Coping With Stress: Cognitive-Behavioral Stress Reduction

this UCSD TV program is presented by University of California television like what you learn visit our website or follow us on Facebook and Twitter to keep up with the latest programs also make sure to check out and subscribe to our YouTube original Channel uctv Prime available only on [Music] YouTube [Music] [Music] it's my great pleasure to introduce Dr Jason saterfield who's we've worked together now for at least 10 years probably 15 15 oh thank you for my mental status alertness um Dr saterfield is an associate professor and of medicine and director of the Behavioral Medicine program in my division of General Internal Medicine and I just found out from the bibliography that he's also an author a book that's about to be published next February so I've already gotten a commitment to get a signed a copy um he's really really really A Gifted teacher and more importantly an expert in the area that he's going to be discussing tonight and I already shared with him that after all of your questions two weeks ago after Dr kemy's uh presentation on the effect of stress on the immune system that you were all very anxious to hear about concrete tools and how that manifests itself s in what's called cognitive behavioral therapy so it's my pleasure to introduce Dr saterfield well good evening everyone it's my pleasure to be here tonight and I I think you might see that uh the talk tonight is a slight change of pace uh I believe you guys have learned a lot about the basic science the basic research behind stress and behind coping you've also learned from Dr kimy two weeks ago about the physiology of stress of course important for disease and it's one of the reasons probably the main reason we want to learn about Stress Management uh tonight I decided that I would take a very practical and very clinical approach so we're going to be talking about a lot of uh very practical Hands-On uh hopefully useful interventions that you can try for yourself or for your loved ones in order order in terms of reducing the uh magnitude of your stress response where we're going to focus there there's uh really a long long menu uh of different types of Stress Management ideas that we could talk about but we're going to focus really on how to use our mind to change the way our bodies feel uh the broad category of mindbody medicine but more specifically we're going to look at cognitive behavioral interventions and how they influence our experience of stress sometimes in negative ways but hopefully we'll learn uh to use them in positive ways in order to do that there are sort of several uh uh Road marks we need to uh uh pass through uh along the way today we want to talk first about some of the stress Basics and I want to calibrate our language to make sure that the words and terms I'm using or sort of matching what you guys have learned already I want to share some basic cognitive behavioral foundation so really give you a little bit of the history and sort of the theoretical underpinnings of why we think changing the way you think might change the way your body feels um let me say from the outset that this is not the Don't Worry Be Happy seminar uh this is not uh about word play it's not about mind games or sophistry it's about understanding the intercon connectedness between how we think uh and how we feel in the the behavioral choices that we make we're going to go through some specific examples of how to work with appraisals the way we think about stressors and the way we think about coping we'll talk about a specific example of explanatory style we'll then move to some present moment coping strategies to change the way that we feel both emotionally and also physically but from there we'll go to much uh uh deeper ways of coping something I've called depth coping it's not necessarily about the present moment but it helps us to lay a more solid foundation in facing the stressors that might be ahead of us in the future and there we'll talk about Connections we'll talk about social support and we'll end by talking about meaning so this is just a quick review from you guys uh Susan folman the very first lecture of this series talked about some of her research uh uh with uh uh di Lazarus she talked about the stress process and these are some of the major players or or uh stages in this process first on the left we have the occurrence of a potential stressor this could be real or it could be imagined this could be an exam you have to take this could be a deadline at work this could be a a conflict a recurrent conflict that you have with a spouse we think about that stressor in a couple of different ways we have our primary appraisals thoughts that you have about the stressor does it matter is it a big deal what are the implications should I really be worried about this or not secondary appraisals this is how you think about your coping uh resources am I able to face this do I know what to do do I have social supports do I have money time energy to do whatever needs to be done to face this potential stressor so potential stressor happens you think about the stressor you do an appraisal of the stressor you do an appraisal of your coping resources and depending on your type of appraisal it helps us to understand the type and the magnitude of your stress response the appraisals help us to understand why two people can experience the exact same event one will feel incredibly stressed the other might not feel that stressed at all it's because they've probably thought differently about the importance of the stressor the primary appraisal or maybe they thought differently about their capacity to cope with that stressor if we're looking at opportunities for Stress Management you should already see that there's a couple of different places we could Target those interventions we could uh change the likelihood you'll be exposed to a stressor or we could change the way you think about the stressor or change the way you think about your coping resources that's not all we also want to think about the nature of the stressor itself or really the frame that we put on the stressor and in general we divide stressors into two categories stress isn't bad stress is important we need stress it helps to activate us it gives us energy it sometimes gives us a focus uh that we need in order to fix or to change a particular problem but there's this split that occurs fairly early on and whether or not we see a stressor as something that's a challenge or something that's a threat if we see something that's a challenge yes it may be difficult it may require a lot of time and energy but I feel a little jazzed up about it it's a project at work that I really like and it's going to take a lot of time but I believe I'm up to it I believe I'm going to learn some something from it I believe I can get help it's a challenge but I don't see it as a threat for a threat in general people see uh it as something that uh the outcome is somewhat unknown a positive outcome might be unlikely Your Capacity to cope with it or even if you know what it will take to cope uh is much lower you see it as a threat you have low control uh and much more anxiety as a consequence of of your approximation or your evaluation of that uh stressor the other thing we want to look at is not just is it a challenge or is it a threat is it chronic or is it acute so is it a one-time only stressor is it something that's going to recur or be present over a period of time worst case scenario in times of in terms of the magnitude of our stress response is something that's chronic so it's going to be there for quite some time and it's something that's seen uh as a threat now we care about these we care about stress and we care about our ways of coping because it is related to our well-being it's related to our mental well-being but also to our physical well-being a as well uh we are mostly going to be talking about uh Stress Management as a way to buffer the physiologic effects of stress but it's important to remember that there are a number of different Pathways that stress can contribute to illness these are the three p primary Pathways um it's important to remember that when most of us get stressed we do the exact opposite of what we need to do to stay healthy so when most people are stressed they sleep less they drink more alcohol they may smoke more cigarettes they pull away from their social supports they eat less food they don't have time to go out and cook uh or to prepare healthy meals so what they're doing as they get more stressed is actually engaging in more Health damaging behaviors so that's one pathway just on a behavioral level another pathway is that we see changes in medical compliance or medical adherence we often see folks who have had uh an exacerbation or a relapse of their disease their diabetes suddenly gets worse because they've gotten stressed and they sto taking their medication they stopped exercising they stopped doing the things that they need to do to manage their disease and stay healthy and the last pathway is the physiologic pathway and this is what uh Dr kimy was talking about and uh talking about how the uh uh stress affects the immune uh system all three are important so we want to help to decrease the magnitude of the stress response this box here we might also want to help people in choosing more appropriate more helpful more constructive ways to cope with the stressor uh this was also in Dr folman's talk the very first talk of the series she talked about as we experience a stressor we think about the stressor our coping resources we have our stress response remember that can be physical emotional behavioral cognitive we decide what it is that we're going to do and our responses to that stressor generally fit into two categories problem focused meaning you roll up your sleeves and you do whatever it takes to change or directly address the stressor so if the stressor is you have say a a relicensing exam that's coming up at some point a problem focused coping uh mechanism would be to study for that exam it directly affects the outcome of that stressor the other category is emotion focused coping and uh it's it's equally important but really has a different Focus here it's not necessarily about doing something constructive to change the stressor it's doing something to change the way that you feel if you're in a situation where the stressor is unchangeable or you've already studied for that that exam as much as you possibly can but you're still feeling anxious distraction might be helpful calling a friend might be helpful doing something that you find pleasurable that pulls your mind that pulls your emotions to a more productive into more positive State might be helpful the best copers are individuals who know when to use what type of coping most stressors require a mixture of both types of coping so you need to know when do I use problem focus when do I use emotion focus and we'll talk about about that a little bit later as I mentioned Stress Management might include interventions at any point on this pathway it may include behavioral interventions to prevent you from being exposed to a stressor let's say that many of your stressors come from your workplace they come from your boss they come from your co-workers they come from the job task itself a perhaps very effective strategy in terms of managing your stress would be to quit your job and to move to a different job your Exchange one group of stressors for a different group of stressors but again you've done something very concrete and behavioral that pulls you away from those things which are causing you stress that would be here on the level of stressors another intervention would be to look at the primary and secondary appraisals you have made and whether or not those appraisals are helpful whether or not those appraisals are accurate we'll talk about that more another intervention might be to directly affect the stress response that you're having uh and here is really the the category of medications so things such as benzo diazines uh pills for anxiety uh that help individuals to turn down the magnitude of uh the stress response that they're having other interventions May teach you better ways of coping either in terms of problem solving rolling up your sleeves and learning how to address a problem more effectively or in terms of building or eliciting uh your social supports or or mood management strategies more effectively all right so let's talk a little bit about some of the basics behind C I nitive uh therapy uh we're really not talking about cognitive therapy per se tonight but we're talking about cognitive behavioral interventions that have been pulled from sort of a a full package of therapy now this full package of therapy was first developed for the treatment of depression uh and the person who who developed them or at least has given primary credit is uh Aaron Beck he's uh in the upper left hand or right hand corner uh of the slide it was uh late 1960s he had been trained in probably one of the premier psychoanalytic training institutes his primary interest was in the treatment of uh depression incredibly common uh and at that time also very uh difficult and challenging to treat treatment sometimes requiring three to four psychoanalytic sessions uh per week up to two to three years uh and not a whole a whole lot of evidence to suggest that the if a person did get better it was the therapy that was helping them well despite his frustration with the length of treatment that was required uh he also began to notice that there were a lot of similar patterns in the depressed patients that he was seeing they all tended to have a very negative self-image they had very negative uh uh mostly hypercritical thoughts about themselves they had a very pessimistic view of the world and of their future and they also had very negative thoughts about other people and other relationships and what other people might do to them or or not do for them in terms of supporting them or loving them he found that in all of his depressed patients they had this cognitive Triad this constellation of a way of thinking that te seemed to deepen and worsen their depressive symptoms the light bulb went on for Beck and he started to think about what if I was to directly address the way a person's thinking if I started at the top how they're thinking in the present moment got them to reflect on the way they're thinking change the way they're thinking would that change the way they're feeling would that eventually change their relationships would that eventually Chang them in a biological sense and that they no longer would meet criteria for this biological disease that we call uh depression as you can guess as The Story Goes he found that this was actually quite effective and now about uh 40 years or so later uh there probably been over 10,000 or so studies looking at CBT not just for depression it's really expanded to anxiety to stress to eating disorders to a lot of different disorders and have found that there's really a collection of both cognitive and behavioral strategies that can be uh effective either for Psychopathology or just generally for mental health some of the general ideas that are important to understand before thinking about cognitive interventions uh is first we're not particularly rational that's not a bad thing uh but we are not computers we are not perfect information processors our memory is very fluid the way we think about our relationships the way we see the world the kinds of things we remember the kinds of things we pay attention to are very much subjective they're mer very much influenced by our personalities they're very much influenced by our environment they're even influenced by our current mood States at the time so it's first of all important that that you realize it's not a matter of intelligence it's not how quick you are that's just the way that people think that what's that's what makes us so fantastic and so interesting but when things don't go so well that can cause a great deal of unnecessary suffering that suffering or what Beck calls uh dysfunctional thinking is common to all psychological disturbances there's sort of a different flavor or a different variety to the types of distortions that tend to occur based on the type of disorder we're thinking about so for an individual who has an eating disorder say anorexia a lot of the distortions are thoughts about the way they look or about their body image about the importance of control over what they're eating for depression it's thoughts about the self it's thoughts about others and it's the pessimism about the the future and about the world the last idea is to remember the interdependence of thoughts feelings and behaviors as represented in this classic triangle that most CBT therapists uh draw for their this is the idea that the way we feel is intimately related to how we're thinking which is also intimately related to our behaviors so an example of that would be say an individual uh is feeling uh depressed so that's the mood that they happen to be in they're feeling depressed so they're thinking things very negatively they have uh they're remembering everything bad that's happened they're making negative predictions about the future they're evaluating themselves very negatively which makes them more depressed which makes them think more negatively which makes them more depressed and so on and so on it's not just about thoughts and mood though it's also about behaviors here in this bottom right hand corner a person's feeling depressed they're thinking very negative thoughts what they tend to do is to shut down and withdraw if things are bad they aren't going to go well they aren't going to be enjoyable you're not going to be very good at it anyway why would you get out of bed why would you bother to try a person's depressed causes them to think negatively which causes them to withdraw and shut down which makes them more depressed which makes them think more negatively and so on and so on the good news about this interdependence is it provides us a couple of different opportunities of where we can intervene to change how a person's feeling now again you can directly intervene with medication say anti-depressants anti-anxiety agents and change the way a person is feeling you can also however look at the level of thoughts how's a person thinking are there ways that we can reassess or change or reshape the ways they're thinking to to change how they're feeling we can also intervene on the level of behavior could we build new social supports could we change their job could we get them to engage in a different mix of activities that would have a more uh positive or constructive impact on their mood and I'll give you some examples of that but important to remember we have lots of opportunities but our two main pathways are entering through the Avenue of thoughts entering through the Avenue of behaviors so we're going to run through several different examples and um I thought would be a lot more interesting rather than me just sort of talking about these actually having you do some of these exercises and we could debrief them uh a little bit you don't have to do them if you don't want to but I would just recommend you do have some place uh some space for notes so we'll do a couple of different exercises as we work through this list I'll ask for a few volunteers just so you get a feel of what it's like uh to do some of these uh strategies we're going to look at a few cognitive interventions we're going to do something called an ABCD we're going to jump then to explanatory Style I I'll describe activity scheduling it's probably a little too complex to do it in in a group that's uh this large but then move to talk about sematic quieting and then I hope we have time to do a social support exercise uh towards the end so to understand the ABCD uh we have to understand sort of the cognitive model that explains why we we feel and we do the things that we do since it's a cognitive model you can imagine they're going to talk about the predominance or the importance of cognition or of thought of of the ways we think about situations the non-cognitive model or the typical model uh is that uh there's an activating event something happens around you and it makes you feel do say a particular thing however the cognitive therapist would say no that's actually not quite true there's a middle step that's quite important that most of us don't think about because it happens so quickly it's automatic it's an automatic thought that pops to mind it's your subjective interpretation of what just happened so the ABC here is the activating event something happened you had some beliefs thoughts about it and those thoughts help us to understand why you felt or did what you did as a result of that situation so here's an example and this is just from my uh Clinic a couple of weeks ago I do see patients here at UCSF uh in the Behavioral Medicine unit um and I try to stay on time I've been on the other side uh of the desk before and have waited very very long time for for my doctors and so I try to stay on time uh and I try to end on time just so people can plan their days and leave their jobs and all that around around their appointment times so first patient comes in on time and uh said to me you know I really appreciate the fact that you always start on time you always remember what we did before we always sort of pick up where we left off it really feels efficient and respectful and I'm really glad that that happens and I just wanted to tell you that so that felt good and that's kind of what I hoped would be the result we have the next patient that come and it was actually just the next day after that we started on time the patient came in came and it seemed a little bit unhappy and I said well what's going on he's like you know you're on time to the dot I don't like this place it's just like a factory same activating event we're starting our appointment on time very different reaction and the reason there was a different reaction there was a very different interpretation of why we're on time first patient thinks it's a sign of respect second patient thinks it's a sign of being dehum dehumanized it's just a factory that they're in not that one is necessarily better or worse but they have different consequences and when I encourage people to look at the beliefs part the B part of the ABC it's not to find the truth it's not toine what's right or wrong it's to think about what thoughts are helpful what thoughts are hurtful if those thoughts are pushing you towards reactions that are helpful no need to analyze them if those thoughts are P pushing you to reactions that aren't so helpful then maybe it's time to take a step back and to think about your thinking I guess the other point I I want to make our our uh is for us just to remember that thoughts aren't facts uh thoughts are opinions they're are best guess or subjective reading of a particular situation uh and if we're able to put our ego aside we'll see that I think for all of us our opinions have at times been wrong our opinions are changeable in fact hopefully they change uh often times as we're presented with new information so all beliefs are changeable they're not facts just because you feel it strongly doesn't necessarily uh make it true we've also found uh in the work of cognitive therapy that people not only have these subjective interpretations or these ideas these opinions people tend to develop habits and the kinds of ideas that come up we all take thinking shortcuts that's the way the human brain works but we tend to find habits probably based on disposition I maybe based on early family history of the types of shortcuts we tend to make these are some examples of some habits of mind uh some of them may look familiar for you or they they may uh look familiar for some of your family members or for friends some people have a habit of overp personalizing so sometimes when bad things happen they assume that it was done to them they take it very personally and get angry or hurt as a consequence there may be a tendency to magnify negative things that happen or to minimize posit postive things that happen you may know individuals who have a very hard time acknowledging their successes who have a very hard time accepting a compliment they tend to minimize the positive that happens and they tend not to remember it uh selective attention uh there's just too much going on in our worlds to pay attention to everything at the same time we tend to focus sometimes on the glass that's half full and other people focus on the glass that's half empty again not necessarily right or wrong or good or bad but we just want to look at the consequences of that particular habit I won't go through all of these but I think other common ones all are non-thinking so I'm all a success or I'm all a failure it's all black or it's all white mind reading probably innate at least that's what social Neuroscience is telling us mind reading is when we're in a social situation and we're picking up those subtle nonverbal Clues from people and we're imagining what they might be thinking some of us are really good at that some of us not so good at it all of us make errors when we're trying to imagine what another person might be thinking some people because they've been hurt a lot in the past because they have a sensitivity to rejection they may always assume that the other person's thinking negative things about them and of course that has its its own set of negative consequences so here's our ABCD exercise and I just want to walk through an example first and then I'm going to ask you if you're willing to do your own ABCD exercise ABCD stands for the activating event that's the a the B are the beliefs C are the consequences and those can be emotional know those can also be behavioral and the the D box in the bottom right hand corner is a dispute box this is where you roll up your sleeves and you start wrestling with your thoughts so you take a step back you ask yourself are these thoughts Fair are they balanced am I making shortcuts is there another side to the story if my friend were to think or to say this what would I say to him or her is there a more constructive way to think about this situation okay so here the example the activating event is I'm sitting at work and I get an email from the boss moving up and important deadline just the facts just the situation beliefs this is terrible I'll never be able to finish this is a setup for failure I'm doomed uh what a selfish creep consequences I feel anxious worried and angry I complain to co-workers that's the behavior the dispute this is going to be tough but I can go over the calendar with the boss and see what we can figure out maybe his hands are tied to I can share my worries with him it shows he trust me with an important an and challenging project so same situation a very different spin in how you think about that situation hopefully with different emotional and maybe with different behavioral consequences as well so what I will ask you to do is to do your own ABCD and the good thing about this is you don't need a special form you just need a blank a square of paper you put an X right down the middle divide it into four boxes activating event beliefs consequences and dispute so I'll ask you to do one of those and I would recommend if this is your very first one ever that you pick an activating event that's relatively small so an example of an activating event that's small would be uh you pulled into the parking garage and you saw how much it cost to park on Parnassus so you might have certain beliefs about that there might be certain emotional or behavioral consequences then we can work on the disputes you of course can do this with a much bigger event uh but in a group setting and we'll be talking about it as a group uh it's a lot harder to talk about divorce bereavement sort of those big emotionally charged uh events those are very hard to work up some disputes so why don't you go ahead and just take a minute write down an activating event write down some beliefs write down any emotional or behavioral consequences and I'm going to ask for a volunteer or two so I I will warn you that nearly everyone gets stuck on the dispute box the first few times they do this it's difficult even for sort of a small uh low investment activating event it can still be difficult when you do it as a group it's a lot easier to do someone else's dispute box because you're not emotionally attached to it so how about a volunteer and I know you guys aren't quite done yet we can work through this together we'll just take one volunteer I'll ask you to share the activating event we'll we'll pull out some of the beliefs talk about consequences and as a group I want to see if we can can fill out the dispute box together so who would like to share an activating event yes what is your activating event uh stock market maret gations so stock market gyration sort of up up and down in the stock market okay very good and in activating event we don't want to have any sort of interpretation to it it's just just the facts what happened stock market goes up and down what were some thoughts that you had the belief the belief box uh uncertainty and how to respond so I I don't know how to respond I'm uncertain about how to respond yes what else well there are feels associated with that anxiety okay so in the consequences box some of the feelings he had he felt anxious what else that's as far as okay so let's pull out a couple more beliefs usually there's a number of thoughts if you start digging a little bit we have gyration in the stock market I'm uncertain about what to do what does it mean that you're uncertain what are the consequences of being uncertain why do we care if you're uncertain well there are there are fiscal they I might lose money this might be painful if I lose a lot of money I might get in trouble by my significant other if I lose lots of money okay you're feeling anxious and do you do anything do you sell do you buy do you turn off the computer what do you do primarily you try to better understand what's going on first of all okay by by getting more information okay so he feels anxious and so he tries to get more information all right so the way you decide whether or not you need to do a dispute box is whether or not the consequences are something that was unes desirable so he's feeling anxious he starts digging for more information should we challenge the thoughts that he had I might lose money this is going to be terrible this might be bad I don't want this to happen should we challenge those thoughts an expert okay so there's maybe a different behavior that he could consult an expert I would say one thing that we can do it sounds like your behavior get more information was something that was very constructive probably helpful it might be Consulting an expert it might just be doing more research on on Company stock that you you've bought the anxiety is something that you know anxiety is a funny thing a little bit of anxiety can be helpful you get too much anxiety and it's not so helpful it's overwhelming and it's distracting and it it's not productive so we might want to think about disputes or thoughts that he could use to turn down the anxiety so that he's at his maximum level of functioning so what might be some thoughts in the dispute box that could help him feel a little less anxious it's temporary this is the nature of the market what goes up comes down and vice versa I didn't go up any okay it may go up anytime what else I have a tax right off okay what else he's probably no worse off than he was di 2 years ago okay so this is a long-term process I can't focus so much on the immediate and what's happening happen so so you guys get it you sort of get the sense of of how he could think in different ways to manage the consequences and in this case we wanted to turn down the anxiety just a bit probably keep the same coping Behavior because it seems like it was fairly uh constructive okay so that's just a quick look at one cognitive intervention you can do ABCDs for just about anything the greater the emotional charge the more difficulty it is to come up with a dispute uh a lot of times we do this in group therapy settings where people can each other's dispute box till they get the hang of how to do their own if you remember when we were talking about Stress Management we mentioned that you could intervene really at any point along that pathway in the stress process the next opportunity we had after the stressors was to look at an individuals appraisals or how they're thinking about a stressor for primary appraisals it's how you are thinking about the stressor itself is it a big deal is it going to matter how painful is it going to be uh uh is this something that's important to me or to my family should I I worry about it common errors that people make in terms of amplifying unnecessarily amplifying their stress response are overestimating the likelihood that a bad event will occur remember a stressor can be something that you're anticipating it doesn't necessarily have to have happened yet overestimating the Badness or the negative consequences of a stressor so this is is magnification of possible negatives worst case scenarios that might happen overestimating the duration or permanence of a stressor uh and only focusing on worst case scenarios so uh again this may be a habit or it may just be with this particular event but teaching someone to step back and to look at that primary appraisal and to look at how accurate that appraisal has been I know this is a lot of words and I won't go through all of these different questions but it's questions that you can ask yourself in order to reassess the accuracy or the helpfulness of your primary appraisal you know this is not don't worry be happy stuff this is just take a step back and say am I looking at this in a balanced helpful way way am I making a realistic appraisal of the situation and what this is going to take and what it will mean to me the answer may be yes you are taking a very realistic look uh the answer may be no you can step back reassess and maybe uh uh change that appraisal the other thing that we can do is decide whether or not to think about it at all uh if we look at uh this is from the Healthy Mind healthy body handbook by soel and Ornstein um idea is that essentially in this day and age probably in in every day and age but they talk about in modern society we have too little time and too many stressors and there's just no way that you can possibly pay attention to every possible thing that might go wrong takes too much energy takes too much time uh and you just would not be able to cope so they suggest a way of triaging or of separating or sorting out the different stressors that are in your life and then deciding consciously where to direct your attention where you would start to roll up your sleeves and what you can really let go they recommend that you divide your stressors into two categories important or unimportant you can already see that the unimportant stuff probably shouldn't get priority look at things that are changeable or unchangeable if we're talking about rolling up your sleeves and trying to change something you better make sure it's changeable first what will be most important of those four categories are things that are important high priority and things that are changeable so if you only have a limited amount of time energy resources you want to focus on what's most important to you what's going to be most changeable uh examples include arguments with a partner problems with your boss or quitting quitting smoking all are important all are very changeable now it is true that uh we do not have complete control over our lives or our choices or the stressors that we must face a lot of times uh maybe in your job maybe uh with the family that you have or the family you married into uh there may be other stressors that you just have to deal with there may be jobs that you're asked to do that you just have to do uh I'm reminded of uh I think some very wise advice from a first mentor of mine uh who explained that there would be jobs along the way uh in Academia and El elsewhere that you really don't want to do and he said Jason I want you to always remember that a job not worth doing is not worth doing well if you got to do it so be it but don't go for the a plus if it's not that important so we can look at primary appraisals we can try to recalibrate we can take a step back and decide if we even want to think about it at all if it deserves any of our time of or or our energy we can also look at secondary appraisals and remember secondary appraisals are about uh our estimations of our ability to cope the resources that we have to face a particular stressor here are some of the errors that amplify a stress respones over overestimating what it will take to cope with a stressor so imagining something's going to take a lot more uh than it actually will uh to resolve underestimating your personal ability to cope a lot of times people forget that they may have been through a lot they may have developed a fairly substantial skill set and they may underestimate what they're able to do they may underestimate or forget important coping resources such as time money energy or knowledge they may underestimate or underutilize uh friends or family believe that they don't have the support that they actually have or they may be just unable or unwilling to tap into those supports to ask for help that they might need so the question is why do we have this tendency to under or over estimate it could either be primary appraisals or secondary appraisals why aren't we sort of spoton accurate in our appraisals you know and I think the reason has to I I don't know if I I I know the answer I think it has to do with the fact that we're not perfect information processors we're not computers our estimations are influenced by our emotions they're influenced by our values they're influenced by our current mood State at the time uh often times they're influenced by anxiety so if you're feeling very anxious you're feeling very vulnerable maybe other negative things have happened to you recently in your past it's going to affect the kinds of appraisals that you make the other impact on appraisals uh if you look at uh there's been studies done where they ask people to estimate the likelihood that they'll be struck by light the likelihood that they will be hit by a car people tend to be okay and terms of their estimates unless there's been a recent news story or something the media has told them and you see this transient but fairly replicable blip in the overestimation of how much at risk or how in danger uh they are from that particular stress or that particular threat so a lot of influences that can push our estimations around this is really just uh uh recommending that people take a step back and say okay what's going into this estimation is it my mood is it my history is it my values maybe it's something in my environment that's caused me to over or underestimate estimate again I won't read through all of these questions but these are intended to help you improve the accuracy of your secondary appraisals asking yourself realistically what resources are needed what are the high and the low estimate so it's okay to think of the worst case scenario but you should also be sure that you think of the best case scenario you know not not uh rosec colored glasses not polyana but if you're looking at things uh at their worst possible case look at the flip side just look at the full spectrum the full Continuum and then make an estimate of how probable those different outcomes uh might actually be we're going to talk about how to elicit and how to tap into social supports a little bit later but I think that that learning that skill of of knowing who's in your inner circle and what those people in that inner circle can provide can really help us in terms of improving the accuracy of our secondary appraisals hey so let's go ahead and and do another exercise this is also a cognitive exercise but a little more specialized the this one is on explanatory style I'll explain what that is after we do the the exercise so uh explanatory style is is roughly the explanations that we give ourselves about why stuff happens good stuff bad stuff neutral stuff we always seem to need an explanation of why did that happen so what I have here is a hypothetical event and I want you just to write down uh what you believe caused this event to occur you're just filling in the blank no right or wrong answer the hypothetical event is your boss selects you as an employee of the month and gives you a large raise this event happened because blank so just write down what you think caused this event to happen you got employee of the month you got a large raise this happened because blank and I'll ask for a volunteer and I'll expl explain what those ratings are are about so who wants to to share what you wrote down yes so this event happened because what because I found pictures okay because I found dirty pictures of him with someone who wasn't his wife so you got employee of the month and you got a large race there's no right or wrong answer again we're interested in consequences of how that that answer the consequences of coming up with that kind of answer so we want to look at in terms of EXP an atory style three different dimensions internal stable or Global so was the cause due to something within me or something I did or is it due to external factors like luck so what would you say on a scale of 1 to seven one it's totally external seven it's totally internal where would you put that a one okay so it's something that the boss did I might move it up a few notches because you decided to do something about what the boss did uh but but you're right was sort of triggered by if he had never done that this maybe wouldn't have happened so there's definitely a big external piece to it the stable Dimension is is this a onetime only event or is this something that's going to keep happening again and again in the future so an unstable explanation is is random luck a stable explanation would be um I have a lot of uh intelligence so that intelligence is going to follow me in different areas of my life so do you say this is stable or unstable a One-Shot deal or is it going to keep on happening it's a one shot deal so pretty unstable kind of a one-hot deal and Global is is it just going to affect you in your job or your relationship with your boss or is it going to affect you everywhere your your family your friends your social life what do you think so it's pretty isolated so here it's external uh it's it's unstable and they call it specific the opposite of of global now when you have your actual explanatory style measure there's a number of different hypothetical events and it's averaged over both positive and negative negative events and the reason this is important is because we've found that uh explanatory style is related to an individual's risk for depression and in general if a person explains negative events as it's my fault it's never going to change and it's going to affect me everywhere that tends to predispose them towards depression depressed people also when they have a positive event happen they say I can't take any credit nothing positive orever happen again and it was really just a one- shot deal so really the the attributions the explanation you gave us for that event would fit more in the depressogenic category it's just one event though so it's not your style uh so you would would need to average it over a number of of other events so where did this stuff come from uh and I think it's important to understand a little bit of the history because it helps us see some of the implications uh of it and I think it also helps us to see sort of the evolution of of of science or research from animal studies up to human uh levels so this was the work of Marty Seligman and many of you have heard of uh learned helplessness or learned optimism before uh he in the late 60s and the early' 70s also at University of Pennsylvania different building from Aaron Beck they were working completely separately uh and he was interested in uh dog studies uh didn't have a term at a name at the time but it eventually became called learned helplessness and the Paradigm was something like this so we'd have a large rectangular cage and there was a divider in the center of the cage on one side there was a metal floor on the other side it was just a a terry cloth floor he would place the dog on the metal side of the cage administer a mild electric shock was unpleasant the dog would jump to the other side you it's very refle reflexive doesn't take a lot to explain why that happens did several repetitions of that the dog always jumps to the other side next part of the experiment you put a divider a a metal wall really in between those two sides of the cage you administer an electric CH shock the dog tries to escape but cannot it hits the divider can't go anywhere keeps trying to escape cannot goes through several repetitions of that until finally the dog learns there's nothing I can do I'm just going to quit trying so they just lay down and they become helpless essentially the most important part of the experiment is the last part where he takes out the divider in that cage so now the dog can escape he administers the electric shock and the dog does nothing so they actually reach in physically and pull the dog to the other side to show him hey you can just move to the other side put the dog back on the metal side administer the electric shock the dog goes nowhere the dog has learned to become helpless as a consequence of those earlier experiences of being unable to escape it doesn't take a lot to extrapolate this to people to see that people who have may may have grown up in circumstances where Escape was impossible where there was abuse children are fairly powerless they may have developed the same sense of learned helplessness so that even though they're now adults their lives have changed their environments are different they now have resources now they can escape they don't take advantage of those resources because they learned to be helpless there was a glitch in this Theory though despite its appeal and that's not everyone who has these aversive events not everyone who's been abused as a child grows up to develop learned helplessness in fact it's less than the majority there's only a subset of folks that go on to become helpless so why is that and the event the answer that eventually emerged was it has to do with their explanatory style kids who are being abused who said it's my fault it's never going to change it's going to be like this everywhere they went on to become helpless kids who said this is messed up this is not me it's not always going to be like this there are places where it's different this is not going to last forever they did not become helpless and they were able to survive or even transcend the circumstances that they were given as children so explanatory style helped us to understand how some people go on to be resilient and why others are unable to do that I want to talk a little bit about uh mood shifting in the moment and we've already really done sort of one exercise of mood Shifting the ABCD exercise can help us to have at least transient changes in our mood it's not a magic wand it doesn't take away all of your anxiety there may still be anxious about the stock market but hopefully what it does is it it it at least decreases the severity or the intensity of those feelings when some people do their ABCDs they they often will rate the initial feeling of anger sadness depression on a 1 to 100 scale they finish the exercise and they rate their feelings and a lot of times they'll see a 20 30 50% dropping the intensity of their negative emotions uh certainly better than doing nothing at all there's a couple of other interventions that we can use to at least temporarily shift an individual's mood I want to talk a little bit about cognitive reprocessing or a form of journaling they want to talk about a selective attention exercise so for journaling uh you know the idea is not new it's been around for a very long time that maybe keeping a diary is a good thing keeping a diary is a sort of a cathartic experience it can get a lot of the feelings out and on paper it's a way to to relieve stress it's maybe even a structured way to capture thoughts and to do a little bit of problem solving uh well finally someone uh and that someone is James pennebaker at the University of Texas decided to test out this particular Theory and to see if journaling was something that was helpful both in terms of mood but also in terms uh of an individual's physical health so like uh a lot of uh uh academic psychologist he first started studying students to see if it was a viable idea and then moved to more uh medical uh in real world populations so his Paradigm was essentially to bring the students into the lab half of them are told to write about a very serious event that happened to really sort of dig into it ruminate about it write about it for about 20 minutes or so the other group they're also writing but they're writing about something very neutral about the weather about trees about something that really doesn't have an emotional charge he has this them do this over a number of weeks gives them mood measures looked at uh who went to student health during that time did anyone develop symptoms and so on as you can imagine in this healthy population there weren't a lot of health effects for the students but there was a marked mood effect and in fact students who wrote about these charged negative events actually reported a better mood as a consequence of this journaling process sort of interesting they they weren't wallowing in it they were reprocessing rethinking and eventually changing the way they felt about that particular event pin Baker was rightly challenged to say well hey let's take this to patients who have real disease maybe chronic diseases and let's see if there's any health effect so pin Baker his graduate students and others whove picked up this Paradigm have looked at a number of of different patients and I I'll give you just a couple of examples here there was a study looking at patients who had uh chronic and fairly severe moderate to severe asthma put them in the same uh Paradigm they uh were told to think about the most negative events in their lives either uh most recent negative uh events or in the past or the largest magnitude negative events the others were told to write about something relatively neutral uh and and not emotionally charged they did this over a period of weeks and they measured something called fev1 that's a forced expiratory volume of air so how much air you can breathe out of your lungs really quickly in one second the more you can bring out breathe out the greater your lung capacity so it's a sign of improvement uh for folks who have uh pulmonary problems they found that for individuals who were writing about the emotionally charged negative events they actually have had an improvement in feev one other studies looked at the severity of symptoms in rheumatoid arthritis same sort of results patients who wrote about the negatively charged events had better results looking at patients who are HIV positive they found that their CD4 count a type of immune cell actually went up there was not a a difference in terms of their outward appearance in terms of their physical health who was getting opportunistic infections or not but there was a difference if you were to look at their immune cells in a under a microscope they had a a larger number of CD4 counts it's not a Magic Bullet doesn't work for everyone it neither helped nor hurt bereaved subjects but I think it's an interesting Paradigm that I'm sure will'll get a lot more research on in terms of what's the exact dose what types of events should you write about who will this help and is there a population that might actually be hurt from doing this sort of intervention we should always remember the potential for harm even in uh our most promising interventions okay the next exercise I wanted to do is one borrowed from uh Rachel rimond here uh there's a lot of variants that's out uh Marty singman who now does positive psychology research has also done research on a a variant of this uh this is something to change your select of attention and in the process to change your mood so why don't I have you answer three questions if you can just jot them down in your notes section so one question is name one thing that surprised you today the second question name one thing that moved you today and I mean emotionally moved you so don't write down your car and the third is describe one thing that inspired you so one thing that surprised you one thing that moved you one thing that inspired you now this is an exercise that we've done informally uh with our medical students and we encouraged our third-year medical students to do it they've uh just left the classrooms they're on the wards incredibly smart uh motivated uh empathic students but they suddenly find themselves feeling incompetent and they find themselves terrified that they might hurt someone because they don't know what to do so they go home at the end of every day remembering every single mistake remembering everything they did wrong and feeling absolutely terrible about themselves so we wanted to give them an exercise to help them shift their attention and to improve their mood so it takes 5 seven minutes at the end of each day think about something that surprised you today on the wards in your clerkship think about something that moved you think about something that inspired you but how about let's hear from one of you uh who' like to volunteer these three things that you wrote down how about a volunteer yes so one thing that surprised you today um a client born in a place where I used to live overseas a client was born in a place you used to live overseas yes one thing that moved you today conversation with my husband conversation with your husband and one thing that inspired you today um a phone interview for potentially a phone interview for a potential new job and how was that inspiring because I got to talk about my accomplishments and I realized how much I've done so she got to talk about her accomplishments and realize that she's actually done a lot so in really just a few minutes very simple exercises we've cognitively shifted your attention to things that are positive things that are inspirational things that are emotionally moving and helped you to savor not something that's made up not something that's false false but something that happened in your day that may have slipped away because it wasn't negative and I think we naturally hold on more tightly to negative things that happen and we forget the things that are positive we forget to savor our successes this is a quick way 5 to 7 minutes at the end of each day that we can do that there are a couple of examples I wanted to show you of Behavioral mood shifting so changing your mood at least transiently it doesn't have to do with cognitive exercises we'll talk about activity scheduling I'll remind you of some relaxation exercises that might help uh and wanted to put in a plug for physical exercise uh we know that it's not only good for your body it's actually good for your mind both in terms of improving your emotional state but also in terms of improving cognitive function you know we we talk a lot today about how puzzles and sort of cognitive challenges can keep your mind sharp actually aerobic exercise has a larger magnitude effect than those cognitive puzzles you can still do them both you can do them both at the same time if you want but physical exercise I think is is is very much an unsunk hero what somatic mean uh somatic has to do with your body so somatic quieting is how to quiet your body how to turn down the stress response so an exercise we're not going to do but I wanted to to show you it's part of a behavioral exercise for depression but I think it's also an important way for us to step back and to reflect on the choices that we make in terms of how we spend our time and the behaviors uh in which we engage a lot of times at the beginning of therapy we'll ask a patient to do an activity record or an activity schedule we give them a calendar this one's a little bit shorten just because I ran out of room there's a box pretty much for every hour throughout the week and we just ask them to fill it in at the bottom of it we ask them to rate their mood on a scale of 1 to 10 where 10 is the best mood ever or the best mood uh on that scale and one is their their worst mood we then have them bring it in and we just look for patterns we look for days that were high mood days where there things you were doing were there people that you were around that raised your mood we looked for days that were low mood days were there things that you were doing or not doing that really pushed your mood down we also look for opportunities there may be sections of unru Ed time or where there's just fillers and I think of TV as sort of a filler or internet surfing as sort of a a filler it can be an important uh distraction at times but if there's large chunks of it uh I think that's an opportunity for a person to make a different behavioral choice that may have a different impact on their mood so we get them to bring in data we look for patterns we try to see relationships between behaviors and moods and then the next step is we actually want them to schedule a couple of pleasant things to do and you would be surprised but for many people this is a very difficult idea of scheduling something that's fun it almost seems antithetical to the notion as if fun things are just supposed to happen or social activities or social contacts are just supposed to happen I would say we need to give them as much or more attention as we give to our appointments that we schedule those certainly take up a lot of time they're not necessarily going to have a positive mood effect but it's not just the pleasant activities that we want to schedule we actually want a well-balanced diet of activities so we want some things that bring us pleasure some things that are distractions some things that help us feel connected to our families or friends we also need activities that give us a sense of competence give us a sense of Mastery you know an activity that recently lifted my mood was cleaning out my garage it was not a pleasant activity I'm not one of those cleaner organizer people that likes to do that but at the end of the activity I thought wow I did it I did it it's finished it's accomplished it had a mood boosting effect now I don't want all those My Week full of those kinds of activities I probably want at least a few of those uh in my week let's talk a little bit about the relaxation response and and I know in Dr Kim's lectures and others they talked about the stress response and sort of all the negative that happens when stress gets turned up fortunately for us uh uh we are are made with uh all of these internal mechanisms that help us to stay uh in Balance one of those is the relaxation response or the activation of the par sympathetic nervous system the the sort of Yang to the yin of of the stress response system herb Benson's been writing about this since the 1970s and has been exploring different ways to help us to get into a state of relaxation where it's not just a a mental or emotional phenomenon but we actually see changes in our respiration heart rate uh blood pressure and so on fortunately for us there are a lot of different ways to reach uh a state of relaxation uh different things uh tend to be preferred by different people you can make uh your own choices about what you like it tends to in involve some form of focused concentration so it could be focusing on your breathing it could be focusing on a yoga posture it could be focusing on a mantra it could be focusing on a Prayer it could be focusing on an image but it's some sort of focused conversation that decreases the chatter uh of of the mind it usually involves a quiet environment but I've certainly had patients that are able to do this in very noisy environments it's a matter of what you're used to uh and it requires a a passive attitude I've uh do a lot of stress management with folks and I I often have uh usually sort of younger men will come in and say I'm going to be the best relaxer that you've ever seen I'm going to learn this better and do this faster than anyone else and so right away I know that's sort of where we need to start that it's not about accomplishment or achievement it's that's the wrong attitude to have as I mentioned there are are lots of different Pathways to achieve the relaxation response and I just have a couple of examples here there are a lot of fantastic programs at the the Bay Area uh in fact The oer Institute uh uh over at Mount Zan also has a number of programs uh as well in your reference list the last slide and also on the first page of the handout there's a number of books that you might turn to to get some ideas about what you can do to reach a relaxation response so the last portion uh of what I wanted to talk about in the next 10 minutes uh or so is uh what I've called depth coping it can certainly improve your mood transiently so the mood in the present but we're really talking about building that Foundation of finding a a source of sustenance uh that will feed you uh through the lean times that will give you the support uh that you need to carry you through we'll talk about Connection in relationships we'll talk about meaning and how those help to promote personal growth perspective and balance so for connection uh if you look at the research on happiness you look at the research on uh subjective well-being uh you look at the research in positive psychology uh really any way you slice it the most common and the most consistently replicated predictor of well-being is relationships doesn't have to be a romantic relationship it can be a relationship with a sibling it can be a relationship with a best friend but it's about relationships and I think we really do uh ourselves and maybe our children a disservice by not investing as much time in teaching about how to have relationships as we do teaching Reading Writing and arithmetic uh we should definitely add in a a relationship class or more those relationships though aren't necessarily just about relationships with other people uh they could be uh relationships uh with uh pets they could be relationships with plants even there's some interesting literature there they could be relationships to a higher power however you choose to Define that higher power or uh your spirituality but first I wanted to to keep us down on Earth and to look at at our our social supports or our relation reltionship with other people and wanted to do just a quick exercise we won't debrief this one but but I want you just to to give it a whirl and see if you can just write this right on the slide that's on your page what you do for this exercise this is a series of concentric circles here's you right in the center of the circle and I want you to think about your social support network so so people that you can turn to for help when you need it and I want you to write them somewhere on this circle for people who are closest to you maybe your significant other your best friend they might be in your inner circle someone who's a friend but you still have some walls up around them they'll be in this next level someone who's an acquaintance might be a little bit further out then outside the circle are all the other people in the world or co-workers or people you just don't really know so why don't you go ahead and just write down the names of sort of those top people who are in your social support network you'll write down your name and their Position will depend on how close they are to you okay so why don't you go ahead and write those down and I'll tell you how we use this exercise clinically so in a clinical setting after a person's been given some time to write the names down in the social support Circle the first thing I look for is whether not there are any names there certainly had the experience where there are no names that a person can put on the sheet at all or you might notice that all of the names are actually on the outside so no one has even made it into these these outside rings for other people they may have a lot of folks in the outside but they're very guarded uh they don't have a lot of intimate relationships so there's no one in the Inner Circle at all so first I look for the number or the quantity of social supports then I look for the quality I look for the level of intimacy now there's no right number of intimate friends that a person's supposed to have it looks like it really just takes one close friend to give you the health protective effects that you need from social support in general however it's recommended that you you have at least two close social supports uh and I think the idea is if you put all your eggs in one basket and something happens to that that basket you're in trouble so you want at least a couple of different supports the other thing that I look at though is not just who is on the map and how close are they to you but then H have the person think about what type of support is that person good at providing there's a lot of different kinds of support some supports very practical can you give me money can you give me a right to the doctor can you help me do my laundry some of it might be uh informational support can you give me advice can you help me problem solve and sort of work aloud and brainstorm about this problem some folks are really good at that and other types of support may be emotional support who's a really good listener whose shoulder do I want to use to cry on when I need to do that your job as the person who needs support is to know what type of of support you need then to turn to the right person to get that kind of support there are a few things more frustrating than needing emotional support and going to your problem solver and all they try to do is to come up with Solutions and they don't really give you what you need it's partly their fault for not understanding what you need it's partly your fault for not either expressing it or maybe going to the wrong person to begin with so the last thing I wanted to talk about is is meaning in our search for meaning the importance of meaning in our lives and as I was thinking about meaning um the the classic book that came to mind for me is a book called Man's Search for meaning it's a book written by Victor uh Frankle uh actually about 50 almost almost 50 years uh or so ago uh and let me tell you a little bit of the story about Victor Victor Frankle for those of you who don't know uh he was a psychiatrist he was Jewish he lived in Germany uh preor War II uh he and his large extended family uh they were uh arrested they were put uh in a Jewish ghetto and they were eventually put into into concentration camps uh he as a psychiatrist began to look at the individuals who are in the camp uh mostly men in his particular camp and notice that some of them died very quickly uh some of them actually survived despite looking like they absolutely should not have survived so he began to wonder what is it that gives a person that will to live what is it that gives a person that ability to keep going despite the circumstances around them uh what he comes up with is this life has the meaning to the very to The Last Breath the possibility of realizing values by the very attitude with which we Face our destined suffering exists to the very last moment he who has a why to live can bear with almost any how he who has a why to live can bear with almost any how for Victor Frankle his why was his family uh and in particular he would think about his wife uh and he uh had planned out his second wedding ceremony of where where he would propose to her of who he would invite what the guest list would be what the menu would be those of you who have had weddings know how many details go into it and how timec consuming it is but that was his purpose reuniting with his wife with his family with his parents with his children uh with his siblings that's what got Victor Frankle through the camps when the war ended and he was liberated from the Concentration Camp he discovered that uh he and his sister were the only two that had survived so here again he was forced with trying to find a new meaning a new why a new reason to go on living and that reason became he wanted to share his insights with the rest of the world he wanted to share what he had learned about the importance of meaning and helping us to endure or maybe even transcend suffering so he wrote the book Man's Search for meaning he went on to found his own School of therapy called logo therapy uh which I think has been so successful there's still a logo therapy school in in Germany actually a couple in Europe but it's been so successful really this idea of the importance of of of meaning of looking for that why has really been absorbed has been integrated in almost every therapeutic school of thought finding the why or finding that source of meaning uh helps us to uh endure not just large sufferings but also small sufferings and certainly the the daily hassles of life as well when I think of it more in sort of the the daily hassles uh or the stress level I think of a story that's uh shared by Steve MC uh he is uh uh a physician here at UCSF founder of our pal of Care Service a very much uh beloved respected compassionate uh teacher mentor and clinician his story for uh the medical students and I believe their white coat ceremony they sort of get their white coats take the Hippocratic Oath it's very sort of moving and meaningful for them um he tells a story about choices that they need to make uh and the story goes something like this he starts off and this is the first day of school so they're all taking notes and they're they're all very serious and says you know you have some choices ahead of you and probably the most important choice that you need to make is what kind of doctor you're going to be sounds normal so far and what I mean by kind of doctor is you have to decide if you're going to have a gas tank or if you're going to have solar panels some of the pens drop and they're wondering now what's wrong with this guy he said what do I mean by that is if you're a doctor with a gas tank and you go to see your first patient and maybe it's challenging takes some energy Burns off some fuel you do a good job you go to the next patient you burn off some more fuel it's taxing but you do a good job you go to the next patient you burn off some more fuel and by the end of the day you've done a good job but your gas Tank's on empty and that's what you take home to your family the alternative is to be a doctor who has solar panels you see your first patient it's difficult it's it's challenging it requires energy but in the moment you realize what a privilege it is to be invited so intimately into the life of another person to be given the opportunity to make a meaningful and Lasting difference that privilege Shines on you radiates on your solar panels and it feeds your soul you go to the next patient it takes energy go to the next patient it takes energy and by the end of the day you're physically tired but your soul is fully charged and that's what you take home to your family so you decide gas tank solar panels again in that situation you still have a stressful job it's still physically exhausting but there's been a perspective shift there's been a reconnection with that source of meaning there's been an appreciation of the why there's been an appreciation of the privilege of the honor really that I think each of us can find in our everyday lives so I hope over the course of of the talk today I know it's been sort of a fast Whirlwind uh that you have some ideas of maybe things that you can try at home just pick one of them try it a couple of times on your own it might be ABCDs it may be journals it might be reading more about explanatory style uh it may be looking at your appraisals and reading through those questions it could also be activity scheduling finding a way to reach the relaxation uh response or hopefully have caused you to to think a little bit about the importance of relationships and especially about the importance of meaning and connection I thank you so we do we do have some time for questions if folks have any questions I'm happy to answer yes so so the question is if you have two children who've been abused why is it that one of them says it's not my fault it's going to going to change there there's other things out there whereas the other child says it's me you know I I we don't know exactly what there is a relationship between a parents explanatory style and their child's explanatory style maybe it's learned maybe it's innate uh if you look at qualitative studies of people who have been abused but have been resilient theyve found a couple of different things and probably the most important factor is they found a surrogate of some kind so there's a teacher there's a coach there's a minister there's a neighbor there's somebody that maybe sees what's going on and says hey you know what it's not you we're going to get you out of this things are going to change may not know that abuse is occurring but they provide that alternate theory that alternate explanation that the the child hopefully can pick up and learn and use and apply to their own life yes so the question is with cognitive behavioral therapy it what age range is it good for essentially um you know the the youngest I've seen it used is for kids who are five or 6 years old or so um it it changes in nature because you know it's complicated to do disputes and to sort of there's a lot of language that's involved in it when they do it with kids uh they use uh comic books and cartoon characters and they come up with stories uh and they'll talk about U trying to remember some of they they had uh poly the pessimist and Ali The Optimist and things good things and bad things happen to both of these characters and they come up with different explanation so they they learn through narratives they learn through stories then they make their own comic books and their own stories then they talk about the relationship to their own life so slightly different methodology but the same general general principles are used yes so the question is really about the value of optimism or pessimism and and is there sort of an optimal range the bias is to say optimism good pessimism bad that's actually not true uh we uh did a study we um with Marty selling Seligman and myself we did a study of law students and we had the idea that pessimism might actually be a uh constructive trait in law school to always see the flaw to always see the crack to always amplify the negative to to do that uh we actually found that the students who succeeded the most in law school were mildly pessimistic now if they were were were highly pessimistic they did not do well they were more on the depressed side but mild pessimism at least in that profession was helpful would be interesting to do that study looking at Physicians if you think about it you might want your physician to be a little bit pessimistic to look think about all the bad things that might be happening to take care of them to test for them to hopefully prevent them but that study hasn't been done so I I think there is a role for pessimism there there's a role for optimism but probably in the mild range and either direction yes so it's a it's a great question it's a question about set point you know when we hear about weight people talk about well is there a weight set point some people are just meant to be heavier some people are meant to be thinner is there a set point for emotion are some people just born happy and are some people born sad uh and I think you know for for anyone who who've had maybe more than one child or more than one niece and nephew you know they come into the world with dispositions uh and so I I think there's definitely a genetic or innate component to that I'd like to think though that that it's not your a set point it's a set range so there's amount of variability within the range that you're biologically able to achieve now the study that Ellen's referring to is a study by Ronnie janof Bulman uh she's a social psychologist and she looked at two groups of of Fairly uh um unusual patients uh the first group were individuals who had recently won the lottery they' become new millionaires so very happy it's a big event for most people they think it will make all their dreams come true what she found actually is you get this this this temporary spike in happiness and excitement and all the things you might imagine they buy bigger houses and bigger cars and so on with within a 12-month period their level of self-reported happiness is back down to where it was before they actually won the lottery and I think that has to do maybe with a misunderstanding of what makes people happy it's not more money it's not a bigger house it's not a bigger car it's relationships and if money helps you have better relationships which it doesn't really uh if it did help you have better relationships you might see more of a difference the other group she looked at though were people who had a very negative event happened to them these were folks who had been in a a motor vehicle accident and who had become a paraplegic so they had become paralyzed from the waist down as you can imagine they became very depressed they became very distressed it causes huge changes uh in your life a huge stress on your family so you see a big dip in their mood but in about 12 months as they had adjusted to their new way of life they had returned to about the same level of functioning and happiness that they had before the accident actually occurred those are fairly specialized groups of patient but I think it makes a fairly persuasive argument that we're at a particular level and even if you have big events that happen there is this pressure to return back to that same level I'd like to think we can bump that around a bit but it doesn't take accidents or illness or money to do that I think it really takes relationships it takes connection and it takes it takes meaning to do that yes right so so she she's asking about the exercise was who's there to support you and it seems like you're on a lot of other people's circles that they turn to you for support and at times that feels like a privilege but at times feels like a a burden really um and I think you know you have to decide for for yourself in any social support relationship with those people on your circle there should be a reciprocity there should be times when you're the listener and they're the talker but there should be other times when they listen and if there's not that sense of reciprocity it's probably time to re-examine and rethink that relationship if you can if that doesn't work out maybe they should move to the further circles the further away from sort of your your core supports yes so so an important strategy will be sort of ahead of time if you can anticipate a stressor is occurring to do a little bit of preparation some Advanced planning to meet that stressor you might do some Advanced thinking about the appraisals and hopefully rallying your supports to be ready if that stressor should occur you're right that can certainly minimize the the magnitude of a stress response you might have right and very important if the stressor is very strong you're right okay how about one one more question all the way in the back so so so the question is is about an individual's willingness to participate if you can still get positive outcomes or not and I think really the the foundation of cognitive therapy is that is a it's a collaborative partnership between the therapist and between the patient so there does have to be Buy in really to get the kinds of gains that you would hope for if you're stuck in a situation where you have someone who needs help and they're not willing to get that help um you you can you know encourage them to see a cognitive therapist you can buy them the right books you can maybe share in behavioral interventions with them we know physical activity is is a good stressful inter stress intervention take them for walks you can help schedule dual Pleasant activities with one another that might help to give them some respit or some relief from a stressful situation but in terms of actually them is to sit down to do the homework if they're not willing to do it I'm not sure that there's a whole lot you're going to gain from that so thank you so much for your time and your attention again I would encourage you to try these [Music] out [Music]

Channel: University of California Television (UCTV)

Views: 351,326

Keywords: stress, mental health, integrative medicine

Id: 0BbHW3H_xmo

Length: 79min 19sec (4759 seconds)

Published: Fri Aug 31 2012