Dr. Perrotti is a Clinical and Forensic Neuropsychologist and Expert Witness with extensive court experience in Civil, Criminal and Family Law matters. He currently maintains a private clinical and forensic neuropsychology practice and is currently a fieldwork supervisor for UCLA interns in the psychology program. He has coordinated hundreds of evaluations for the courts, plaintiffs, and defense counsel in personal injury, assessment of pain and suffering, workplace issues, Traumatic Brain Injury, assessment of child sexual abuse accusations, PTSD, false confession, and eyewitness ID. Dr. Perrotti is an Independent Medical Examiner for the State of California and routinely conducts (Independent Medical Examinations) IMEs for the plaintiff and defense. Central to his evaluations are objectivity, adherence to ethical guidelines, and best practice standards and findings based on evidence-based research. He is a regular presenter of Peer-Reviewed papers to forensic psychologists at the American College of Forensic Psychology. He has also served as an expert witness for the Attorney General of the State of California in Standard of Care cases as well as administrative law matters. He is able to assist in detecting malingering and suboptimal effort on psychological tests taken by litigants.
He also has testified in child sexual abuse cases wherein Gold Standard child investigative interview protocols are not followed. He has presented testimony to juries on childhood memory and false memory syndrome. He has served as a rebuttal witness and has testified on other neuropsychologist’s assessments and reports. He has presented research to juries on false memory, suggestibility, child memory, and child investigative interview protocols best practice standards. He is certified by LA County Superior Court in neuropsychology, false confessions and eyewitness ID. He has conducted neuropsychological assessments on veterans for the US Military Command. He also is an Expert Medical Reviewer and opines on the employability of litigants as well as functional capacity.
Dr. Perrotti is also a neuropsychologist. He conducts comprehensive neuropsychological assessments including brain injury, neurodegenerative diseases, and assessment of functional capacity. In other words, he’s a big deal.
The title for today’s podcast is: Finding a sane space in an insane world.
Today’s Podcast is on managing stress, anxiety, and depression with COVID-19. New research on neuropsychology.
“Hello Dr. Perrotti, how are you doing today?”
“Doing well, thank you.”
“So today, a lot of people are dealing stress with anxiety, as well as depression due to COVID-19 and you are in the process of writing a paper/article on the topic, can you give us an update of what you are working on right now?”
“Well right now I’m working on and really concerned about the effects, specifically the psychological effects on people during the stay at home orders in place. Of course, stress affects physical health, such as causing cardiac arrest and other physical problems. However, on the bright side, the governor is moving step-by-step towards a healthy point and move towards opening up offices and other retail businesses, which in turn is good since this has been terrible for the economy. I think the governor is a very cautious person, which is a good thing, in terms of health and safety. Unfortunately, there’s a lot of people who are great office workers and great at working in a team and now are currently at home working in fear, saying “We can’t go back to the office.” While some people are saying, “I love working at home.” I think what we’re talking about here is understandable that COVID-19 is causing a lot of this fear, and I think some of it is has been exaggerated by the media and of course, when you’re afraid or anxious about something, it’s more reinforcing to avoid approaching what you’re anxious about.”
“The first step is recognizing the paralyzing effects of fear increases isolation, so for some people it’s more comfortable for them to stay at home. So the answer to this is to embrace safety guidelines and good sense and good judgment, to embrace CDC guidelines such as social distancing, sanitizing surfaces, and screening patients for symptoms. I also find it interesting that some professionals in these medical professions are doing everything remotely and avoiding face-to-face visits. There’s nothing that the government says that indicates the need for this. Governor Newsom in the very beginning, for example, designated medical health providers as essential workers, meaning they could go into the office. Yet, there are some providers doing remote therapy, remote assessment, which sounds horrible, because some of it is not standardized. So, people should stay in step with what we are seeing, which is taking gradual steps, and that’s the only way for this to work in beating this fear.”
“Thank you for that Dr. Perrotti, you mentioned that employees are gradually going back to work in the office, are your employees currently working in the office at this moment?”
“How was that transitioning from the non-COVID era to the COVID era with your employees?”
“Well it’s working out well, we use social distancing protocols, sanitizing surfaces, and we only have one patient at a time waiting, screening for symptoms, and this has been currently working quite well. Actually, the majority of patients prefer to come for a face-to-face visit, and probably less than 1% do not feel comfortable doing that, and I tell those people they need to do what they are comfortable with and tell those people that it’s fine.”
“You said the title of the podcast today was “Finding a Sane Space in an Insane World” can you elaborate on that?”
“Well, I think a sane world is a place where you’re keeping step with what the government is doing. The governor is doing things step-by-step in phases, he’s opening beaches, he’s eventually going to be opening up offices so office workers can come back. That is, dealing with reality, which is being sane. Insanity is, well there are some people that I know, who told me that they haven’t left the house in two months other than two times, and actually that is increasing your vulnerability for COVID-19 more than anything. This is because you are inactive, therefore, your resistance is going to drop since you are not getting anything physical exercise, you are not going out with your peers, isolation increases which increases depression, and your self-worth is decreased since people have great impressment in their jobs. I think when you’re isolating to the extent that you aren’t even going out and getting exercise, it’s not a healthy thing.”
“You said to find a sane space, can you elaborate on ‘space’?”
“Well, humans are social animals, and I think isolating is not a good thing. I think people should get out, but follow social distancing, of course. They could even go out by themselves, like take a walk on the beach. There’s nothing prohibiting that, as long as it’s active, as long as you are active. However, there are some things that I’ve seen that I didn’t understand, like a man sitting by himself on the beach with an umbrella, and there were three police officers there. I didn’t understand why they were around him. I think also getting out and being active, and although many businesses are closed down, many of them have curbside services so you’re not exposed to the same isolation at home. It’s essential to break the chain of isolation since it causes people to lose hope; it causes people to feel helpless. So, staying active, meeting with friends, and practicing social distancing is important and that’s what we call self-care. Self-care is very important.”
“As a Doctor yourself, what kind of precautions would you carry out?”
“Well, I think you should put yourself in situations where you have control, where you can walk away from people. For example, when you go to a grocery store, you can maintain social distancing. I think the areas that are at risk right now are areas where you don’t have control, such as flying in airports. You don’t know what’s going to happen when you are flying and don’t know who may or may not have the disease and just sit there. I think that avoiding crowds is important, as well as following the safety measures is enough. Basically, making sure you are in control of the situation, but I don’t think you should be paralyzed by fear and stay home without going out.”
“What would you advise to the general public in regards to managing stress [and depression]?”
“Well I think it’s important to realize thoughts cross feelings, and that you have to reset your thinking. Others have much more catastrophic thinking, everything’s horrible, I can’t go out, I might get sick, etc. This is catastrophic thinking and is a thought distortion that is caused by stress and depression. Resetting your thoughts is thinking, ‘Okay, today I’m going to set some goals. I’m going to the beach, I’m going to get some groceries, I’m going to call my boss and say I don’t necessarily have to work remotely. Basically, setting goals which then leads to making progress instead of catastrophic thinking, which is not a good thing.”
“How would we replace fear?”
“I think you replace fear by relaxation exercises and thinking positive thoughts. Fear is something you approach one step at a time, like calling your boss to see what office precautions are in place, finding out more what the government is saying, and the great thing about people is that when they face their fears, they do pretty well. You need to realize you’re going to have some anxiety, but after 2-3 times, the anxiety goes away and you come out more courageous and a stronger person.”
“What is some advice that you can give to the general public?”
“Well, I think you need to do a benefit-risk analysis with your decisions. I believe there’s a great risk of staying isolated throughout a longer period of time, with the effects on your health and stress. As opposed to embracing and going on with the progress on society, with the governor opening up businesses. Certainly, there are still risks with travel and crowds not maintaining social distancing, but there’s a lot of benefits to going out and being productive. If we don’t challenge our fears as a nation and move from isolation to embracing our careers and our jobs with the comfort of these safety measures, then it won’t do any good.”
“How about the news Dr. Perrotti?”
“Well people shouldn’t binge-watch the news because it only exacerbates anxiety, and really there’s a lot of the news that’s inaccurate. For example, someone told me that the death rate is inflated because the hospitals get paid for each case that is reported, and this was fact-checked. I also think there’s not enough attention to young people who have had COVID-19, and many, many of these people recovered in the majority of cases. The other thing is to be selective about what you watch. Instead of CNN, watch other reputable sources and organizations that follow the CDC, be aware of where the source material is from, and know that the content may not be regulated. Instead, watch a happy movie, read a book, and do something you enjoy, leaving any of your fears and anxiety. People have overreacted in trying to take control of their fear at the expense of other people. This includes guarding shelves and hoarding supplies. I think people need to be aware of is very, very much influenced by politics. It’s not good to oversaturate yourself with tv news, watch something else, or use your time to do something productive like work on a project or get back to work and think about ideas to contribute to the company.”
“So you are a neuropsychologist, not many people know what that means, what exactly is neuropsychology, and what does a neuropsychologist do?”
“A neuropsychologist is a person who’s an expert in diseases of the brain, whether neurocognitive diseases like dementia and Alzheimer’s, expert in the treatment of traumatic brain injuries, seizure disorders, and anything to do with the brain and behavior because the brain affects behavior. We do testing and assessment of problems that have to do with brain dysfunction.”
“What are some neuropsychological effects of COVID-19 that you’ve seen in patients that you’ve read about or like to share about?”
“Well, there’s been some early research, however, it’s not well-developed at all, but it has to do with COVID-19 causing problems with cognitive processing and causing serotonin deficits. One problem is that you have to factor out the individual’s premorbid history if they had these problems before then it might not necessarily be caused to COVID-19.”
“You said that we are social animals, can you elaborate on that?”
“Well, I think people do their best when they can interact with each other. That’s why you have teams in an office, that’s why in our practice we have a research team. People do best sharing ideas and supporting each other, and intermingling with each other. Social interaction is healthy, productive, and makes people feel better about themselves. Like people working on COVID-19, everyone is working together for a common goal. For example, there are researchers that are communicating with Chinese and Russian researchers around the world sharing their knowledge. You cannot do that alone, people need to work together.”
“As a practitioner and scientist yourself, what are some resources that people can go to that are reliable and science-evidence based.”
“I think National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) are reliable resources.”
“How about health care professionals, are they also reliable resources?”
“That’s an interesting question, I think health care professionals that are doing a lot of work remotely, in some sense, are reinforcing the fears of patients since the majority of patients want to come in the office. These professionals that are working remotely, there’s nothing that I know of that mandates that this is how it’s supposed to be. There’s nothing that I read of that says this, rather, we are deemed as essential workers and that we should go on to work.”
“How about alleviating the fears for children?”
“Well, we are models for children. If we are fearful, the child is going to be fearful. Actually, infants, they can sense the mother’s stress and sense a stressful environment. As we go, they go, so if we become frozen in fear, they’re going to be frozen in fear. There’s a lot of research that shows on infants and children, that if adults cannot handle stress, it increases cortisol levels on children and they take longer to recover from stress because the parents take longer to recover on stress. This is transmitted and there are studies on this.”
“Final advisement dealing with stress due to COVID-19?”
“My final advisement is not to be frozen with fear. Be cautious, use safety measures that are out there for everybody and also look at what is going on with California and see the gradual phases it’s going through. If you’re not in step with that, then you’re going to question yourself if you are paralyzed in fear, because if the government is going one way and safety measures are there, and you’re going the other way then maybe you should get support, talk to another health professional to address your anxiety and fears. Certainly, COVID-19 is a terrifying thing, but the answer is not to succumb to fear and paralysis. The answer is to utilize the safety measures in place and follow the guidelines of the gradual opening of our society.”