Episode 441: A Deeper and Lasting Wellness with Dr. Monica Vermani

In this episode, we uncover the secrets of deeper and lasting wellness guided by the incredible Dr. Monica Vermani. Throughout our conversation, Dr. Vermani shared several mental health and wellness strategies and explained why CBT and MBSR work and how they can help you reduce stress and improve mental health. You’ll also hear about her journey into the medical field, the three distinctive ways problems manifest in our lives, and practical tips to improve our relationship with our inner voice.

Steve Shallenberger: Welcome to all of our podcast listeners, wherever you may be in the world today. This is your host, Steve Shallenberger, with Becoming Your Best. We have a wonderful guest with us. She’s one of Canada’s highest-rated clinical psychologists, a public speaker, teacher, and author in the field of mental health and wellness. In her private practice, she provides a multifaceted treatment approach in treating adolescents and adults suffering from trauma, abuse, mood, anxiety, substance addictions, and related conditions and disorders, as well as family and couples therapy. So, I’d like to welcome Dr. Monica Vermani.

Dr. Monica Vermani: Thank you very much, Steve, for having me.

Steve Shallenberger: That is quite a background, and you serve quite a range of patients.

Dr. Monica Vermani: I’ve been very fortunate since a young age to have great training and wonderful institutions. I started my career in correctional facilities and then moved on to working with mood and anxiety in hospitals. But pretty much, I specialize in adults, and I work with mood, anxiety, high stress, and traumas.

Steve Shallenberger: Well, here’s a little bit more background on Dr. Vermani. In 25 years of private practice, she’s treated thousands of patients through supportive psychotherapy and CBT, which I first read about in Why We Sleep. So, I’d like to talk a little bit more about that book. That was very interesting: cognitive behavior therapy, mindfulness meditation, and Mindfulness-Based Stress Reduction. The acronym for that is MBSR. I’ll read a few more so that we have them: mindfulness-based cognitive therapy, Breath, Body, Mind. I want to hear about some of these, and eye movement desensitization and reprogramming. These are very interesting. These are acronyms that probably just flow right off your tongue. They are a little bit new to me, some of them. In 25 years of practice, Monica has treated so many patients with these therapies, and it’s been a great help for her and her patients. Monica, tell us about your background, including any turning points in your life that have had a significant impact on you.

Dr. Monica Vermani: I do truly feel like I didn’t choose the field. The field was kind of laid out for me. I grew up with a parent who had a workplace incident that put him into a trauma of his own. I grew up with a father who needed some healing, and I never realized it as a kid, but he definitely had trauma from his workplace incident. As we grew up together, I became a caregiver in the household. So, learning to be a caregiver with my mom, as we grew together, we formed a little team. I think you just altruistically become this caregiver. As I grew up, I enjoyed volunteering in places where I could help. I started volunteering at a distress line, and from that, I was working at a department store from a young age. Some of the people would be like, “Hey, you know what? You’re really kind, and you help people out. You should get into that social work or psychology stuff.” Then, I got into U of T for a science degree. I chose to start off with the science degree—the biologies and chemistries. Then, as I took psychology and sociology, I also took criminology and women’s studies. That led me to enjoying it and doing so well that I pushed myself a little further. I got internships and practicums working in shelters with abused women and children, at a correctional facility with women and then men offenders. As I learned how to work with extreme populations of suffering, I got to learn how to do everything in the middle. I got some great training at CAMH (Center for Addiction and Mental Health), just working with anxiety disorders, as well as forensic populations at the Medford Center. I then worked with brain and spinal cord injury patients—people who were paralyzed from the neck down or the hip down—military work, and 911 work, where I also had meditation.

Dr. Monica Vermani: Meditation has been a part of my personal journey since I was a kid with my dad not doing well. As I learned meditation in the household as I grew up, mindfulness meditation was a big thing that was being spoken about as I was doing my schooling. I started getting more engaged with learning on a certified level through U of T: mindfulness meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy. As I worked with the military and 911, I met these wonderful psychiatrists in New York who were doing a Breath Body Mind program. They had switched a lot of their practice from doing medication as psychiatrists to doing more breath and body work to help people override physical symptoms or negative thoughts, helping empower themselves versus feeling depleted and victimized by whatever suffering they were going through. So, I’ve been blessed with so many wonderful mentors and meditation teachers, psychiatrists, psychologists, and social workers. I’ve learned from so many different disciplines that my multifaceted treatment approach is really unique to the individual who’s in front of me.

Steve Shallenberger: Wow! What a bag of arrows in the quiver to treat the things that are needed for people. First of all, let’s just talk about your book because you have a lot of this in your book, A Deeper Wellness. Tell us why you wrote the book, who it’s for, and basically what’s in the book.

Dr. Monica Vermani: During the pandemic, my own patient population got a little bit more stressed out. As you can tell, the world was on pause. That pause and reflection period brought some balance and rest for some people. For a lot of people, it brought their symptoms and issues to the surface. I found a lot of my own patients wanting more time with me, as well as new patients. There were first responders working around the clock—nurses, doctors, and firefighters. Then there were people who weren’t working at all and had all their trauma surface to the point where they needed to deal with it and attend to it. During the pandemic, I realized I needed to bring some resources that were not just one-on-one with me. I started working a little bit on my time around my patient care to write articles during the pandemic. These articles are on my website under my podcast section. I also read them out loud for people with chronic pain who just want to listen to them. There was also a meditation I recorded per week. As I was doing this, I realized a book would be handy. A lot of my patients wanted a workbook, and I’d give them exercises. I took my own exercises and some of the work I was doing writing these articles and decided to write A Deeper Wellness, which is about conquering stress, mood, anxiety, and traumas that were at the forefront and high during the pandemic. The book is actually a workbook. It’s more than just reading it; it’s about engaging with it. Wherever you are, at whatever age bracket, you will find yourself able to work with this book and work through A Deeper Wellness, learning how to be a higher, better version of yourself deep down inside. I think that’s the purpose we’re all here for—to learn how to be higher, better versions of ourselves. Sometimes, self-help tools are good because I do this work day after day. I know what people are looking for. I also know the hot topics people struggle with: anger, understanding symptoms, panic disorder, anxiety, people-pleasing, putting others ahead of ourselves, losing focus, and being distracted. The book covers many top topics of you working through wherever you’re at, conquering your symptoms, alleviating them, and bringing them down through techniques. Cognitive behavioral therapy techniques look at challenging thoughts and understanding hot topics like guilt, boundary setting, or anger. You really understand, on a psychological front, why you are getting angry, feeling guilty, feeling addicted, why you can’t break this habit, and why you are procrastinating. So, I took the hot topics, put them in a book with exercises, and I also have an online platform with life lessons for people who don’t want to read and work through it. They can just watch little videos with a handout and a worksheet. During that time, my TED Talk came out, titled “Think About It: Thoughts Are Powerful Things.” Good or bad, everything ever created started with a thought. We often need to look at the power of our thoughts. That’s a little bit about what cognitive behavioral therapy does—it reframes and reconceptualizes narratives or thoughts. That TED Talk has leveraged the book, and the book is also leveraging the TED Talk. In October, I’ll have a master class on “Think About It: Thoughts Are Powerful Things” and how to reframe negative thoughts to more positive ones using a systematic approach.

Steve Shallenberger: Amen. What we think about is what determines what we do—our behavior—and that gives us the results we get. So, if someone’s having trouble with positive thoughts and they’re really troubled with anxiety or things that may be worrying them—it could be a relationship, a work conflict, or a personal issue like losing someone important—how do they get the right thoughts going? What’s your recommendation?

Dr. Monica Vermani: So, Steve, the first step to treatment, regardless of who you are and what you’re going through, is awareness. In the book, I describe my way of explaining symptoms. Any problem in life—grieving, self-esteem issues, anxiety, depression, money problems, social struggles, work problems, school issues, whatever you consider a problem in your life that is holding you back from living authentically—you can put on this table, and every problem will always manifest in your life in three distinct ways. The first way things manifest in your life is physical or physiological: headaches, muscle aches, abdominal distress, constipation, diarrhea, heart palpitations, crying, sensitivity, irritability, angry outbursts, eating too much or too little, sleeping too much or too little, panic attacks, fatigue. The list goes on. The second way things show up in your life is cognitive: negative thoughts. From zero to ten, you’re not born in that world. You’re born in a household. The way mom and dad love each other is love; the way mom and dad fight is conflict resolution. We learn a lot of narratives and belief systems from our upbringing. As we grow, we have life experiences that we sometimes personalize—the hard ones. Thoughts like “I’m not good enough,” “I’m not smart enough,” “I’m a failure,” “I’m unlovable,” “I’m unworthy,” and not feeling worthy or deserving of better come from here. These are thoughts about you, your world, your capabilities, relationships, and how to cope.

Dr. Monica Vermani: The third way things show up in your life is behaviorally: lifestyle habits. So, you have physical symptoms from head to toe, negative thoughts racing in your head. What does it look like in your life? Eating too much or too little, sleeping too much or too little, alcohol and drug use. Here, we have avoidance, denial, procrastination, staying in a bad relationship, putting up with abuse, rage, and angry outbursts of our own, porn addictions, food addictions, overcompensating, people-pleasing, procrastination—like I said—staying in a job that’s not good, not asking for that raise, dropping out of school. The list goes on. So the three of these keep your problem standing in life. You go to your medical doctor, they might break this leg and give you medication. Medication throws a blanket over your physical symptoms to dampen them and do some genetic repair, but it doesn’t really change the dynamics in your life. So, a lot of what I do as a clinical psychologist is CBT (Cognitive Behavioral Therapy). I reframe the thoughts and the negative behaviors that you might be stuck in as habits of self-soothing. I also teach meditation, which, on a physical front, involves sitting with symptoms instead of always looking to numb and get away from them.

Dr. Monica Vermani: EMDR, as you mentioned earlier, is Eye Movement Desensitization Reprocessing. It’s about me helping you go into your own memories to figure out what physical symptoms led to negative thoughts and behaviors that you formed from difficult childhood or difficult experiences in life. By going into certain memories where you formed these negative cognitions and thoughts, we can reframe them more easily and understand where you personalized something that had nothing to do with you. We all have a dynamic going on, and the first step to treatment is always awareness. When you understand this, it feels more manageable. Otherwise, we live with all of these symptoms within us, and it can feel quite overwhelming. One of the chapters in the book goes over this table and helps you understand how to break down your symptoms, understand how they’re presenting, and then, baby steps—slow and steady wins the race. Let’s take on one of these symptoms and work through it with a solution that allows you to be a higher, better version of you. Many of us need to realize that one way to better ourselves is to envision good for ourselves. I always tell patients, if I had a magic wand and could take away your problems, where would you like life to go? I try to take you from where you are to where you want to go. The gap between where you are and where you want to go is just your symptoms. Understanding how to bridge the gap is where the gold comes in, and that’s what this book’s about—bridging the gap between where you are and where you want to be.

Steve Shallenberger: You’re saying then, as you think about issues that any of us may confront in life, you want to really be very aware of what the issue is. Is that what you’re saying?

Dr. Monica Vermani: Being aware of the impact of the issue in your life is crucial. So, the first step to treatment is to look at how anxiety, depression, sadness, or anger manifests in your body. What does it feel like in your stomach? Do you experience heart palpitations, crying, sensitivity, irritability, panic attacks? Symptoms can fluctuate. Your mind might be foggy, you might ruminate and be unable to sleep, and you can’t stop thinking about something. What’s happening on a physical front? On a negative thoughts front, what are the thoughts that rotate in your head that make you feel less than? “I’m not good enough,” “I’m not smart enough,” “I’m not capable.” And what are some negative behaviors you do that keep you stuck, like isolation, withdrawal, not seeking the help you deserve, not asking for help, not going to your medical doctor, self-medicating, using drugs or alcohol, procrastination, or keeping too busy? Sometimes overworking is a symptom of us escaping from our bigger problems in life.

Steve Shallenberger: Let’s talk about sleep. Dr. Walker, in Why We Sleep, talked about CBT as one of the most important medicines, although it’s not a medicine; it’s cognitive behavioral therapy. He shared in the book that most sleep medications are actually counterproductive, and he said the starting point is CBT. Can you describe how that can be helpful for someone that may have trouble going to sleep?

Dr. Monica Vermani: Understand that whenever we have physical symptoms, we also have negative thoughts related to those symptoms. Think about how we can stay busy, busy, busy and distracted, running away from our anxiety all day. But when you lie in bed, you’re vulnerable. When you lie in bed trying to put yourself to sleep, you’re trying to deescalate from the go-go-go mode to a place of rest. In that silence, when you’re alone, negative thoughts that you don’t address during the day might bubble up. A lot of people may have generalized anxiety disorder where they lie in bed and ruminate, thinking over and over about all their problems, worst-case scenarios, catastrophizing, and not feeling good enough. In that place of rest, where we’re supposed to replenish and rejuvenate, we end up spending a lot of time ruminating and thinking, escalating symptoms when we should be deescalating and resting. Realize that a healthy quality of life is divided into eight hours of work, eight hours of play, and eight hours of sleep. One-third of your day is in sleep because you are repairing the wear and tear on your nervous system.

Dr. Monica Vermani: You are repairing the wear and tear on your muscles and your body. If you can’t sleep at night because in that quiet, everything you haven’t addressed is bubbling up, that’s a problem. Anxiety comes in, negative associations tied to sleep come in. Many of us dread going to sleep because we know we’re not going to have a good quality of sleep. Some people have physiological issues, like sleep apnea, where they can’t breathe properly. They might be drinking alcohol to take the edge off the stress. Alcohol is a depressant and can give us broken sleep at night, or you’re using drugs. The same thing—weed can be a depressant. If you’re eating or exercising a lot before bed, you’re escalating and stimulating yourself. We don’t understand that sleep hygiene is very important. A part of healthy sleep hygiene is paying attention to the thoughts tied to associations with sleep, but also what comes up when you lie in bed. Some of us can say we fall asleep right away, while others feel like it’s a miserable place where your mind’s racing and you don’t know how to settle it.

Steve Shallenberger: How would you use cognitive behavior therapy to prevent that? You just shared a few of the things. Are those habits examples of CBT?

Dr. Monica Vermani: Some of them are. Realizing good sleep hygiene involves understanding unhealthy patterns related to sleep that we reinforce, such as eating before bed or being too stimulated by being on our devices. If you’re stimulating yourself, how are you supposed to calm down? Secondly, if we overwork, you go, go, go, and then jump into bed. Well, that’s not healthy. You need to go, go, go and then find a way to deescalate, to come to a state of calm, to be ready for bedtime. Watch calming things, listen to soothing music, drink chamomile tea, make your bedroom an environment you look forward to going into. Your bed should be for sleep or recreational activities. If you’re not having intimacy, you should be asleep, which means you shouldn’t be reading books, on your devices, or watching TV in bed. It’s important to recognize the habits you’re reinforcing. That’s the behavior part in CBT—looking at unhealthy behavior habits that we can reframe for healthier habits. For example, not eating before bed, not exercising before bed, and reducing all technology use two hours before bed. Maybe even bring in healthy habits like melatonin, chamomile tea, or using magnesium. There’s a lotion that you can put under your feet that helps you calm down, or you can take magnesium supplements. Learning how to bring in healthy habits for sleep is crucial. On the thought front, break any negative thoughts you have about sleep. If you have a sense of dread, you’re obviously not looking forward to it.

Dr. Monica Vermani: And then there are negative thoughts that come with sleep, where you’re afraid to fall asleep because you’re worried about these negative thoughts creeping in. Learning how to reconceptualize looking forward to rest, having love and compassion for yourself, and having love and compassion for the content can help. Maybe do a guided meditation where you’re replacing negative thoughts with more positive ones—replacing negative dialogues and narratives with more soothing, calming, reaffirming affirmations as you go to bed. Progressive muscle relaxation, where you relax every muscle of your body, is like counting sheep in some ways. Instead of ruminating on the negative thoughts, take charge of your thoughts. Focus on your breathing patterns, relax, but also look at the content you can replace, which might be following a guided meditation. It might be imagining where you would like your life to ideally go and bringing yourself to a place of love and compassion for your symptoms, too. CBT involves reframing the thoughts around sleep, but also the thoughts related to the content that ruminates when you wake up in the middle of the night. Some people say, “I wake up in the middle of the night thinking about work.” Well, let’s find healthy habits where you can bring yourself back from work and say, “Here and now, all is well.” Use affirmations to reaffirm being in the present moment rather than thinking about tomorrow morning. You’re not there yet. These are skill-building techniques. Sometimes our parents don’t teach us healthy skills because they don’t have them themselves. It’s not about blaming mom and dad; we do the best we can with what we know. It’s important to take charge of your life, to know more by visiting professionals, reading blogs, and using workbooks centered around improving things. Cognitive behavioral therapy is a lot about reframing negative thoughts, challenging them, and then reconceptualizing them to be more positive and uplifting so that you feel in charge of your life versus powerless and worthless.

Steve Shallenberger: Thank you for that answer. In a couple of chapters of your book, one we’ve already talked about—putting your problems on the table—that’s the starting point of working through them, understanding them, being aware, and then using some of the things that you’ve recommended that we’ve talked about today. I know you also have a chapter called “Communication,” which seems to deal a little bit with anger. Why do you call it communication?

Dr. Monica Vermani: The biggest and best person we have to learn how to communicate well with is ourselves. We all have a tendency to play a lot of games, engage in manipulation, and self-sabotage or self-harm by dismissing the truth about our symptoms and how something may be a problem. The first step to treatment is awareness. The first person you have to learn to be honest and communicate openly with is yourself—being honest about how things in your life may be feeling out of control and how certain symptoms might be a bigger problem. I tie it in with anger because anger is a blanket term. Words like anger, happy, sad, and nervous cover a lot of territory but don’t give you specifics. Anger, in particular, can come from many other places that are real feelings about yourself. Anger is never about the other person; it’s about what gets elicited in us. So, it’s about communicating to yourself—when I’m angry, what’s really coming up? Anger can stem from love, frustration, feeling not good enough, not lovable, not worthy, feeling bored, insecure, inadequate, stupid, embarrassed, betrayed, guilty, or a loss of control. It can come from feeling denied, dismissed, or experiencing a lack of joy. It’s important to realize what’s really happening. For example, I had someone talking about dating this morning, so I’ll bring that example in. I’ll even use one of my own examples. My dad used to say something like, “If you spit on the ground, do you ever look it up?” I’d say, “Ew, no.” He’d say, “When you say something, stick to it.” This became one of my core beliefs.

Dr. Monica Vermani: So, hypothetically, I start going on a date with someone from an online dating site. I go on this date, and it’s someone I like. We start talking, and the person says, “I’m going to call you tonight.” I wait, and I don’t get a call. Anger bubbles up, but my anger is not at the person. My anger comes from my narrative and story that when you say something, you do it. This person said something and didn’t do it. However, because it’s new dating, I don’t want to rock the boat, so I don’t say anything. I suppress it and people-please, but eventually, I tell the person, as we get to know each other, “Hey, I didn’t appreciate you telling me you were going to call me, and you didn’t call.” Now, fast forward. We’re dating for six months. He knows I expect him to do what he says and commit to it. Six months later, he’s like, “I’m hanging out with the guys. I’ll give you a call at the end of it,” and doesn’t call me again. He might have lost track of time or whatever, but I’m angry because now I’m insecure. Has he met somebody else that night? I might have other things bubbling up, like frustration that I’ve told him over and over that this bothers me and he’s not listening to me. I’m feeling unseen, unheard, and unvalued. I might have feelings of inadequacy coming in, or feelings of anxiety, like what if something bad happened and that’s why he didn’t call me. Fast forward even longer—five years go by. We’re married, we have kids now, and he says, “I’m gonna go out with the guys and I’ll give you a call to tell you when I’m coming home,” and I get no call. Now I know he just loses track of time, maybe has ADD or something, and he doesn’t mean to harm me, but I’m still angry. This time I’m angry because we have kids and a family, and what if something bad happened? I don’t know where he is. He didn’t call me. Now it’s coming from a place of concern, maybe from a place of insecurity—what if he met somebody else? I’m less attractive since I had kids.

Dr. Monica Vermani: Realize that anger is never about the other person. That person has been the same all the way through, but what’s coming out of me changes based on my phase of life, who I am, and what work I’m doing on myself. Am I working on my self-care and self-esteem so that I feel good about myself and don’t project it on others? People don’t mean to make you angry many times; we’re personalizing their behaviors because we have standards or narratives, and we’re having a clash. It’s important to realize what’s underneath my anger. The person might be frustrating me, but what is really bothering me? That’s about healthy communication with yourself and addressing: “I’m feeling insecure right now. I’m feeling inadequate, lonely, not good enough.” Because if you communicate well with yourself, you can communicate well with your partner. When my partner comes home at midnight and didn’t call me, instead of losing my temper and getting angry and making it worse, I can say, “Honey, I love you, but when you don’t call me, I worry. I get frustrated, I feel insecure, I wonder where you are. I start imagining what’s life going to be like if you died on the street, and I don’t know where you are.” He’s like, “Whoa!  You go through all that? Well, I’m going to try to make a sincere effort to call you, because obviously what goes on underneath your anger is something I have to help you with.” We’re teams. We should help each other, but the first step is always awareness of what’s really bothering me. When you work on yourself, some of what bothers you shifts in presentation. Anger is a blanket word. It doesn’t tell you much, but if you go deeper, you’ll see what you’re really angry about and what’s being elicited in that scenario.

Steve Shallenberger: I love what you just described, and all that’s in your book, and what to do about it.

Dr. Monica Vermani: The book is great for helping you dissect things that are daily triggers, whether it’s people, situations, or feelings of inadequacy. It focuses on learning meditation wherever you’re at, whether you’re a beginner or an advanced practitioner. It’s about helping you learn how to go inward and be a better person. There’s a quote I love to live by: “Being well-adjusted to a sick society is unhealthy.” We sometimes raise our kids to be well-adjusted to a competitive society that overworks, overstretches, and puts external instead of internal value. We often look for external validation when we need to bring more awareness to our internal traits and learn how to self-soothe and value ourselves first and foremost. One of my big quotes is, “Don’t give from an empty well; give from your overflow.” Take care of yourself, whether it’s working with a therapist or using self-help books. Learn how to work on yourself so you can be a better person for others. When you’re in pain and suffering with symptoms, it spills over onto others. When you’re in a place of health, there’s a ripple effect that impacts others. That ripple effect is important. If you want a better world, start with yourself.

Steve Shallenberger: Oh, that’s great. Well, thanks. I can’t believe we’re out of time already. How can people find out about what you’re doing?

Dr. Monica Vermani: I’m everywhere on social media. You can go to my website, drmonicavermani.com. You can also find me on Instagram, Facebook, LinkedIn, TikTok, and YouTube. Please do. There’s lots of wonderful mental health tips and content on how you can improve yourself to be a higher, better version of you. If you want your loved ones to work on themselves, sometimes the best way to motivate them is by working on yourself.

Steve Shallenberger: This is a workbook. Does it happen to be available on Audible?

Dr. Monica Vermani: I definitely did that for my chronic pain patients and people who don’t like to read and work through the workbook. It’s also on Audible. It’s great to have firsthand just to work through the exercises. You can get this book on Amazon as well as on my website.

Steve Shallenberger: Thank you for being with us, Monica. It’s been a delight. Thank you for sharing your wisdom, your experience, and the practical applications. I’m sure all of us, whether in our own lives or those we associate with, can benefit from applying what you’ve talked about today.

Dr. Monica Vermani: Thank you very much for having me, and I hope you all enjoy the tips.

Steve Shallenberger: For our listeners, it’s been great being with you—always a privilege. We wish you the best in all that you’re doing as you work on becoming your best, your higher, better self. In the very process, you bless all of those people around you. We wish you a great day. This is Steve Shallenberger, your host, signing off.