Shoutout Social - Meet Kristy Lamb, MD

See Dr. Kristy Lamb’s first video on MedCircle. At BOLD Health, we are leaders in mental health, wellness, and addiction treatment and consulting. There is no substitute for excellence and experience. We believe in hiring the best therapists and doctors in mental health. Call us to experience the BOLD difference. BE BOLD


Video Transcript

00:00 [Music]
00:05 welcome to MedCircle i'm Kyle Kittleson
00:07 joined today
00:08 by Dr Lamb Dr Lamb thank you for being
00:11 here this is your first time on med
00:13 circle i'm sorry we couldn't do this in
00:14 person but i'm glad we could do it
00:15 virtually
00:16 why don't we start off with an
00:17 introduction on who you are and
00:19 what your role is providing mental
00:22 health care
00:22 in your community fantastic yeah thanks
00:25 for having me i
00:26 am Dr Kristy Lamb i am a psychiatrist
00:29 i'm also trained and board certified in
00:30 family medicine as well
00:33 i am the co-founder and ceo of bold
00:36 health
00:37 we are a mental health clinic here in
00:39 encinitas california
00:40 and we treat primary mental health as
00:43 well as substance abuse
00:45 and um have been up and running since
00:48 2017.
00:49 i trained at georgetown in um
00:53 general medicine that's where i went to
00:54 medical school and then came to ucsd
00:56 here in san diego for
00:58 a combined residency in family medicine
00:59 and psychiatry
01:01 and have been practicing dual practicing
01:03 ever since
01:05 i want to start off from the top saying
01:07 thank you for
01:08 providing your time giving your
01:11 information and insight it's always
01:13 valuable
01:13 but especially during these very
01:16 uncertain times so thank you
01:18 from me and thank you from our med
01:20 circle members uh in this
01:22 session we're going to talk about the
01:24 triangle of conflict what is this
01:26 yeah so the triangle of conflict um is a
01:30 theory a psychoanalytic theory that was
01:33 first really formulated concretely
01:37 by david malin but is based actually off
01:40 of
01:40 a lot of the freudian um original
01:43 concepts
01:44 of the unconscious processes that really
01:46 drive anxiety
01:48 and our symptomatology in regard to
01:50 mental health
01:51 so it's a very basic concept that
01:55 um basically states that our deep core
01:57 feelings
01:59 five to six different philosophers will
02:01 uh
02:03 posit different kind of core feelings
02:05 but deep core feelings at some point in
02:07 our lives
02:08 most of us were told are not okay
02:11 we shouldn't have them those feelings
02:13 get pushed down and this is the bottom
02:15 of the triangle feelings
02:16 and anxiety goes up so anxiety is one
02:19 other kind of part of this triangle
02:22 um so any of us who may have experienced
02:24 trying to hold back tears maybe in a
02:26 movie
02:27 or you know not trying to keep feelings
02:29 in
02:30 you'll notice that your throat might get
02:31 a little bit tight
02:33 uh you may start to get a little shifty
02:35 right a little bit
02:36 um avoidant right anxiety goes up
02:40 and then anxiety feels really
02:42 uncomfortable basically by definition
02:44 and so then we do things what we would
02:46 call defenses
02:47 to avoid feeling that anxiety to
02:50 regulate that anxiety
02:52 but really at the core defenses keep us
02:54 from feeling those deep core feelings
02:56 that we
02:56 in our childhood learned are forbidden
02:59 that we
03:00 shouldn't or can't feel these feelings
03:01 there'll be a problem in relationship
03:03 so we push them down we get anxious and
03:05 then we defend through now defenses can
03:07 be
03:08 anywhere from um you know
03:11 going for a run right so if i'm angry i
03:14 push it down i might get a little
03:15 anxious in my body and i might go for a
03:17 run that might be a really healthy
03:18 discharge
03:19 it doesn't actually have me going back
03:21 and actually dealing with the core
03:23 feeling that i'm having
03:24 but it's it's a healthy release but the
03:28 defenses can also become
03:29 more destructive or more pathological
03:32 things that can this is where our
03:34 symptomatology for mental health can
03:36 come in so this is where
03:38 we can dump into depression self-attack
03:40 isolation
03:41 avoidance uh drinking or drugging
03:44 um and so this triangle of conflict has
03:47 become
03:47 really the foundation of the therapy
03:49 that i do in conjunction with medication
03:51 management's with with patients
03:53 so that we can really understand the
03:56 core processes that are going on that
03:58 mental health um is really
04:01 you know there's twofold there's the
04:02 biological piece
04:04 of neurotransmitters and um kind of
04:07 inborn temperament
04:08 brain structure electrical activity but
04:11 there's also a huge component that is
04:14 actually more malleable which is
04:16 our psychodynamic uh relationship to
04:18 ourselves and to others and this is the
04:20 place where therapy really plays a big
04:22 role
04:22 so this is the place where we can
04:24 understand why we're dumping into
04:26 depression or
04:28 our cravings for substances go up or ocd
04:30 symptoms are higher
04:32 because of things that have been going
04:33 on in our lives we can feel a sense of
04:34 control that we can intervene in a
04:36 different way
04:37 okay so this triangle of conflict then
04:39 has three
04:40 main points the the first point if i'm
04:43 understanding correctly
04:44 are the the cognitive distortions or
04:48 or misperceptions we have that likely
04:51 came from how we were raised and these
04:53 can be
04:53 limiting beliefs or the thought of i'm
04:56 not good enough
04:57 but whatever the however those manifest
04:59 for an individual
05:00 those types of feelings of course lead
05:02 to anxiety which is the second
05:05 part of the triangle and then we try to
05:08 cope whether we're doing so
05:09 consciously or subconsciously to curb
05:12 that anxiety
05:13 in the best case scenario we might go
05:15 for a run but we're still not dealing
05:17 with the core
05:18 issues and a worst case scenario we
05:20 might turn to drugs and alcohol
05:22 and then we're definitely not dealing
05:23 with any of the issues correctly
05:25 absolutely yeah and so if you think of
05:27 an example of this right i could get
05:29 angry at my husband for something he's
05:31 really done like really be
05:33 pissed at him right i also love him so
05:35 this the anxiety often comes up in the
05:37 midst of
05:38 mixed feelings so anger towards someone
05:40 that i also love can be really hard to
05:42 hold
05:43 um most of us have been told it's not
05:45 okay to be angry
05:46 um i'll give you something to be angry
05:48 about we learned that anger's not okay
05:50 so we push it away but anytime we push
05:53 away a feeling
05:54 we get anxious so then i may beat myself
05:57 up and say gosh if i hadn't you know if
06:00 i'm angry at my husband
06:01 for um you know uh
06:04 coming home late well if i had let him
06:07 know
06:08 or if i had helped him so that he could
06:11 have gotten off the door
06:12 earlier then this wouldn't be a problem
06:14 right i'm turning it back on myself
06:15 in some way so defensively
06:19 rather than feel my anger directly
06:21 towards him i get anxious
06:22 and i turn it back on myself i may feel
06:25 anger get anxious
06:26 and say screw him i'm gonna go have a
06:29 drink
06:30 i could say i'm gonna go for a run lots
06:32 of different things that i could do
06:35 healthy or unhealthy it's keeping me
06:38 from actually getting
06:39 in connection with this deep core
06:40 feeling of anger which is really
06:42 important
06:43 the feeling of anger is letting me know
06:45 i'm not okay with my husband's behavior
06:47 right
06:48 now right i want to address this right
06:50 so anger
06:51 moves us if we allow ourselves to really
06:53 feel it to set a boundary to say hey hon
06:56 i love you
06:57 love and what you did made me angry
07:00 yeah i'm wondering if we could talk
07:02 about this right so when we can tolerate
07:04 the feeling we can actually then engage
07:06 in a healthy way okay so that sounds
07:10 really nice on paper but when i'm angry
07:13 at somebody especially in a long-term
07:15 romantic relationship
07:17 it is so hard for me to feel angry
07:21 and then use that feeling to very calmly
07:24 say
07:25 hi i love you but i would love to talk
07:28 about this thing
07:29 i'm going why did you do that why do you
07:31 think that would be okay
07:32 so how do i i understand what you're
07:35 saying
07:35 but how do i actually put that into
07:37 practice because that's difficult
07:39 absolutely and so this is where i see
07:43 many of my patients this is the primary
07:45 work that we're doing together
07:46 is to help them really feel deeply their
07:49 feelings even the painful ones even the
07:51 hard ones
07:52 so that they can feel regulated in it
07:54 without feeling anxious
07:56 because if i'm feeling anxious over my
07:58 anger and i haven't completely repressed
08:00 it
08:01 i might say i'm so angry right
08:04 and that's where anger plus anxiety can
08:07 lead to discharge can need to be
08:09 being me saying oh i'm so pissed why did
08:12 you do this you're the worst right
08:13 that's
08:13 discharging out my anger because
08:16 really a feeling is nothing more than a
08:19 physiological response in the body so if
08:21 my husband does something that pisses me
08:23 off
08:24 my chest expands i feel heat in my body
08:27 and i don't know if you notice but your
08:28 hands went like this right i've
08:30 clenched fists or hands like this right
08:32 that's what anger is it's just a
08:33 physiological sensation in the body
08:36 so if i can tolerate that and not get
08:38 anxious over it
08:39 and i can notice my jaw clench and i can
08:42 take a deep breath
08:44 i can say that makes me really angry
08:48 that's powerful but only when i'm
08:49 grounded right
08:51 when i'm not getting anxious over these
08:54 feelings
08:54 so if i get anxious over my anger i feel
08:57 out of control
08:59 i often will do things i wish i didn't
09:02 or say things i wish i didn't say
09:04 but if i can take a deep breath regulate
09:06 my anxiety over my anger
09:09 i can be very clear and i feel like this
09:11 is kind of my life's purpose
09:13 is to um free anger from the
09:16 stigmatization that this is a horrible
09:18 thing
09:19 it's actually this beautiful emotion
09:21 that lets us more deeply connect with
09:23 other people
09:24 that if i can really tell you hey what
09:26 you're doing is actually pushing me away
09:29 is making me angry and we can work
09:31 through that that actually
09:32 deepens our relationship so i can be the
09:35 most
09:36 rational the most grounded when i let
09:38 myself fully feel all of these feelings
09:42 now if if you're able to do that that's
09:45 wonderful
09:46 what if your spouse is unable to meet
09:49 you there and you approach them and say
09:52 hey look i love you so much and this
09:55 thing that happened i felt myself get
09:57 really angry
09:58 and instead of me you know boiling over
10:01 this i just wanted to bring it to you
10:02 and see if we could
10:03 at least talk about it or maybe even
10:05 find a solution which sounds beautiful
10:07 but then they respond with
10:08 well what do you mean you're angry
10:10 you're so sensitive you know and then
10:12 they
10:13 they meet you with that type of emotion
10:15 how should we respond to that
10:16 such an important point yeah and so it's
10:18 actually something that i often you know
10:20 in couples therapy often you know
10:22 sometimes people say oh we need to work
10:24 on gratitude or we need to work on being
10:26 more loving i'll actually say you
10:27 actually need to work on being angry
10:28 with each other
10:29 and we need to cultivate the space to
10:31 say not only
10:33 do i want to know let you know that i'm
10:37 angry i also want to work on being able
10:39 to accept your anger
10:40 without immediately getting defensive
10:42 yeah i get defensive we can't have a
10:44 conversation and then you're going to
10:45 meet me here
10:46 so it's such an important point so a
10:48 technique that i
10:49 have coined the term leaning into the
10:51 defenses right and so if somebody says
10:53 you're so sensitive and i you just say
10:55 yes
10:56 because i yeah i'm having feelings to
10:58 this so
10:59 you're exactly right i i i
11:02 i am being maybe a little overly
11:04 sensitive to this because if we lean in
11:07 you can't fight somebody who's agreeing
11:08 with you oh absolutely
11:11 that shut the whole thing down when you
11:12 said that i just started nodding because
11:14 that shuts the whole thing down yeah
11:16 you're right you know what and in the
11:17 past
11:18 i've gotten really aggressive and i and
11:20 i know that sometimes these
11:21 conversations when we talk about things
11:23 where i'm upset
11:24 i've been kind of i can be kind of awful
11:27 i don't want to do that i'm wondering if
11:29 we could come back and we could talk
11:31 about this in a different way
11:32 this time so lean into the defense and
11:35 then ask for what you want
11:36 right yeah but you always do that i i do
11:40 don't i
11:41 i do yeah and so i would love for this
11:43 to go differently because i noticed this
11:45 anger coming up and i don't want to pull
11:46 away from you i actually want to connect
11:48 with you
11:49 right and this is a really important
11:50 point is that anger is actually
11:53 connecting when you can actually be
11:55 received
11:56 for your anger it's the it makes us feel
11:59 incredibly safe because then i can be
12:01 angry and you can still love me
12:05 we can still be connected absolutely
12:08 this is this is really great
12:09 and i appreciate you letting me play
12:10 devil's advocate here absolutely
12:12 yeah so what happens though
12:16 when somebody perhaps has
12:20 uh missed i don't even hate going here
12:23 kind of but like misplaced sensitivity
12:26 meaning if i uh forgot to take the
12:30 garbage out
12:31 yeah right i just forgot i was busy and
12:34 my spouse comes in and says
12:36 that really upset me that you forgot to
12:38 take that and we need to have a
12:40 i would go we need to have a
12:40 conversation about the fact that i
12:42 forgot to take the garbage up i would be
12:44 annoyed
12:45 that this little my new thing that i'm
12:48 viewing it as
12:49 uh is causing us to have a full-blown
12:51 conversation
12:52 so i guess i'm asking where is the line
12:55 between
12:56 all right let's get in touch with our
12:57 anger and be communicative to
12:59 are you kidding me we need to you need
13:02 to have a little more resilience
13:04 well it sounds like then you're angry
13:06 towards the partner
13:08 yeah and then we need to have a
13:09 conversation about that you're right
13:11 right all right and and the idea with
13:14 you know with the couples that we talk
13:15 that i talk with it's
13:17 when the person tells you they're angry
13:19 what we can do is say
13:21 i really i'm never working to make you
13:24 angry
13:25 so can we maybe understand this a little
13:27 bit better um you know i had
13:29 so much on my plate and i really do i
13:32 hope you know i really do try to
13:34 do my load and i usually take out the
13:37 trash
13:38 but i know you know that we had all of
13:40 these things going on and there was some
13:42 and so
13:43 i forgot and so i'm sorry that i forgot
13:45 um
13:46 and i hope that makes sense um and
13:49 you know the other however the other
13:52 caveat to that is
13:54 sometimes we are just trying to piss our
13:55 partners off right and can we
13:57 like can we own it like you know um this
14:00 past weekend
14:02 you know i was kind of being a jerk to
14:04 my husband he's like what i was like
14:06 i don't even know why i'm angry i am
14:08 being a jerk like and then i could own
14:10 it right and then we could talk through
14:12 that right and so
14:13 the idea that if i'm being overly
14:15 sensitive
14:16 if i'm being under sensitive all of it
14:19 is okay if we can talk about it i may
14:22 not even know why i'm angry
14:24 i may not know why i'm being overly
14:26 sensitive right that partner could say
14:28 gosh
14:28 i know you always take the trash i don't
14:30 know what's going on there's probably
14:32 something else underneath because it's
14:33 usually not about the trash
14:35 right you know it's about something else
14:38 right and so just starting the
14:40 conversation i have a
14:42 a mentor who talks about this idea that
14:44 the feelings are the light bulb
14:46 so if we let the feeling through it may
14:48 not make sense
14:49 we may not completely understand it but
14:51 if we let the light
14:53 of feeling illuminate the room we'll see
14:57 all we saw was the trash but as we feel
15:00 the anger we can look and see oh it
15:01 wasn't the trash can
15:03 it was the fact that we haven't felt i
15:04 haven't felt connected to you
15:06 and so i'm being pissy about this thing
15:08 that has nothing to do with the trash
15:10 but
15:10 i miss you and i want to connect right
15:13 so if we can allow the feeling to just
15:15 again
15:16 illuminate what's really going on we
15:18 usually do the flip
15:20 it's like i can't feel unless it's
15:21 justified i can't feel unless i know
15:23 that it's accurate
15:25 but um you know if we put you in an fmri
15:29 and um show you uh your partner not
15:33 taking out the trash
15:34 your amygdala is gonna fire 200
15:36 milliseconds before your brain goes
15:38 that's really annoying right so the
15:40 feeling comes
15:41 first and comes from the stimulus
15:45 and then we can think about it and
15:47 understand it try and negate it and act
15:49 like we're not angry but we are
15:51 and it may not make sense it's like it's
15:53 just the trash can why am i so upset
15:55 but i am yes and and it's in it like you
15:58 said it's not
15:59 it's not about the trash exactly that's
16:02 the vehicle in which this is coming to
16:03 surface
16:04 that uh that's good Dr Lamb
16:08 pretty good you're setting the bar
16:09 pretty high here this is the first one
16:11 we're recording a lot of videos today
16:12 this is our first one
16:14 so um okay now we've talked about the
16:16 relationships
16:18 part of the of this triangle how could
16:21 this apply and i'll let you choose an
16:23 example
16:24 of a workplace issue and how we can be
16:27 aware of our thoughts to navigate that
16:29 more effectively
16:31 yeah so i find this comes out a lot and
16:33 um
16:34 you know i think that as we're talking
16:35 about this whole triangle we're thinking
16:37 about this idea that
16:38 when we push down feelings anxiety goes
16:40 up and the higher our anxiety is
16:43 the more we're going to probably go to
16:45 less helpful
16:46 defenses so higher anxiety often worse
16:50 defenses so if i'm a little bit anxious
16:54 or stressed during the week and my
16:55 husband pisses me off
16:57 right i might be a little bit sniffy or
16:59 something but if i'm
17:00 really stressed i might you know snap
17:03 back in it you know i might really kind
17:05 of take it over the edge
17:06 and so just modulating and noticing our
17:10 baseline level of anxiety can be really
17:12 helpful and in the workplace you know
17:14 we've seen this recently with a lot of
17:16 stress going on in in work environments
17:19 um
17:19 that people who might otherwise be able
17:21 to navigate a conflict in a healthy way
17:24 that they may be more likely to be
17:26 potentially some people get really
17:28 demanding
17:29 some people go passive when they're
17:31 feeling really anxious
17:33 some people get really controlling and
17:35 so
17:36 i've even seen in our own office here
17:38 right that um
17:39 some of that going head-to-head where a
17:41 small thing going on people having a
17:43 difference
17:44 of opinion about how a policy policy
17:47 should roll out or how we should do
17:48 things right
17:49 feelings get pushed down there's some
17:51 sense that there's some frustration but
17:53 we're not really allowing the feelings
17:55 to be anxiety goes up
17:57 and then somebody gets really
17:58 controlling or
18:00 sends out 17 emails because their way of
18:04 discharging anxiety is through
18:06 um spreadsheeting and emailing right
18:09 i've met that person yeah i am that
18:12 person
18:15 not to point any fingers right but um so
18:18 if we can notice right and i i mean if
18:20 i'm up at three in the morning sending
18:22 an email
18:22 like i need to check myself i need to
18:25 notice
18:26 wow these this is my defensive pattern
18:29 i need to re excuse me really check in
18:32 and say
18:33 okay what's going on right now where is
18:35 this anxiety and what's coming up
18:36 underneath this
18:37 i'm feeling like i have to detail
18:40 everything
18:41 what feelings am i noticing as we're
18:43 trying to
18:44 shift to more things to virtual or
18:46 whatever we're kind of navigating
18:49 wow i'm anxious because i got a lot of
18:50 feelings about this i'm frustrated
18:53 um there's some grief about losing some
18:55 of the
18:56 in-person groups as we go to virtual so
18:58 there's all these feelings that come up
19:00 and if i'm not navigating them or
19:02 noticing them and sharing them and
19:04 creating space to
19:05 kind of process all of this my anxiety
19:08 can go up and i can take it out um
19:11 on the computer i think that
19:14 we live in a world more than ever where
19:17 people
19:17 are doing everything possible to avoid
19:20 feeling even remotely bad
19:23 and i've noticed i will do that with um
19:26 my phone as soon as i feel
19:29 uh irritated annoyed frustrated tired
19:32 whatever i go well let me get on
19:34 instagram
19:35 and now my mind's thinking about this
19:38 person i don't know on instagram and
19:40 blah blah blah
19:40 and i'm constantly avoiding my feelings
19:42 and then at the end of the day when i
19:44 try to go to sleep and i put my phone
19:46 down for the first time my brain
19:48 goes excuse me Kyle all those feelings
19:50 you suppressed
19:51 we have to address right now yeah and
19:53 then of course i'm like well i'm going
19:54 to take a melatonin and try to avoid
19:55 them even further
19:57 and you do that for months and years and
19:58 all of a sudden this
20:00 problem absolutely and this you know
20:04 kind of i have a different way of
20:06 conceptualizing a lot of mental health
20:08 in that i you know i prescribe
20:10 medications i am
20:12 board certified psychiatrist i use the
20:14 dsm
20:15 in order to speak to other providers but
20:18 really
20:18 um that's the diagnostic and statistic
20:20 manual that kind of gives criteria
20:22 for um specific um
20:26 mental health disorders but based on
20:29 this triangle of conflict i
20:30 really psychodynamically can
20:33 conceptualize mental health
20:35 symptoms as just that as symptoms
20:38 right that there's this unresolved issue
20:41 that's dumping into something whether it
20:43 be substances or ocd symptoms or
20:46 binging and purging or um cutting right
20:49 i'm gonna i'm not gonna feel anger
20:51 towards you i'm gonna get anxious and
20:52 i'm gonna cut myself
20:54 right and it can really dump into
20:56 depression as well so this can be a huge
20:58 place where we can
20:59 isolate avoid and numb i had a patient
21:03 who had
21:03 ocd tics severe depression
21:07 um had just come out of the hospital and
21:10 um
21:10 we noticed that as soon as she had any
21:13 conflict in her life with
21:14 anyone in her life she would dump
21:18 massively into depression isolate
21:20 couldn't get out of bed
21:21 and the more that we could give her
21:22 access to just letting it be okay that
21:24 she had these mixed feelings
21:26 her depression resolved and now she
21:27 comes in smiling
21:29 and you know saying um you know i
21:33 you know i have no depressive symptoms
21:35 last week um i was really pissed at my
21:37 mom
21:37 it's like great right we've all been
21:40 there yeah
21:41 right i could notice i was angry she
21:43 didn't even have to it wasn't anything
21:44 that you know her mom wasn't doing
21:46 anything egregious
21:47 right but she could just notice that
21:48 even these little small things that she
21:50 kept pushing down
21:51 we're building and building a building
21:53 and just dumping into depression and so
21:55 the more that we can allow ourselves
21:57 to be free to feel exactly what we feel
22:00 the less all of these symptoms come in
22:03 and i see that again and again and again
22:04 clinically
22:05 excellent i hope people are taking notes
22:07 of this this is
22:08 simple stuff but impactful stuff once
22:10 you can realize it Dr Lamb thanks for
22:12 sharing
22:13 uh some of your time with us today we'll
22:15 have more from Dr Lamb so make sure you
22:17 check
22:17 the links below this video i'm Kyle
22:19 Kittleson remember whatever you're going
22:21 through
22:21 you got this
22:26 [Music]

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