The Art and Science of Stress Management

Holly Hatton-Bowers Author

03/31/2022 Added

9 Plays

Description

Steven Wengel, MD, Professor of Geriatric Psychiatry Assistant Vice Chancellor for UNMC Campus Wellness Join us for a webinar to learn about the scientific basis for practical stress management techniques to use in your personal and professional lives. Techniques for improving your quality of life will be discussed, such as self-care strategies like sleep, exercise, mindfulness and meditation, as well as the value of engaging in the humanities, social connection, and a practice of gratitude.

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[00:00:00.080]My whole career for about the last 30 years or so,
[00:00:02.950]I'm actually a geriatric psychiatrist by trade,
[00:00:05.800]so I work in the College of Medicine at UNMC,
[00:00:09.080]and I spend about half my time seeing older adults
[00:00:11.512]with depression and Alzheimer's disease
[00:00:14.020]and bipolar disorder and all those sorts of things.
[00:00:16.950]But I spend the other half doing wellness things
[00:00:19.550]largely for UNMC, but also for the state.
[00:00:21.899]About four years ago, our chancellor here at UNMC
[00:00:26.260]created a new position for me
[00:00:27.750]because he knew that I was very interested
[00:00:29.320]in physician burnout and burnout in nurses
[00:00:31.670]and other healthcare professionals and students.
[00:00:34.650]So I created a new position.
[00:00:35.880]I'm the assistant vice chancellor for campus wellness.
[00:00:38.270]That's a big, lofty sounding title,
[00:00:39.890]but basically I end up trying to do a lot
[00:00:42.480]of these kind of outreach talks, I really enjoy doing this.
[00:00:44.742]I try to teach self-care skills to healthcare students
[00:00:48.380]and anybody that'll listen for five consecutive minutes.
[00:00:51.570]So again, delighted to have the chance
[00:00:55.049]to address you, folks.
[00:00:56.630]So I'm gonna take a risk, I'm gonna ask you to take a risk
[00:00:58.920]insofar as you're willing to, and share in the chat,
[00:01:03.730]and wait till I tell you to do,
[00:01:05.370]this is a technique that I learned from somebody else.
[00:01:08.570]As you'll hear,
[00:01:09.770]I'm gonna throw a lot of spaghetti at the wall,
[00:01:11.690]a lot of wellness ideas,
[00:01:12.590]and these are ideas I've stolen from other people.
[00:01:14.940]I don't think I've created any of these myself.
[00:01:16.618]I'm not that creative,
[00:01:18.050]but I'm pretty good at stealing other good ideas.
[00:01:20.290]So there's an idea I stole
[00:01:21.400]from some psychology friends recently.
[00:01:24.260]So what I'd like you to do is think about
[00:01:26.230]how you're feeling today from one to five,
[00:01:29.370]and five is the best you've ever felt,
[00:01:31.270]you're just on top of the world, everything's great.
[00:01:33.620]One is the worst you've ever felt in your life.
[00:01:36.050]I hope nobody's a one today,
[00:01:37.360]but pick a number just in your head.
[00:01:40.270]And what I'm gonna ask you to do is,
[00:01:42.100]and if you don't feel comfortable putting the real number,
[00:01:44.170]just put a four, let's say,
[00:01:46.897]but put a number into the chat,
[00:01:49.540]but don't hit send or don't hit Enter until I tell you.
[00:01:52.340]And so that way you don't have to feel embarrassed
[00:01:54.410]being the first one to go first.
[00:01:55.840]This is called the waterfall technique.
[00:01:58.100]So pick a number and say,
[00:01:59.580]you can do a random number if you want.
[00:02:00.930]We won't hold you to the actual number.
[00:02:03.170]So if you got a number to put into the chat,
[00:02:05.320]I'll do it myself and wait.
[00:02:07.060]I'm gonna count down from three to one.
[00:02:12.260]When I hit one, hit Enter, okay?
[00:02:14.450]Three, two, one, enter.
[00:02:18.060]And see what happens, you get this waterfall thing.
[00:02:20.040]So I put in three, which is a pretty realistic account
[00:02:22.132]for how I'm doing today.
[00:02:23.830]So I just thought that's a useful technique
[00:02:25.169]and it's kind of a nice ice breaker.
[00:02:27.040]You may wanna use that at future meetings.
[00:02:29.190]It kind of lets you sample the,
[00:02:31.210]looks like did we all do threes?
[00:02:32.670]Yeah, looks like it, right? So there you go.
[00:02:35.030]And I think there's a lot of that going around when people,
[00:02:37.090]and again, that's hopefully,
[00:02:38.633]those are probably real numbers.
[00:02:40.860]That's kind of typical these days because of the environment
[00:02:44.100]which we're living between the pandemic.
[00:02:46.140]And even though the numbers are coming down here,
[00:02:48.160]they're going up elsewhere,
[00:02:49.180]but they're coming down in the States,
[00:02:51.100]but the war, the economy, you name it.
[00:02:54.701]These are tough times, right?
[00:02:57.190]So let me share my screen.
[00:02:58.520]I can't do anything without PowerPoint, so I apologize.
[00:03:01.130]Lots of PowerPoint slides. Can you see those hopefully?
[00:03:03.560]Give a thumbs up. Okay, thanks.
[00:03:04.970]So I'm doing this kind of on behalf
[00:03:07.030]of my little core wellness team.
[00:03:08.465]So I work with two psychologists,
[00:03:10.560]Ali DeLizza and Kati Cordts.
[00:03:12.260]They're both really smart people
[00:03:14.221]and they've taught me a lot.
[00:03:15.590]So some of the things on these slides came from them
[00:03:18.630]and some I've kind of ripped off,
[00:03:20.940]or pardon me, borrowed from other people.
[00:03:24.000]So let's dive in.
[00:03:24.950]So I'm gonna talk, first of all,
[00:03:26.339]about a very practical technique that I personally practice,
[00:03:30.970]and I would encourage you to give this a try.
[00:03:33.280]You may do a version of this already on your own,
[00:03:35.780]but here's, but in case you don't,
[00:03:38.040]turns out when we're stressed,
[00:03:40.490]we tend to breathe shallowly and quickly,
[00:03:43.370]and you may know that.
[00:03:44.710]And if you deliberately slow your breathing down,
[00:03:47.699]you will tend to make yourself
[00:03:50.230]a little bit calmer in the moment.
[00:03:52.280]So I'm gonna ask you to do is practice this right now.
[00:03:54.910]It'll take about a minute.
[00:03:56.500]So in a couple of seconds,
[00:03:58.280]I'm gonna ask you just to breathe really slowly,
[00:04:01.780]and by slowly, I mean count to six silently inside your head
[00:04:05.070]as you take a breath in,
[00:04:06.240]hold it for maybe one or two seconds, doesn't matter.
[00:04:09.230]And then count to six as you exhale,
[00:04:10.526]I'll warn you that you gotta hold your breath back
[00:04:12.776]as you exhale 'cause it's not normal to exhale that slowly.
[00:04:16.650]You gotta kinda pace yourself, but do that.
[00:04:19.480]I'm gonna ask you to do, I'm gonna do it myself
[00:04:21.120]'cause I need a little stress reduction right now,
[00:04:22.830]so it's gonna go quiet.
[00:04:24.140]So do that, four of those breaths.
[00:04:25.540]Six seconds in, hold it for a second.
[00:04:27.490]Six seconds out times four.
[00:05:12.900]Okay, keep doing it if you wish.
[00:05:15.530]It is something, if you were watching me,
[00:05:17.940]you might have noticed I closed my eyes 'cause I can,
[00:05:20.230]but you don't have to close your eyes.
[00:05:22.140]You can do it when you're driving,
[00:05:23.320]you're late for a meeting,
[00:05:24.340]you're kinda white knuckling it
[00:05:25.590]'cause you're late, whatever, great thing to do.
[00:05:28.150]But this is a great way to start a meeting,
[00:05:29.804]a team meeting, it centers people and all,
[00:05:33.350]plus it's just good for you.
[00:05:35.130]I find if I practice it deliberately a couple times a day,
[00:05:37.758]after a while, after you practice it deliberately,
[00:05:40.090]it starts becoming kind of automatic,
[00:05:41.740]and your body you will start doing it
[00:05:43.330]when you're under stress, so I really encourage you.
[00:05:45.262]It does not get any simpler than that.
[00:05:47.630]I like simple things.
[00:05:49.270]The older I get, the more I like simple.
[00:05:52.170]Okay, let's talk about the context here.
[00:05:53.775]I won't dwell on the pandemic
[00:05:55.540]'cause it's two years of this and you know it,
[00:05:57.540]you're all experts at dealing with pandemics
[00:05:59.880]and Zoom meetings and all the stuff
[00:06:01.250]that we've all had to do.
[00:06:02.120]But just be aware,
[00:06:02.970]it's been what a roller coaster ride it's been, right?
[00:06:05.950]And this is not looking at COVID-19.
[00:06:08.113]This is just the reaction,
[00:06:09.835]the psychological reaction we have to any disaster,
[00:06:12.990]whether it's manmade or natural,
[00:06:17.440]that even after the thing is over,
[00:06:20.180]there's this long up and down recovery period.
[00:06:24.270]Well, COVID-19 is just different.
[00:06:26.570]It isn't a tornado or a flood
[00:06:27.944]or the normal things we deal with
[00:06:30.490]that are pretty short-lived.
[00:06:31.690]The aftermath takes a while.
[00:06:32.569]But normally, most disasters themselves are short-lived.
[00:06:36.105]This disaster is two years and it's still going.
[00:06:40.430]So this recovery phase, whenever that starts happening,
[00:06:44.550]is gonna gonna take some time.
[00:06:46.320]We will recover, we're resilient, we'll get through it,
[00:06:49.360]but there'll be lots of ups and downs.
[00:06:52.970]So in the meanwhile, anybody that's heard me talk before
[00:06:57.710]has heard me talk about this term
[00:06:59.442]or you may have picked it up yourself.
[00:07:02.000]But about a year ago, we started seeing these articles
[00:07:05.380]like in The New York Times and other publications
[00:07:08.890]about languishing, the sense of the blahs.
[00:07:12.580]That's why I think we are all threes today, right?
[00:07:14.860]It's languishing.
[00:07:16.920]The odds are, you don't have a mental illness.
[00:07:20.090]Now you might, you might have depression or anxiety.
[00:07:21.518]Those are common things.
[00:07:22.790]And if you do, there's no stigma and no judgment obviously.
[00:07:25.120]That's why I spend my life treating these conditions.
[00:07:27.880]But pretty good chance,
[00:07:29.390]if you're feeling like a three a lot of the time,
[00:07:31.547]you are, what we call in my field of psychiatry, normal.
[00:07:36.300]This is called languishing and it's a case of the blahs,
[00:07:40.150]but it's combination the blahs
[00:07:41.680]plus feeling kind of restless.
[00:07:43.260]Like I feel like I'm kinda on the edge,
[00:07:46.070]but I'm also kinda not real motivated to work out,
[00:07:49.530]to exercise, to read, to do the fun stuff
[00:07:52.040]I used to do, whatever.
[00:07:52.873]So if you have any combination of that,
[00:07:54.750]pretty good chance you're normal, it's languishing.
[00:07:57.610]And it's probably caused by of the two years
[00:08:00.000]and running of being on high alert because of the pandemic.
[00:08:04.430]Our cortisol levels, that stress hormone
[00:08:07.261]that we create out of our adrenal glands
[00:08:09.670]has been running high for a long time,
[00:08:11.640]and we're not used to having that.
[00:08:13.340]Our bodies are not intended
[00:08:14.720]to have two years of high cortisol levels.
[00:08:17.230]And that's why it makes you feel crummy and restless.
[00:08:20.524]I think, it's good to just to normalize things.
[00:08:24.060]Here's a definition on it.
[00:08:27.070]Again, it's not depression and it's not necessarily burnout.
[00:08:34.380]It is, like I say, kind of a normal, not kind of,
[00:08:36.950]it is a normal phenomenon.
[00:08:40.630]Here's a description, somebody talked about it.
[00:08:42.183]I feel kind of stuck, I'm in limbo,
[00:08:44.190]there's the essences of life buzz around me.
[00:08:46.560]In other words, other people seem to be busy
[00:08:48.460]and doing things and moving forward,
[00:08:50.880]but I can't quite grab that myself.
[00:08:54.390]Life is sort of overwhelming,
[00:08:55.408]and yet, it's also not engaging enough.
[00:08:57.880]These kind of funny mixtures of feelings, right?
[00:09:01.070]Tired, burned out, not real excited,
[00:09:02.736]but restless, eager to engage, and trying.
[00:09:05.950]So kind of a funky blend of mixed emotions.
[00:09:10.130]So if you feel any combination of that stuff,
[00:09:12.280]guess what, again, you're normal.
[00:09:14.560]Here's Doc Wengel's prescription for languishing.
[00:09:17.060]I write a lot of prescriptions for Prozac, and Zoloft,
[00:09:19.850]and other things, but here's a prescription you can take
[00:09:23.030]without having to go to the pharmacy.
[00:09:24.730]So first of all, cut yourself some slack
[00:09:26.720]for crying out loud.
[00:09:28.232]We are all adapting as best we can
[00:09:31.230]to these crazy, goofy circumstances.
[00:09:33.910]So cut yourself some slack, give yourself some grace,
[00:09:36.280]whatever phrase you wanna use.
[00:09:38.030]You're not lazy, you're not a slacker
[00:09:39.379]'cause you're not doing the things you normally would do,
[00:09:41.920]whether it's at work, or home, or whatever.
[00:09:44.630]Sometimes I think we all, myself included,
[00:09:46.353]we have to remind ourselves about meaning and purpose.
[00:09:48.770]Like even writing down, what's my personal mission statement
[00:09:52.170]or what things are important to me,
[00:09:54.310]family, friends, faith, whatever it may be,
[00:09:57.793]hobbies, your pets, doesn't matter.
[00:10:01.160]But sometimes, it's kinda writing down
[00:10:03.200]what's important to you actually helps.
[00:10:05.870]Obviously, social connection.
[00:10:07.280]We're all craving more of that,
[00:10:08.810]and I think we're starting to be able
[00:10:10.060]to do more of that as the restrictions ease.
[00:10:13.000]I was talking to a friend of mine earlier today,
[00:10:14.393]who's a fellow geriatric psychiatrist,
[00:10:17.000]and she's in Maryland,
[00:10:18.680]and she went to the annual meeting.
[00:10:20.500]So just like your groups, you have meetings,
[00:10:24.710]you have local, regional, and maybe national meetings.
[00:10:27.060]So there's a national meeting of geriatric psychiatrists
[00:10:30.290]in March, and it was last week,
[00:10:32.090]and she went to it for the first time in three years,
[00:10:35.800]'cause the last two years, we're all virtual.
[00:10:37.800]And she said it was kind of fun
[00:10:40.510]and kind of weird at the same time,
[00:10:42.480]'cause they were still trying to do the hybrid thing
[00:10:44.440]for people who didn't wanna come.
[00:10:45.690]And she told this story about one
[00:10:46.950]of the geriatric psychiatrists that was at the meeting
[00:10:49.450]came from California, flew all the way from California
[00:10:51.546]to Orlando to go to the meeting and said,
[00:10:54.677]"It was the greatest meeting I've ever been to."
[00:10:57.010]So she came initially for the introductory,
[00:11:01.775]the opening ceremony and the reception.
[00:11:04.255]And then she spent the rest of the meeting
[00:11:06.040]at the pool doing it remotely.
[00:11:08.706]But she could have done that from California.
[00:11:10.610]But so anyway, it's just weird, right?
[00:11:13.560]The times are just weird.
[00:11:15.520]So I would encourage you though, as much as you can,
[00:11:19.260]get in the same room with somebody you care about
[00:11:21.740]and that's better, Zoom is good in one hand.
[00:11:23.650]This is a convenient meeting
[00:11:25.380]'cause I know you folks are all over the state
[00:11:27.420]so you didn't have to drive to Omaha or whatever,
[00:11:29.197]so it's kinda convenient.
[00:11:30.750]But on the other hand, Zoom isn't quite as good
[00:11:33.060]as being in the same room with people you care about.
[00:11:36.090]And then do a little something.
[00:11:37.760]What the heck do I mean by that?
[00:11:39.040]Well, okay, I stopped going to the gym during the pandemic
[00:11:43.060]'cause it didn't seem like a real safe thing to do.
[00:11:45.940]And so now maybe it's time I start doing that again,
[00:11:48.341]but one of the things that keeps me from doing it is,
[00:11:50.871]I used to go, okay, three times a week
[00:11:53.025]work out for at least a half hour, 45 minutes,
[00:11:55.750]so that was my old level.
[00:11:57.180]Right now, my new level is zero 'cause there's a big gap.
[00:12:01.250]And so sometimes, when there's a big gap,
[00:12:03.370]feels like, well, if I'm gonna do it again,
[00:12:05.203]I gotta go from zero to 60 in two seconds,
[00:12:08.524]and I gotta go back to my old level, and that's really hard.
[00:12:12.390]So instead, what if I gave myself permission to say,
[00:12:14.740]okay, you know what?
[00:12:15.573]Here's my new normal for now is going back to the gym
[00:12:19.820]once or twice a week,
[00:12:21.970]and I only have to stay five or 10 minutes.
[00:12:24.210]All I have to do is go there, pick up,
[00:12:27.715]go to the weight, the free weight, the dumbbell stack,
[00:12:31.230]pick up whatever weight I want,
[00:12:34.010]do a couple of curls and put it back.
[00:12:35.730]And if I've done that, hey, I'm gonna give myself a sticker.
[00:12:39.956]That's good enough.
[00:12:41.590]I don't have to strive for my old level of performance.
[00:12:44.450]Now while I'm there, once I've done that in initial steps,
[00:12:47.093]sometimes then you'll say,
[00:12:48.547]"Okay, gosh, I'm already here, might as well do more."
[00:12:51.470]And that's fine, but if I don't,
[00:12:52.710]if I'm having a low energy languishing day,
[00:12:57.050]that's good enough, that five minute,
[00:12:59.440]picking up a weight and doing a couple of reps
[00:13:01.120]is good enough for now, and that's what I mean by,
[00:13:03.360]sometimes just getting back into doing
[00:13:04.766]just a little something consistently can be pretty helpful.
[00:13:09.650]Okay, so this is a slide
[00:13:10.890]one of my psychologists friends put together.
[00:13:12.602]So when you think of illness, what do you think?
[00:13:15.570]These are great things, okay, we're eating a healthy diet,
[00:13:18.212]staying active, meditating, doing mindfulness,
[00:13:21.190]all good stuff.
[00:13:22.720]But sometimes people get tired of hearing,
[00:13:25.110]well, you should be doing these things.
[00:13:26.582]It can seem rather preachy, right?
[00:13:29.800]And what it can really feel like is more,
[00:13:32.020]sometimes, pick your favorite meme here.
[00:13:35.120]I kinda like the inner peace one.
[00:13:36.900]I need it and I need it right now.
[00:13:38.697]Give it to me immediately.
[00:13:40.950]But like I say, you can sometimes come across
[00:13:43.625]a little preachy, and then I get this a lot in healthcare.
[00:13:48.310]I was talking to Holly before we started,
[00:13:51.470]when I talk to healthcare providers,
[00:13:54.010]a lot of times to say,
[00:13:56.717]"Getting enough sleep is actually really good for you
[00:13:59.010]and doing some exercise and doing some mindfulness."
[00:14:01.220]They say, "That's great, but don't have time
[00:14:03.600]too busy taking care of patients.
[00:14:06.493]Gimme something I can do in two seconds."
[00:14:10.180]And so sometimes, they don't really wanna hear it.
[00:14:12.580]But I'm gonna say it anyway.
[00:14:14.561]I hope you will take one or two ideas away from like,
[00:14:17.720]I'm gonna throw a lot of spaghetti at the wall,
[00:14:20.330]listen for that one or two things
[00:14:22.130]you can take away and take back home.
[00:14:23.740]Maybe it's already something I've already said,
[00:14:25.330]maybe that six-second thing, the breathing thing,
[00:14:28.810]maybe it's the waterfall technique.
[00:14:30.139]Who knows? Whatever.
[00:14:31.370]But maybe one or two things will resonate.
[00:14:36.010]Okay, I'm gonna gonna get into the neuroscience
[00:14:37.990]of stress here for just a minute or two.
[00:14:40.343]I talked before about cortisol,
[00:14:42.463]but let me back it up a step,
[00:14:44.750]and we're gonna talk about this part of the brain
[00:14:46.182]called the amygdala, that's how you pronounce it, amygdala.
[00:14:50.300]It's the fear center or the anxiety center of the brain.
[00:14:53.190]It's really deep down in the brain,
[00:14:55.430]and structures that are deep down in the brain
[00:14:57.480]as compared up here and near the surface are old structures,
[00:15:01.070]things we share with lots of other species,
[00:15:03.530]kind of primitive structures.
[00:15:05.830]But even though they're primitive, they're pretty important.
[00:15:07.710]So the amygdala is designed to keep you and me alive
[00:15:10.280]in the event of a life threatening situation, like what?
[00:15:14.070]Well, so let's say you see,
[00:15:16.600]probably don't see a lot of saber-toothed tigers,
[00:15:18.471]I certainly don't,
[00:15:20.430]but let's say you're out hiking in Yellowstone
[00:15:22.952]and you see a bear.
[00:15:25.460]Well, anytime your brain takes in
[00:15:27.070]a new piece of information,
[00:15:29.460]part of what your brain does with that information
[00:15:31.950]is have your amygdala make a quick decision about,
[00:15:34.540]is this gonna hurt me or not?
[00:15:36.740]And if the amygdala says, "Yeah, it could,"
[00:15:39.730]it's gonna hijack the rest
[00:15:41.160]of your brain temporarily and take over.
[00:15:44.350]And when it takes over,
[00:15:45.430]I also like to call it pulling the fire alarm.
[00:15:48.050]It's gonna basically activate your fight-or-flight system,
[00:15:52.000]which in medical parlance is referred
[00:15:53.900]as the sympathetic nervous system,
[00:15:56.500]and you're gonna crank out a lot of stress hormones
[00:15:58.820]like epinephrine, which is sometimes called adrenaline,
[00:16:02.380]and you're also gonna crank out a lot of cortisol.
[00:16:05.420]I mentioned earlier, cortisol, I think,
[00:16:07.100]is this long-standing high levels of cortisol,
[00:16:09.308]in my opinion, or one of the reasons
[00:16:11.130]maybe why we're languishing.
[00:16:13.410]Let's talk about some of these other,
[00:16:14.610]the catecholamines, the adrenalines of the world.
[00:16:17.910]So there's these two parts of the autonomic nervous system,
[00:16:22.230]and this is the part of the nervous system
[00:16:24.176]that's working in the background.
[00:16:26.430]We normally don't have much conscious control over this.
[00:16:29.280]It just kind of automatically takes care of things
[00:16:31.810]like keeping your heart beating and keeping you breathing.
[00:16:34.070]It's really good that we don't have
[00:16:35.305]to think about those things
[00:16:36.850]'cause you don't want to forget to breathe
[00:16:38.760]or forget to make your heart pump, right?
[00:16:41.240]So that's why it's automatic, so automatic or autonomic.
[00:16:45.070]So there's these two halves,
[00:16:46.270]the left side is the sympathetic nervous system,
[00:16:48.490]the fight-or-flight system,
[00:16:50.750]the right side is the parasympathetic nervous system,
[00:16:54.210]AKA the rest and digest system.
[00:16:57.550]So a few minutes ago,
[00:16:59.203]when you did the six-second breathing thing,
[00:17:01.700]you and I temporarily at least turned on
[00:17:04.569]our rest and digest system.
[00:17:07.420]And at any given time, your body and mine
[00:17:11.380]is running off of one of these two systems.
[00:17:13.900]I don't think you can really run 'em simultaneously
[00:17:16.120]or using one or the other.
[00:17:18.410]I would much rather my body is running
[00:17:20.540]on the green side than the red side,
[00:17:23.540]but frankly, because of just stress and the way we live
[00:17:27.220]and the pandemic, and the war, and everything else,
[00:17:30.210]a lot of times, we're running in the red zone here
[00:17:32.240]more often than we would like to.
[00:17:33.860]It's just a normal thing.
[00:17:36.060]We can change that by the strategies I'm gonna talk about,
[00:17:39.800]but it takes some conscious effort.
[00:17:43.640]Just more evidence that the stuff really,
[00:17:47.662]there is actually a science to it.
[00:17:49.566]And you can actually tell the difference
[00:17:51.280]between a stressed brain, this brain here,
[00:17:53.980]and a non-stressed brain if you do PET scans,
[00:17:56.620]which were fancy scans
[00:17:58.327]looking at how the brain is using glucose.
[00:18:02.170]So it really does affect brain function,
[00:18:04.050]but here's the punchline really.
[00:18:05.440]So when we activate the fight-or-flight system
[00:18:07.750]through that primitive thing through the amygdala
[00:18:11.060]and some other primitive structures,
[00:18:13.690]we temporarily turn off
[00:18:15.660]some of the higher level brain functions here
[00:18:18.559]described as executive functioning.
[00:18:20.870]I look at that again, in my simple minded terms,
[00:18:22.961]it's largely referring to things that the frontal lobes do,
[00:18:26.912]thinking, having perspective,
[00:18:30.739]being able to make good decisions, and so forth.
[00:18:34.010]That part of the brain doesn't work so well
[00:18:35.950]when we're running in fight-or-flight mode.
[00:18:39.050]Think about that, think about the last time your body
[00:18:41.310]went into full fight-or-flight mode.
[00:18:43.830]The phone rings at 2:00 AM
[00:18:45.310]and wakes you up out of a sound sleep.
[00:18:48.610]Your heart starts pounding, and you think,
[00:18:50.131]it's almost never good news at 2:00 AM, right?
[00:18:53.310]So your brain got hijacked by the amygdala,
[00:18:56.387]and you're thinking, what horrible thing is going to happen?
[00:18:59.550]That's a good example of this happening.
[00:19:03.390]So what do we do about that?
[00:19:05.160]Well, the punchline, this is a busy slide
[00:19:09.010]and it's sort of, again, techy,
[00:19:10.990]but I'm gonna walk you through it briefly here.
[00:19:16.740]Let's leave the frontal lobes,
[00:19:18.310]my favorite part of the brain, prefrontal, frontal.
[00:19:20.870]Let me leave that out for the moment.
[00:19:22.270]Let's talk about these two parts of the brain,
[00:19:23.802]which are kind of more, again, primitive, I would say.
[00:19:27.410]So there's a part of the brain called the nucleus accumbens,
[00:19:29.754]which is also called the pleasure center of the brain.
[00:19:32.800]That's the part of the brain that fires off impulses
[00:19:36.660]when we do highly pleasurable things.
[00:19:38.830]And that could be a runner's high.
[00:19:40.360]I never got a runner's high back when I used to run,
[00:19:42.820]but some people do,
[00:19:44.470]or drugs of abuse and alcohol work through this,
[00:19:47.950]that's why they give you a buzz,
[00:19:49.904]sex works through that, roller coaster rides,
[00:19:53.700]could be a lot of things.
[00:19:54.810]Anything that's really pleasurable,
[00:19:55.970]highly pleasurable works through that part of the brain.
[00:19:58.630]That part of the brain loves it
[00:19:59.900]when you do things that are highly pleasurable.
[00:20:04.160]This part of the brain, the dorsal striatum,
[00:20:06.860]it likes it when you do familiar things,
[00:20:09.350]doesn't matter if it's good habit or bad habit,
[00:20:12.170]as long as that part of your brain recognizes it,
[00:20:15.100]this is something he or she did before, it's gonna say,
[00:20:18.207]"Hey, keep doing it 'cause I recognize that behavior."
[00:20:21.370]Let's say you have a bad habit that you don't really like,
[00:20:25.010]but it's pleasurable in the moment
[00:20:26.980]and it's familiar 'cause you've done it a lot,
[00:20:29.350]and whether that's an eating thing, or a drug thing,
[00:20:32.110]or a pornography thing, or whatever it is
[00:20:34.970]or whatever that thing is, or it's too much Netflix binging,
[00:20:38.670]nothing wrong with that, i'm not judging that.
[00:20:40.380]I'm just saying, but let's say you have something,
[00:20:42.100]a habit you'd rather not have, it's hard to break.
[00:20:46.370]And the reason it's hard to break
[00:20:47.480]is not because you are lazy or a slacker or lack willpower.
[00:20:50.382]It's simply because of the neurology of it
[00:20:52.920]that if you have those habits and we all do,
[00:20:54.970]we all have something, you got two parts of your brain
[00:20:57.886]that are conspiring to make you want to keep doing it.
[00:21:02.370]But then you have our friend, the frontal lobes,
[00:21:04.810]the prefrontal cortex, like the parents,
[00:21:06.950]it's kinda like the parents of these two kids.
[00:21:11.790]And it's the parents are saying,
[00:21:12.919]"That isn't really the best habit in the world."
[00:21:15.170]Maybe, again, this doesn't apply to you, folks,
[00:21:17.440]but let's say somebody we know has a meth habit.
[00:21:21.690]Well, boy, it feels really good in the moment.
[00:21:24.000]Meth really caused your brain,
[00:21:25.480]caused your nucleus accumbens to light up really big time.
[00:21:28.970]And if it's a familiar habit, again,
[00:21:30.369]so you've got two parts of your brain saying,
[00:21:31.927]"Hey, keep doing it."
[00:21:32.860]But your frontal lobes are saying,
[00:21:34.677]"That's really maybe not a good thing for me to do."
[00:21:36.790]But it's an unfair fight, it's two against one.
[00:21:40.420]So what do we do about it?
[00:21:41.430]We're gonna do everything we can
[00:21:42.800]to make the parents stronger, the frontal lobes.
[00:21:45.610]And I got most of this part out of this book
[00:21:47.780]called "The Upward Spiral."
[00:21:48.900]It is a great book.
[00:21:49.840]If you wanna learn more about practical things you can do
[00:21:52.430]or I can do for treating anxiety and depression
[00:21:56.600]and the science behind it, it's a great book.
[00:21:58.740]So it's got science, it's not heavy into the science,
[00:22:01.080]but if you like to learn a little bit more
[00:22:02.560]about the why it works, it's really a good book.
[00:22:05.940]So here's what the book would say.
[00:22:07.490]These are things it really have been proven
[00:22:09.228]to make the frontal lobe stronger,
[00:22:10.960]and in the end, make us happier and healthier.
[00:22:15.040]So I'm gonna touch on most of these here
[00:22:18.313]at least for a couple of minutes.
[00:22:22.180]But before we do that, here's some things we try.
[00:22:24.393]We're resilient, we try stuff on our own,
[00:22:27.160]and we try things, but a lot of times,
[00:22:29.810]these things don't work really well, so I don't recommend,
[00:22:32.040]you don't have to be a teetotaler, but I would say,
[00:22:34.480]drinking a gallon of wine a day to numb your stress,
[00:22:37.104]maybe not the best thing to do,
[00:22:41.260]but other distracting behaviors.
[00:22:43.330]What do I mean by that?
[00:22:44.640]Well, here's one. I dunno if you can read the caption.
[00:22:47.787]"Wow, it's only 11:00 PM, that still leaves time for me
[00:22:50.500]to ruin tomorrow by staying up
[00:22:51.890]doing nothing on the internet."
[00:22:53.830]I'm guilty of that.
[00:22:55.312]So I think oftentimes, when we're feeling stressed out,
[00:22:58.965]we maybe stay up later than we ought to
[00:23:02.910]doing distracting things,
[00:23:04.290]whether it's social media, internet browsing.
[00:23:07.009]I tend to watch a lot of old sitcoms at night
[00:23:10.307]when I'm kinda feeling, had kind of a rough day
[00:23:13.067]and wanna just sort of do something mindless.
[00:23:15.300]I'll watch "Seinfeld" reruns or things like that,
[00:23:17.034]and it makes me feel better in the moment.
[00:23:19.300]But the problem is, if you stay up too late, of course,
[00:23:20.999]then you're shorting yourself on sleep
[00:23:22.662]and you'll feel bad the next day.
[00:23:24.380]But there's actually a name for that.
[00:23:26.300]I don't have a slide for that, but there's a name for that,
[00:23:28.727]and it's called revenge bedtime procrastination.
[00:23:33.120]I'll say that again, revenge bedtime procrastination.
[00:23:38.070]That is apparently a term from China
[00:23:40.530]and it translates to that.
[00:23:42.360]I get the bedtime procrastination, but what's the revenge?
[00:23:45.500]Who are you taking revenge out on?
[00:23:47.400]I guess maybe myself tomorrow, I don't know,
[00:23:52.090]but it's a funny thing, or maybe you're taking revenge
[00:23:54.550]out on the day that you just had.
[00:23:55.674]What a bad day, I deserve to stay up late
[00:23:59.400]doing this other thing.
[00:24:00.310]So anyway, taught you a new term here,
[00:24:01.790]revenge bedtime procrastination, I'm guilty of that.
[00:24:05.730]The other distracting behavior here,
[00:24:07.327]you see, even Alexander Graham Bell noticed this,
[00:24:10.267]"Now that I've invented it,
[00:24:11.470]I have this odd compulsion to hold it in my hand
[00:24:13.703]wherever I go and glance at it incessantly."
[00:24:16.560]Now that may or may not apply to you,
[00:24:18.353]but I bet you, it applies to young adults
[00:24:20.895]that you encounter in your home or at work, right?
[00:24:24.270]But I found myself if I'm not particularly young,
[00:24:25.995]but I found myself kinda doing that,
[00:24:28.087]and I get stressed out and I'm kinda bored,
[00:24:30.250]I pick up my phone and I look at,
[00:24:32.621]obsessively look at the news or go to Twitter
[00:24:35.810]or something like that, right?
[00:24:37.160]It's a real thing, it's a real deal.
[00:24:43.060]Okay, we did this already, but just a reminder,
[00:24:44.870]as I'm talking, I'm not good gonna stop now,
[00:24:46.730]but feel free, as you see fit,
[00:24:48.638]go ahead and take a few more of those nice, slow breaths.
[00:24:50.684]You can do it while I'm chatting.
[00:24:52.750]You don't have to close your eyes or anything.
[00:24:57.500]Some other self-care things. So what else works for us?
[00:24:59.970]So I mentioned sleep.
[00:25:01.344]I give a whole hour-long lecture
[00:25:03.127]to my dental students on sleep,
[00:25:06.800]but I'll give you punch line.
[00:25:08.150]It's good for you. You know that, of course.
[00:25:10.590]But one of the things you probably, you may not know,
[00:25:12.990]because I don't think this is very widely known
[00:25:15.710]that if you are chronically sleep deprived,
[00:25:19.210]not only will you be tired, that's obvious, right?
[00:25:22.230]But you might be more anxious,
[00:25:23.820]and it might be be because of not getting enough sleep.
[00:25:26.160]They've done some really interesting studies
[00:25:27.710]with college students
[00:25:28.770]and they take non-anxious college students
[00:25:32.960]and they deliberately make them get a little bit less sleep,
[00:25:35.462]like a half hour less or an hour less
[00:25:37.600]than they normally would.
[00:25:38.433]And they do that for a while, like a few weeks,
[00:25:40.150]and they find they start getting kinda nervous
[00:25:42.380]and they don't know why.
[00:25:44.070]So if you've been feeling,
[00:25:45.330]maybe your languishing is worse than usual,
[00:25:47.879]maybe get another half hour sleep might make a difference.
[00:25:52.270]Incidentally too, and again,
[00:25:54.090]I say this with a little bit of trepidation.
[00:25:57.120]Remember, I told you I'm a geriatric psychiatrist.
[00:25:59.750]One of the risk factors for Alzheimer's disease
[00:26:01.717]that people are learning more and more about
[00:26:03.700]is chronic sleep deprivation
[00:26:05.780]'cause sleep is the one time
[00:26:07.276]when our brain takes out the trash
[00:26:08.760]and gets rid of toxic substances that we produce
[00:26:11.795]when our brain is active during the day.
[00:26:14.600]Now, the reason I'd say that with a little trepidation,
[00:26:16.930]I don't want you to worry you're gonna get Alzheimer's
[00:26:19.170]if you have trouble with insomnia, 'cause many of us do.
[00:26:22.095]It doesn't mean you're gonna get Alzheimer's,
[00:26:25.720]but it's one of many risk factors.
[00:26:28.050]The whole point is, do your best to get some sleep.
[00:26:33.008]Exercise, I'm sure I don't have to tell you
[00:26:35.380]it is really good for you.
[00:26:37.840]If you read Korb's book, that "Upward Spiral" book,
[00:26:41.340]he has this metaphor that a lot of neuroscientists
[00:26:43.605]refer to exercise
[00:26:45.120]as being like Miracle-Gro for the brain.
[00:26:48.416]So you're in the extension office, it's springtime,
[00:26:51.386]getting ready for planting season, I guess, right?
[00:26:53.606]So I'm a gardener myself, I like getting out there
[00:26:56.550]and getting my hands dirty,
[00:26:59.325]and gardening, incidentally,
[00:27:01.300]is another wellness strategy, it's really good.
[00:27:03.200]And there's some evidence
[00:27:04.040]that getting our hands down physically in the dirt
[00:27:06.410]is actually healthy.
[00:27:07.376]There's some evidence that gardeners
[00:27:09.810]actually get exposed to a soil-borne bacterium
[00:27:14.530]that somehow influences your serotonin levels in your brain.
[00:27:17.913]Again, it's kind of a squishy science.
[00:27:20.170]I don't know if we can take it to the bank.
[00:27:21.460]But gardeners, in general,
[00:27:23.020]do seem to be happier and healthier.
[00:27:25.160]But getting back to the metaphor
[00:27:26.857]of Miracle-Gro for the brain,
[00:27:28.580]there's a brain chemical called BDNF,
[00:27:32.250]brain-derived neurotrophic factor.
[00:27:35.800]And the more exercise you do, the more BDNF you crank out,
[00:27:38.732]and it makes your neurons, your nerve cells
[00:27:41.100]much happier and healthier and they connect better,
[00:27:43.800]so it's really, really good for you.
[00:27:46.310]And again, if you wanna learn more about that,
[00:27:47.770]get Korb's book, he has a whole chapter on exercise.
[00:27:51.305]That breathing thing, I call it a micro-practice
[00:27:54.138]'cause it only takes a minute or so
[00:27:55.930]as compared to doing a half hour of yoga
[00:27:57.850]or something like that, all good too, I might add.
[00:28:00.120]But if you're really busy,
[00:28:01.220]micro-practice thing is a good thing.
[00:28:05.060]Come back to mindfulness meditation here in a minute,
[00:28:08.190]staying socially connected, I mentioned.
[00:28:10.140]And then I'm gonna talk a little bit about the humanities.
[00:28:12.580]This has become one of my new things
[00:28:13.889]that I've really kind of gotten into.
[00:28:15.650]It's not a new thing.
[00:28:16.570]A lot of people have been...
[00:28:19.540]Many, many people through millennia have recognized
[00:28:22.328]that the arts are really good for you in many ways,
[00:28:26.610]but there's some really interesting new data,
[00:28:29.020]scientific data demonstrating this.
[00:28:31.750]So for example, there was a study done
[00:28:33.207]with US medical students, oh, I don't know,
[00:28:36.280]five or six years ago, I think,
[00:28:38.450]where they asked medical students,
[00:28:39.982]how much exposure to the humanities are you getting
[00:28:43.520]while you're in medical school?
[00:28:45.490]Now most medical students will say,
[00:28:47.150]not much because they're too busy studying,
[00:28:49.590]but some of them make a deliberate effort,
[00:28:51.620]whether it's going to plays, or reading for pleasure,
[00:28:54.870]or playing a musical instrument, or going to concerts.
[00:28:58.080]And they found basically that the bigger dose
[00:29:00.030]of the humanities they got in medical school,
[00:29:03.520]the higher they scored on wisdom tests,
[00:29:07.067]I'm not sure how they measure wisdom,
[00:29:08.870]but somehow they do perspective and empathy,
[00:29:11.420]which are really important qualities
[00:29:13.100]for healthcare providers,
[00:29:14.630]and the lower they scored on burnout.
[00:29:16.660]So it's really interesting.
[00:29:17.660]We're trying to figure out how do you incorporate
[00:29:20.040]some exposure to the humanities
[00:29:22.366]for busy healthcare students and providers?
[00:29:25.409]Harvard, we're not doing a ton of that at UNMC,
[00:29:27.750]we're doing a little bit and I'd like to do more.
[00:29:29.271]But Harvard, for example,
[00:29:30.870]they have a mandatory medical humanities course
[00:29:32.979]for medical students, for example.
[00:29:35.290]I think that's kinda neat.
[00:29:37.630]I'll come back to that concept though in a minute.
[00:29:40.480]If you wanna learn more about meditation specifically,
[00:29:43.421]this is a, I don't have her name here, I'm sorry.
[00:29:46.750]My slides got a little bit jumbled.
[00:29:48.440]I was kind of tweaking them at the last minute
[00:29:50.480]and I apologize, I left off the caption for this.
[00:29:54.900]If you want a really good TED Talk,
[00:29:57.140]it's only about 8 1/2 minutes long.
[00:29:59.390]I encourage you to, let's see, you can't see it on there.
[00:30:02.127]This woman's name, the speaker is Sara Lazar.
[00:30:06.270]I can put it in the chat actually for you.
[00:30:11.618]If you Google her name and TED Talk,
[00:30:16.462]just literally Sara Lazar TED Talk, it'll take you to this.
[00:30:19.540]And it's about 8 1/2 minutes long
[00:30:21.230]and she gets into the science of meditation.
[00:30:24.216]And this slide that I showed you right here,
[00:30:28.580]she actually has some interesting studies
[00:30:29.980]showing that people that meditate regularly
[00:30:32.685]seem to have less brain shrinkage as they age,
[00:30:36.240]especially in the frontal lobes,
[00:30:38.230]my favorite part of the brain, the frontal lobes.
[00:30:41.160]So it's really cool, it's an entertaining,
[00:30:43.394]and really good TED Talk.
[00:30:46.330]So if you're interested in learning more
[00:30:48.370]and she'll talk about the amygdala incidentally too.
[00:30:51.840]Let me tell you what, we've got a nice chat.
[00:30:53.657]I noticed. Let's see.
[00:30:55.780]So Jenny, you asked about, I'm going back to the chat here,
[00:30:58.440]falling asleep is habit-based and it's harder than it seems.
[00:31:00.960]Yeah, I agree.
[00:31:02.370]How does napping fit into this?
[00:31:03.670]That's a complicated and good question.
[00:31:07.222]As we all know,
[00:31:08.520]there are certain societies around the country,
[00:31:10.630]especially I think in Latin America,
[00:31:12.100]where taking an afternoon nap is part of the culture
[00:31:14.205]and they seem to do just fine,
[00:31:16.591]then they stay up a little later at night
[00:31:18.580]and I think socialize and have late night.
[00:31:20.740]In Spain, they don't eat dinner
[00:31:22.180]till later nine o'clock at night or whatever because,
[00:31:24.860]but it's a two-edged sword
[00:31:27.242]'cause I actually just read a headline
[00:31:30.410]of an article yesterday on napping.
[00:31:33.390]And I'm sorry to say, yet again,
[00:31:34.720]another association with sleep and Alzheimer's,
[00:31:36.780]saying people that nap too much and too regularly
[00:31:40.180]seem to have a little higher risk of Alzheimer's disease.
[00:31:42.620]So again, it kinda goes in the face
[00:31:44.320]of what I said before about not sleeping enough.
[00:31:47.480]So I don't know that we know about that
[00:31:51.849]and it's complicated.
[00:31:55.140]And so another question.
[00:31:56.020]So Sarah, you got a good question
[00:31:57.210]about sleep deprivation if you have a baby.
[00:31:58.930]Well, that's also a normal phenomenon, right?
[00:32:01.357]So I don't have a good answer for that, it's common,
[00:32:04.700]but I think we're wired, we're resilient enough
[00:32:08.230]to get through those first months and years, I guess,
[00:32:12.340]without permanent damage, let's put it that way,
[00:32:15.060]but it is kinda like par for the course, I think.
[00:32:19.150]Not a good answer for how do we deal with that
[00:32:21.220]other than just, it does get better.
[00:32:26.270]So I'm gonna shift gears a little bit
[00:32:28.310]and talk about gratitude.
[00:32:29.666]But before I do gratitude,
[00:32:31.640]here's a really interesting metaphor
[00:32:33.340]that, again, I stole from somebody else,
[00:32:34.956]a neuroscientist that said,
[00:32:36.608]"The human brain is like Velcro for negative events
[00:32:40.650]and Teflon for positive events.
[00:32:43.210]And that really registered with me and it's really true.
[00:32:45.680]So think about a day in your life
[00:32:47.350]when things went pretty well, things at work,
[00:32:51.139]things at home went pretty well,
[00:32:52.840]but maybe one thing in your day didn't go so well.
[00:32:55.260]You get a snarky text or email from a friend,
[00:32:57.303]and it's like, where'd that come from?
[00:33:00.680]What are you gonna hold onto at the end of the day
[00:33:02.570]and talk about with your significant other,
[00:33:04.078]or your friend, or whatever at the end of the day?
[00:33:06.710]Is it gonna be the 95% that went well or the 5%?
[00:33:09.563]If you're like me, it's gonna be the negative thing, right?
[00:33:12.010]And it is really true.
[00:33:13.478]We really stick with those negative things
[00:33:16.876]better than the positives.
[00:33:18.650]I think the survival thing.
[00:33:19.890]I think we're kinda wired that way.
[00:33:21.530]It's probably has to do with the amygdala and all.
[00:33:23.980]So the good news is you can turn that around
[00:33:27.740]and you probably know this or some of you already do this,
[00:33:31.498]but keeping a gratitude journal is a great way
[00:33:33.978]to help your brain look for positives
[00:33:35.942]instead of naturally looking for all the negatives around
[00:33:39.330]'cause there's plenty of negatives, right?
[00:33:40.970]But there really are a lot of positives
[00:33:42.131]if you go looking for it.
[00:33:44.060]So the basic strategy that most people recommend here
[00:33:47.201]is once a week, write down three things
[00:33:51.940]that you're grateful for that happened in the last week.
[00:33:55.460]So I'll say that again, once a week,
[00:33:57.430]write down three things that you're grateful for
[00:33:59.700]that happened in the last week.
[00:34:01.560]So I personally do mine on Sunday
[00:34:03.370]because that Sunday it's a little slower day
[00:34:05.100]and I got a little more time to reflect,
[00:34:06.490]so I get out a little journal that I keep
[00:34:09.060]and I write down three things I'm grateful for.
[00:34:11.420]Sometimes it's pretty easy,
[00:34:13.010]sometimes I have to think kinda hard
[00:34:15.670]because I feel like I'm just not having a great day
[00:34:17.734]or doesn't seem like a really great week, I don't have,
[00:34:20.444]and that's okay.
[00:34:21.610]That's the whole point of this
[00:34:22.940]is making yourself look for the positives,
[00:34:26.620]kinda trains your brain to do that.
[00:34:28.290]So I'm not always good at that, but I'm working on it.
[00:34:31.040]If incidentally, there is a whole science to this,
[00:34:33.565]there's a psychologist at the University of California Davis
[00:34:36.831]that has made his whole career
[00:34:38.440]on studying the brain effects of gratitude journaling,
[00:34:41.693]including doing like MRI scans of people that do it.
[00:34:44.900]It's really cool.
[00:34:45.733]I've got a reference list later
[00:34:47.070]that he's got a bunch of books on gratitude
[00:34:49.196]that if you're interested, you look up.
[00:34:51.719]They're very readable and very uplifting books.
[00:34:55.836]I mentioned the humanities.
[00:34:58.140]Let me see, we've got something in the chat, let's see.
[00:35:00.210]Need to practice looking for the positive.
[00:35:01.490]Yes, well, join the club, me too, I'm glad to be...
[00:35:05.040]Oh, you're a glass half full person, that's good.
[00:35:07.030]So my son is an engineer that reminds...
[00:35:09.760]I'll tell you a quick joke here.
[00:35:11.030]So the optimist looks at the glass as half full.
[00:35:15.400]The pessimist looks at the glass as half empty.
[00:35:18.410]The engineer looks at the glass
[00:35:19.980]as being twice as big as it needs to be.
[00:35:22.610]So I dunno if you have any engineers in the family.
[00:35:24.405]Engineers are very practical people.
[00:35:28.091]So another good comment here, Jenny too,
[00:35:30.240]about keeping track of how much news we watch.
[00:35:33.930]Boy, that hits home with me too, that it can be so riveting.
[00:35:38.090]And especially now with the 24-hour news cycle,
[00:35:40.920]which again, I'm old enough to remember
[00:35:42.470]when the news meant watching Walter Cronkite at 6:00 PM
[00:35:45.380]and then watching your local news
[00:35:46.690]at 10:00 PM, and that's it.
[00:35:47.850]And then we're reading a thing called a newspaper,
[00:35:49.660]those big paper things,
[00:35:52.490]that are getting to the obsolete apparently.
[00:35:55.490]That's what news used to be, right?
[00:35:57.510]But now it's 24/7 and you can sit there
[00:35:59.218]and I've done it, you've done it probably,
[00:36:01.330]sit there in front of your favorite cable news network
[00:36:04.430]and watch the same story over and over and over.
[00:36:08.480]And everything's breaking news
[00:36:10.100]and there's always a scroll thing at the bottom.
[00:36:12.950]It's toxic. It really is.
[00:36:14.950]You don't wanna be ignorant to the news,
[00:36:16.590]but you don't wanna over,
[00:36:17.830]I think of it like a powerful medicine,
[00:36:19.524]you need just the right dose.
[00:36:21.350]Don't take too much of your heart medicine, for example.
[00:36:24.040]Don't take much of the news.
[00:36:25.640]So thanks for bringing that up.
[00:36:26.560]That's really, really a great point.
[00:36:29.210]I mentioned the humanities, I'm sorry, I'm talking fast,
[00:36:31.370]but I wanna be respectful of your time,
[00:36:32.354]and there's a couple more things I wanna get to.
[00:36:35.250]I know this is not a practical thing for most people,
[00:36:37.503]but I'm really, really lucky here at UNMC,
[00:36:40.290]that UNO is just down the street
[00:36:42.310]and we have a school of music.
[00:36:43.580]So a few years ago, we started an amateur orchestra
[00:36:46.960]of nurses, and physicians, and pharmacists,
[00:36:49.900]and grad students, and whoever wants to join.
[00:36:52.050]So we actually have a medical orchestra
[00:36:53.490]that's actually, between you and me, pretty good,
[00:36:57.170]and they actually do concerts.
[00:36:58.830]Of course, during the pandemic,
[00:36:59.890]they've had to change things.
[00:37:01.440]But they're actually back to rehearsing live.
[00:37:03.850]Well, not everybody plays the cello or the flute,
[00:37:06.340]so we started a choir.
[00:37:09.910]So this is the first rehearsal of the Nebraska Medical Choir
[00:37:13.810]sometime earlier, I guess, last fall.
[00:37:16.130]And of course, they're all socially distanced,
[00:37:17.710]wearing masks and all that.
[00:37:18.710]So we're eager to hear how they sound.
[00:37:20.790]They're gonna be doing a concert in May
[00:37:22.535]along with the orchestra.
[00:37:25.330]But what else can you do for the humanities?
[00:37:27.710]This is something, this is hot off the presses.
[00:37:29.730]So just today, I wonder if anybody else
[00:37:32.570]has already heard of this, you may already,
[00:37:34.400]but I learned this just literally three hours ago.
[00:37:38.150]I was talking to this friend of mine,
[00:37:39.360]the geriatric psychiatrist on the east coast,
[00:37:41.151]and she told me she is working on getting certified
[00:37:43.960]in this thing, Visual Thinking Strategies.
[00:37:47.440]You can look that up. This is part of their website.
[00:37:50.910]It is a really cool art-based visual arts-based way
[00:37:55.940]of opening up one's thinking, and communication skills,
[00:37:59.840]and observation skills.
[00:38:01.430]So apparently what they do
[00:38:02.515]is they literally do this exercise.
[00:38:04.940]You can see on the screen,
[00:38:05.890]they take a piece of art that is a little ambiguous,
[00:38:09.680]and most art is, unless it's just a bowl
[00:38:11.684]of fruit or something.
[00:38:13.960]Most art is a little bit ambiguous.
[00:38:15.740]So they show an ambiguous picture
[00:38:17.940]and they ask these three questions.
[00:38:20.210]What's going on in the picture?
[00:38:21.560]And again, it's not about art theory.
[00:38:24.400]They say nothing about the artist or the background.
[00:38:26.567]None of that. It's just like, what do you see going on?
[00:38:30.180]And then you say it.
[00:38:31.640]And then, well, what do you see that makes you say that?
[00:38:35.930]And then, what more can you find?
[00:38:37.660]And they've done it with individuals,
[00:38:38.761]they've done it with groups,
[00:38:39.950]they've done it with K-12 classrooms,
[00:38:42.020]they've done it with college students,
[00:38:44.520]they've done it with a apparently a wide variety.
[00:38:46.760]So you can actually get certified in doing that
[00:38:49.720]and asking those questions.
[00:38:51.300]So anyway, I thought that's really cool thing.
[00:38:52.700]She is studying, my friend on the east coast.
[00:38:54.706]She's actually studying doing this
[00:38:56.620]with patients with dementia and their caregivers.
[00:39:00.820]I thought, what an interesting thing
[00:39:01.933]where you could have that,
[00:39:03.150]'cause even somebody with advanced Alzheimer's disease
[00:39:05.127]assuming they still have some verbal skills,
[00:39:06.797]they can look at a portrait, and they can say,
[00:39:09.497]"Oh, I see this looks like New York City
[00:39:12.170]in the background and looks like four young people,"
[00:39:14.410]or whatever it is.
[00:39:15.430]So I thought, what an interesting way
[00:39:16.640]to get a conversation going.
[00:39:18.550]So let's see, we have a comment,
[00:39:20.420]economic development engagement.
[00:39:21.750]Oh, some, the artistic endeavor
[00:39:22.794]because it engages different, yeah, I like that.
[00:39:25.890]Answer would be different if the artistic exercises that,
[00:39:28.100]I love that, like I say,
[00:39:29.562]you folks probably know more about this than I do.
[00:39:32.260]I just thought, that sounds kind of intriguing.
[00:39:34.640]It sounds fun too, right?
[00:39:35.870]It says, a different way of having a conversation
[00:39:37.936]and getting people thinking and talking.
[00:39:41.690]Okay, so a couple other concrete resources,
[00:39:43.672]and I can send you these slides too, if you want.
[00:39:46.970]These are three phone apps that were put out by the VA,
[00:39:50.400]the Veterans Administration,
[00:39:51.730]so you can trust them that they're evidence-based
[00:39:54.780]that use good science and they're free
[00:39:56.640]'cause it's tax dollars at work.
[00:39:58.690]Some of these wellness apps are good,
[00:40:00.930]but they charge you a subscription, these are free.
[00:40:03.890]So there's COVID Coach,
[00:40:05.080]which was designed to help with COVID anxiety.
[00:40:08.320]But tell you what, even if you're not worried
[00:40:09.770]about the darn pandemic, it's just a really good general,
[00:40:12.559]of all the three, it is my favorite
[00:40:15.140]'cause it's got a little of everything.
[00:40:16.200]It's a little mood checker, an anxiety self-checker,
[00:40:18.848]and you can plot your skill,
[00:40:20.044]you can plot how you're doing over time,
[00:40:23.490]a whole bunch of really good stress management tools,
[00:40:26.130]some calming meditations and breathing exercises,
[00:40:29.380]got ambient, whatever, it's got a little of everything.
[00:40:32.060]For people that struggle specifically with insomnia,
[00:40:34.198]Insomnia Coach is a really good one
[00:40:37.970]and it goes beyond just normal relaxation stuff,
[00:40:42.280]which is all good, but it actually gets
[00:40:43.870]into behavioral strategies for treating chronic insomnia.
[00:40:47.390]And then for folks that really wanna dive really deep
[00:40:49.920]into mindfulness, Mindfulness Coach, guess what?
[00:40:52.840]Again, all put out by the VA and free, so check 'em out.
[00:40:59.600]Okay, so I'm gonna finish with, in this part,
[00:41:03.080]I'm gonna go through fairly quickly,
[00:41:05.010]but this part was completely designed
[00:41:06.465]by a colleague of mine, Dr. Ali DeLizza,
[00:41:09.397]who is a child and adolescent psychologist.
[00:41:12.750]So she's big on this thing called behavior analysis.
[00:41:15.350]So she's been teaching me a little bit about,
[00:41:17.600]so this is common thing that people
[00:41:19.130]that work with developing disabled people
[00:41:20.851]and young adults of various get into,
[00:41:24.380]it's a clinical strategy.
[00:41:26.660]And so they remind us the ABCs of behavior,
[00:41:29.986]the antecedent, what happens before a behavior,
[00:41:32.920]the behavior itself, and then the consequence, ABC, right?
[00:41:36.210]So good example, you're teaching your dog to sit,
[00:41:39.930]so you say the word, sit.
[00:41:41.370]If and when the dog sits, you reward it,
[00:41:44.110]good dog and they get a cookie
[00:41:46.080]or don't give your dogs cookie,
[00:41:47.180]but a milk bone or some other dog-appropriate treat, right?
[00:41:51.203]So that makes sense.
[00:41:52.900]But we're no different in some ways
[00:41:54.617]than our dogs and our cats.
[00:41:57.320]We respond to those things too.
[00:42:00.080]And so if you're gonna give,
[00:42:01.232]so this is, I guess what I'm doing now
[00:42:03.500]is turning the conversation into
[00:42:05.000]you wanna start a new habit,
[00:42:07.040]you wanna get back to an exercise habit,
[00:42:08.970]you want to get back to a, whatever, a journaling habit.
[00:42:12.659]So these are technical terms that psychologists use
[00:42:17.790]to describe effective consequences.
[00:42:19.950]So you wanna reward yourself for getting back to the gym.
[00:42:22.790]So first of all, the reward should be immediate.
[00:42:25.770]If you reward yourself next week, it doesn't work as well.
[00:42:29.090]Salient, so it's gotta make sense.
[00:42:31.010]So it's something, the reward be meaningful to you.
[00:42:35.450]Consistent, makes sense.
[00:42:37.050]Discriminant, I think what that means in this context
[00:42:41.210]is that you can tell the difference
[00:42:43.170]between this reward and other rewards.
[00:42:46.080]So let's say, it is me getting back to the gym.
[00:42:49.550]So I hate doing it 'cause it's at the end of the day,
[00:42:51.920]I'd rather sit in front of the tube,
[00:42:52.939]watching Food Network and "Chopped" episodes.
[00:42:57.575]But I really wanna get to the gym a couple times a week.
[00:43:00.161]So I'm gonna come up with some kind of reward.
[00:43:01.760]So every time I do it, I get the cookie,
[00:43:04.460]like the dog gets the cookie.
[00:43:06.160]I'm gonna find something,
[00:43:07.300]but it's gotta be a different reward
[00:43:08.443]for that behavior, for going to the gym
[00:43:10.650]than the other things I reward myself with.
[00:43:14.500]And so here's the thing, I like this.
[00:43:16.590]So we all have those punch cards
[00:43:20.040]you get the 10 punches from Dunkin'
[00:43:23.440]and you get a free cup of coffee or something.
[00:43:26.350]You can make up your own punch card.
[00:43:28.450]And like in this case, saying no.
[00:43:30.150]We all overcommit to stuff
[00:43:31.490]'cause we're all friendly people, right?
[00:43:33.220]I've got everybody in this call,
[00:43:34.170]you say yes to things, and later you regret it.
[00:43:37.779]And so make yourself a punch card and say,
[00:43:40.377]"Okay, every time I say, no, I put a check by the box
[00:43:43.610]and then I get an ice cream cone at the end."
[00:43:45.540]I thought, well, that's kinda clever.
[00:43:48.460]Changing the environment.
[00:43:49.660]So again, if you tend to overeat
[00:43:51.840]because you have too much distracting or tempting things
[00:43:56.183]at the house, try to have more healthy food around.
[00:44:01.360]If you're trying to get back into reading,
[00:44:02.646]find a comfortable nook,
[00:44:04.661]so your brain associates that comfortable chair
[00:44:08.170]with your new behavior.
[00:44:11.232]We talked a little bit before about overengagement
[00:44:14.250]with the news, same with our phones,
[00:44:15.830]turn on that nice do not disturb feature,
[00:44:17.730]kind of a nice thing.
[00:44:19.689]Little social pressure is sometimes seen as a bad thing,
[00:44:22.850]but maybe not.
[00:44:23.683]What if you challenge a friend
[00:44:25.517]to have a little friendly competition
[00:44:29.330]for however many minutes you work out or who knows what.
[00:44:33.110]Values, that's a big thing.
[00:44:34.775]What are your values as motivators?
[00:44:36.685]Is it your health?
[00:44:38.420]Is it loved ones, your faith, whatever it may be?
[00:44:43.030]Reminding ourselves of that.
[00:44:44.257]Again, I know I'm going real fast here,
[00:44:46.140]but again, I can send these to you.
[00:44:47.723]You can look 'em over later.
[00:44:50.300]This is again something
[00:44:51.433]that my psychologist friends do a lot
[00:44:53.880]when they're helping families with kids get the chores done.
[00:44:58.500]So have it listed and really have them consistently do
[00:45:02.870]a certain behavior over time.
[00:45:06.550]And then make sure we try to build in some rewards
[00:45:08.809]'cause we all like getting the cookie.
[00:45:12.320]And then this thing, so let me talk about this
[00:45:13.880]for just a moment, so shaping behavior.
[00:45:16.070]So if you've ever been to SeaWorld or places like that,
[00:45:19.267]and you watch the dolphins jumping through the hoop thing,
[00:45:21.580]well, how the heck did they train 'em to do that?
[00:45:23.930]It's not normal dolphin behavior.
[00:45:26.310]So apparently, what they do do
[00:45:27.870]is they get the wet suit on
[00:45:31.470]and they in the water with the dolphin
[00:45:33.090]and they watch where it's swimming
[00:45:34.450]and they literally put the hoop right in front
[00:45:36.140]of where it's gonna go anyway.
[00:45:37.770]so it just automatically goes through the hoop.
[00:45:40.270]And guess what, as soon as it does, they say,
[00:45:42.127]"Hey, good dolphin," and they give it a fish.
[00:45:44.570]And so they do that over and over again,
[00:45:45.870]so it gets used to swimming through the hoop.
[00:45:47.550]And then guess what,
[00:45:48.383]then they raise the hoop up a little bit
[00:45:49.880]so it's a little bit above, part of it's above the water,
[00:45:52.640]and then a little more, a little more, a little more.
[00:45:54.420]So eventually, they get it to where
[00:45:55.610]it's jumping out of the water.
[00:45:57.180]Didn't happen overnight, probably took weeks,
[00:45:59.250]maybe months to get it to do that.
[00:46:00.920]Well, same way with us.
[00:46:02.260]I don't have to get back to my old workout habit right away.
[00:46:07.170]I can go to the gym, like I say,
[00:46:08.390]five minutes a day instead of 30.
[00:46:11.180]Smart goals, you know about this.
[00:46:12.484]You can look that up too,
[00:46:13.876]I always have to remind myself what it stands for,
[00:46:16.620]but it's a good way to come up with goals.
[00:46:18.016]Interest of time, I'm just gonna keep plowing ahead here.
[00:46:22.780]I'm gonna say one more pitch for this book.
[00:46:24.630]I really love this book.
[00:46:25.468]And if any of this stuff resonates with you
[00:46:28.018]and you wanna get into a little deeper, it's a great book.
[00:46:30.387]It's only about 16 bucks on Amazon so it's pretty cheap.
[00:46:34.140]It's a nice blend of practical,
[00:46:37.613]how to get back into an exercise habit,
[00:46:40.627]or sleeping better or whatever,
[00:46:44.410]but also talks a little bit about the neuroscience.
[00:46:47.360]And so Korb, the author, will talk about how,
[00:46:53.370]like during the pandemic, we've all gotten so disrupted.
[00:46:55.648]Our routines have gotten disrupted.
[00:46:57.430]And when too many routines get disrupted,
[00:46:59.323]you sometimes say, "Why bother?"
[00:47:01.470]I'm not exercising, I'm not socializing, I'm not doing this.
[00:47:06.047]You get into a downward spiral.
[00:47:08.140]So Korb says, "Okay, let's turn that into an upward spiral.
[00:47:11.000]Let's pick one thing."
[00:47:12.890]You can't fix everything.
[00:47:13.890]It's overwhelming to try to fix everything.
[00:47:16.000]You don't have to, pick one thing.
[00:47:18.260]Maybe it's just, I've had to tell my medical students
[00:47:20.480]during the pandemic when we sent 'em home,
[00:47:22.260]when we did everything remotely.
[00:47:24.440]Even though you're not coming into the clinic anymore,
[00:47:26.870]take a shower every day, pretend you're coming in,
[00:47:29.170]get dressed, pretend that you're,
[00:47:31.160]get back into your old routine.
[00:47:32.540]And if you do that for a while,
[00:47:33.950]then maybe you'll start doing this next thing
[00:47:35.800]in a couple weeks.
[00:47:36.633]And then you'll start doing this thing, whatever.
[00:47:37.760]You just pick one one at a time,
[00:47:39.740]and eventually leads to an upward spiral.
[00:47:42.650]I kinda like that idea.
[00:47:45.340]A couple resources, forget this.
[00:47:47.193]This is the UNMC app.
[00:47:48.840]And I don't know if non-UNMC people can get the app,
[00:47:51.860]but if you can, it might be useful.
[00:47:53.650]There's a mental health screening test on it.
[00:47:55.440]But mostly, what I wanted to point out is,
[00:47:57.790]if you wanna learn more, a list of these resources,
[00:48:00.220]the books, like the gratitude book and stuff like that,
[00:48:03.397]if you look at our website, the wellness website at UNMC
[00:48:06.621]and poke around, you'll see a list of those.
[00:48:08.970]So just simply Google wellness UNMC
[00:48:12.180]and it'll take you to that webpage.
[00:48:14.620]And you can find that list of apps and books
[00:48:16.909]and stuff that I've talked about today, including this one.
[00:48:22.120]So one more free resource.
[00:48:23.608]If you wanna really, again, dive into mindfulness,
[00:48:26.352]UCLA has a really good free app with hundreds
[00:48:29.930]of health related podcasts that are free.
[00:48:33.260]Lots of meditations, just another really good resource.
[00:48:38.980]I already talked about those. And this is my team.
[00:48:42.700]So I wanna give a lot of shout out to my friends,
[00:48:44.824]Kati and Ali, who again,
[00:48:46.810]teach me something new every day
[00:48:49.090]about wellness from their point of view.
[00:48:51.830]So just really privileged to work with them.
[00:48:55.330]I'm gonna finish with this slide.
[00:48:56.430]We have a few minutes here to chat some more.
[00:48:59.290]This is the new logo that Kati and Ali and I
[00:49:01.315]and a PR firm came up with about a year or two ago.
[00:49:04.980]And they're really good, this PR firm was really good.
[00:49:08.200]We said we wanted a logo that would remind people
[00:49:10.460]to take care of three population, well, two populations,
[00:49:14.290]themselves and people around them.
[00:49:16.810]And I wanted it to be visually appealing and remind them.
[00:49:21.871]So if you look at this, what does it look like?
[00:49:23.820]Most people say, "Looks like somebody
[00:49:25.210]in the lotus position doing yoga."
[00:49:26.850]That was kind of deliberate, right?
[00:49:28.660]So it looks like legs on the bottom,
[00:49:30.130]which is the foundation, looks like a heart and a head,
[00:49:33.750]and that's deliberate.
[00:49:35.150]It also, and that part's, that's good.
[00:49:37.980]This might be one of those visual thinking strategies
[00:49:40.070]I should have said.
[00:49:41.130]What do you see here?
[00:49:42.300]I didn't do that, I should have done that.
[00:49:43.970]But the other thing that it, this is the subtle piece.
[00:49:48.126]It looks like a triangle,
[00:49:50.696]and that is because my friends in public health
[00:49:55.620]taught me a while ago that there are three levels
[00:49:58.060]to a public health strategy, it's a pyramid,
[00:50:01.100]and the base of the pyramid is prevention,
[00:50:02.848]and the next one up is screening, the next one up,
[00:50:05.270]the little peak of the pyramid is treatment.
[00:50:07.590]And that's true for COVID-19, right?
[00:50:09.520]We wanna prevent it as much as possible
[00:50:11.460]through masking and social distancing and vaccinations,
[00:50:14.990]then you wanna screen for it,
[00:50:16.160]so like everybody can get free screening tests
[00:50:18.108]from the federal government and all that.
[00:50:20.290]And then the peak,
[00:50:21.270]you always want the peak to be the smallest,
[00:50:23.040]but some people are still gonna need to be treated for it.
[00:50:25.680]So we teach people in the hospital,
[00:50:26.921]if you need hospitalization, how to care,
[00:50:29.480]and we've learned a whole lot
[00:50:30.313]about treating people with COVID-19 obviously.
[00:50:33.530]But this applies to mental health too, right?
[00:50:35.765]So we do a lot of prevention stuff like this,
[00:50:39.150]a lot of screening keep an eye on others.
[00:50:41.620]So this is the punchline.
[00:50:44.210]So we remind people, take care of yourself,
[00:50:45.840]that's the base of the pyramid, that's the prevention part.
[00:50:49.770]The heart, have a heart for others,
[00:50:52.150]take care of others around you, keep an eye on.
[00:50:54.270]If you see a colleague that looks like
[00:50:55.750]they're distressed and not feeling so good,
[00:50:57.687]take 'em aside, buy 'em a cup of coffee, talk to 'em.
[00:51:00.940]And then the head, be willing to take care
[00:51:03.358]or receive care from a mental health professional
[00:51:06.099]when you need to, because that's a big,
[00:51:08.670]stigma's alive and well, right?
[00:51:10.470]We all know that.
[00:51:11.303]It certainly is in healthcare,
[00:51:12.880]but I think it is in society at large.
[00:51:16.020]Okay, that's enough of that.
[00:51:17.420]So, sorry, I've talked more than I wanted to.
[00:51:20.350]I wanna leave more time for Q&A,
[00:51:23.470]but at least I'm glad you sent comments
[00:51:25.340]and questions in the chat, so thank you for doing that.
[00:51:30.376]But we have a few minutes.

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The Art and Science of Stress Management

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