E 244 Why Your Teen Is Not Listening and What Actually Works

Is your teen constantly overwhelmed, anxious, or shutting down? In this episode, we explore practical, research-backed ways to help them regain calm and confidence, without forcing or fixing.

Join me, Cynthia Coufal, teen anxiety coach, as I sit down with Dr. Matthew Berstein, psychologist, educator, and mindfulness expert, for a refreshing conversation about how anxiety shows up in teens and what actually helps.

You’ll learn:

Why typical adult responses can backfire with anxious teens

How mindfulness can be accessible and effective—even for skeptical teens

What self-awareness looks like in real life (not just theory)

Simple ways you can support your teen without increasing tension

Whether you're a parent, educator, or coach, this episode is packed with takeaways you can use today.

🔔 Don’t forget to subscribe for more episodes on helping teens manage anxiety with confidence and clarity.

📌 Resources Mentioned
Learn more about Dr. Matthew Bernstein  

Article Dr. Bernstein mentioned

 Struggling with anxiety in your family? If anxiety is causing tension, fights, or disconnect in your home, you don’t have to face it alone. I help parents bring more peace, confidence, and connection to their families. Let’s talk—schedule a free consultation today or email me: ccoufal@cynthiacoufalcoaching.com

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Transcript

Hi everyone. Thank you for joining me for the Teen Anxiety Maze this week. This week I have a fun guest for us, Dr. Matthew Bernstein, and he is a clinical psychiatrist with more than 20 years of experience, and he's also the CEO of Accord, which we're gonna talk about all that here in just a little bit.

But he is one of the leading voices. In metabolic psychiatry. So this is something new for me I didn't know a lot about, and you're gonna find out about it today. And as parents, this is such important information because we can help our child's mental health by how they eat and their nutrition. So, and, and many other things.

So we're gonna talk about all that. So, do you go by Matthew or Matt? 

Matthew Bernstein: Call me Matt. That's great. 

Cynthia: All All right. Alright, well Matt, it is so good to have you with us. Thank you for joining us. 

Matthew Bernstein: It's my pleasure to be here. Thanks for inviting me. 

Cynthia: [00:01:00] Wonderful. Well, can you tell us what is Metabolic Psychiatry like?

I don't think a lot of people know what that is. 

Matthew Bernstein: Well, it's new so I'm sure a lot of people don't. But people will be hearing about it more over the next few years. 'cause there's a tremendous amount of. Of research happening on this topic in big universities. And when those studies get published, we're gonna have it in the news and people are gonna be talking about it.

So I think it's a little bit of a sneak peek of some of where the field of psychiatry's going in the next few years. And it's really this idea that. Our brain is part of the body. It's not a whole separate thing. And everything in the body is subject to metabolic processes. Metabolism is this idea of taking nutrients and turning 'em into energy, but also turning it into molecules that our cells need to do their function.

So turning it into hormones and proteins and enzymes and neurotransmitters. Metabolism is all of [00:02:00] that. Mm. And the brain is the most energy hungry organ in the body. It's only about 2% of the weight of the body, but uses somewhere around 20% of the energy throughout the day. So it's most sensitive to problems in metabolism of any organ.

And so we're finding that when people are, you know, that there's a bidirectional correlation between. Metabolic health and brain health or mental health. 

Cynthia: Hmm. And so that's the 

Matthew Bernstein: idea is that if we can intervene, you know, psychiatry is so focused on intervening on the brain, but actually if we intervene on the metabolism, that improves the brain health.

And there's a long history behind all of this, which we can get into. 

Cynthia: Oh my gosh. Well, so when you talk about metabolism, I just think about food or nutrition, right? But you are probably also talking about sleep and other things that go along that are connected to our metabolism. Is that right? I.

Matthew Bernstein: Absolutely. So yeah, I mean, nutrition is very powerful for metabolism, but so [00:03:00] is exercise. You know, we change our metabolism every time we move our body. And sleep also affects metabolism. Mm-hmm. And circadian rhythm alignment, you know, which is even a little more, you know, advanced than just thinking about sleep, but it really helps with sleep.

Mm-hmm. And then even things like mind body relaxation practices. Meditation, breathing exercises, yoga, that affects metabolism as well because it affects the mitochondria, which are these incredible organelles that are in all of our cells that are sort of at the, the center of this whole story about metabolism.

Cynthia: Hmm. That is I, I can really geek out on some of that kind of stuff. I love science and how all that stuff works. Well, you have an interesting story about why this is important to you. So how did you even get into this metabolic psychiatry? I. 

Matthew Bernstein: Yeah, it's, I mean, there's a, a long story, I'm not gonna tell the full long story version, but, you know, I've always had an open mind as a psychiatrist trying to think of all the [00:04:00] ways that, you know, I can help my, my clients and my individuals.

But my mind really opened up when two of our three children got very sick about eight years ago. And they were very happy, well adjusted kids at the time, age 12 and 14, and we have three boys. They were doing well at school and sports and music and friends and all this stuff. And literally overnight two of my three sons, I.

It came down with tremendous anxiety and depression to the point where they literally could not go to school. They could not see their friends, they could not function in all the normal ways. They couldn't think the way they used to. They couldn't perform, you know, they couldn't read. I mean, almost anything that they used to do, they couldn't do.

And it was very, all of a sudden and. Cut to the chase. It took a couple of years to figure out that it looked very psychiatric and we were doing a lot of psychiatric treatments. Turns out that it was a form of [00:05:00] autoimmune disease called autoimmune encephalitis, essentially, where the immune cells.

Attack parts of the brain. There's a diagnosis called pans that is all about infections, leading to autoimmune processes. And that's what they had. And it took a couple of more years to get adequate treatment for that. They had a really, you know, really severe case of this. And eventually, you know, we did get adequate treatment, but it really.

Opened my mind as a clinician, as in my professional life, that it's not all about neurotransmitters. It's not all about, you know, psychotherapy and talking that, you know, the, the re what's going on in the rest of the body really matters to the brain. Mm-hmm. So I had that open mind, you know, my mind open to this, I, this concept of.

You know, connecting body and brain. And then, you know, there's been more and more published about the power of metabolism specifically for mental health, and I found that that's really, you know, one of the best ways to intervene, to really think about the whole body and the whole person 

Cynthia: in a [00:06:00] way. This makes me think about a student I had years ago who was she was cutting herself and I don't think she was suicidal, but she was very depressed and the cutting was just a way for her to release all these emotions and terrible feelings she had inside.

And I remember calling her parents and telling them, you know, this is happening and you need to seek treatment. And a lot of families are. Reluctant to do mental health treatment. And so this family said, well, we'd like to go to our physician first. And I said, well, that's totally fine. You know, just make sure you tell them these things so that they can help you make a good decision as a family.

And she had a thyroid disorder. Right. And as soon as they got her on medication to regulate her thyroid, all of that went away. Hmm. And that was my first experience of, and now that would be a medication [00:07:00] type thing, not kind of like what you're talking about. But at the same time, I would've never guessed in a million years that that had anything to do with a physical problem.

I thought she, you know, her brain isn't working correctly, or she doesn't have enough. Anything to like feel better or, you know, she's has too much anxiety or whatever it was, and. That was my first like, oh my gosh. And I really started talking to parents more about, you know, at least talk to your doctor, your physical, general practitioner doctor too, because there's so many ways that these things can be connected that we didn't even know about before.

So that's kind of similar in a way. I mean, she probably maybe could have done different with her food too, and I don't know if. If that ever happened. But I mean, that's a very important 

Matthew Bernstein: story and a very important concept for your listeners that you know, and and Bravo for, for those parents to go to their primary care and Bravo for that primary care doctor to do a medical workup.

[00:08:00] And they were lucky that it was something that was easily caught on a regular lab panel. 

Cynthia: Yes. 

Matthew Bernstein: And I think the problem though is that there's so many things that can be going on that wouldn't be picked up on a standard lab panel at the primary care doctor's office or the pediatrician's office. And then the message back to the family is.

You're medically fine. This is psychiatric or this is mental health. Mm-hmm. When again, we we're dividing these things up that shouldn't be divided up. And then at the mental health clinic, they're not gonna be look, thinking about all these potential physical things. They're just gonna be focusing on.

Psychotherapy and neurotransmitters, and that's a very narrow view of what could be going on with someone. And so, I mean, that's my biggest message to your listeners is don't let the system turn it into this narrow focus that you know, it's important as parents and individuals to think broadly about all the things that might be going on and all the things that might be able to help.[00:09:00] 

Cynthia: Well, I was gonna say, what should the parents be doing then? How, what should they look at first, or what are some things they could try at home, or who should they be talking to to get this real information? 

Matthew Bernstein: Well, it, it's tricky. I mean, there are practitioners out there that are looking for root causes of things.

There's this whole functional medicine world, and there are people probably in almost every community who are doing that kind of work or. They can be found online. So if someone really thinks that, Hey, I, you know, this may, you know, the doctors are calling this depression or anxiety, but I think there's something physical going on.

I wanna try to get to the root cause of that. There are people out there who are, you know, you know, able to work with families, to look into, you know, really look more in depth, at much more extensive lab work and examinations of what's going on to try to find. What the root causes might be. And that's in the end, what we ended up doing with our kids.

That's how we got to the root causes and got to solutions that we were not getting with the best [00:10:00] mental health care that we could find. And, you know, we could, we, we were finding expert people, but I. You know, the standard approaches just, were not working. So I, you know, that's, that's a very important message, I think.

But, you know, the, you know, the other message is that sometimes we can't, we can look for all kinds of root causes and we can't find them, or it's too expensive to look at all these root causes 'cause it's, it's not often covered by insurance. A lot of that kind of work. Yes. And so, you know, thinking about the things that might work for almost anything.

You know, is also a, another way to think about this, and that's almost, you know, partly how I got into, you know, eventually landing on focusing on metabolism because it's so powerful. Mm-hmm. It can do so much for the brain and for the rest of the body to really focus on. Really good nutrition and sleep and exercise.

You know, as a doctor we get trained that, you know, being a doctor is to do these things that only doctors can do, prescribe medications, do [00:11:00] surgery, and that's how kind of our whole culture thinks about it. And we sort of neglect the power of these other interventions, which are mm-hmm. Truly amazingly powerful when done in the right way.

And so, and these things don't have to cost a lot of money, mm-hmm. With a little bit of information. Someone can completely clean up their diet and have an incredible response to almost any of these types of situations mm-hmm. That involve brain health. So so I think that's a, that's a hopeful message that yes, it can get very, very complicated, but we can try to simplify and come up with, you know, some, some things that can be universally helpful for people.

Cynthia: Yeah. Do you have a specific diet or do you have some way that, something that people could look at to say, this is what we, how we should start at home looking at diet and sleep, and what are some things that we could do to make it better? 

Matthew Bernstein: Yeah. Well, I mean, I think a lot of the things I'm gonna say are things that people have heard before, so [00:12:00] forgive me for that.

But but really it is some of, some of the things that are we, we already know. We, we know that all of these processed foods with that are laden with sugar and, you know, high carb, you know, simple carbohydrates and industrial oils and a bunch of chemicals that are really, you know, manmade in a, in a lab that are mm-hmm.

Probably not things we should be putting in our bodies three or four times a day. Mm-hmm. And yet that is exactly what is going on in mm-hmm. You know, most. You know, schools and, and unfortunately in, in many homes as well. Mm-hmm. Because we're all so busy and we sort of bought into this food system that, you know mm-hmm.

We go to the grocery store, you know, not 90% of the stuff in the middle of the aisles is all of this ultra processed food and there's now tremendous evidence about how dangerous that is. And, you know, so, so that's the first place to start. And it's not necessarily that easy though, I mean, mm-hmm. You know, when [00:13:00] someone tries to cut sugar and, you know, process flour out of their diet, they're often going to find that this is not as easy as it might sound.

You know, and people might think like, oh, well it's not a big deal. I can take it or leave it. But then I challenge you to, you know, maybe for 30 days avoid added sugars and process, you know, any food that has added sugars in it. And that's also not that easy 'cause they hide it in the labels and under different names.

But if someone, you know, can try to do that for 30 days, you know, they'll, they'll find that, you know, it's not that easy to do, Right. Really just eating real whole foods. You know, in, in place of those processed foods. So that's a place to start. Yeah. 

Cynthia: If a family did it for 30 days. If they were able to get, you know, especially when I think about teenagers, right?

If my parents had told me that I couldn't eat certain things, I would just go eat 'em when I wasn't with them. So, absolutely. I don't know, you know, it might be difficult to do this, but if they were to [00:14:00] be able to you know, their teen could get off of sugar and or flour for 30 days. Would they see the a change in that amount of time, or would it need to be longer?

Matthew Bernstein: Usually people notice a change just in that amount of time. Okay. Now, it's not that you're gonna get the full benefits in that amount of time. Sure, sure. The longer you do it, the more benefits you get. But 

Cynthia: yeah, even that 

Matthew Bernstein: amount of time will make a difference. And then if someone can add in some more aspects, if they're successful with that, then you know, think about adding an exercise program.

If there's not any exercise going on, even just starting with walking, if someone's not moving their body at all, just going from zero to. Walking 30 minutes a day is an enormous benefit. And you can see that within 30 days for sure. And then, you know, if they're really getting into the diet stuff that I'm talking about, then, you know, I would then advocate for even trying to drop carbohydrates even lower.

And then, you know, ultimately, the most powerful [00:15:00] dietary intervention for brain health is the ketogenic diet. Mm. 

Which is a specialized diet and you know, it does require some supervision and learning to figure out how to do appropriately. Mm-hmm. But there's a long history of using the ketogenic diet in medical settings, going, you know, going back to 1921 at the Mayo Clinic, when they invented the diet to treat pediatric epilepsy, another brain condition.

Cynthia: Oh, that's interesting. Well, I have done keto before. I don't know that I was you know, followed it to the letter, but I did it pretty, pretty closely and I did feel better and I still do try to. I always call it like the 80 20 where I'm mostly doing it, and then sometimes I have a piece of cake or something.

But I do love it. It's of all the diets I've ever done in my life, which has been lots, I do like that one the best. I mean, it's one that I find. Easier to be on because the food I can eat [00:16:00] I like. Right? And that it tastes good and it's not, you know, a cardboard, you know, whatever, you know, or some dry piece of.

You know, I, I remember like other diets that I was on, like the food that I could eat, I was like, ugh. Right. And I could never stay on it 'cause I hated it so bad. Right. And I keto was always the easiest one for me because the food tastes good. 

Matthew Bernstein: It, it can. Yeah. Mm-hmm. I mean, there are versions of it that are absolutely delicious.

Mm-hmm. At our program we have a, a chef actually making food and it's amazing. Yeah. 

Cynthia: Well, that's what I, I wanna talk about that too. You have a residential program now. Is it for all ages or is it for, you know, what, what is this about and how do, how do people find out? It's, it's for 

Matthew Bernstein: adults. So we started at age 18.

Okay. It's for people who, you know, really struggling with their mental health, you know? Mm-hmm. And really wanna do this whole immersion in this whole metabolic approach. Mm-hmm. So we have a dietician there who's crafting an [00:17:00] individualized ketogenic diet for people using Whole Foods, and generally we recommend sort of an omnivore meaning.

You know, animal proteins and animal products, but also lots of vegetables, mm-hmm. For their benefits, which, which I strongly believe in as well, and very, you know, and high and ketogenic diet for people who don't know is a diet that's high in fat. Meat, moderate in protein and very, very low in carbohydrates.

So it sort of flips the food pyramid a little bit upside down. 

Cynthia: Mm-hmm. 

Matthew Bernstein: Mm-hmm. 

And what that does is it causes the body to make these things called ketones. And ketones are an alternative source of fuel for the brain, but they're also a signaling molecule to tell our bodies and our cells and our brains to do some very important things.

That end up becoming very, very good for mental health. 

Cynthia: Hmm. 

Matthew Bernstein: And so you know, it's a very powerful intervention. So at the program, they're getting that ketogenic diet. They get an [00:18:00] exercise program usually with a, a trainer a mindfulness groups where we're talking and teaching mindfulness practices, breathing meditation, yoga and then circadian rhythm alignment.

So we're getting people up in the morning seeing the sun in the morning, which is the most powerful way to set their circadian clock. 

Cynthia: Mm-hmm. Getting 

Matthew Bernstein: to bed early, you know you know, reducing blue light before bed, really making sure people are getting that sleep rhythm and. In play. And then lots of measurements along the way.

So we're measuring ketones, we're measuring glucose on a regular basis with a continuous glucose monitor. We're measuring mental health scales and we're having, you know, what I consider to be absolutely incredible outcomes with people with really significant mental health challenges, focusing on their metabolism to improve their brain health.

Cynthia: Wow. That is amazing. That just reminds me, I started listening to the book Drop Acid, which is about uric acid. Yes. And so is that, do you see that as part of kind of [00:19:00] when people's uric acid is too high, they also have these health issues? 

Matthew Bernstein: Absolutely. Yeah. I mean, uric acid is a little tricky. It doesn't correlate perfectly with brain health.

I mean, I, I read that book as well, or 

Cynthia: maybe physical health, 

Matthew Bernstein: but it does correlate with physical health in many ways. Mm-hmm. And, and it correlates with metabolic health, but it's, I don't think it's the most important thing to measure. The thing that we really are looking at in terms of metabolic health is this thing called insulin resistance.

Cynthia: Mm. Or 

Matthew Bernstein: you know, so people have probably heard of insulin. Insulin is the hormone that gets. Produced by your pancreas when you eat carbohydrates, and to some extent when you eat protein and we're all becoming insulin resistant, which eventually leads to pre-diabetes and diabetes. 

Cynthia: Mm-hmm. 

Matthew Bernstein: About 50% of Americans are either have type two diabetes or are pre-diabetic at this point.

Mm-hmm. Mm-hmm. And if you add up all the people who are insulin resistant ends up becoming. Most people based on the way we're eating. And this is having a huge toll on our mental health. Mm-hmm. You know, at, at the same time that these rates of obesity [00:20:00] and diabetes are skyrocketing. Our mental health, you know, rates of anxiety and depression as you and your listeners probably know are also skyrocketing.

Cynthia: Mm-hmm. And 

Matthew Bernstein: that's because these things are tightly correlated. These are very much causing each other to happen. Mm-hmm. Oh my gosh. Yeah. 

Cynthia: So in this residential program, do people have to live? I don't, I don't even remember what state you're in. 

Matthew Bernstein: We're in Massachusetts. Okay. Outside Boston. Yeah. 

Cynthia: Do people have to live in Massachusetts to be part of that or to have their insurance pay for it or things like that?

Matthew Bernstein: So it is a program that it, it was originally conceived as a residential program. Mm-hmm. And we have, you know, some people coming and staying there. We do have people come from different states to, to be in our program. Unfortunately, insurance doesn't cover almost all of it because insurance isn't interested in covering.

Sure. Residential mental health care. Mostly they're also not interested in covering nutrition. 

Cynthia: Mm-hmm. They're not interested 

Matthew Bernstein: in covering personal trainers. And so [00:21:00] most of the stuff that we're doing, they don't wanna cover, unfortunately. Mm-hmm. 

Cynthia: Yeah. 

Matthew Bernstein: So we now have, some people come as, as a day client.

They live nearby and they're coming for the day having all their meals with us. We are launching a coaching program as well, and there are some other national. Coaching, dieticians and other coaches who are doing these types of treatments as well. There aren't that many yet. This is still pretty new, but mm-hmm.

But, but it exists out there and we have some of those resources listed on our website. So if people go to our website, they can link to some other programs that exist around the country that are, you know, some of them are online and things like that. Yeah. 

Cynthia: That's great. Well, I'm definitely putting all your stuff in the show notes so people can find you and find out more about this.

'cause it is fascinating. And I know a lot of parents that I work with, they're just desperate to find some answers. And I think this is another way that they can take some control over how can I help my child with their mental health? Because it feels like you're helpless. Well, I. Can't get into their head or I [00:22:00] can't, you know, make them not have these thi thoughts or feelings or whatever.

But maybe you can by how you're feeding your family or what kinds of foods you're offering and making sure they're getting exercise and have good sleep hygiene and the things that can really help our mental health. They can really have. A lot of control or at least help, you know, control some of that, especially starting early.

If their child never experienced eating a lot of McDonald's, they're not gonna necessarily wanna go to that all the time. So I wanna make sure that my families have that information. 

Matthew Bernstein: That's right. I mean, I think that's, I'm glad you're picking up on that. It's one of the parts about this that I love is that it puts the power back in the hands of the individual and the family as opposed to.

You know, you're relying on an expert doctor to come up with just the right medication or an expert therapist to come up with just the right therapy, and if somehow their therapy or their medication doesn't work for you, you get sort of labeled as [00:23:00] treatment resistant. 

Cynthia: And 

Matthew Bernstein: this is putting the power back in the hands of the individual that we can control our own health to a large degree.

It's not easy. I'm not trying to say, oh yeah, just go and do it. It's super easy. You know, if anyone who's done a ketogenic diet, whole Foods version, knows it's. Takes some work to learn how to do it. Mm-hmm. 

Cynthia: And 

Matthew Bernstein: it's definitely more work, more cooking involved because 

Cynthia: Yeah, you 

Matthew Bernstein: can't just pick the food up at the takeout and expect it to be what you need.

Mm-hmm. But on the other hand, you know, if you put that work in, you may have incredible results that you are desperate for. And yes. Yes, absolutely. And, and I think your point about starting young is also very, very important, so. 

Cynthia: Mm-hmm. 

Matthew Bernstein: There's a study that I wanted to just make people aware of. This came out in 2021 in this journal, JAMA Psychiatry, and they were looking at over a long period of time metabolic health in kids and what it led to in terms of mental health outcomes.

In late [00:24:00] adolescents in, in their twenties, and they came up with some pretty incredible findings. So let me see if I can remember and get this right. So the, the kids who were the most insulin resistant, which is this thing that I was talking about, a sort of sign of poor metabolic health at age nine at the highest quartile of them, most insulin resistant were three times more likely than the others.

To end up having a severe mental illness, like a psychotic disorder in their twenties. Mm-hmm. Oh my goodness. So metabolic health, you know, at risk in youth leading to really bad mental health outcome. 

Cynthia: Mm-hmm. And 

Matthew Bernstein: then the kids in, during puberty who gained the most weight during puberty ended up with a five times increased risk of depression in their late twenties and early twenties.

So, I mean, I'm not trying to scare people, but I am trying to make the point that. Metabolic health really, really matters. Mm-hmm. It's not this separate thing, like I'm just doing my thing when I'm eating and then I go to the therapist [00:25:00] and try to work on my mental health, where I'm really trying to get people to connect these dots that this, yes, all is one system, and the way you take care of your body through food and exercise and sleep will affect what's going on in your brain and it will affect things like.

Anxiety and we have control over those things. 

Cynthia: Yes. I love that. Yeah. I, I think that the US feeling like we have agency is so important, and this is one of those ways that we totally have a way to form this and help this from the very beginning, if that's. If we wanna do the work that it's gonna take to do that.

So I love that. I'm so glad you were my guest today. I this is such important work to get out in the world and if you find like a link to that study, I can always put that in the show notes too, so that the parents can look at that and see what they think about it as well. 

Matthew Bernstein: Sure. I, I'll, I'll be happy to send it to you.

Yeah. Sounds 

Cynthia: good. Well, thank you so much for being with us. 

Matthew Bernstein: Thanks for [00:26:00] having me. It was really a pleasure. Sure. 

Cynthia: Mm-hmm.