualization and peak performance. That is really where I saw that flow is trainable and attainable, and the steps to get there were exactly the ones I was already helping people with. That's when I started talking about then doing the golden hour where you use these three steps, reframing, mindfulness, challenge as gates that you get through to set your dispositions right so that now you can go into flow in the task you're doing.
That was a huge epiphany for me. I still remember it when I saw that these two interests of mine have the same architecture. You have to be able to shape your attitude, you have to be able to shape your attention, and you have to be able to shape your action in advance so that you have this threefold way of shaping yourself. That's what we call self-mastery, is your ability to shape your attitude, your attention, and your actions. That's exactly the freedom that I had first read about with Viktor Frankl. This kind that, "At the core of every psychological disorder, freedom remains," Viktor Frankl said.
Because you always have the ability to reframe and to become more mindful, and then to set a way to actively challenge yourself. I could see then in my practice that when people came to me who were overwhelmed by life, often what has happened is that understandably, they tried to reduce the amount of challenge in their life, but challenge reduction gives challenge a negative valence and then they just feel like they have to avoid it more and more and more.
Sal Daher: Right, right, right.
Dr. Kevin Majeres: Actively challenging themselves goes away and all that's left in their life then are these challenges coming from the outside. They're being challenged passively by everything in their life. I found that the sense of being overwhelmed can flip the moment they restore this element of active challenge. At least in this next hour, I'm going to challenge myself in some very concrete way with these simple steps and I'm going to start getting traction again in this thing that's been overwhelming me. That's OptimalWork. We help people flip around anxiety and overwhelm.
Sal Daher: That is outstanding. I invite listeners to check it out at optimalwork.com. I will certainly delve deeper into this. As we think about wrapping up the podcast, Dr. Kevin Majeres, are there any thoughts that you want to communicate to this audience of founders, of angel investors that you think could be valuable for them?
Advice to the Audience
Dr. Kevin Majeres: I think that the effort to do something new, to be an entrepreneur, requires a lot of support. There are these skills though that we don't often think are related to the spirit of creative entrepreneurship but the biggest thing we're buttressing like your creativity in whatever you're doing, is to keep asking yourself when you sit down to work, how can I do this in a new and better way?
Start with the next task you're about to do, the thing right in front of you, or look at what you're dreading. Those items that you're dreading, you only dread because that's where the strengths lie that you want to grow in. That's the direction of meaningful growth. Is there a way then of actively challenging yourself to grow, identify the skill that would make that easier, identify the ideal that would make it more meaningful, or the bond that would make it deeper.
You can always identify some positive way of stretching yourself. I would hope that everyone, I think entrepreneurs are well positioned because we get so much feedback when the work we're doing serves people and meets a real need. I see that spirit of service as the ultimate source of creativity. That's the right source and the best process, like working with the spirit of service and being creative, that is what ensures the best outcomes.
Outcomes are a trailing indicator of the right things happening. You don't want to get too focused on them. Focus instead on, is your work bringing out your best, then it will do the most to serve others too.
Sal Daher: Process is what leads to the outcome. You've got to work on the process and creating a process which is constructive and productive. That's going to result in the outcome and not just focus on the outcome because that can be very frustrating without doing the work that supports it. Well, Dr. Kevin Majeres, I'm very grateful that you made the time.
Dr. Kevin Majeres: My pleasure. It's been great having you and talking to you here, Sal. I look forward to keep the conversation going.
Sal Daher: This is Angel Invest Boston, I'm Sal Daher.
[music]
Sal Daher: I'm glad you were able to join us. Our engineer is Raul Rosa. Our theme was composed by John McCusick. Our graphic design is by Katharine Woodman-Maynard. Our host is coached by Grace Daher.