In This Issue:
BHWP Spotlight
A Study in Wellness
Wellness in Practice:
Awake!
In the Flow
Made to Move
BHWP Spotlight
While incredibly important, emotional wellness is not the easiest topic to put into words. Emotions are an ineffable part of being human, notably appearing without conscious effort and sometimes even beyond our control. Where language is limited, emotions offer another path to self-expression and knowledge. Linked to intuition, emotions can drive our awareness and creation. They also give us guidance about our deepest desires and direct us toward our aspirations.
And the reverse is also true. Focus on repetitious negative thoughts and behaviors can generate damaging emotional states, affecting both our stress levels and resiliency. Given this, it would be beneficial to ask ourselves, “How do I want to direct my focus and energies?” How much time do you want to spend on social media? What type of information do you want to consume? What movies and television shows are you going to watch? What genres of music do you want to listen to? What people do you want to spend your time with? Only after we know our responses to these types of questions can we make a mindful choice. Similarly, we have the choice to think thoughts that nourish personal wellness. Consider whether what you are thinking is harmful or helpful. Then take a moment to redirect. I hope the perspectives offered in our newsletter provide you an opportunity to hit the pause button and consider your own emotional wellness.
Registration is open for two upcoming BHWP Trainings!
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Rocky Mountain Tobacco Treatment Specialist Training Program: May 14 – 17, 2018
Motivational Interviewing for Behavior Change – Level II: July 31 – August 1, 2018
A Study in Wellness
Developing Resiliency
Ten faces looked at me, each with a unique expression: enthusiasm, reluctance, contemplation, fatigue, reservation. I was surrounded by a group of 4th year medical students about to learn where they will be matched for their 3 to 7 years of residency training. Some of these students will further specialize and add 2 more years to their education.
As our conversation evolved, it became clear that some of the medical students were anxious about the grueling environment of residency training, including competitive atmosphere, exhausting work schedule—sometimes working 30 hours in a row—and being subjected to harsh, and not always constructive, feedback from attending physicians. While all these conditions can lead to burnout for young physicians,1 in some tragic cases, the unrelenting pressure and stress leads to suicide.2
How are individuals expected to endure almost a decade of such traumatic conditions? One medical student mentioned the term resiliency. The American Psychological Association (APA) defines resiliency as the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress.3
Resiliency is a complex concept. Resiliency may mean something different depending on the individual, the family, the society or culture. Resiliency is dynamic and varies for different phases of life or stages of existence. Resiliency also differs depending on context. Consider the different qualities of resiliency needed under various acute or chronic conditions: enduring a decade of grueling medical school training; experiencing and continuing on after a violent school shooting; escaping a war-ravaged country and living as a refugee; surviving a hurricane or wildfire and making sense of life in the aftermath.4
The interplay of factors that lead to war, gun violence, natural disasters, or even the culture of medical school training is complex, but researchers are finding that resiliency can be learned and developed.4 One of the major factors that contributes to increased resilie
ncy are caring and supportive relationships with others including family, friends, or other survivors.3
Social support can, furthermore, be a protective factor against developing post-traumatic stress disorder (PTSD) as evidenced by a recent study examining resiliency and trauma. The study found that seeking social support was associated with increased resilience and reduced risk of developing symptoms of PTSD. Social withdrawal, on the other hand, was associated with lower levels of resiliency and greater risk for developing symptoms of PTSD. These findings correlate with those of other studies that have found a positive association between social support and resiliency.5
In addition to seeking social support, the APA suggests a number of other active strategies for fostering resistance including taking decisive action, rather than wishing problems or stressors would disappear; looking for opportunities for self-discovery in the face of trauma such as experiencing an increased sense of strength or self-esteem or developing ones spirituality; taking steps toward small, achievable goals; and practicing self-care in order to remain strong.3
I gazed at the faces of the medical students. By expressing their concerns and sharing their experiences thus far, they were engaging in one of the most effective ways of developing resiliency—making connections. One student looked at his friend sitting next to him and told her he never would have made it through neurology without her. She gazed back with a knowing smile and said, “You’re welcome.”
References:
- Shanafelt, T. D., Bradley, K. A., Wipf, J. W., & Back, A. L. (2002). Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine, 136, 358-367.
- Morris, N. (2016, Oct 9). Medical school can be brutal, and it’s making many of us suicidal. The Washington Post.
- The American Psychological Association. The road to resilience. APA Help Center.
- Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5, doi: 10.3402/ejpt.v5.25338
- Thompson, N. J., Fiorillo, D., Rothbaum, B. O., Ressler, K. J., and Michopoulos, V. (2018). Coping strategies as mediators in relation to resilience and posttraumatic stress disorder. Journal of Affective Disorders, 225, 153-159.
Wellness in Practice
Awake!
I am passionate about continually striving for more and achieving my goal. When puzzled by a problem, I work towards a solution-relentlessly. I’m fueled by my excitement about what may be just around the corner, so I keep going. Even the pressure of a deadline can be energizing.
Whether due to nature or nurture, this is who I am. Certainly, our society supports this push to go further and to succeed. And it’s fun to achieve, to make progress, and to create. But with these benefits, there are also costs. It usually starts in my jaw. Then my neck and shoulders. At first, the tension is barely noticeable. I stretch my muscles and try to shake it off. While I was feeling driven and full of passion, I wasn’t listening to my experience of increasing stress.
Many of us have learned to ignore the wisdom of our emotions and the guidance it provides. Sometimes it takes physical symptoms like muscle tension to notice there is more going on. How does it happen? In part, we are condition
ed over time to listen to others instead of ourselves. We are told that our emotions or perceptions are inaccurate. We are taught rules to follow so everything might be orderly and safe. Over time, we internalize these messages and make them our own, often overriding conflicting truths our emotions offer.
Of course, living in a society requires living by consensus. But problems arise when we listen solely to what others tell us rather than being attuned to our internal guidance. Or when external expectations are more important than our own. The messages I received about hard work have served me well and are congruent with my authentic self. And I also need (and want) to listen when feelings of stress tell me I need a break. Every day, we have an opportunity to follow the guidance of a really wise person-ourselves! Take time to listen to what you and your emotions have to say.
In the Flow
In the Spring of 1998, I was completing a counseling psychology internship at a local non-profit organization. My counseling duties included work with individual adults, couples, and school-aged children with whom I met weekly at a Denver elementary school. As fate would have it, I was in an elementary school on April 20, 1998 when the Columbine mass shooting occurred. This elementary school was a feeder school to Columbine and was located about ¾ of a mile away from the site of the shootings. We were on lock down for six hours that day and quite a few of the children in my care were siblings of Columbine students.
Although we didn’t know it at the time, two of those children lost family members in the Columbine shooting that day. Many more had siblings who, though not physically harmed, experienced profound and long-lasting psychological t
rauma. Prior to entering and throughout my Master’s program, I worked almost exclusively with cancer patients and survivors. I often traversed the foggy landscape of uncertainty with my clients and explored existential concerns. That being said, nothing in my background prepared me for Columbine, where, in the company of those little children-those pure hearts, so freshly cracked open and raw-I was expected to be a guide. I was personally devastated and furious at the senseless death of innocent kids. How was I going to help when I couldn’t deal with my own anger and other emotions?
It was in this context that I first learned of fierce compassion, or the way in which anger can be channeled into compassionate action. It was through fierce compassion that I found the courage to witness the suffering in the Columbine community and to give voice to the ineffable for those too numb to speak. I’ve experienced fierce compassion and seen its power many times over the years, as it relates to gun violence and a variety of other social justice issues. No doubt, it is on my mind now because of the recent mass shooting at Stoneman Douglas High School in Florida and the subsequent swell of action from the students who are demanding change. I deeply believe that fierce compassion is essential in all meaningful social change movements. It is also crucial to our work in public health, as we are faced daily with health inequities and issues of social justice. If we redirect our anger away from those we are angry at (aggression) and toward those we are angry for (compassion), the power of anger can be truly transformative.
Made to Move
We live in tumultuous times. Between our polarizing political landscape, harsh economic realities, and seemingly nonstop, shocking headlines both nationally and internationally, little feels stable these days. But wait a minute… when one stops to objectively compare our modern era to those of the past, is it actually any less stable? I would argue that it is not; in fact, I believe that in some respects we are living in a time of relative stability.
Perhaps I am in the minority in this cursory evaluation, but regardless of whether you agree with this premise or not, why do things feel so volatile and unstable to so many people?
I’m not naïve enough to believe there is a simple answer, but if I were to choose a simplistic, cover-all explanation for this feeling, it would be the rapid technological changes that have enveloped the world over the past generation. Things are moving, and moving fast. The world is more interconnected than ever before, and the speed and regularity with which we now receive news and communications has accelerated exponentially in recent years. There simply has not been enough time to smoothly adapt. And while there are undoubtedly benefits to many of these technological advances and their corresponding societal developments, they nevertheless represent a formidable challenge to our emotional wellness. Essentially the short-term, rapid-fire nature of modern life has made things feel less stable and more chaotic, even if that might not be the case objectively.
This acceleration is unlikely to change, so, like it or not, we’re charged with navigating the emotional impact that it will continue to produce. We must adapt to be able to absorb the information we consume in a productive manner, and yet, as importantly, be abl
e to protect ourselves from overexposure. I do not suggest burying one’s head in the sand, but rather, applying a mindful approach to the way in which you consume and react to information. Take the time to think about how your exposure to the news, social media platforms, and/or the demands of frequent communication may be impacting your emotional wellness. Are any of these things producing negative emotional effects or becoming overwhelming? If so, consider taking a break and rethinking the manner in which you consume information and communicate. Allow yourself to find the approach the works best for you; do not let societal pressures dictate your approach. Avoid those elements that are overly or unnecessarily upsetting, stressful, or counterproductive.
None of us can stop the technological acceleration that society is undergoing. Nor can many of us afford to ignore it or blindly disengage from the world. Therefore, we are left to take care of ourselves by mindfully evaluating the way in which our exposure to these forces shapes our emotional well-being, and acting accordingly, in our own best interest. If you take the time to do so, you’re more like to preserve your emotional wellness, and perhaps that nagging feeling of instability will appear less daunting.