Episode 431: Pathological Demand Avoidance in Coaching & Persistent Depression

Welcome to another episode of the Hardcore Self Help Podcast with Dr. Robert Duff! In this Q&A episode, Dr. Duff tackles two insightful listener questions on very different but equally important mental health topics.

A listener working as an individual sports coach seeks advice on how to best support a talented but highly resistant student who displays signs of Pathological Demand Avoidance (PDA). Dr. Duff dives into:

• What PDA is and how it manifests in individuals, particularly in relation to autism, ADHD, and other neurodivergent conditions.

• The importance of reframing PDA as a high drive for autonomy rather than defiance.

• Practical coaching strategies to work around demand avoidance, including collaborative goal setting, offering choices, and making training sessions more engaging and playful.

• The significance of open-ended questions and genuine curiosity in understanding the root of a student’s resistance.

A listener describes their struggle with long-term, low-grade depression despite attempts with medication and therapy. Dr. Duff provides insights into:

• Understanding Persistent Depressive Disorder (formerly known as dysthymia) and how it differs from episodic major depression.

• Behavioral activation as a treatment approach, including strategies for identifying and engaging in potentially enjoyable activities despite a lack of motivation or pleasure.

• The five-minute rule to help overcome resistance to activities.

• Medication considerations, including alternatives like Wellbutrin (bupropion) and the combination drug Auvelity, which may have fewer side effects.

• Non-medication treatments such as Transcranial Magnetic Stimulation (TMS) and ketamine therapy.

• The importance of evaluating life circumstances to identify external contributors to chronic depression, such as hidden identity struggles or unsatisfying relationships.

[00:00] Intro and updates on Dr. Duff’s upcoming bipolar book
[03:00] Question 1: Pathological Demand Avoidance (PDA) in coaching
[12:00] Strategies for engaging students with PDA
[14:00] Question 2: Chronic low-grade depression and treatment options
[19:00] Behavioral activation and the five-minute rule
[23:00] Medication alternatives and non-pharmacological treatments
[27:00] Life circumstances and their role in persistent depression
[28:00] Outro and listener support requests

• Dr. Duff’s website: http://duffthepsych.com

• Email your questions: duffthepsych@gmail.com

• Follow Dr. Duff on Instagram: https://instagram.com/duffthepsych

• Dr. Duff’s book “Hardcore Self Help: F**k Depression”: https://www.amazon.com/Hardcore-Self-Help-Depression/dp/B01J4H5A40

• Previous episodes on TMS and ketamine treatments: http://duffthepsych.com/podcast

• More on ketamine treatments: https://duffthepsych.com/ect-and-ketamine/

Thank you for tuning in! If you found this episode helpful, please consider sharing it with a friend or leaving a review. Your support helps the podcast grow and reach more people who need it. See you next time!

Episode 430: Integrative Approaches to Recovery with Dr. Malasri Chaudhery-Malgeri

In this episode of The Hardcore Self Help Podcast, I sit down with Dr. Malasri Chaudhery-Malgeri, also known as Dr. Mala, to discuss her integrative approach to addiction recovery, rehabilitation, and mental health treatment. Dr. Mala shares her personal journey that led her into the field, the importance of holistic and individualized treatment, and how she has worked to break down barriers in accessing quality care.

• Dr. Mala’s personal journey into psychology and addiction recovery work

• The challenges of pushing for integrative mental health care

• How trauma informed her approach to treatment

• The importance of cultural competence in mental health and recovery

• Understanding addiction recovery as a non-linear process

• The necessity of breaking isolation in the recovery journey

• The evolving role of virtual therapy and accessibility in mental health care

• How alternative and holistic approaches such as yoga, meditation, and adventure therapy are valuable in rehabilitation

• The role of family and loved ones in supporting recovery

• How to advocate for personalized treatment if current options aren’t working

• Resources available through Recovery.com for both individuals and families

00:00 – Introduction to Dr. Mala and her background
02:00 – How Dr. Mala entered the field of psychology and recovery
06:00 – Why she emphasizes integrative approaches in treatment
10:00 – Challenges in advocating for a holistic recovery model
12:00 – Misconceptions about addiction and recovery
16:00 – The importance of connection and breaking isolation
21:00 – Alternative therapeutic approaches that work
27:00 – The role of family and community in recovery
33:00 – Steps to take if current treatment isn’t effective
38:00 – Recovery.com and available resources
44:00 – Final words of wisdom for those struggling or supporting a loved one

• Recovery.com: https://www.recovery.com

• State of Recovery 2025: https://recovery.com/news/the-2025-state-of-recovery-5-trends-in-behavioral-health-you-need-to-know-about/
• Giving Voice to Depression Podcast: https://www.givingvoicetodepression.com

• Recovery.com Podcast: https://www.recovery.com/podcast

• Instagram: https://www.instagram.com/recoverydotcom

• Email: duffthepsych@gmail.com

• Website: https://www.duffthepsych.com

• YouTube: https://www.youtube.com/@duffthepsych

• Instagram: https://instagram.com/duffthepsych

If you found this episode helpful, please consider sharing it with someone who might benefit. And as always, take care of yourself!

In this solo Q&A episode of the Hardcore Self Help Podcast, I answer two deeply personal and important listener questions. The first comes from a trans man struggling with the impact of anti-LGBTQ+ legislation, fear for his safety, and overwhelming feelings of hopelessness. We talk about tangible ways to navigate the stress of doomscrolling, finding community, and taking back control in uncertain times.

The second question dives into the pain of heartbreak—specifically, the loss of a best friend after unrequited love. I discuss how to process grief, handle regret, and move forward when a relationship changes in ways you didn’t expect. Whether you're facing fear, loss, or uncertainty, this episode offers support, validation, and practical steps to help you through it.

00:00 — Intro: You Are Seen, You Are Valid
02:00 — Shoutout to the Finch App: A Fun Self-Care Tool
03:00 — Coping with Fear & Uncertainty as a Trans Person in a Hostile Climate
10:30 — Managing Doomscrolling & Social Media Overwhelm
14:00 — The Importance of Community & Seeking Safe Spaces
18:00 — Mental Health Resources & Seeking Support
19:00 — Handling Unrequited Love & The Pain of Heartbreak
22:30 — Why You’re Not to Blame for How Things Changed
24:00 — Navigating Grief & Loss in Relationships
27:30 — The Power of Solo Time & Rebuilding Your Life
29:00 — Closing Thoughts & Next Episode Preview

• Finch App – A self-care companion that makes mental health a little more fun! Download here
• Trans Lifeline – www.translifeline.org | (877) 565-8860
• The Trevor Project – www.thetrevorproject.org | Crisis support for LGBTQ+ youth
• Find a Therapist – www.psychologytoday.com

I’m Dr. Robert Duff, a clinical psychologist and the host of the Hardcore Self Help Podcast. My goal is to break down mental health topics into real, relatable, and actionable advice. Whether it's tackling anxiety, navigating personal challenges, or discussing the latest in psychology, I’m here to help you thrive.

🌐 Website: www.duffthepsych.com
📷 Instagram: @duffthepsych
🎥 YouTube: Dr. Duff’s Channel

💙 If this episode resonates with you, please rate & review the podcast, and share it with someone who might need it. You are not alone.

#MentalHealth #LGBTQSupport #Heartbreak #CopingSkills #SelfCare #Doomscrolling #HardcoreSelfHelp