The hardest part of confronting targeted violence is seeing the storm form before it breaks. We sit down with Dr. Pedro Julnes, MD, a psychiatrist who is an expert in lone actor violence. During this discussion with our hosts, he traces how personal grievance hardens into ideology, why extreme overvalued beliefs aren’t delusions, and what real world cues tell us when risk is rising. Along the way, we compare lone actor violence with psychotic aggression, crimes of passion, and predatory harm, then focus on the behavioral signatures that cut across politics and subcultures.
 
 Dr. Julnes presents the indicators of this type of violent behavior: distal warning signs versus proximal indicators. Distal signs include grievance that becomes central to identity, ideological framing, failure of sexual pair bonding, and a shift toward simplistic, absolute thinking. Proximal signs look like a suicide risk pathway: research, planning, preparation, capability testing, leakage, and rapid functional decline. Terrorist Radicalization Assessment Protocol (TRAP-18) provides a useful structure here, but the clinical mindset is familiar—act on behavior, anchor to specifics, and escalate safety when planning appears.
 
 This conversation is practical, not abstract. We cover alliance-building with patients brought in under duress. We outline concrete steps clinicians can take. We also address the systems gap: many cases live in the gray zone of “no crime, no psychosis.” Hospitals, schools, and courts need coordinated threat assessment processes; the VA’s model shows it can be done.
 
 If you want a grounded guide to spotting fixation, understanding internet-fueled contagion, and acting ethically when ideology meets behavior, this conversation delivers clarity without sensationalism. Subscribe for more thoughtful dives, share with a colleague who handles risk assessments, and leave a review to tell us what more you’d like to know on this topic and others.

Resources named in this episode:   

Book: Extreme Overvalued Beliefs: Clinical and Forensic Psychiatric Dimensions   (By Tahir Rahman, MD, with Jeffrey Abugel​)

 Threat assessment tool: Terrorist Radicalization Assessment Protocol-18 (TRAP-18)​ - TRAP 18 Manual - Global Institute of Forensic Research (J. Reid Meloy, PhD, ABPP)

Further reading: see the source list at end of the episode transcript.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Ever worked hard, did everything “right,” and still felt unseen? 

Our conversation with Dr. Ellen Astrachan-Fletcher gets to the heart of why: when control becomes a shield, it also becomes a wall. We dig into Radically Open Dialectical Behavioral Therapy (RODBT) and the hidden costs of over-control—perfectionism, emotional inhibition, and the quiet loneliness of feeling unknown—even in a crowded room

We start with the bell curve of emotional control, where under-control and over-control live at opposite tails. Dr. Astrachan-Fletcher breaks down bio-temperament -- the built-in settings that shape threat and reward sensitivity, detail versus global focus, novelty seeking, and inhibitory control. She shows how these traits steer coping long before we learn clinical “skills.” 

If traditional DBT excels as treatment for under-control, RO DBT unlocks the stuck places for over-control by targeting openness, genuine vulnerability, and the social signals that invite connection. You’ll hear how small cues—polished fixes, self-sufficiency, quiet corrections—can accidentally signal superiority or distrust, leaving the most conscientious person out of the celebration.

We also unpack why so many clients cycle through higher levels of care for eating disorders and depression: they stabilize in structured settings, then return to lonely lives without the tools to build a “true connection.” RO DBT reframes feedback as a gift, uses playful teasing to lower perfectionistic armor, and treats social signaling as a change target—not a footnote. Along the way, we discuss ADHD, trauma’s masking effects, self-injury patterns in OC vs. UC, and how culture rewards control while overlooking its costs

If you’ve ever been “the nicest person no one really knows,” this one’s for you. Learn how to move flexibly within your temperament, send warmer social signals, and practice safe vulnerability that actually deepens bonds. 

Subscribe, share with a friend who needs it, and leave a review with your biggest “I feel seen” moment—these are great observations to share as they inform others and ourselves.  

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Suicide continues to be one of the most important mental health crises of our time, but with compassionate thoughtful treatment, people struggling with suicidal thoughts can find support and healing. In this episode, Menninger Clinic clinicians, Dr. Patricia Daza and Dr. Adrian Lira, explore Collaborative Assessment and Management of Suicidality (CAMS), an evidence-based approach to assessing and addressing suicidal ideation.

With decades of experience in both inpatient and outpatient settings, these experts discuss how CAMS shifts the conversation surrounding suicide by focusing on its four pillars: empathy, honesty, collaboration and suicide-focus. CAMS is not an intervention for depression or any other disorder. It is specifically designed for suicide. 

Instead of just assessing risk or treating suicidal thoughts as a symptom of depression or another condition, this model puts patients in the driver's seat, helping them identify their own reasons for feeling suicidal and uses those insights to create personalized treatment plans. “And really, the data has shown pretty strongly that even one session of CAMS, like in an emergency department with an assessment and discharge plan, can have significant effects,” Dr. Daza explains.

The conversation looks at the complex nature of suicidal thoughts, showing that people can feel both a wish to die and a desire to live at the same time. Our experts share how recognizing these mixed feelings can spark hope and support recovery, while also addressing common myths about suicide, from the misconception that talking about it increases risk to the belief that it is selfish. As Dr. Lira notes, “The risk might already be there. You're just kind of identifying it earlier on, discussing it and hopefully using some interventions to decrease some of that risk.”

For those supporting someone who is struggling, or anyone wanting to understand how suicide treatment can be handled with care, this episode highlights how thoughtful, judgment-free approaches can lead to improvements in outcomes. Join us as we unpack strategies and tools to navigate moments of crisis. 

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Trauma changes us, but it doesn't have to define us. In this insightful conversation with internationally recognized clinical psychologists Dr. Robin Walser and Dr. Darrah Westrup, we explore the transformative potential of Acceptance and Commitment Therapy (ACT) for trauma recovery.

 Drawing from their combined six decades of specialized experience and their new book, "You Are Not Your Trauma: An ACT Guide for Healing from Within," these pioneering clinicians challenge conventional wisdom about trauma treatment. Rather than framing recovery as a battle to eliminate painful memories and sensations, they reveal how psychological flexibility creates space for both holding pain and building a meaningful life.

The heart of their approach lies in what they call a "hold and move process" – helping trauma survivors open up to their internal experiences while simultaneously connecting with deeply held values. For those who feel fundamentally damaged by trauma, this pathway offers profound liberation. As Dr. Westrup explains, "That sense of self is really a sense of being broken... prior to ACT I'd never come across a way to really help someone shift that."

Through their phase model of trauma treatment, they thoughtfully scaffold recovery from safety and stabilization through trauma exposure work and ultimately to values-based living. This structure acknowledges that healing isn't linear while providing clear direction for both clinicians and survivors. 

What makes their work truly revolutionary is the weaving of values throughout the entire process. "You've been waiting too long already," Dr. Walser emphasizes. "Let's not another minute go by where we're not thinking about how we're going to get you connected to [what matters]." This values-based orientation provides crucial anchoring during the inevitably difficult moments of trauma work.

Whether you're a trauma therapist seeking new approaches or someone personally navigating the aftermath of trauma, this conversation offers genuine hope and practical wisdom for expanding life beyond the constricting effects of trauma. Join us as we discover how to reclaim wholeness after suffering.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

What happens when the journey into parenthood collides with mental health challenges? This episode pulls back the curtain on a critical yet often overlooked aspect of becoming a parent - perinatal mental health - and discusses The Menninger Clinic’s innovative "hospital without walls" approach to supporting families.
 
 Clinical social workers Emily Pyle, LPC-S, and Michael Riley, LCSW-S, from Menninger 360 join us to explore their wraparound care model that meets parents exactly where they are - in their homes and communities. They reveal a stark reality --- that perinatal mood and anxiety disorders are the leading medical complication in childbearing and the leading cause of maternal death in the United States, affecting one in three pregnancy-related deaths.
 
 The conversation explores how mental health challenges manifest differently between birthing parents and their partners, with fascinating insights into the biological and psychosocial factors involved. They reveal that up to 10% of new fathers experience clinical depression or anxiety, often showing symptoms through distancing behaviors, substance use, and irritability. Also sharing that  fathers undergo documented hormonal shifts including decreased testosterone and increased cortisol.
 
 Moving to a multigenerational perspective, the discussion examines how untreated perinatal mental health issues can impact child development through disrupted attachment and the modeling of coping mechanisms. Our experts share crucial warning signs for clinicians and loved ones to watch for, while emphasizing that effective, evidence-based treatments exist, emphasizing that the challenge lies in making them accessible.
 
 Whether you're a mental health professional, an expectant parent, or someone supporting a growing family, this episode offers vital insights into creating supportive environments during one of life's most transformative journeys. Listen and join the conversation about how we can better support the mental health of parents and families.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Every therapist has faced that moment: a young client struggles with discrimination, but you're unsure how to help them name and navigate what they're experiencing. Dr. Ryan DeLapp has created a roadmap for this crucial work through his Racial, Ethnic and Cultural Healing (REACH) Program and his groundbreaking workbook, "Empower Yourself Against Racial and Cultural Stress."
 
What began as an undergraduate term paper on health disparities evolved into Dr. DeLapp's lifelong mission to address the psychological impact of discrimination. Here he shares insights into his approach such as: 

• Using inclusive terminology to create space for education rather than defensiveness
 • Following character stories to help young people identify patterns of cultural stress in their own lives
 • Customizing coping strategies based on individual values, goals, and specific impacts
 • Building an "identity filtration system" to maintain self-worth despite encountering bias
 • Navigating generational differences in how families approach discrimination
 • Balancing validation of parents' lived experiences with their children's current needs
 • Incorporating simple screening questions in clinical settings to open conversations about cultural stress
 • Preparing clinicians through personal growth and comfortable exploration of these topics
 • Moving beyond acknowledging pain to fostering empowerment and self-love
 
Whether you're a therapist seeking to better serve diverse clients, a parent trying to understand your child's experiences, or someone navigating these waters personally, this episode offers invaluable insights into fostering self-love and resilience in the face of discrimination. 

 Listen to Mind Dive podcast wherever you get your podcasts and visit menningerclinic.org for more episodes.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Dr. Meredith Gansner discusses the complex relationship between teen depression and social media, drawing from her groundbreaking research and clinical experience as a child psychiatrist at Boston Children's Hospital. Far from offering simplistic condemnations of digital technology, she presents a nuanced view of how social media both helps and harms vulnerable young people.

The conversation reveals how depressed teens often turn to social media as a coping mechanism—finding temporary relief from symptoms through distraction, connection, and validation online. Yet this same engagement can paradoxically intensify isolation, disrupt healthy behaviors like sleep and exercise, and expose teens to potentially harmful content about depression and suicide that doesn't follow safe messaging guidelines.

Rather than advocating for rigid restrictions, she encourages a family-based approach to screen time, urging parents to model healthy digital habits and prioritize teaching digital literacy over relying solely on parental control tools. Dr. Gansner emphasizes the importance of open, ongoing conversations about digital media, steering away from abstinence-only mindsets. For more insights on supporting teens in the digital age, listeners are encouraged to check out her book, Teen Depression Gone Viral. 

For clinicians, educators, and parents struggling to support depressed teens in our digital age, this conversation offers practical wisdom and a balanced perspective that acknowledges both the genuine benefits and serious risks of social media in young lives.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

What happens when neurodiverse children transition to adulthood without crucial life skills? Kristen Lombardi and Dr. Christine Drew tackle this pressing question in their groundbreaking book "Spectrum of Independence." Drawing from decades of professional experience, they reveal how many children with autism and intellectual disabilities "graduate to the couch" after school ends, lacking the fundamental skills needed for meaningful independence.

The conversation unpacks their innovative approach to teaching daily living skills, starting with task analysis—breaking seemingly simple routines like toothbrushing into manageable components. This method transforms overwhelming challenges into achievable goals, allowing parents to pinpoint exactly where their child struggles instead of giving up entirely. "It's not that they can't brush their teeth," Lombardi explains, "it's that they can't complete specific steps within that process."

Perhaps most remarkable is their emphasis on starting early. While many parents focus on academics, waiting until adolescence to address independence creates missed opportunities. Teaching a seven-year-old to shower independently provides years of practice before the pressures of adulthood arrive. As Dr. Drew powerfully notes, "People with disabilities' worlds get really small, really fast if we're not careful"—highlighting how limited independence restricts future options for housing, employment, and community involvement.

The authors balance practical advice with compassionate realism, acknowledging that independence exists on a spectrum. Their message resonates with profound hope: regardless of where a child falls on that spectrum, progress is possible with the right teaching approach. "We can always teach one more skill," Dr. Drew reminds listeners, offering a lifeline to parents navigating the challenging journey of raising neurodiverse children.

Ready to transform your approach to teaching independence? Check out "Spectrum of Independence" and discover practical strategies to expand your child's capabilities and future possibilities.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Sleep takes up nearly a third of a patient’s life, yet its importance to mental health outcomes has been drastically understated in therapeutic conversations. Dr. Myrtle Jeroudi, a neurologist at The Menninger Clinic, weighs in on how deeply intertwined sleep disruption is to mental health disorders and why asking the right questions regarding sleep is a crucial step in clinical assessments. A patient’s disrupted sleep habits often signal deeper disturbances and, if left untreated, can lead to worsening symptoms. Early sleep intervention in treatment can lead to better sleep hygiene and habits, potentially eliminating the need for medication-based intervention. As more and more individuals seeking mental health care report sleep issues nationwide, Dr. Jeroudi stresses the need for clinicians to perform robust sleep assessments for better therapeutic outcomes and improved long-term health. 

 “When you don't sleep well, your mood is going to be impacted, but the way we've understood this relationship has changed to be bi-directional, where one affects the other,” notes Dr. Jeroudi. “So, if you have depression or anxiety, you're not getting good sleep. And when you have those bad nights of sleep or poor quality of sleep, it's going to impact how severe your mood disorder is too.” 

 Dr. Myrtle Jeroudi, MD, is a staff neurologist with the Menninger Clinic's Sleep Medicine Service and is an assistant professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. She is board certified in neurology, clinical neurophysiology and sleep medicine. Her research has been published in peer-reviewed journals that include the Journal of Neurotrauma and Epilepsia and Seizure: European Journal of Epilepsy. Dr. Jeroudi earned her bachelor’s degrees in biology and medicine and society from Washington University in St. Louis and her medical degree from UT Southwestern Medical School. 

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Burnout in health care settings is an all-too-common struggle for healthcare professionals. This month Dr. Jessi Gold explores the toll of the pandemic on health care workers and how these workers can overcome the emotional and psychological exhaustion that accompanies such a demanding field. The dangers of allowing burnout to fester can be catastrophic, not just for the individual, but for health systems as a whole, as the silent suffering of their workers can lead to inefficiencies in care and loss of public trust.  She discusses her framework for confronting burnout and shares her approach of being vulnerable as a therapist with these patients to help encourage them to open up since they are so used to hiding their suffering.

 Dr. Jessi Gold, M.D., serves as the inaugural Chief Wellness Officer for the University of Tennessee System and as an associate professor of psychiatry at the University of Tennessee Health Science Center. Dr. Gold graduated from the Yale School of Medicine and has received numerous awards and accolades for her contributions in mental health and psychiatry, especially during the COVID-19 pandemic. Her first book, “HOW DO YOU FEEL?: One Doctor’s Search for Humanity in Medicine,” is available now and explores the personal tolls of a career spent healing others. 

 “We’ve long believed that somehow if we just tried harder, this really hard thing that we do, where we listen to people’s traumas and problems, that if we just became numb to it, that it won’t affect us,” notes  Dr. Gold. “Thinking like that never made sense to me. Of course, it affects us and, while it’s not a weakness, it is something that we have to prepare for and factor into our approach.” 

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email [email protected]. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.