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Resilience with Dr. Jonathan DePierro
151 Plays1 year ago
In today's episode, Fara and Grant have a conversation with Dr. Jonathan DePierro, an Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, and the Associate Director of the Center for Stress, Resilience and Personal Growth. Dr. DePierro talks with Fara and Grant about the research his team conducts on resilience, and how we might more productively think about resilience in our everyday lives through practice.
We hope you enjoy!
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Transcript
Understanding Resilience: Skills and Behaviors
00:00:00
Speaker
It's really based on the idea of what have we observed what is the research say that resilient people actually do thinking about resilience less so. It is partly so but less so as a stable personality traits that you have or you don't but as a constellation of people skills.
Introducing Doorknob Comments
00:00:18
Speaker
Hello i'm dr fair white and i'm dr grant brenner.
00:00:22
Speaker
We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the door knob comment. Door knob comments are important things we all say from time to time, just as we're leaving the office, sometimes literally hand on the door knob.
00:00:39
Speaker
Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out.
00:01:05
Speaker
Hi, I'm Farrah White, here with my co-host Dr. Grant Brenner.
00:01:10
Speaker
Thanks so much for joining us today. We have a really special guest who I'm excited to interview.
Dr. Jonathan DiPierro on Resilience
00:01:17
Speaker
Dr. Jonathan DiPierro is an associate professor of psychiatry and an associate director of the Center for Stress, Resilience, and Personal Growth at Mount Sinai. He is also the co-author of the recently released third edition of Resilience, The Science of Mastering Life's Greatest Challenges. Thanks so much for being here today. Thank you for having me on.
00:01:39
Speaker
Yeah, yeah, yeah, absolutely. So I guess, you know, a good place to start always and what I'm always curious about, just hearing people's stories and how you sort of got into the field of resilience, what drew you there and what has been keeping you there? Yeah, that's a really good question. So professionally,
00:02:03
Speaker
Um, I'm a clinical psychologist, so I did my PhD at the new school, uh, which is in lower Manhattan. I was there from 2009 to 2016 doing the long work that is a clinical PhD. And in my training, I did a variety of different things, but I worked in a research lab. My advisor was, is Dr. Wendy D'Andrea. She was my PhD mentor and she studied the physiology of complex trauma.
00:02:30
Speaker
and understanding what happens in the body and what happens in the brain when people have had a lot of trauma exposure. And I also did training during that time at Mount Sinai's World Trade Center Health Program. So I did a lot of work working with 9-11 responders, many of whom had developed PTSD or anxiety or alcohol misuse as a result of seeing a lot of human destruction and suffering down at ground zero and during the recovery effort. And then I later
00:02:59
Speaker
joined Sinai as faculty working in the World Trade Center Health Program in 2017. Through all of that, the way I began to see resilience was a little bit different than I think how it had been talked about in some of the literature. So I tend not to see resilience as simply the absence of PTSD, but I think about resilience as also what people do when they've developed PTSD.
Redefining Resilience: Beyond PTSD
00:03:22
Speaker
How do they recover? What are the skills and resources they use to help them get through their day and still function
00:03:30
Speaker
in spite of or in addition to the symptoms that they're experiencing because we have, everybody has strengths with the, the world trade center responders that I was seeing. Yeah, they had pretty high PTSD symptoms, but they were also parents and some of them worked and they were brave enough to show up in my therapy office in person before the pandemic. All of those things are markers of resilience. They supported each other. They supported their, their retired colleagues who were ill. They drove them to appointments. They did all of those things.
00:03:59
Speaker
And that's not captured by our understanding or wasn't captured by some understandings of resilience as simply the absence of PTSD after a traumatic event or the absence of depression after a trauma. There's much more to it to that. And when the pandemic happened, I was part of a small team that at the direction of our dean, Dennis Charney at Mount Sinai and my co-author started a center
Mount Sinai's Resilience Center
00:04:26
Speaker
called the Center for Stress, Resilience, and Personal Growth. We took some experiences with taking care of 9-11 responders and used it as a starting place for understanding how do we support the resilience in a preventative way and how do we take care of the behavioral health of our own Mount Sinai healthcare workers. There's 45,000 folks that work for Mount Sinai in some capacity. I really got strongly involved in
00:04:52
Speaker
engaging, teaching resilience, building resilience through that center, which is going strong. It's now over three years old and we do workshops and we provide behavioral health care. We've published over a dozen papers about the work that we've done. More recently, the third edition of this book, Resilience, the Science of Mastering Life's Greatest Challenges.
00:05:12
Speaker
It's excellent. The revision looks really great. I had a chance to get a copy before we were recording and I have the original two and there's a lot of really pragmatic. I think every chapter is organized so that at the end there's really understandable, actionable advice for people, which of course we know when people are under stress, you have to make sure the messaging can be used.
00:05:38
Speaker
So it's not too too academic or anything and it's full of great vignettes and illustrations. Yeah, that's one of the major differences with this edition. The other two were academically oriented meant for perhaps graduate students or folks that were in the field and wanted to learn more about the mechanics of resilience from biological point of view. And so we've balanced that with many more narratives. We interviewed 20 or so more people for this version of the book.
00:06:07
Speaker
and really practical and evidence-based advice that's at the end of every chapter, as you said. I think one of the downsides of having so many books out there is that there's a lot of bad advice out there that's not grounded in science or grounded in one study finding that becomes an entire book that we find out later doesn't replicate.
00:06:28
Speaker
So that's kind of interesting that you bring it up because I do think that that's something that people have to be particularly psychologically minded people that maybe don't have graduate degrees but are very curious.
00:06:44
Speaker
It's hard to know where to get the right information. And of course, with your background, obviously, this book is a great source. But how do you sort of measure resilience? How do you conceptualize it when you're writing a book like this? Part of the challenge is that there are many, many different definitions. There isn't a single consensus definition, although NIH has actually been working on a consensus definition.
Exploring Definitions of Resilience
00:07:12
Speaker
of resilience from internal working groups there. But we think about it broadly as the ability to adapt, recover, and grow from life's challenges big and small. So I think that that opens up a lot of possibility to other things fitting in there. So the possibility that suffering and resilience can coexist. Suffering and growth can coexist.
00:07:37
Speaker
is an important thing that that definition opens up to and doesn't limit us to thinking about resilience simply as the absence of a diagnosis. And you ask the second question, which is, how do you measure resilience? And I think when we're thinking from a measurement point of view, we need to define what we're measuring first before we can make a measurement tool of that thing. And if there are 15 different definitions, then there are 15 or 30 or 100 different
00:08:04
Speaker
measures, maybe all measuring different aspects of the same construct. But we actually recently developed a measure called the Mount Sinai Resilience Scale.
New Resilience Measures
00:08:14
Speaker
And one of the things that we do in this measure is it's really based on the idea of what have we observed? What does the research say that resilient people actually do? Thinking about resilience less so, it is partly so, but less so as a stable personality trait that you have or you don't.
00:08:32
Speaker
as a constellation of teachable skills. So for example, giving social support, getting social support, having spiritual practice, physical exercise, minding your diet, all of these things are measurable behaviors that as a clinical psychologist, I can teach people to
00:08:53
Speaker
engage in more or I can direct them towards and this will you know the research shows boost their resilience you know we know from longitudinal studies the more people engage with social support the more protected protected they are we actually just published a paper yesterday looking at this in world trade center responders where social support around the time of 9-11 predicted trajectories of depression and anxiety the more support you had the less likely you were to have sustained symptoms
00:09:20
Speaker
I mean, I can't help but think about all of the recent disasters that have been unfolding in today's world. Do you think that social support, strong social support looks different today? I guess you don't really have to comment on social media, but I'm just trying to, you know, imagine like, you know, the world is very different.
00:09:45
Speaker
and we're aware of disasters and tragedy in a new way, maybe than we ever have been in history because of the connectivity through the internet. There's also a global mental health crisis affecting everyone, but notably adolescents and young adults. I wanted to mention one thing or ask about one thing in terms of how we conceptualize resilience.
00:10:11
Speaker
there's a concept called post-traumatic growth, right? People may be familiar with, and it seems like, you know, we can sort of fold that into the idea of resilience, though sometimes the elements of growth versus, so with resilience, you know, there's an idea that we can return to baseline. And sometimes that's great if there is that baseline to which to return.
00:10:35
Speaker
The context changes though and there's a demand on adaptation right and so what it means to be resilient if you can kind of go back to your house and go back to your old life. Is very different than what it means to be resilient if there's like with the pandemic like a new normal because then in addition to kind of re re equilibrating we also need to adapt.
00:10:58
Speaker
And I think that this is really demanding for people. So identifying these levers like social support, we know that early on that increases the positive trajectory, sort of in a way it reminds me of how dissociation around a trauma predicts a greater likelihood of clinically significant post-traumatic symptoms.
Community and Social Support
00:11:18
Speaker
In other words, you know, I wonder if community is the antidote for dissociation, which seems obvious if you say it out loud, what are the underlying things? But these are simple things people can do is the point. And that's what you need at those moments. You can kind of unpack it later. What I wanted to ask you about, you're saying like resilience is simply not the absence of PTSD.
00:11:42
Speaker
There's a model that sometimes people use because mental illnesses can be it's like either or right. You either have it or you don't, even though we know that that's not true. Even though there's different levels of severity, even though there's, you know, 10 to the eighth different combinations of PTSD symptoms that still meet the criteria. That's like an inside joke. Um, in other words, the way we diagnose PTSD has so many different facets to it that you can have.
00:12:07
Speaker
Two people who have completely different symptom presentations who both are diagnosed with ptsd we don't really know that much about subtypes so one thing we do is we instead of talking about either or definitions and this is leading into the question. Is the dimensional model.
00:12:25
Speaker
So it's not like PTSD or not PTSD, but more like what are, what are the stress elements and what is each factor contribute and how does that relate to resilience? Like a person kind of knowing their, um, their sort of dashboard, like what, you know, what would the lights on the dashboard be? If I want a heads up display to keep track of my own resilience. Yeah. So I think.
Practicing Resilience Skills
00:12:50
Speaker
Having a varied toolbox is probably the best bet in terms of your, your resilience dashboard. So our scale is 24 items and there are 24 different things that we find that resilient people do. Do you have to do all of them all at the same time at once to be resilient? Probably not, but having a varied toolbox and of things that you actually regularly engage in.
00:13:15
Speaker
Yeah, exercise is well and good. But if you're not exercising regularly, you're not going to be using that in a crisis. If it's not part of your DNA, social support is great. But if you don't have a social network, when a crisis happens, building one in the midst of a crisis is not going to be helpful. So having a very toolbox that you engage in before you meet it is probably the best bet. And thinking about who is in your network, what are my core values?
00:13:42
Speaker
What are the things that I know keep me on a solid foundation? What are the resources available to me? And you had mentioned different ways of thinking about resilience and mental health symptoms. And there are studies and I've participated in them. I've worked on these studies where the trajectory of people who don't develop PTSD over time, they follow them and they have very, very low symptoms. They're called the resilience group.
00:14:09
Speaker
In actuality, it's more like they're the resistance group, like they resisted the development and they continue to resist the development. But I think calling that group resilient is a shortcut and doesn't, I think, give credit or service to the resilience found in, for example, people who develop symptoms and recover after one or two years and end up in the same place in terms of symptoms as the people who never, never, never develop symptoms in the first place. And what we know from our healthcare workers, which makes this even more complicated,
00:14:38
Speaker
is that you can have a very high score on the Connor Davidson resilience scale, which is the more commonly used measure of resilience, and also have a high score on measures of symptoms. There isn't necessarily a strong negative correlation between these two things. You can be high on both symptoms and resilience. Of course, our healthcare workers are going to say they can adapt to challenges and bounce back.
00:14:59
Speaker
Right there. That could be problematic in some respect, you know, so people who are more resilient are likely to get assigned to tougher jobs. And, you know, I like to think of, I don't know if this is supported in the research per se, but sometimes when people talk about being resilient, it's a kind of a brittle resilience and it's more like they mean they're stoic and they can white knuckle it.
00:15:23
Speaker
And which means that eventually they're going to get into trouble and then, you know, it's sort of like losing your keys. You lose track of your resilience because it's not really flexible. Right. And then the idea of resistance, that's almost more like preparation, right? So if you think in terms of like crisis as a cyclical thing, right, it's really important to understand over time. One thing I'll add, just like symptoms are not categorical, whether you, you know, you have PTSD or you don't.
00:15:53
Speaker
Resilience is not categorical. It's a dynamic, evolving process. Actually, I think the literature is catching up to that point. I'm seeing papers that are talking about moment by moment resilience, resilience over a period of days or weeks, not simply you measured at year one and then 10 years later in the same group on a single scale. We're thinking about processes that happen on a moment by moment basis, choices that we make.
00:16:21
Speaker
things that we do or don't do, those determine how we feel. The scales and measurements are not caught up to capturing that level of specificity, and neither is our biological measures. We don't have a blood test or a brain scan for resilience because it's a multifactorial process. There's a lot of variability within people.
00:16:43
Speaker
and the relationships between a blood biomarker or something that's going on, a chemical that's circulating and symptoms or resilience are fairly weak. Yeah. Well, it's a complex model, right? And medicine in general is kind of catching up with complexity theory where like you're saying, there's always a few things that are like buttons for the system. If you push that button, you kind of know what will happen. But so many other things are like,
00:17:13
Speaker
This the whole is greater than the sum of the parts or their emergent properties is what they call it. I'm thinking about this because in disaster mental health response a couple of groups I'm working with vibrant emotional health the group for the advancement of psychiatry a committee on disaster trauma and global health that a co-chair developed a chronic cyclical disasters model.
00:17:34
Speaker
which exactly tracks multiple overlapping factors over time in a more qualitative way. I know there are people who do quantitative work on systems like that. There's a guy, I think his name is David Krakauer at the Santa Fe Institute, who does quantitative modeling of these very horribly complex systems. It makes me wonder if they're working on this computationally. I'm kind of a physics geek, so I apologize for that digression.
00:18:03
Speaker
Yeah, it's a it's a real challenge to be able to assess. And then certainly, it's a challenge to intervene as well. Because if you don't know what's going on, it's hard to know what's going to be helpful in the moment. So you need to have a really good measurement strategy and get good data before you intervene. And actually, it's one of the things that we learned from working with our health care workers. And we're sure you know this in disaster mental health.
00:18:26
Speaker
you and Craig say, if you've seen one disaster, you've seen one disaster. You might have coined that phrase, actually. But the other thing, too, is that there are populations that are affected differently from disasters.
Customizing Resilience Training
00:18:39
Speaker
So in our health care system, we have workshops that teach people around factors around resilience. And we deploy them differently. We tailor them to different occupational groups. We actually just recently published a paper tailoring this material
00:18:55
Speaker
and content to our security officers. And that content looks a little bit different than what we provide to the nurses and the psychiatry and other medical residents. The learning is the same, but the messaging is tailored and a little bit different. We did this recently with a faith community in New York City where we integrated Bible passages into teaching and scientific literature around
00:19:19
Speaker
resilience. And that was really well received. So when we when we do this intervention, not only are people different, but there are communities that are different and you need to be on the ground and have really good data. And I'm sure you know this too from disaster mental health before you start intervening and taking something off the shelf and saying, okay, let's do our prolonged exposure in this disaster zone.
00:19:40
Speaker
and good data and also good relationships. And it goes beyond, you know, the catch phrase is cultural competency, but it goes way beyond like cultural competency. It's building relationships. It's being respectful that we have different kinds of expertise. One of the chapters in a disaster book that you contributed to that we just submitted to the publisher, I researched on communication and relationships and crisis situations.
00:20:06
Speaker
There's so many different layers to it but they use this idea of a communication ecology. And so so many different groups are involved in building resilience for any specific stakeholder group. I think for listeners it's you know so it's so much more work right how much work does it take to take the same data that you know like it works.
00:20:27
Speaker
And then craft it and use good risk communication and tailor it and test it with different stakeholder groups and have the relationships with the community leaders so that you make sure that you don't do something really obviously that's a bad idea right off the bat. What, what has it been like for you to develop these things just, um, in terms of that, those relationships that workflow and in terms of listeners too, if they're thinking about their own communities, what should they be doing?
00:20:55
Speaker
It kind of reminds me as we're talking about how when I was in early graduate school and I think with a lot of my classmates too, as we were learning to do psychotherapy and I trained in a psychodynamic school, the new school, sitting with the patient, understanding their emotions, being present with them, it felt like doing nothing. And I kept walking away from my meetings with patients
00:21:21
Speaker
And my supervision saying, oh, I'm not, I'm not doing anything of this person. And in fact, I was doing quite a lot. Um, but I had to retail or, you know, re, um, frame what it is that I was doing to see where I was being quite helpful to this person. Um, there's a, I think there is an urge, especially, you know, in disaster work to rush in and do something. Um, but I think the most important thing you can do is to be humble.
00:21:48
Speaker
about your impact and out where and what you can do and to build relationships. And I think it probably serves folks and it served us and the work we do with healthcare workers to play the long game and develop longstanding relationships even before something bad happens so that they know that they can go to you and you sort of know the culture and maybe you've crafted something or put some processes in place, develop relationships with leaders that are key to your success before you go in and start to do something.
00:22:17
Speaker
And relationship building, trust building, getting that input, getting that feedback has been really integral to our success in our center with our variety of healthcare worker, you know, occupational groups. And that's doing something. That's very active. And those relationships go a very long way. If we didn't have a trusting base of relationships, almost none of these things that we do would be successful.
00:22:43
Speaker
Yeah, I think that's such a good point. And the idea of the long game, I'm wondering, especially now with where companies and there has been so much change, and there's been a lot less, let's say physical togetherness, like in an office, and and potentially a lot more
00:23:06
Speaker
burnout. I don't know. Do you in your book or right now give advice for people who are looking to create a more supportive work environment, you know, increase the resilience of their, their teams and that kind of thing, I guess for leadership. Yeah. Yeah. And we, we know that resilience saves money. That that's right. It does. I mean, certainly at a very basic level, if your employees are not suffering or
00:23:35
Speaker
successfully treat their depression, then they're out sick less, and they turn over less if they have, and to your point, if they have a strong relationship with their leader, leadership support, I was at a talk recently, and the person presenting was showing data about how if an employee has a trusting relationship with their leader, that employee's home relationships are actually more healthy.
00:24:02
Speaker
Like the leader is like role modeling for them or maybe like helping them manage stress such that their, their own communication at home is better. So the leader is so crucial, not only at work, but actually trickling down and impacting the employee's home life in a positive way. We always think about the negative, but not the positive. There was another study like that where they found that a person, an employee's mental health was more, more of their mental health was accounted for by their work relationships than their therapy.
00:24:30
Speaker
Uh-oh. Uh-oh. I wouldn't say, uh-oh. I think this is one of the things that I've learned in the work that I do recently is that a lot of the spaces where I've been helpful have been a real broadening of my understanding of what a psychologist is. I trained to physically sit in a room with one patient for the most part. And even the pivots of telehealth was a difference from that.
00:24:58
Speaker
But that, you know, our center and there are organizations similar to us that have become a resource, not only to the individual employees, but to the health system writ large. I did last week a training with some of our new leaders to the institution on psychological first aid. So what you typically might see or give people training in a disaster setting, lay people.
00:25:20
Speaker
I taught them how to recognize signs of stress in their employees and how to make appropriate referrals, so elements of psychological first aid. These are skills that are increasingly being integrated into the workforce, into the onboarding of leaders, into the way employers think about the culture of the place. I think the psychological dimensions and not just around productivity, like how many widgets can you put out in a factory, like organizational psychology, but it's
00:25:49
Speaker
I know it's organizational psychology is more than that. Um, but like the mental health and wellbeing dimension being something that's increasingly looked at and that we, uh, with our colleagues at Mount Sinai, I've really been focusing on what skills can we give to empower leaders in an uncertain time. Uh, and this is the, you know, drawing on, I'm sure, you know, Grant Everly Jr's work, uh, on like empowering leaders during crisis. Some of those principles have been really helpful, but also,
00:26:18
Speaker
For an individual person, employee, one of the little bits of advice that I give is to start small. So I was at a talk recently and somebody asked a similar question. And I said, OK, look down at your phones, scroll through your text messages, look who you work with, and send a message that says, hey, how are you doing? Send a completely random, unexpected check-in message to people. Say, hey, how are you doing? How are things? Haven't talked in a while. What's up?
00:26:47
Speaker
That's very deeply appreciated and takes all of five seconds. And that builds a sense of trust and that they're going to do the same to you. And then maybe they'll do it to somebody else. I do that myself. I go through my phone and check in with people.
00:26:59
Speaker
I do that too. It's like a virtuous cycle where people think about the butterfly effect, why a very small thing reverberates. And I agree that joke about, uh-oh, the therapist is not the most important determinant of mental health. It really is a system. And I do think that the more psychologically sophisticated every single person on the planet gets, the better things will be. I'm thinking about it a lot right now because of the conflict in the Middle East.
00:27:29
Speaker
And in my view, so much of this is organizational trauma in the form of intergenerational trauma. It gets very much in the way of resolving conflict. It undermines resilience, you know, just in any particular system, whether it's a family or a company or, you know, a nation state. But like you're saying, John, to have leaders
00:27:55
Speaker
learn, like learn right about these things. And it, it has this effect throughout the system. Um, and then the small habits, right? People have heard that one, but like start small and like nothing is too small. So people are like, Oh, I'm going to start exercising for an hour a day, three days a week. And guess what? You're probably not going to be able to do that starting tomorrow, but you could probably do five minutes of exercise most days. Yeah, that's right. I think.
00:28:25
Speaker
And I think there are certain old philosophies that are shifting and might be shifting slowly, but
Emotional Expression in Healthcare
00:28:32
Speaker
are shifting. So for example, the idea that healthcare workers have to be stoic and suck it up and just be tough and not show their emotions at work and can't cry at work and don't let people see you, you know, show emotions, especially in like a high pressure setting. Those kinds of philosophies are sort of going away.
00:28:50
Speaker
the understanding is that you show up as a human being to your job and you're not a machine or a robot that can simply switch off your feeling and end that the work that you do has a real emotional impact and you bring that emotional impact into the work that you do prospectively. And that's a good thing and it can be distressing at the same time. There's a lot of post-traumatic growth that we see in our healthcare workers actually
00:29:16
Speaker
you brought this up. So to define for the listeners, post-traumatic growth is thought to be the positive changes that can occur as a result of a struggle following a traumatic event. So you work through something that's upsetting, and you can actually see, or you might report on or say that you've had some positive changes in your life as a result of really going through something terrible and feeling that pain and horror. So actually,
00:29:44
Speaker
While 40% of our healthcare workers in April of 2020 screened in for depression, anxiety, or PTSD, and some surveys that our colleagues did at Mount Sinai, 80% said that they had some degree of post-traumatic growth. And that's, for example, a new sense of your own personal strength. Hey, I went through something. I didn't know I could do that. I guess I can. I guess I'm stronger than I thought. A new sense of personal relationships.
00:30:10
Speaker
So you build bonds in the trenches that are lifelong. You talk about people going into combat together, and those become lifelong buddies. That's some extent of post-traumatic growth. Strengthening of your faith, strengthening of your priorities in life, or fine-tuning your priorities in life will be awesome. Now, going back to my original point about resilience being complicated is that it's actually
00:30:33
Speaker
those people with moderate symptoms of PTSD, moderate distress that have the most post-traumatic growth. So if you think about a, it's like an inverse U-shaped relationship, a hill, where people with low distress have low post-traumatic growth or typically report low growth, people with very high distress are probably so disabled in some way by the symptoms that they can't think about
00:30:59
Speaker
perspective on their challenges. But it's really that middle portion of people with moderate distress that are working through something
Growth Through Moderate Distress
00:31:07
Speaker
actively and that were affected by it that have the most growth. So that's really interesting to think about that distress and growth go together. So it's not growth in the absence of distress. It's the process of working through something perhaps that's leading you to this end point. That's not really an end point. It's more like an evolution.
00:31:26
Speaker
It's a different process. Like you're on a different developmental path where challenges are interpreted more as growth opportunities. And, you know, the self help kind of memes are really heavy handed about that. And it can set people back because you can feel almost like if you're not
00:31:44
Speaker
growing than you're failing. But that middle zone is really like you see that everywhere in psychology, right? Like even if you're studying for a test, if you don't have enough anxiety, you're going to be like, oh, just watch Netflix. It'll be fine. And if you have too much anxiety, you'll be like, I can't focus. So that balance is always where growth occurs. It's also like a pearl in an oyster, right? Like the distress is the irritant and the response is growth.
00:32:13
Speaker
And it can be, it can be growth. That's why in some ways I see my job as a therapist, as a healthcare provider, as someone who does a lot of teaching around resilience, as accompanying people through distress. Like I don't want to define my role as taking away distress because I also tell my patients this all the time. Anxiety, fear, sadness, those are basic human emotions. I can't, nor would I want to go into your brain and disable a basic human emotion.
00:32:41
Speaker
This is what makes you human. It's the intensity and duration of it that becomes problematic. But these emotions give texture to life. So I'm not going to take away your fear and your anxiety. I'm going to help you manage it so it doesn't overwhelm you.
00:32:56
Speaker
What are some key emotion regulation skills that people could use pretty quickly? Any, any, any favorites? Yeah. So one of the ones that I, I often teach and it's actually really convenient for healthcare workers is box breathing. Some, some surgeons, for example, might've learned it already from in their training, but it's to imagine traversing the edges of a box or square in your mind. And as you go up one side, you breathe in for four seconds. So not just.
00:33:25
Speaker
really quick puff and, and hold it, but really an inhalation that lasts four seconds. So breathe in for four seconds. You hold it in your body for four seconds. And then you do an exhale that lasts for four seconds. And even just training people to do that can take forever because people, especially people with anxiety, take short, quick, panicky breaths that are shallow. Um, so retraining people to breathe slowly.
00:33:52
Speaker
is really helpful. Now, some people talk about breathing, resetting the nervous system. I think that that's a little bit too bold. It certainly does give some feedback to the brain that the situation is a bit more safe. If you're breathing more slowly and in a more measured way, the signals from your heart are going back to your brain and giving feedback that it's safe. Does it completely hit the reset button, like resetting your Xbox or computer? No.
00:34:22
Speaker
Well, it's like because part of stress, as you notice, your heart is pounding and then you interpret that as more. That's right. The interpretation. And so would you say that people, let's say in these times when let's say between crises, you know, just trying to build that baseline resilience should be working on these things on a daily basis so that they're more likely to be able to access them?
00:34:51
Speaker
Yeah, I was thinking about social support as kind of like a soccer net. And you don't want a soccer net with holes in it. You want a network that's robust, that's well strengthened, that if you go in and there's like a loose string, you sort of tie it back in place. So that takes a little bit of effort. It's not an amazing amount of effort because a little bit of support can go a long way. But you want to know who are the people in your corner if things were to go awry. And there are like social support being an example.
00:35:21
Speaker
there are many different kinds of social support and they all convey a different but all positive benefit. So there's what's called tangible support. So tangible support is someone who can loan you a $5 bill or someone can help you pay, you know, if you're behind on rent, someone can help you out or drive you to a doctor's appointment or watch your dog. If you have to go out of town, that's tangible support. They're giving you something or doing something for you that you can observe.
00:35:48
Speaker
And then there's emotional support, someone to validate your feelings, someone to be in your corner to say that they've got your back, that kind of thing. Um, don't ask them for money though. Don't, right. And it might be, that's a good point. It might be different people who give this different kind of support, but tangible support is one important kind of social support. So is that kind of emotional support and giving support is actually,
00:36:12
Speaker
pretty important too. Our colleague Steve Southwick before he passed away was involved in a study where they asked veterans, how often do you give support, emotional support to other people in your life? A lot of veterans said yes. And it turned out that giving support to people conveyed a mental health benefit to you. It blew back on you in like this altruistic way. And if you gave and got support, all the better.
00:36:34
Speaker
Giving support, I think, is an understudied aspect of social support. We always think about people in disasters, people after trauma, like how much perceived support do you have? How much do you feel that people have your back? Well, we should also ask, how much do you give support to other people?
00:36:49
Speaker
we always advise that that's one of the first things you do. And also to reestablish routines, you know, say in a refugee camp or in a shelter, you get people and you find out what they can do and you put them to work in the best possible sense. But do you recommend for going back to box breathing for a sec? Is this something people should practice when they're not bugging out so that it's like muscle memory? Yeah, you asked the leading question. Of course they should. Right. So,
00:37:17
Speaker
these skills just like box breathing like anything else are things that are best practiced before you need to use it. So actually, today, my hospital is doing a disaster like preparedness drill in our emergency room and they're doing that so that they know what to do when a crisis actually happens or they have skills that are like really up to the highest level when a disaster happens. And so you absolutely have to practice these things before you absolutely need them because in those moments where you need them,
00:37:47
Speaker
you won't have the brain space to be learning something new. Yeah, I think that's so key and something that I try to work with a lot in my practice, that during these good times, well, these are the times to work on the skills and to strengthen the social connections because it's not always gonna be like that, unfortunately. Crisis is sort of part of life. And I think this has been super, super helpful
00:38:16
Speaker
For me, I guess this takeaway point that people who have sort of moderate symptoms of PTSD and the growth, the post-traumatic growth that they demonstrate, I think that's a good incentive for people who really feel like they're on that higher end symptom-wise. I don't know if they treat those symptoms and they move from the higher end into the more moderate end, will they have
00:38:44
Speaker
you know, those same benefits, I guess is my question. And maybe it's not been studied yet. I would say potentially. I think certainly when people have severe symptoms of pretty much anything in the mental health space, depression, anxiety, PTSD, panic, the general hallmark of that is kind of rigid thinking. You think in black and white ways and absolute terms, everything is all bad. I'm always going to feel this way. People hate me. The world is an unsafe place. I can't trust anyone.
00:39:13
Speaker
categorically without question, no wiggle room. And post-traumatic growth requires a little bit of wiggle room in perspective. So you would think that if through, say, cognitive therapy where you're challenging some of those beliefs, you gain some perspectives and you put the events that happen to you in a context, then it opens up opportunities for post-traumatic growth because it allows you to think more flexibly
Identity and Trauma
00:39:41
Speaker
and holistically about the event and its impact on your life. So some people feel an event or two happened to them. They've been in a disaster. They went to help out at Ground Zero and that is 99.9% of their identity. That's how they define themselves. That's how they're always to find themselves in relation to this event. And that's really dangerous because you don't leave space for anything else in your life.
00:40:05
Speaker
or any other way of thinking about it other than this is the worst thing that's happened to me and it's in a stormy of the rest of my life. So if people notice that the story that they have about who they are is very tightly bound to a particular traumatic or adverse experience, that's kind of like a red flag for myself. Oh, I'm sort of, and yeah, you can train cognitive or mental flexibility. That's a resilience factor I know from your work.
00:40:32
Speaker
And I think there's an implicit thing we're saying. And then I have I have kind of a tough question I want to ask before we have to stop. I think the implicit thing is you don't have to experience post traumatic growth. And if you if you're not doing that, it doesn't mean there's anything wrong with you. That's not everyone who lives through a difficult I was going to say who lives through hell needs to become like a Zen master as a result. Yeah. And we're not talking about becoming we're also not talking about becoming a Zen master. I think I think it's I
00:41:02
Speaker
erroneously called a silver lining because that gives it a sense that it's like entirely positive. It's not it's I have a colleague that does palliative care work and of life work and work in grief. And one of the things that she thinks about is unsought gifts, things that you didn't ask for, but you got
00:41:22
Speaker
I think, yeah, I have a lot of feelings about that, particularly when that is portrayed in a superficial way on social media. I lost a parent at a young age, and I'm never gonna think of that as a gift. And if anyone tries to tell me that that's a gift,
00:41:38
Speaker
I think I would, I would object strenuously though I can understand that I have changed and grown as a result. The hard question I wanted to ask you was how do you deal with betrayal? Because a lot of times when there are disasters and trauma, you know, there's mistrust of authority and then you're coming in sort of as authority trying to help people. And how do you deal with that kind of hard to establish trust and safety? Yeah. So I think one of the things that,
00:42:08
Speaker
has been really crucial in reestablishing trust and safety is being reliable, answering the phone, answering the emails, taking the meetings, hearing from people, hearing people out, not initially, you know, this, I have a habit of sometimes offering advice too quickly as a therapist, but not immediately offering advice, really getting a sense for and a feel for what their needs are. So when we
00:42:31
Speaker
go and support units, we really speak to the leadership, we speak to the line staff and hear what their specific concerns are and give them ample time and build a trusting relationship. And we show up, we're reliable and we deliver. And I think those kinds of things of just being visible and being consistent, delivering on your promises and not over promising in terms of what your scope of influence is.
00:42:57
Speaker
even a small change that they see can help reestablish a little bit more trust in the system. And of course, there's going to be setbacks, right? Like, the world is an unstable place. There are a lot of strains and stressors in the healthcare environments right now. But I think even small gestures of consistency can go a long way.
Accessing Further Resources
00:43:18
Speaker
That wasn't such a tough question. I guess not.
00:43:23
Speaker
Well, thank you so much for joining us today and for sharing all of this expertise. I think it's super valuable. Everybody should go out and buy your book, Resilience, the Science of Mastering Life's Greatest Challenges. Where and how can we find you if, I don't know, people are interested in learning more about what you do? Yeah, so the book is available on Amazon. I would encourage people to Google
00:43:50
Speaker
Our center, which is the Center for Stress, Resilience, and Personal Growth at Mount Sinai. I also have a faculty profile. People can reach me over email. I'm happy to answer any follow-up questions. Great. So thanks for joining us today. And we look forward to hearing your feedback. Please rate and review us. And you can follow us on Instagram as well.
00:44:13
Speaker
Yeah, thanks for joining us. Very thought-provoking, and I'm in the midst of working on several different projects related to resilience, and this has really been specifically helpful, so thank you. Yeah, thanks for having me. Remember, the Doorknob Comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.