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We sit down with clinical psychologist Faust Ruggiero to delve into the transformative insights from his book, The Fix Your Depression Handbook. Faust offers practical guidance on achieving internal balance and breaking free from the grips of depression. Join us on a journey to unlock happiness as we discover invaluable techniques to tap into our internal power, redefine what happiness means to us, and cultivate a life filled with peace, love, and authenticity. Don’t miss out on the opportunity to gain a fresh perspective on overcoming depression and embracing a more fulfilling life.

Faust Ruggiero is a clinical psychologist.

He discusses his book, The Fix Your Depression Handbook.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Faust Ruggiero. He’s a clinical psychologist. His book, which we’ll talk about today, and there’s an excerpt on that on KevinMD, is called “The Fix Your Depression Handbook.” Faust, welcome to the show.

Faust Ruggiero: Kevin, thanks so much for inviting me. It’s a pleasure to be with you.

Kevin Pho: So we’re going to talk about your book in a little bit, but before we do that, just briefly share your story and journey.

Faust Ruggiero: You know, I’ve been doing this for 40 years now, over 40 years. I was that kid that everybody came to talk to, so psychology was just the natural way for me to go. I’ve done everything from clinics to prisons to kids to senior living, you name it, I’ve been around. So about 37 years now in private practice.

And this is now, “The Fix Your Depression Handbook” is the third one, the fourth one is being written as we speak. So it’s been a very fulfilling, very good journey for me.

Kevin Pho: All right, so you said that you’ve been doing this for decades now. So from just a historical standpoint, how have you seen the field of what you’re doing, clinical psychology, how has that evolved over the years?

Faust Ruggiero: You know, it’s an interesting question. When I was just starting out, people would come, particularly when in private practice, and very, very few people on medication, maybe 10 percent of the people, something like that. Today people come in and 75 percent of them are already taking something. That’s the big change that I’ve seen. The pharmaceutical industry’s got their claws in and people are just buying into it.

The other thing I’m looking at are just the disconnection people are dealing with, which we didn’t have before. The fast pace, the connectivity, everything’s external as opposed to working from the inside. So I try to move people back in that direction if I can.

Kevin Pho: Yeah, so how do you adapt to all these changes? You mentioned specifically about all the stimulation that’s out there, people are on their devices, all the connectedness, which could be good and bad. So how do you adapt as a therapist?

Faust Ruggiero: Well, the first thing I do is keep myself grounded. And I tell that to everyone, because I do a lot of trainings for clinicians, and I would say, you’ve got to keep yourself grounded. Stop paying attention to what you think the pressures are out there. If you get caught up in that, you’re going to focus on that and get stuck there.

Everyone walks into my office, whether it’s a new person that comes in, whether it’s an older person, whatever, they come in and I deal with their specific needs. I will disallow cell phones and things like that in the office, and we are there for an hour to do what we need to do. I set the goals like I always have, and I’m pretty dynamic in the process, and I keep focused there. I don’t get myself overwhelmed with what’s happening in the world. That’s huge for a clinician, I think.

Kevin Pho: All right, so your book, there’s an excerpt on KevinMD. Your excerpt is titled “The journey to internal balance and self-fulfillment.” It’s an excerpt from “The Fix Your Depression Handbook.” So tell me what led you to write this book.

Faust Ruggiero: You know, the first book I wrote, the flagship book if you will, “The Fix Yourself Handbook,” was about 36 different chapters, all different kinds of problems, kind of what we see in counseling. I went from there to anxiety, now to depression. And I’m just seeing the progression in the country. We’re seeing more suicides than ever, with far more resources available. It’s fast-paced, it’s anxiety, it’s a whole anxiety depression syndrome people get into. I’m anxious, now I’m depressed.

So when I started the work with anxiety and depression, I wanted to get the myths out of the way first, all the stuff people focus on, and let’s get down to the facts. Let’s put a program together that works. It’s what I do in counseling with people.

My philosophy, my personal feeling about anxiety and depression, is we’ve got to go physical first. Let’s get the body in order. Let’s make sure the adrenal glands, the thyroid glands, that they’re not doing things that are affecting the way people think and feel. Let’s go there first, get all that stuff straightened out, then we’ll work with the emotions and the intellect and how they’re affected.

But that’s the progression that I work with. I start physical, and I find that about 30, 35 percent of the people are dealing with that type of thing. And then you get into the chemical imbalances and neurotransmitter activity. But let’s get physical first.

Kevin Pho: So specifically, when you say let’s get physical first, are you looking for physiologic causes that could be corrected that may lead to symptoms of anxiety and depression?

Faust Ruggiero: Absolutely. We want to get those out of the way, because if you’re coming to me and you’re saying I’ve got depression, I’ve got anxiety, and I start doing all these nice coping things, and let’s go into your past and do all that, but what we have is an antagonist that’s physical, well, I’m not getting to that. That’s not fair to you, because now you’re dealing with that and we haven’t gotten there.

So I get them into the primary care people, the docs and all those things, get the blood work done, get all those kinds of things going. Let’s get that stuff out of the way first. Then I know what I’m working with.

Kevin Pho: So assuming that we ruled out the physiologic causes, take us into your office. What’s your approach to someone with depression?

Faust Ruggiero: OK, we send to the doctor, they come back and say things are OK, or they corrected it with a medication of some sort, whatever. The physical is addressed.

Now I’m going to start going into undercurrents for this thing, past traumas, things that people are carrying with them every day. I’m going to look at their diets, I’m going to look at their sleep patterns, all those kinds of things. I call it the initial purge. Let’s get what you’re doing that’s toxic for you, or it’s causing you some dysfunction or some problems, let’s get those things out of the way first. Because if we don’t, no matter what I tell you, you’re going to go back and do those things and it’s going to hurt you. So that’s my first thing, that purging, let’s get the negatives out of the way.

Then we start looking at the cognitive things. What are you holding on to, or what are you obsessing on, what kind of pain are you bringing forward with you? And we start working on those and getting those things straightened out. And then we start to work with emotions and how you’re feeling about those things, but that actually comes later. I think too many clinicians go there first. Well, tell me how you’re feeling. That’s good, and I weave that in, but I don’t want to make that the focus in the beginning.

And the other thing I’m very big on in all the books that I’ve written, just like in counseling, is I give them tons of information, but then I give them applicable, actionable steps. Whether it’s in the chapters in the book or what I do in the office, you’re leaving, let’s do this, so for next week do these little things, and when you come back let’s look at how you’re doing with those. So I’m giving them a whole progression, a whole process that they can tune into and tie into how we’re making the changes in their lives.

Kevin Pho: You know, in the KevinMD excerpt you talk about the concept of internal balance. So talk more about that.

Faust Ruggiero: You know, when you look at the human species, we are physical, emotional, intellectual, spiritual beings. That’s what we are. So it’s common sense to say we need to attack all of those, we need to address all those with ourselves.

Buddhists call it nirvana, call it what you will, I call it internal balance. It’s simply getting to the point where those internal attributes are kind of balanced. Where you get your body in order so it’s healthy, your emotions are not overriding your intellect so you can think clearly, your intellect, your mind is able to fact find and grab and get information and put it in a coherent perspective for you. Spiritually, if you’re willing to follow that, you’re connecting with the core of yourself, whether it’s God or the universe or whatever you choose.

But let’s get those things all working properly so there’s a balance there, and you’re not experiencing this physical thing this day, or this emotional override that day, or your mind is obsessing and a thousand thoughts are coming in at one time. We want to get that all balanced, and that’s where health comes from.

Kevin Pho: So give us a case study where you use this approach and it successfully moved the needle for one of the patients. So give us a success story.

Faust Ruggiero: Easy. I have a woman that comes in, she is now 40 years old. She comes in, some marital issues, but she herself, when I sent her to the doctor, she came back with a thyroid condition. The numbers were just outside the range, so they could medicate a bit, the thyroid came down, so we balanced out some of the anxiety.

Now we started to go through her life and we saw all the things she was doing wrong. The eating, the wrong foods at the wrong time, the lots of caffeine in her body. Worked a job in a factory where during the afternoon, as they’re getting tired, an energy drink went in. She had an abuse history, so we needed to deal with that.

So we got all the physical things in order first. We went back and got those past pains and traumas and we started to put those things in order, so we dealt with some emotional concerns there. She was an obsessive thinker, so we gave her some skills, some coping things to do with the obsessive thinking. We got that obsessive thinking down, so the intellect was working a little bit better. She was a person raised in a church family, got away from that. I said, why don’t you go back and at least test the waters, and went back and put that into the mix.

And in about a year, it took us almost a year to do this, but six months we started to see some significant change, a year into the process she was a person with much more confidence, left the factory job, is now a supervisor in a facility that is worldwide and doing really well. But she’ll come back to me and say, we balanced me out, and I know how to keep myself pretty much there. I’m not perfect, I go up and down yet, but I know that that balance works for me and I know what I have to do to keep that.

Kevin Pho: So I’m a primary care physician, and as you know we see patients every 15 to 20 minutes, and depression and anxiety for that matter very prevalent in my patient population. So from your perspective as a counselor, what are some high yield tips that I can use in the exam room to help address this in the limited time I have?

Faust Ruggiero: You know, I’m thrilled to say you’re saying 15 minutes. Where I live, the hospitals are buying up physicians’ practices and their model is, we need to get them out in under 10 minutes, seven, eight minutes, they want them in and out. That’s horrendous. We know that that’s where the pressure is.

What I work with, three docs who are willing to do, actually we trade each other, put it that way, we’re privy to what each other does. And all I asked them to do is, I gave them some questions to ask. Let’s go back and on those four subjects, let’s get the physical in order. What are you experiencing? Here’s the emotional, do you have some old past stuff that’s going on? Are we looking at some of that stuff? Are you having racing thoughts? Are you going to bed at the end of the day just exhausted, and your eyes open up, so to speak, and now you’re thinking three or four or five things that really you shouldn’t be thinking about?

And really those three, the docs don’t go too much into the spiritual, some may, but those three things. If we can get those things in order, what we find is, when I get them, not only do I know what the doc found, I now am working together with the doc. We’re going back and forth. And I do that with my people. I always tell the docs, they prescribe meds and then, I’ll see you in a month. And I say, prescribe them, get them to me, I’ll get back to you and we’ll keep the flow going. That’s how it works well.

Kevin Pho: So it’s like a partnership, obviously, where you have the medications, but that works so well and complements the therapy you provide, right?

Faust Ruggiero: Right. And we know that medicine takes care of the physical symptoms, but it doesn’t get to the causes of what’s got them depressed and anxious, or whatever it may be. So that helps them.

The docs are always in communication. I’m very blessed to have three of them that really keep in tune, and we can go back and forth constantly. If I see someone I’m going to send them there, they get a call, this is what I saw, this is what you might want to look for. So nobody’s getting a cold call, so to speak, and there’s a lot of information flow back and forth. And since the time for a doctor to see a patient is so cut down now, that communication really needs to be emphasized, really needs to be a very inclusive part of the treatment plan, I think.

Kevin Pho: Your book is called “The Fix Your Depression Handbook.” Tell me the other main messages you want readers to come away with after reading your book.

Faust Ruggiero: Best thing I tell people is not to get overwhelmed and get caught up in thinking this is who you are. I’ve got depression, I’m a depressed person, I’m going to be that way the rest of my life. I have anxiety, I’m going to stay there.

Everything you have is treatable. And you’ve got all this stuff inside you. We’re just going to get your body in order, we’re going to uncover everything that’s there. And it’s not who you are, it’s what you have. It’s treatable. And if you are willing to stick with a plan, we’ll get you to where you need to go.

Kevin Pho: We’re talking to Faust Ruggiero. He’s a clinical psychologist. His book is “The Fix Your Depression Handbook.” Faust, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Faust Ruggiero: For the physicians, communication is essential. Now, we just touched on that. Don’t treat them and street them, so to speak.

For the clinicians, we’re moving into this online kind of stuff, and I think we can miss a whole lot of things. Get a depressed person who stays in their depressed environment and clicks on a Zoom link, and you talk to them and you never touch them, you never see their body language. Go try to see as many as you can in the office. That helps. Spend time with them, ask them a lot of questions, try to get away from doing everything too fast. Slow is the way we’re going to make changes that are going to last.

Kevin Pho: So that’s very interesting that you said that, because I think that a lot of behavioral health services are trending towards more Zoom sessions, online sessions, partly because of access, ever since the pandemic especially. So there is certain value to, of course, seeing a patient that is physically in front of you.

Faust Ruggiero: And you’re right. The other part of this is the transition. We know electronics are here to stay, we all knew this was going to happen, but we went in so fast and without a real coherent plan. We didn’t train clinicians to say, all right, this is what you’re going to do with online counseling, let’s start training you and preparing you. And make that part of the college curriculums, make that part of the training programs, the continuing education, all that sort of thing. Let’s put that in there. We didn’t do that. It just switched there, and now people are doing it.

And it’s far more profitable. You can make your $120 or $130 an hour and you don’t have an office to go to and all the insurances and salaries that go along with it, so you pocket a lot more money. Plus you can write that off on your income taxes, your business is in your house. So I can see all the reasoning. But we don’t want to lose sight that the patient is the primary focus, and we want to make sure that what we’re giving them is exactly what they need. So I’d love to see more training in terms of that. I’m doing it for people, I’m hoping other people are doing it also.

Kevin Pho: So now, through your lens as a behavioral health specialist, what are some things that we can miss if we don’t do these online sessions correctly?

Faust Ruggiero: Well, the first thing is diagnosis. Diagnosis is a multifaceted kind of thing. It’s not, as right now we’re staring at each other, and you’re going to tell me some things. When I see you in the office, things are slower, I’m asking a lot more questions, I’m seeing body language and all the kinds of things that are going on.

So the first thing I tell them is, don’t try to treat them in the first session, even the first two. Make that, you set up your rapport, keep doing that, get to know, get to understand what it is so you can make a proper diagnosis.

The other thing I tell them is, in the office we do treatment plans and all those sorts of things. Online, people are getting away from all the paperwork and all that formal stuff. So continue to have a treatment plan. If you can’t follow a treatment plan, how do you expect your client to be able to work with one?

So it’s about being able to diagnose, that slow process, and it’s about being able to put a treatment plan together that works for the patient.

Kevin Pho: Faust, thank you so much for sharing this perspective and insight, and thanks for coming on the show.

Faust Ruggiero: Kevin, it’s been a pleasure. Thanks so much for inviting me.