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

In today’s episode of the Hardcore Self Help Podcast, I sit down with world-renowned psychiatrist, author, and DBT expert Dr. Blaise Aguirre to tackle the complex topic of self-hatred. As a pioneer in the treatment of borderline personality disorder (BPD) and adolescent mental health at McLean Hospital, Dr. Aguirre offers a compassionate and illuminating perspective on how self-hatred forms, why it’s so persistent, and how we can work toward healing.

Dr. Aguirre explains why self-hatred is often learned early in life through invalidating experiences and abusive environments and why it differs from self-criticism or depression. He introduces practical tools to break free from self-loathing, such as identifying its roots, recognizing toxic relationships, and taking steps to separate identity from these damaging beliefs.

We also discuss the challenges of treating patients with self-hatred, the transformative power of dialectical behavior therapy (DBT), and how his latest book, I Hate Myself, provides a groundbreaking resource for those suffering from this deeply ingrained struggle.

If you’ve ever wrestled with feelings of unworthiness or struggled to overcome negative beliefs about yourself, this episode is packed with strategies, hope, and actionable advice to help you move toward a healthier relationship with yourself.

00:15 — Introduction: Meet Dr. Blaise Aguirre
02:00 — From Philosophy to Psychiatry: Dr. Aguirre’s Career Path
07:30 — Understanding Self-Hatred: How It Develops and Why It Persists
15:00 — The Role of Validation in Parenting and Mental Health
20:45 — The DBT Approach: Why Skills-Based Therapy Works for BPD and Self-Hatred
27:00 — Breaking Down Self-Hatred: Separating It from the Self
34:20 — Overcoming Self-Hatred: Practical Tools and Steps for Healing
40:15 — The Importance of Compassionate Treatment in Mental Health Care
45:00 — A Sneak Peek Into I Hate Myself
50:20 — What Parents and Caregivers Need to Know
57:00 — Dr. Aguirre’s Final Thoughts on Healing and Hope

I’m Dr. Robert Duff, a clinical psychologist and the host of the Hardcore Self Help Podcast. My mission is to break down complex mental health topics into relatable, actionable advice. On this podcast, we dive deep into mental health, personal development, and the strategies that help us thrive. Each episode features expert interviews, practical tips, and answers to listener questions, all designed to help you live a healthier, more fulfilled life.

• Dr. Blaise Aguirre’s Website: www.IHateMyselfBook.com
• Learn More About DBT: McLean Hospital’s DBT Program
• I Hate Myself: Dr. Aguirre’s Latest Book (Coming February 2025)

• Website: duffthepsych.com
• Instagram: @duffthepsych
• YouTube: Dr. Duff’s Channel

This episode is brought to you by NoCD, a leading provider of virtual therapy for obsessive-compulsive disorder (OCD). If intrusive thoughts and compulsions are impacting your daily life, NoCD offers specialized Exposure and Response Prevention (ERP) therapy. Schedule a free 15-minute consultation to learn more at www.nocd.com.

Hope you find this conversation as inspiring and thought-provoking as I did! Don’t forget to share your thoughts and takeaways in the comments.

#MentalHealth #SelfHatred #BlaiseAguirre #DBT #BorderlinePersonalityDisorder #SelfCompassion #TraumaHealing #Parenting #Mindfulness #SelfHelp

In this special episode of the Hardcore Self Help Podcast, I lead you through a guided meditation designed to help you let go of mental burdens and find focus in an overwhelming world. Using visualization techniques and intentional breathing exercises, this meditation offers a space to acknowledge your stressors, release tension, and tap into a feeling of calm and clarity.

This experience is set in a vivid mindscape of space, where you can imagine yourself aboard a futuristic spacecraft, surrounded by the beauty of the cosmos. Together, we’ll navigate through moments of recognition, release, and rejuvenation. By the end of this session, you’ll feel more centered and grounded, with a renewed connection to how you’d like to move forward.

Whether you’re a seasoned meditator or new to mindfulness, this episode is a judgment-free zone to focus on yourself. Bookmark it to return to anytime you need a mental reset.

Sponsor
This episode is brought to you by NOCD, a leading provider of virtual therapy for obsessive-compulsive disorder (OCD). If you’re stuck in cycles of overthinking, compulsive behaviors, or intrusive thoughts, NOCD offers specialized treatment using Exposure and Response Prevention (ERP)—a gold-standard therapy for OCD.

They provide virtual sessions with licensed therapists, accept many major insurance plans, and offer support between sessions to make treatment as accessible as possible.

Visit https://www.nocd.com to schedule a free 15-minute consultation and take the first step toward relief. For more insights on OCD and ERP, check out my interview with Dr. Patrick McGrath in episode 406 of this podcast.

Chapters:

• 00:15 — Introduction: Why This Meditation Matters
• 03:00 — Sponsor: NOCD – Treatment for OCD Symptoms
• 04:30 — Setting the Scene: Guided Visualization in Space
• 08:00 — Acknowledging and Offloading Mental Burdens
• 13:00 — Breathing for Release: Techniques to Let Go
• 17:00 — Choosing Your Focus and Setting Your Intention
• 19:30 — Relaxation Breathing and Body Scan
• 25:00 — Final Reflections and Letting the Experience Settle

About the Podcast
I’m Dr. Robert Duff, a clinical psychologist and host of the Hardcore Self Help Podcast. My mission is to make mental health topics relatable and actionable. Whether through guided meditations like this one, Q&A sessions, or expert interviews, I aim to help you navigate life’s challenges with clarity and confidence.

Connect With Me:

• Website: https://duffthepsych.com
• Instagram: https://instagram.com/duffthepsych
• YouTube: https://youtube.com/duffthepsych

Hashtags:
#GuidedMeditation #Mindfulness #MentalHealth #Relaxation #StressRelief #SelfHelp

In this inspiring episode of the Hardcore Self Help Podcast, I sit down with Dr. Jordan Grumet, a hospice director, author, and podcast host, to explore how we can transform our lives by embracing the concept of “little p purpose.” Dr. Grumet shares insights from his latest book, The Purpose Code, which offers actionable strategies to uncover and build a meaningful life, regardless of your circumstances.

Our conversation dives deep into the difference between “big P Purpose” (society’s lofty, often unattainable ideals) and “little p purpose” (daily actions that bring joy and meaning). Dr. Grumet shares his personal journey—from losing his father at a young age to becoming a physician driven by unresolved trauma, to ultimately finding fulfillment by pursuing his passions for writing, speaking, and connecting with others.

Key takeaways from our discussion include practical ways to recognize your purpose anchors, how to turn regrets into motivations, and why pursuing joy in small, intentional ways can lead to profound impact and lasting legacy. We also explore how Dr. Grumet’s work in hospice has shaped his understanding of what truly matters in life, highlighting lessons from those at the end of their journeys.

This episode is packed with wisdom for anyone feeling stuck, searching for meaning, or simply looking to live with more intentionality and joy.

Sponsor
This episode is brought to you by NOCD, a leading provider of virtual therapy for obsessive-compulsive disorder (OCD). If you're caught in an endless loop of “what-ifs” or struggling with obsessive thoughts and compulsive behaviors, NOCD offers specialized, evidence-based therapy designed just for OCD—Exposure and Response Prevention (ERP). They accept many major insurance plans, making it accessible and affordable, with support available between therapy sessions.

Take the first step by visiting https://www.nocd.com to schedule a free 15-minute call with their team. Plus, check out my interview with Dr. Patrick McGrath, NOCD’s Chief Clinical Officer, on episode 406 of this podcast to learn more about OCD and their approach.

Chapters:

• 00:15 — Introduction: Meet Dr. Jordan Grumet
• 02:00 — Finding Purpose After Loss: Dr. Grumet’s Early Life
• 06:15 — Purpose Anchors: Joyful Work vs. Goal-Oriented Burnout
• 10:45 — Lessons from the Hospice Life Review
• 16:30 — Regrets of the Dying: Turning Regret into Action
• 20:00 — Building Purpose When You Feel Stuck
• 24:15 — Tools and Levers: Joy of Addition and Art of Subtraction
• 30:00 — The Difference Between Meaning and Purpose
• 37:00 — How Small Joys Create Big Impact and Legacy
• 44:15 — Practical Steps to Start Building a Purposeful Life
• 50:30 — Final Takeaways: Finding Your Purpose Anchors

About the Podcast
I’m Dr. Robert Duff, a clinical psychologist and the host of the Hardcore Self Help Podcast. My mission is to break down complex mental health topics into relatable, actionable advice. Each episode dives deep into mental health, personal development, and strategies for living authentically and fulfilling your potential.

Guest Links

• Dr. Grumet’s Website: https://jordangrumet.com
• The Purpose Code: https://jordangrumet.com/books
• Podcast: https://www.earnandinvest.com/episodes

Connect With Me:

• Website: https://duffthepsych.com
• Instagram: https://instagram.com/duffthepsych
• YouTube: https://youtube.com/duffthepsych

#MentalHealth #Purpose #PersonalDevelopment #Legacy #SelfHelp #Mindfulness

In today’s year-end wrap-up episode of the Hardcore Self Help Podcast (Episode 425), I reflect on 2024 and reveal my guiding word for 2025. Instead of traditional New Year’s resolutions, I choose a single word each year to serve as a focal point and inspiration. I revisit last year’s word—Connection—and discuss what worked well, like strengthening family bonds and growing professionally through clinical supervision and podcast interviews, as well as what didn’t go as planned (like making new friends or achieving full Spanish fluency). These reflections highlight how intentions can guide growth in unexpected ways.

Looking ahead to 2025, my new word is Mend. From addressing health issues to repairing lingering logistical and financial tasks, I want to focus on making what I already have stronger and more sustainable, rather than building from scratch. This year’s theme is about restoring, improving, and taking care of what’s important in my personal life, home, and professional endeavors—including the podcast and Duff the Psych projects.

Join me as I wrap up 2024, share my aspirations for 2025, and encourage you to reflect on your own values, accomplishments, and future direction. Thank you for another year of support and attention. I’ll see you in 2025!

Chapters:

00:00 — Reflecting on Another Year: Gratitude & Long-Term Listeners
01:00 — Beyond Resolutions: Choosing a Guiding Word Each Year
03:00 — Reviewing 2024’s Word “Connection”: Wins, Misses & Insights
05:00 — Personal Highlights: Family Bonding, Board Games & Quality Time
09:00 — Professional Growth: Clinical Supervision, Networking & Interviews
11:00 — Language Ambitions: Progress in Spanish, But Not Fluent Yet
13:00 — Introducing 2025’s Word: “Mend”
14:00 — Repairing & Improving: Health, Home Projects & Finances
16:00 — Podcast & Brand Updates: Refining Instead of Expanding
18:00 — Final Thoughts: Entering 2025 with Intention & Flexibility

About the Podcast

I’m Dr. Robert Duff, a clinical psychologist aiming to make mental health more accessible. On the Hardcore Self Help Podcast, I break down complex psychological concepts, share actionable tips, and provide relatable advice to help you live a healthier, more fulfilled life. Whether through solo episodes, interviews, or listener Q&A, my goal is to support your mental well-being without unnecessary jargon.

Connect With Me:

• Website: https://www.duffthepsych.com/
• Contact: https://www.duffthepsych.com/contact
• Email: duffthepsych@gmail.com
• Instagram: https://www.instagram.com/duffthepsych/
• YouTube: https://www.youtube.com/c/DuffThePsych

#MentalHealth #SelfHelp #PersonalDevelopment #Mindfulness #NewYear #Goals #Intention #Reflection #Podcast

In this solo Q&A episode of the Hardcore Self Help Podcast (Episode 424), I tackle two listener questions that address challenging mental health scenarios. The first question delves into the concept of antidepressant-associated chronic irritable dysphoria (ACID), a proposed condition rather than a formally recognized diagnosis, and the potential long-term effects of antidepressants in the context of bipolar disorder. I break down the limited research behind ACID, emphasize the importance of comprehensive care, and acknowledge the frustration that can arise when medications seem to worsen symptoms instead of helping.

The second question focuses on waking up early with irritability and racing thoughts. I provide practical strategies like pre-bed journaling to offload worries, identifying actionable steps for lingering concerns, and creating a calming buffer before sleep. I also discuss the importance of reexamining one’s work environment, considering meaningful changes, and finding fulfillment outside of a stressful job. Throughout the episode, I offer insights on self-advocacy, exploring alternative treatments, and laying the groundwork to regain a sense of control in your daily life.

Chapters:

00:15 — Introduction: Needing More Questions & Holiday Scheduling
02:00 — ACID Explained: A Proposed Condition, Not a Formal Diagnosis
08:00 — Bipolar Disorder & Antidepressants: Complex Interactions and Research Gaps
11:00 — Frustration with Care: Inadequate Guidance and Long-Term Medication Issues
14:00 — Exploring Alternatives: Therapy, Lifestyle Changes, and Treatments Like TMS/Ketamine
21:00 — Morning Irritability: Unpacking Workplace Stress & Uncontrollable Factors
24:00 — Reevaluating Work: Finding Meaning Outside Employment and Considering Changes
27:00 — Pre-Bed Journaling: Offloading Worries, Identifying Action Steps, and Creating Buffers
30:00 — Final Thoughts: Gratitude, Year-End Plans, and Continuing the Journey

About the Podcast

I’m Dr. Robert Duff, a clinical psychologist and the host of the Hardcore Self Help Podcast. I’m here to demystify mental health, break down psychological concepts, and provide actionable advice without unnecessary jargon. Through expert interviews, listener Q&A, and relatable discussions, this podcast aims to help you live a healthier, more fulfilled life.

Connect With Me:

• Website: https://www.duffthepsych.com/
• Contact: https://www.duffthepsych.com/contact
• Email: duffthepsych@gmail.com
• Instagram: https://www.instagram.com/duffthepsych/
• YouTube: https://www.youtube.com/c/DuffThePsych

#MentalHealth #Antidepressants #Bipolar #WorkStress #Journaling #SleepHygiene #QandA #SelfHelp #Psychology