#067 Dr. Ashley Mason on Drug-free Approaches for Treating Depression, Insomnia, and Overeating
Dr. Ashley Mason, a clinical psychologist at UCSF, discusses non-pharmacological treatments for depression, insomnia, and overeating. She covers whole-body hyperthermia for depression, cognitive behavioral therapy for insomnia, and mindfulness techniques for managing cravings and unhealthy eating behaviors.
Deep Dive Analysis
14 Topic Outline
Introduction to Dr. Ashley Mason and Whole-Body Hyperthermia
Distinguishing Whole-Body Hyperthermia from Standard Sauna Use
Preliminary Research on WBH for Clinical Depression
Hypothesized Mechanisms: Thermoregulation and Inflammation in Depression
Developing an Accessible WBH Protocol with Infrared Sauna Domes
Importance of Slow Heating and Heat Adaptation for WBH Effectiveness
New Research: WBH and Cognitive Behavioral Therapy for Depression
Social Connection as a Benefit of Heat Practices
Understanding Chronic Insomnia vs. Chronotypes
Causes and Perpetuating Factors of Insomnia
Components of Cognitive Behavioral Therapy for Insomnia (CBTI)
Strategies for Tapering Off Sleep Medications with CBTI
Mindfulness and Behavioral Change for Overeating and Addictive Behaviors
Environmental and Cognitive Tools for Modifying Eating Habits
9 Key Concepts
Whole-Body Hyperthermia (WBH)
A more intense and controlled clinical heat treatment compared to typical sauna use, often involving specific core body temperature targets, precise protocols, and keeping the head outside the heating element for cooling. It is used in research for conditions like depression.
Pathogen Host Defense Theory of Depression
A theory proposing an integrated understanding of depression's origins, linking underlying mechanisms such as immune responses (e.g., cytokines, lipopolysaccharide) to their influence on human behavior and mood.
Thermoregulatory Dysfunction in Depression
The concept that individuals with depression often exhibit higher nighttime body temperatures and are less efficient at cooling themselves down through thermoregulation. Improvement in depression symptoms has been correlated with a decrease in core body temperature.
Cognitive Behavioral Therapy (CBT) for Depression
A gold-standard psychotherapy for depression that focuses on the interconnectedness of thoughts, feelings, and behaviors. It aims to identify and interrupt negative thought-feeling-behavior loops to improve mood.
Cognitive Behavioral Therapy for Insomnia (CBTI)
A non-pharmacological, first-line treatment for chronic insomnia that includes multiple components: sleep hygiene, stimulus control, sleep restriction, cognitive techniques, and relaxation techniques, all designed to improve sleep patterns and reduce sleep-related anxiety.
Stimulus Control (for Insomnia)
A core component of CBTI that re-establishes the bed as a place solely for sleep or sex. If an individual cannot sleep, they are instructed to leave the bed and return only when they feel sleepy, breaking negative associations with the bed.
Sleep Restriction (for Insomnia)
A CBTI technique that initially limits the amount of time an individual spends in bed to match their actual average sleep time, thereby building sleep pressure. As sleep efficiency improves, the time allowed in bed is gradually extended.
Dysfunctional Thoughts
In CBT, these are unhelpful thought patterns that are often not entirely true or serve to perpetuate negative feelings and behaviors. Examples include black-and-white thinking, personalization, and 'should' statements, which are addressed through exercises like thought records.
Mindfulness for Behavioral Change
A technique applied to behaviors like overeating or smoking, where individuals intentionally slow down and pay close attention to the sensory experience and true reward of the action. This can lead to a re-evaluation of the behavior's desirability and reduced engagement.
8 Questions Answered
WBH is a more intense and controlled clinical treatment, often involving infrared heating to specific core body temperatures with the head kept outside the heating element for cooling, unlike a standard sauna where the whole body, including the head, is heated.
WBH may help correct thermoregulatory dysfunction observed in depressed individuals, who often have higher body temperatures and impaired cooling, and could also trigger beneficial anti-inflammatory responses similar to exercise.
Slowly heating the body, rather than immediate exposure to high heat, can improve heat tolerance, allow individuals to endure the treatment longer, and potentially increase the effectiveness of WBH for depression, similar to how a frog adapts to gradually warming water.
Chronic insomnia is a distressing sleep disorder characterized by persistent difficulty falling or staying asleep, or waking too early, for at least three nights a week over three months, whereas being a 'night owl' is a biologically determined preference for late bedtimes and wake times, not necessarily a sleep disorder.
Insomnia is often triggered by major life changes (e.g., retirement, job loss, relationship changes) but is perpetuated by 'bad sleep hygiene' behaviors adopted to cope, such as reading or working in bed, napping, or inconsistent sleep schedules.
Yes, individuals dependent on sleep medications can transition to CBTI, often with a very slow, extended tapering plan developed in collaboration with a prescriber, which helps reduce physiological rebound insomnia and anxiety associated with quitting.
Unhealthy behaviors often provide immediate, powerful rewards (e.g., comfort, relief from stress) that are more compelling than the distant negative health consequences, creating a learned reinforcement loop.
By slowing down and paying close attention to the actual sensory experience and true reward of the behavior (e.g., taste of a stale donut, feeling of smoking), individuals can become disenchanted with it, reducing its perceived reward value without relying solely on willpower.
21 Actionable Insights
1. Strict Bed Use for Sleep
Implement stimulus control by reserving your bed strictly for sleep and sex, removing all other activities like reading, watching TV, or worrying, to re-associate the bed with rest. If unable to sleep, get out of bed and return only when sleepy.
2. Restrict Bed Time for Sleep
Practice sleep restriction by maintaining a consistent wake time every day (including weekends) and only going to bed when truly sleepy, restricting your time in bed to the actual hours you sleep to build sleep pressure and improve sleep quality. Gradually increase time in bed by 15 minutes weekly as sleep efficiency improves.
3. Challenge Negative Thoughts (CBT)
Challenge dysfunctional thoughts by creating a ’thought record’ where you identify evidence for and against a thought, then develop a more balanced, adaptive thought that reflects reality to reduce anxiety and improve emotional regulation.
4. Mindfully Observe Unhealthy Habits
Practice mindfulness when engaging in undesirable behaviors like eating junk food or smoking by slowing down, focusing intently on the experience (taste, smell, sensation), and observing the true reward, which can lead to disenchantment and reduced consumption.
5. Control Your Environment
Control your environment to promote healthy choices by removing tempting ‘bad’ foods or addictive substances from your immediate surroundings, making it physically impossible to engage in undesirable behaviors.
6. Pair Heat Therapy with CBT
Combine whole-body hyperthermia with cognitive behavioral therapy (CBT) to potentially enhance engagement in therapy, as heat may make individuals more inclined to talk and participate, creating a powerful mind-body intervention.
7. Slow Heating for Heat Therapy
Begin whole-body hyperthermia from a cool state and gradually increase temperature over a longer period, as this slow heating process may improve endurance and increase the treatment’s effectiveness.
8. Cool Head During Heat Therapy
During whole-body hyperthermia, keep your head outside the heating element and use cool cloths or ice on your head to maintain comfort and enable longer endurance of the session.
9. Slowly Taper Sleep Medication
If tapering off sleep medication, do so extremely slowly by using a gem scale to make minuscule reductions (e.g., 0.1mg at a time) over an extended period (months) to minimize physiological rebound insomnia and reduce anxiety about quitting.
10. Maintain Consistent Wake Time
Establish a consistent wake time every single day, including weekends, to regulate your circadian rhythm and build sleep pressure, which is a fundamental component of effective insomnia treatment.
11. Standardize Sleep Medication Intake
If using sleep medication, standardize its use by taking the same dose at the same time every night, rather than reactively taking it only when you can’t sleep, to avoid perturbing your circadian rhythm and reduce anxious questioning.
12. Heat Therapy for Exercise Alternative
If physical limitations prevent aerobic exercise, consider whole-body heating practices like sauna as an alternative to potentially trigger similar beneficial biological pathways that exercise activates, such as anti-inflammatory changes.
13. Heat Therapy for Depression/CVD
Consider whole-body hyperthermia or sauna use for individuals experiencing both depression and cardiovascular disease, as this treatment may offer benefits for both conditions, which often coincide.
14. Maintain Heat Therapy at Home
After initial intensive whole-body hyperthermia sessions, consider supplementing and maintaining the benefits with at-home sauna tents (with head out) to sustain wellness and reductions in depression symptoms over the long term.
15. Practice Muscle Relaxation
Practice progressive muscle relaxation by tensing and then relaxing different muscle groups throughout your body, moving from one area to another, to shift focus from your thoughts to your physical sensations and aid in relaxation before sleep.
16. Access CBTI Resources
Access Cognitive Behavioral Therapy for Insomnia (CBTI) through self-help books like ‘Quiet Your Mind and Get to Sleep,’ dedicated apps (e.g., Sleepio, Insomnia Coach), or by finding local providers through specialized websites.
17. Sustain CBTI Principles
Maintain long-term sleep wellness by continuously applying CBTI principles, understanding how your behaviors affect your sleep, and making informed decisions about occasional deviations, knowing the potential impact on your sleep.
18. Pre-plan Healthy Food Choices
Make decisions about potentially unhealthy behaviors, such as ordering food at restaurants, ahead of time when you are not in the moment of temptation, to promote healthier choices and avoid impulsive consumption.
19. Visualize Future Health Goals
Use ’episodic future thinking’ by imagining yourself at future health goals or events (e.g., wearing a specific dress in three weeks) to help inform and motivate healthier decisions in the present moment.
20. Mindful Harm Reduction for Treats
Practice mindful harm reduction by consuming unhealthy treats only up to the point of genuine enjoyment, stopping when the pleasure diminishes (e.g., after a few bites), to reduce overall intake without complete deprivation.
21. Address Underlying Physical Issues
If an unhealthy behavior is used to alleviate a physical symptom (e.g., drinking soda for migraines), prioritize addressing the underlying physical issue with appropriate medical treatment first, rather than relying on the behavior.
5 Key Quotes
If you take a frog and you throw it into boiling water, it jumps right out. It says, this is too hot. I can't stand this. But if you put the frog in the cold water and then you slowly heat it up, it can stand to be in the heat for a whole lot longer.
Dr. Ashley Mason
A big scary thing 20 years away is different than a really comforting thing two minutes away.
Dr. Ashley Mason
When we change our perceived reward value of things, for example, yes, we can change those patterns in our brain.
Dr. Ashley Mason
When we use different parts of our brain to be anxious or to be fearful, we're not also... it's more difficult to also be curious and open to experience.
Dr. Ashley Mason
Once you know Santa isn't real, you can't unknow that. Once you learn the things you learn in CBTI, you can't unknow them.
Dr. Ashley Mason
5 Protocols
Whole-Body Hyperthermia (WBH) Protocol (Janssen Study)
Dr. Ashley Mason- Participants were placed into a Heckel machine (sauna tent with infrared heating lamps) with their head outside the heating element.
- They were heated until their core body temperature reached 38.5 degrees Celsius.
- After reaching the target temperature, the sauna was turned off, but participants remained in the machine for another hour, during which their temperature continued to rise to approximately 38.85 degrees Celsius.
- Throughout the session, cool cloths were applied to their head, and water was provided.
Whole-Body Hyperthermia (WBH) Protocol (Dr. Mason's UCSF Study)
Dr. Ashley Mason- Participants lie in an infrared sauna dome with their head outside.
- A rectal probe continuously monitors core body temperature.
- A research assistant sits at the participant's head, providing water and applying giant ice cubes and cold cloths to the head to maintain comfort and help endure the heat.
- Heating continues for 70 to 80 minutes, allowing the participant to slowly heat up until their core body temperature reaches approximately 38.5 degrees Celsius (101.3 degrees Fahrenheit).
Cognitive Behavioral Therapy for Insomnia (CBTI) Core Protocol
Dr. Ashley Mason- **Sleep Hygiene**: Address and modify behaviors that negatively impact sleep, such as napping, inconsistent sleep schedules, late caffeine intake, and excessive bright light exposure at night.
- **Stimulus Control**: Re-establish the bed as a place exclusively for sleep or sex. If unable to sleep, get out of bed and return only when feeling sleepy, avoiding activities like reading, watching TV, or worrying in bed.
- **Sleep Restriction**: Determine the average amount of time an individual actually sleeps over a week (maintaining a consistent wake time). Then, restrict the time allowed in bed to this average plus 30 minutes. Gradually increase time in bed by 15 minutes weekly as sleep efficiency (time sleeping / time in bed) consistently reaches at least 85%.
- **Cognitive Techniques**: Identify and challenge 'dysfunctional thoughts' (e.g., black-and-white thinking, personalization, 'should' statements) related to sleep. Use 'thought records' to evaluate evidence for and against these thoughts, developing more adaptive and reality-based perspectives.
- **Relaxation Techniques**: Practice methods like progressive muscle relaxation, where different muscle groups are tensed and then released, to shift focus from racing thoughts to bodily sensations and promote physical relaxation.
Extended Taper Plan for Sleep Medication Cessation
Dr. Ashley Mason- Collaborate with medical prescribers (e.g., psychiatrists, internal medicine doctors) to create an 'extraordinarily extended' taper plan for sleep medications.
- Utilize gem scales to measure and implement very small, precise reductions in medication dosage (e.g., reducing by 0.1mg increments if possible).
- Maintain each reduced dose for several weeks to allow the body and mind to physiologically and psychologically adapt.
- Standardize medication use by taking the same reduced dose at the same time every night, avoiding reactive use (e.g., taking a pill only when struggling to sleep).
Mindful Smoking Protocol
Dr. Ashley Mason- Sit down at a table with the cigarette, ensuring no other activities are engaged in (e.g., no reading, drinking coffee, watching TV).
- Rate how you feel emotionally and physically before and after smoking.
- Pay close and curious attention to the sensory experience of smoking, including the taste and smell, to truly evaluate the reward.