Recognizing and Building Resilience

Everyone experiences loss, grief, and stress – as humans, we are unfortunately no stranger to adversity. What is crucial, however, is the ability to navigate the challenges to our emotional and psychological wellbeing in a healthy way. People who are resilient are able to grow through uncertainty, recover from setbacks, and perform under pressure. This remains true and important for those struggling with mental health or substance use disorders. A significant part of treatment is teaching patients the skills to manage the triggering situations that feed into their illness; sustained recovery means putting these skills into daily practice for the long-term. And so resilience can be learned and practiced! It is a powerful tool that helps people to not only survive but thrive in the face of even seemingly insurmountable obstacles.

00:00 Introduction
02:50 Overview of Webinar
03:28 Stress & Mental Health: How Does Stress Impact our Mental Health & Wellbeing
06:43 Polyvagal Chart
08:05 Relief
09:48 Types of Stress Responses
13:10 Burnout
16:10 What are the Signs of Burnout?
22:42 Resilience
25:37 Contributors to Resilience
31:56 Managing Adversity: How can we Cope with Adverse Events?
33:45 Seven Strategies to Complete the Stress Cycle
39:40 Planful Problem Solving
43:52 Redefine Winning and Failing
46:28 Focus on Meaning
53:03 Conclusion

00:00 INTRODUCTION

Suanne: Hello everyone, thank you for joining us today for our educational webinar. For anybody who has been a regular attendee of our webinars so far, welcome back and anybody new, thank you for joining us for the first time and we hope to see you coming back again.

A little bit about us at EHN Canada, we are the nation’s largest network of private mental health and addiction treatment centers coast to coast.

We have our Edgewood treatment Center out in BC, Sandstone in Calgary, Bellwood here in Toronto, and our French language facility Clinique Nouveau Départ in Montreal, and our brand-new facility that just came under our EHN Canada family, Ledgehill out in Nova Scotia. If you do ever have any questions about our programs or our treatment centers you can always visit our website ehncanada.com.

A few housekeeping items today, our webinar is being recorded and within the next week, we will be sending an email out to all of the attendees with a link to the recording, your slides, as well as your CEU certificate.

Everyone is on mute today. Please feel free to use the Q and A box at the bottom of your screen to submit any questions you might have for Sandeep today. And so, with that, I would like to take this opportunity to introduce our speaker Sandeep Marwaha.

I’m very pleased to have her with us today. She is a registered occupational therapist and registered psychotherapist with Bellwood health services in Toronto. She’s got 15 years of experience in the mental health and acute care settings, and she is well skilled in treating routine anxiety disorders, substance use disorders, as well as providing therapy to veterans and first responders who are struggling with occupational stress injuries and we’re, like I said, we’re very pleased that she’s able to join us today and share some of her knowledge with you. Thank you, Sandeep.

Sandeep: Thank you so much Suanne. Hi everybody, good morning, or good afternoon, depending on where you’re logging in from across the country. So today what we’ll be talking about is how to recognize and build resilience.

So, please, like Suanne said if you have any questions, please go ahead, and type them into the chat box and hopefully there will be time at the end of the presentation to answer some of your questions.

02:50 OVERVIEW OF WEBINAR

Sandeep: So just a little overview of what we will be discussing today. So, first talk a little bit about what is stress and how does stress impact mental health. And, then talk about burnout. What is burn out? What are the signs of burnout and how can we identify burnout in ourselves and others? And, and then spending a little bit of time talking about what resilience is and then hopefully spending a good portion of our time talking about ways that we can manage adversity. How can we cope with difficult situations in our lives, and it is part of coping with adversity that also helps to build our resilience.

03:28 STRESS & MENTAL HEALTH

HOW DOES STRESS IMPACT OUR MENTAL HEALTH & WELLBEING?

Sandeep: So first, how does stress impact our mental health and wellbeing?

Before we kind of go into that, I just want to talk about a little, about what the stress cycle is, so stress isn’t just something that happens in and of itself. There is a process to it, and so, normally, there is a stressor that happens, followed by a stress response and then relief. So what are these different components and what do they look like?

So, what is a stressor? A stressor can be any external or internal experience that our nervous system interprets as a threat. So, an external experience can be like we all find ourselves in COVID – coronavirus; knowing there’s a pandemic happening right now is an external stressor. Internal experiences can be even our own reactions to this coronavirus. Internal experiences can be things like our self critic and self-critical thoughts. It can also be physical sensations that are occurring internally, which can be a stressor and once the stressor is perceived and interpreted as some type of threat by the nervous system, our stress response gets activated.

And so, what is a stress response? Basically, what happens is whether it’s through our five senses or through our internal senses, our brain interprets our sense as a threat, it will then send a cascade of chemical, electrical, neuro physiological responses across the body, and the whole plan is to get the body ready for action, and so this stress response that we have is very much an evolutionary response that we’ve inherited from our ancient cave people ancestors, and the main goal of the stress response and really the main goal of the brain is survival and to keep us alive so anytime there is some type of threat that is interpreted, the brain will then send chemical and physiological kind of signals for the remainder of the body to get active.

And so, what does this mean? This means that our heart rate will increase, our blood pressure will increase, our breathing will increase, and adrenaline and cortisol be flowing through the body, which then tenses our muscles, and all of this is to get us ready to either fight or flight or run away. And so certain systems, when our stress response is activated, get prioritized in our bodies and then, at the same time, other systems in our bodies get deprioritized, so our digestive system gets deprioritized, our immune systems get deprioritize, our reproductive systems get deprioritized because those aren’t needed in this moment for fight or flight. So this is a really important thing to remember is that stress is about movement, whether towards or away from the threat, and it is about getting our bodies ready to act.

06:43 POLYVAGAL CHART

Sandeep: What I’ve included here is the Polyvagal Chart. One of the theories about stress and trauma comes from the Polyvagal theory, and just really briefly what I want to kind of highlight is that when the stress response is active, what’s happening is the yellow area of the chart, so again that fight or flight response, the sympathetic nervous system is activated, we’re in hyper arousal, so that means our arousal is higher, our bodies are in active mode.

And with this comes as you can see, on my right side of the screen are those physiological responses that I mentioned, so blood pressure increases, heart rate, oxygen circulation goes to vital organs, and then other areas of the sympathetic nervous system, other areas are in the body or decreased in terms of their activity level and then emotions that are common or felt during this fight flight time are things like frustration, worry, concern and as our arousal increases as the threat or a stressor as the severity of threat is interpreting is higher and higher, the intensity of our emotions also increases.

08:05 RELIEF

Sandeep: So, once we are able to either manage a stressor and our stress response has gone up and then it has completed in that perhaps a stressor has been removed, we’ve been able to deal with a stressor successfully, we come into an area of relief, and I’m just going to go back and show what that relief, so relief is what we feel when we are in that green zone and what does that mean? So, relief means that we’ve survived the stress. There’re different ways that we get to this state of relief. You know, sometimes we shake it off, like you know when we get startled by something, say there’s a loud bang and immediately our system is like “what was that?” and we jump right? Then we go and we turn to see oh somebody just dropped a book. Sometimes they’re just going to shake it, we’ll be like oh that was nothing, that was just a book. That act of shaking actually helps to kind of purge some of those chemical and physiological leftovers in the body from the stress.

Other ways that we experience really is through social connection, so we cry, we hug, we celebrate with others, we breathe really heavily, and we exhale and all of these activities and ways of dealing help, like I said, to purge those chemical physiological leftovers, and that, in a way, helps to complete the stress response.

09:48 TYPES OF STRESS RESPONSES

Sandeep: But what’s happening in modern day life? So, when you think about it, the stress response was designed to kind of deal with incidental, short term stressful events, right? So if you think about our ancient ancestors, in a sense, you know there might have been a predator that was kind of around us and we had to figure out how to manage that, so as soon as a predator was gone or we were able to fight or flight, we could kind of have enough time to allow our bodies to return to homeostasis and were then able to complete a stress cycle. So, what that stress response would kind of look like is that first line graph under positive, so there’ll be an event that happens, and our stress response or arousal system gets really high, we deal with a stressor, and then we kind of slowly and quite quickly are able to go back to our baseline.

But what is kind of happening in our modern day lives is that oftentimes our stressors aren’t going away, they’re still there. And the other piece is that we sometimes don’t have adequate time to complete the stress cycle. Other times we actually don’t have the skills, or the knowledge, or the coping skills to deal with the stress cycle. And what ends up happening is more of what the second and third chart show where we’ll get an increase in stress response and our recovery can either take a long time, like the second chart, or we kind of stay in a state of hyperarousal, and so what this means is by staying in this state of hyperarousal for a longer amount of time, we are not able to purge those chemical and physiological signs of stress – they remain in our bodies and so what does that look like? So that means that our heart rates are high, we’re kind of tense all the time, we’re irritable and angry, our digestive systems aren’t very, aren’t working well, we get sick a lot because our immunes systems aren’t as a functioning as effectively, and so you know, this leads to long term stress, and then the long term stress in terms of our own resilience and how we respond to stress can also then result in these longer term mental health difficulties and then how we respond to our mental health difficulties can also indicate or play a big role in terms of the ways that our stress remains.

Really stress is a huge component to our physical and mental health well being and oftentimes in our modern day lives we are not able to kind of get rid of the stressors because the stressors kind of remain, it can be financial stressors, relationship stressors, it’s coronavirus. Coronavirus hasn’t gone anywhere, in fact for us in Ontario it’s gotten worse, and so our stressor is still there and what we’ve been trying to do is manage that stressor and for some of us it has kind of become a bit difficult because we haven’t been able to have a sense of relief.

13:10 BURNOUT

Sandeep: So, what can happen? So, often times this is when we can find ourselves in a state of burnout, and so burnout can happen in workplaces, it can happen in our work lives, it can also happen in our personal lives, and this is also what a lot of us are seeing in terms of clients that are coming for treatment or asking for support. Many people have kind of reached their limits in a sense and are in a state of burnout. So what is burnout?

And what I wanted to do was kind just to go back to this Polyvagal chart and talk again about what is happening in terms of our nervous systems, and so one way that I kind of think about burnout is that it’s what happens when we’re in that red zone on the chart. It’s kind of like a version of the freeze response. Typically when we think of the freeze response we think of, you know, kind of like playing dead right, so if we’re being attacked by a predator, kind of thinking about us in ancient times, sometimes playing dead would be effective in kind of misleading the predators to think that we’re not really that tasty of a lunch, that we’re already kind of dead and there’s no point in kind of continuing to try to kill us, so to speak, and so they’ll leave our bodies, perhaps to go and get more animals to kind of join, engaging in the lunch and when that predator leaves it kind of gives a body and that person or that animal the opportunity to leave, right it’s like suddenly the body would turn back on and they can escape.

Other times the freeze response happens when there’s no other response, when we aren’t able to escape the predator, and we are not able to escape the threat. And so, the body will freeze in terms of it will decrease the heart rate, decrease the blood pressure, and we’ll start to engage in the system of numbing, numbing the body, shutting it off so that it doesn’t feel any additional pain. That’s kind of the most extreme version of the freeze response. The way that I kind of see burnout is that it’s a version of this freeze response, maybe on the lower end of this chart where you know we see the little bit of the helplessness, the sense of feeling trapped, depression and numbness. That’s kind of what burnout is, and this is also when our bodies in the state of hypo arousal, we’re not as active where our body starts to slow down as a way to protect ourselves.
And so, how does this show up in day to day?

16:10 WHAT ARE THE SIGNS OF BURNOUT?

Sandeep: The model of burnout that I’m using is from a recent book that came out by Emily and Amelia Nagoski, it’s called Burnout: How to Complete the Stress Cycle and they conceptualize burnout as kind of having three different processes and these different processes are emotional exhaustion, decreased sense of accomplishment, and depersonalization. So, what is emotional exhaustion?

Emotional exhaustion can be experienced as physical fatigue like exhaustion, right, real physical exhaustion, this sense of brain fog, difficulty focusing, difficulties with memory, difficulties with concentration, and you know kind of forgetting things that happened or forgetting conversations. There’s also this sense of feelings of cynicism and pessimism like oh you know, things just don’t matter anymore, nothing is going to work out. They’re also physical pains and digestive issues that are part of this emotional exhaustion and so, if we were to go and think about that state of freeze right and long-term impacts of stress, well long-term stress, it deprioritizes our digestive system, which then results in digestive problems. There is a lot of tension, muscle tension, that results in physical pain and then the brain fog and the physical fatigue are also signs of kind of the body slowing down and kind of numbing us from this ongoing stress that we’re feeling, because our bodies are like we can’t really handle this anymore.

Another thing that can happen as well, is this decreased sense of accomplishment, and this is where our sense of self efficacy, our sense of self effectiveness, kind of takes a bit of a hit where when we’re in that fight flight system, we’re actively doing right, we’re doing things as a way to deal to stress, or to deal with a threat. And then, after a while of kind of doing what we think is going to be effective, is no longer effective or it’s not working, we get into a state of, well what’s the point? Why do I even bother… nothing I do it will make a difference, and so there really is this lack of motivation that can kind of turn up as well.

And finally, another process that kind of shows up is this sense of depersonalization, and this is when we start to feel disconnected from other people. So we may have less empathy for others, we find ourselves struggling to feel compassionate or caring for others, and this also a part of that numbing that can happen when we’re in that hypo arousal or freeze state and that emotional numbing is there as a way to kind of, it sounds paradoxical, but it kind of is there to protect us, because, due to this emotional exhaustion, due to this decreased sense of accomplishment, our minds and our body systems are like, “we can’t do anything anymore,” and so what I kind of have to do is turn off that empathy and compassion, because I actually don’t have the capacity for it. And for those of us that are in helping professions, this can be really demoralizing sometimes because a lot of us are here to help others. We want to help others feel better and improve their lives and once we start to notice, you know we’re a bit cynical or not feeling as motivated and we’re not really caring about other people’s situations anymore, that in and of itself can be quite triggering and upsetting for us because it’s like we’re not in line with our values and who we want to be and what’s important to us.

And so, I’m just going to kind of give all of you a chance to kind of look at this list and just think about how many can you check off right now? Are you experiencing any of these? Are you really connecting with any or are you kind of in a state of knowing? You know what, I’m not feeling exhausted or depersonalize right now, I’m feeling pretty good. And there’s no judgment, it is what it is.

Because when we think about it, we’ve all been dealing with this pandemic crisis for over a year, and we have kind of been in varying levels of stress response. And what I’ve been hearing a lot is people are like, I’m hitting a wall. I’m not as effective as I was. I’m more irritable, I’m more cranky, I just have less patience, it’s hard for me to get going in the mornings. That’s kind of burnout; that’s us reaching that hypo arousal stage of the stress response and it’s normal. It doesn’t mean that it sucks any less but it’s normal. And for those of us that are in helping professions, this burnout is probably even more severe because we’ve been working really, really hard to ensure our safety, ensure our client’s safety, ensure our family’s safety, and to see the numbers going up is very disappointing and can really contribute to that sense of futility. So, if you are feeling a number of these different sensations or experiences right now, I’m just going to ask you to kind of take a moment and just be really kind to yourself. Maybe even say, “yeah it makes sense that I’m feeling like this. It’s really hard. And I’m not alone in this, there are probably thousands, if not millions of people that are feeling a lot of what I’m feeling right now.”

22:42 RESILIENCE

Sandeep: So how do we overcome this adversity that we’re all experiencing or how do we help our clients overcome the difficulties in their lives? One of the theories and ideas is that resilience, emotional resilience is a large part of what helps people manage through the multiple stressors and stressful experiences in their lives.

What is resilience? There’s no one kind of coherent or agreed upon definition, but basically resilience is conceptualized as an ability to respond and adapt to life’s events and respond and adapt effectively to help people bounce back from setbacks and disappointments and to be able to do this in ways that ensure that people are aligned with their values and with meaning and what’s important to them, and the other piece is that resilience is not something special. It’s not really extraordinary. It’s what many of us have. We all have resilience; we are all resilient. I mean our ancestors had to be resilient in order for us to even be here. Resilience is something that is part of who we are as human beings. What is differing, is maybe the extent to which we are resilient. One of the things to remember is that because we are resilient doesn’t mean we haven’t experienced hardship. We actually need to experience some hardship and some emotional distress in order to learn how to manage it, and so you know, sometimes what I found in my work is that individuals who kind of were very protected, who maybe had you know kind of like that helicopter parenting style or people that were very much sheltered from experiencing any kind of problems or stress or people who had others kind of solve their stressful situations, they actually don’t have a lot of resilience, and then as they enter adulthood and are starting to encounter you know the stressors of being an adult, there is this kind of sometimes a bit of crumbling where their stress has increased to a certain point, and they’re not able to manage it very effectively, and so this can then result in mental health difficulties. There’s also the other spectrum, the other set of the spectrum where too much stress can also inhibit people’s resilience and I’ll get into that in the next slide.

25:37 CONTRIBUTORS TO RESILIENCE

Sandeep: So, what contributes to resilience? One of the things to keep in mind is that in our in our western context, there is a very individualistic kind of approach to mental health and well being, and as we’re increasingly learning, increasingly becoming aware, is that our mental health and well being is very much a result of our communal experiences and healing does happen in communal settings. And so, resilience develops through various factors, these include personal, biological, and the environmental and system level factors play a large role as well.

So, in terms of personal factors, these can include, kind of like, genetic things, you know our temperaments. We’re all born with various temperaments, with varying levels of emotional sensitivity, and some would even say kind of our personalities are somewhat genetic. So, some research has shown or suggested that personality can contribute to resilience, so people that are kind of higher on the scale of openness, extraversion, and agreeableness tend to have more resilience. Individuals who have more cognitive flexibility, so able to kind of see different perspectives, able to kind of see more than one approach to difficulties or problems. Individuals who have really affective emotional regulation skills are also quite resilient. Some biological environmental factors can include the environments, our early childhood environments. There is strong research that shows that harsh versus nurturing environments shapes early brain development. And then that subsequently impacts our nervous system and our sensitivities to threat and stress and then the environment and systems in which we grow up can also play a huge role in shaping our resilience, so you know, if we grew up in settings where there’s a lot of social support. That can include social support in nurturing from family, extended family, our peers, schools, community environments can play a huge role. We will often hear stories of individuals who grew up in quite harsh family environments but were able to connect with role models or really nurturing individuals in their communities and it’s that connection with that individual or individuals that were nurturing that helped to build resilience.

Another piece to look at it, as well, is that there are huge socio-economic forces and social policies that play a huge role in our resilience. And so, when you look at you know funding of schools and funding of social services, those are again very much part of our communities, and so, if the community in which we’re living is not able to nurture that emotional wellbeing, well then that’s also going to negatively impact our ability to develop resilience.

So, you know, in some ways, absolutely having some difficult life experiences helps us to develop resilience right because we’ve got to have some difficulty in order to know what to do with it. But it’s a spectrum; too little stress doesn’t help to build very good resilience and too much stress, too many stressors as well does not help to build resilience, because when you think about it what’s happening is that for those on the higher end of the stress spectrum, their stress response is kind of always on, and so there is an opportunity to successfully reduce that stress response, and so the body is just becoming increasingly sensitive to threat and stress and it’s not able to develop the skills necessary up to that point in their lives. So, it’s really important to take a broad perspective of individual’s resilience. Often there is, you know in our societies and our culture to blame individuals, oh they’re just not resilient. They just don’t know how to deal with stress. But let’s kind of take a look back and think about what was their environment like? What were the social policies in which they grew up like? You know what hardships, what racism, what classism, what intergenerational trauma are these individuals also dealing with as they managed and dealt with their hardships?

I like this quotation from Brene Brown, which is that resilience is more available to people curious about their own line of thinking and behaving. And so, this goes again to this ability to be self reflective and cognitively flexible. And again, these skills of self reflection and cognitive flexibility are also skills and ways of being that we learn from others in our environment, and these are also ways of being that are often fostered in the environment that we’re in, so again it’s resilience is very much a nature and nurture situation. What we want to do as we’re working with people and even working with ourselves is thinking about how can I encourage individuals to be curious about themselves so that they are able to develop the skills and the knowledge to be more resilient? Sometimes that curiosity also includes understanding the circumstances in which they were raised, the circumstances in which they grew up, because again that helps them to understand themselves, and it can kind of help to take away a lot of that self blame that individuals who are prone to mental health diagnosis and substance use disorders, helps to mitigate some of that self blame and to engage in some self compassion, and self compassion is something that also helps with resilience.

31:56 MANAGING ADVERSITY: HOW CAN WE COPE WITH ADVERSE EVENTS?

Sandeep: So how can we cope with adverse events? There are many ways, so even if you know we’ve kind of gone to a point in our lives where its like, okay you know what, my resilience isn’t so great and there’s various different types of measures and assessments, and things like that that you can do to measure your resilience, but, in general, if you know you’re like, you know I’m kind of struggling with my resilience right now, or right now, you know after a year of being in corona, this coronavirus pandemic, I’m not feeling so strong, I’m not feeling so resilient, or even if we have clients that are approaching us saying I’m just really struggling right now. There are still ways that we can foster this. It’s not a what is it? An end sum game, is that even the right word? But it’s not an all or nothing thing, it’s not either we’re resilient or not, it’s something that we can develop and nurture over time. So how do we do this?

So, one way is to being more intentional about completing that stress cycle. So, if we kind of, if you want to just refresh your memory to those three-line graphs that I had, and how oftentimes we’re kind of staying in that high stress or hyperarousal state where were not completing the stress cycle. What we want to do is intentionally engage in activities that help to flush out the leftover chemical and physiological stressors and stress, sorry, even if the stressor is still there. So, the stressor can still be there, but we’re actually still able to engage in activities that helps to manage the stress of the moment. And what this does is it then helps us to better be able to manage a stressor when it comes back in our face.

33:45 SEVEN STRATEGIES TO COMPLETE THE STRESS CYCLE

Sandeep: So, what are some things that we can do? So, there are seven strategies here, so when you’re feeling really stressed, when you’re hyper aroused, when you’re feeling quite anxious or angry, or whatever it is, sometimes what can help is a really good cry, is allowing ourselves to feel the emotion. Because often what’s happening is when we’re in the state of hyperarousal, because it’s so uncomfortable and unpleasant, we’re actually doing a lot of things to avoid feeling it. And, by avoiding feeling that stress, we’re actually just letting the stress build up more and more in our bodies, and so what we want to do is engage in activities that helps us to feel that emotion or emotions and release it, so crying is one way to feel the emotion, and the act of crying does release chemicals. I mean, there are chemicals and hormones in our tears and one thing to do is while you’re crying is, to actually focus on the physical act of crying, so being mindful of your crying. So, focusing on what does it feel like when the tears are coming down my face? What does it feel like when that snot is just like draining out of our nose? I know it sounds gross, it totally does, but again, what this is doing is helping us connect with that physical act of crying rather than getting caught up with the thoughts associated with crying, because often we have really negative thoughts about our crying and that actually activates the stress response even more, so just cry. Give yourself a good cry. This doesn’t mean the stressor is gone, but what this does is it allows your body to feel the emotion.

Something else that we can do is engage in diaphragmatic breathing, and so this is such a, often it’s even kind of like an instinctual response, right? Sometimes after a really stressful phone call or a stressful interaction with somebody, often times you know I’ll just give a big exhale and that exhale, what that does, is that heavy exhale actually activates our vagus nerve. It activates, I believe it’s a dorsal part of the vagus nerve, which then activates the parasympathetic nervous system, which is that part of the nervous system that helps us to rest, helps us to digest, helps to connect with others, and that is the calming aspect of the nervous system. And so, breathing deeply where we really focus on expanding the diaphragm and then having the exhale longer than the inhale helps to activate the vagus nervous system and activate a parasympathetic system, and that also helps to flush out the stress in our bodies, and brings us to a point where we can be more effective, ongoing.

Laughter as well, is a way to manage stress and it to be perfectly honest, sometimes after a stressful day at work I will intentionally watch comedies. Whether it’s Parks and Rec or the Office, or Superstore I know I need a really good laugh. And that doesn’t mean the stressor has gone away, but what that means is I’m again able to engage in that activity of releasing some of those negative or difficult, stressful chemicals.

Affection is also something else that can help to complete the stress cycle so there’s some research that shows like a 20-minute hug, like a 20-minute bear hug where you’re just enveloped in somebody else’s arms helps to activate that parasympathetic nervous system. Affection can also include a really meaningful conversation with someone and again that’s connection.
Some studies even say, like a six second kiss helps to activate connection in the parasympathetic nervous system. Sometimes what I’ll even do is, so I have two small kids, a six-year-old and a four-year-old and if they’re you know, having a rough time and they’re totally dysregulated, sometimes I’ll just ask them, “do you want a hug?” And what we call them in our house is huggles, a combination of cuddle and hug. I’ll be like, do you need a huggle and what we’ll do is we’ll just sit down and we’ll hug for a little while and maybe that hasn’t taken their stressor away but it’s just helped them to regulate themselves.

Another really effective way of completing the stress cycle is movement; exercise, dance, shaking it off, so again, anything to activate our bodies helps to take out that stress response. In this pandemic, you know I think one of the things that has been difficult for people is their gym routines or their exercise routines have been interrupted, so I encourage you to find other ways to move. It can be a dance party and dance like no one’s watching and you know it can be even sometimes doing some jumping jacks or running on the spot, anything to flush out those chemicals.

And then creative expression is also another way, and so this can include artwork, this can include playing an instrument, this can include listening to music, even sometimes going out in nature is also, in really appreciating the beauty of nature, looking at the different colors and watching the animals. That is also a way of engaging the parasympathetic nervous system, which helps to regulate our stress response.

39:40 PLANFUL PROBLEM SOLVING

Sandeep: And there are also other things that we can do, so there are some stressors that we can control right so there’s some sources that we can’t and so, some for some stressors that we can’t control so, for example, if we know we’re going to have a stressful conversation with somebody, if we know we’ve got you know, a really busy day coming up, and we’re starting to feel that anticipatory anxiety, let’s do some plan for problem solving, right? So, what does this mean? This means let’s anticipate what other problems I’m going to maybe encounter and let me develop a cope ahead plan so if X happens, what will I do? If A happens, what will I do? And the idea is to start and get our minds ready for different options and solutions, letting our minds know that these are different things that we can do, so we’re not stuck. So that when the stressor shows up, we don’t kind of go into this freeze responsive of “oh my God I don’t know what to do.” We’ve already kind of thought about it, so what can often happen is when we think about and plays sort of incidents in our mind, so if you imagine ourselves solving the problem is, in our minds that, in a way tricks or brains into thinking you’ve already done it so it’s kind of like then like we’ve rehearsed it already. So, this is a way of coping with stress and in managing adversity.

And the other piece is to really focus on breaking large task into small steps, because often what happens is we just kind of get lost in all the details and we just see all this huge, big problem and what we want to do is take a step back and think about well, what are the discrete things that I can do? Rather than this huge task I need to overcome, I’ve got to do one thing first, then I can do the next thing, and then the next thing.

And the other thing to do is include strategies to complete the stress cycle in your plan for problem solving, so include moments to do some deep breathing, to incorporate some laughter, to call a friend and have that social connection. Include that in your problem-solving plan, it’s so important, and this is again for stressors that that we can control.

And then there are stressors that we cannot control. There are stressors that maybe are ongoing and COVID, I’m going to keep talking about COVID, because I feel like that’s the one thing that connects everybody in the world right now, and like COVID is a bit of a nuisance right now, and we cannot control it, and so what we can do is radically accept. And so, what is this concept of radical acceptance? Radical acceptance means completely, totally accepting with our minds, bodies, and spirits that we cannot change the present facts. We don’t have to like them, we don’t have to like that coronavirus is here, and that you know, there’s another lockdown on Ontario. We don’t have to like it, but rather than getting stuck in, why is this happening again? Why is this happening to me? Why can’t my kids be in school? Why do I have to do online schooling with my kids? Why can’t I go to the gym?

What this keeps us doing is fighting with reality and if we keep fighting with reality, we are not able to deal with it, because what we’re actually trying to do in our minds is change something that actually cannot be changed. So radical acceptance is what helps us to keep our pain from turning into suffering, and suffering is what leads to long term stress and mental health difficulties, so it’s about acknowledging our pain, that yes, this sucks, this is hard, and I can’t change anything about it. The only thing that I can do is change my response to it; is change how I engaged with this stressor that I cannot control right? Because the more we focus on what we cannot control the more we feel helpless and futile, so it’s about what can I manage in this situation? And we can only change our responses once we accept what we are dealing with.

43:52 REDEFINE WINNING AND FAILING

Sandeep: Another idea is to redefine, what does it mean to succeed or win and what does it mean to fail? And often what can happen is that we become very fixated on the outcome, you know so, for example, let’s say you know there’s a really great job that you want to apply for and what we get really fixated on is, am I going to get the job? Will I get the job? I need to get the job. What kind of sucks is that whether we get the job or not is kind of our control right? Because, ultimately who decides is probably an interview panel that we just meet when we do our interview and it’s up to them and it’s also up to the other candidates that are interviewing and how well they do.

And so, if we stay so focused on the outcome, what that does is, it is actually a bit more stressful because again that’s something that we cannot control. But what we can control is the process, so how can I focus on preparing for this job interview? What do I need to do? What do I need to research? How can I ensure that I feel comfortable with my knowledge and skills going into this interview? That’s all I can control, so the idea of redefining winning. Winning can be, you know, the small successes. Okay I got the interview, that’s a win. Okay, I did the interview, that’s a win. And then, if I get a job, well that’s awesome and that’s a win, but again it’s like, how can I define winning as I go along the steps, rather than thinking, everything is a fail if I don’t meet that one outcome? And that kind of goes back to setting small goals and celebrating small successes.

And the other piece is really re-examining your expectations. Oftentimes our expectations are unrealistic and way too high, and if we’re setting unrealistic expectations for ourselves, we’re kind of always failing right, if we’re not meeting them, and that in and of itself is a stress. That’s a stressor. This sense of I’m not achieving, I’m being very self critical of myself that contributes to our threat, sorry it’s interpreted as a threat by our system so it’s like, how can re-examine my expectations and redefine what it means to be successful?

46:28 FOCUS ON MEANING

Sandeep: The other piece is to focus on meaning, and I really like this definition of meaning from Nagoski and Nagoski’s book Burnout, so they define meaning as, the nourishing experience of feeling like we’re connected to something larger than ourselves. It helps us thrive when things are going well, and it helps us cope when things go wrong. And what this does is it helps us to manage that sense of futility that can sometimes arise after we’ve been experiencing stress for a long time that turns up when we’re in burnout.

And so, how do we even know like what is meaning, how do we develop that? Well one of the first things is to really know your values, so explore and understand your values. And oftentimes what can happen is people end up in distress, or like this moral conundrum when they’re behaving in ways that are not aligned with their values. So again, the goals, the outcomes, we cannot control. What we can kind of manage whether we’re making decisions and taking actions that are in line with our values. So that even if something doesn’t turn out the way we were hoping for, at least we have the knowledge that, you know what I still stayed true to myself. I still stayed true to what matters to me while I engaged in this pursuit. It helps us to cope with disappointment.

And what I’ve included here is a copy of an activity, called the Bullseye activity, and this is a values reflection activity from acceptance and commitment therapy. And what it does, is it has us reflect on what matters to us, our values in different domains of our lives, and then to kind of evaluate how closely we are living in mind those values as certain points in our lives and often I’m kind of like what I said, is the more away from target we are from our values can often result in more distress, so it’s about kind of seeing okay, what are my values? What matters to me?
Am I aligned with them right now and if I’m not, how can I start to make intentional choices and decisions so that I can align with them somewhat more?

And another piece to do as well, is to kind of create a new narrative about your adversity, so this is something that we can do for ourselves, this is also an activity that we can guide individuals and clients through and the idea of rewriting the narrative our adversity, is to develop a sense of what did I learn about myself? What lessons did I learn? What have I learned about in terms of my strengths and my abilities? Because if you have been able, if you were here right now, you survived your stress, you survived that adversity. Perhaps you’re still in a bit of rough shape, but you still were able to survive it in some way, so what were you able to do? Right, so some of these things to review are, you know what were some parts of the adversity that you cannot control and what did you do? What did you actively do to survive the adversity in the moment? What resources did you leverage to continue to survive after the adversity past? And then to kind of reflect on, well when else have I used these resources? Resources can include things like your own personal abilities, your strengths, your knowledge. Perhaps there were some social resources, people in your environment. What were you able to resource in order to survive the adversity and how are you still here? Right, like again yeah maybe you’re in rough shape, but you’re still here, so you were doing things that helped you to cope and manage. And so, how do we identify what those are and really build on those?

And the other piece is to really identify, like what parts were not controllable? Because often what can happen is your mind gets stuck on these parts of the story that we couldn’t control and we beat ourselves up and we engage in a lot of self blame, but to really, really flush those pieces out because, again what that does, it helps us to develop some self-compassion and understanding that, you know what, what I could control, I did, and there are other parts that were out of my control and that’s okay because I’m still here and what did I do to get here? And again, that helps people to tap into their resilience and we can really then build on that to help people further develop the resilience and be able to withstand ongoing stressors and manage their mental health.

And then something that we kind of want to be doing on a regular basis is you know I kind of call it planting and watering your seeds. And so, what does this mean? So, S stands for developing social connectivity, really focusing on developing meaningful connection with other people, incorporating regular exercise into your, into your routine. Education: this means learning. It doesn’t mean going up you’re going to the master’s or a PhD. but can you learn a new skill? It’s interesting, I learned recently that when we learn something new or are engaged in a novel task that actually releases dopamine in our brains so, dopamine is very much part of the pleasure system and so if you’re in a funk right, how can you maybe engage in a new skill, learn something new, as a way to keep your mind active? And diet, having a healthy, balanced diet is also really important and sleep. Sleep, sleep, sleep, sleep, sleep and what I’ll say, sleep and rest. So sleep I think it’s well known, the importance of having adequate sleep, but also looking at how can I incorporate more rest into, into my schedule? We are all very much part of a hustle lifestyle, where you know working hard and not resting are kind of really rewarded and I’m here to say that that’s crap. We need to rest, so what are ways that you can incorporate rest and restoration into your day, so that you are able to have the reserves to deal with the stressors when they show up?

53:03 CONCLUSION

Sandeep: So that concludes my presentation and thank you very much everybody for your attention, and I believe we have some time to answer some questions so I’ll throw it to you Suanne.

Suanne: Yes, Hi Cindy, Thank you so much. That was wonderful we’ve already got some very positive comments coming through. There are a couple questions in the Q and A box, and so we’ll try to get through as many as we can.

The first one kind of goes back to a little bit to the beginning of your presentation around the freeze or the flight response. The question is, what if you have symptoms from both freeze and flight? Is that possible? For example, feeling anxious and depressed about something.

Sandeep: Yes, absolutely, it is very much possible to have kind of two emotions at the time, and so what you want to do when that is happening is kind of reflect on which one is the most intense, right so is it my anxiety that’s the most intense right now, or is it the depression? And then what you want to do is kind of intervene and address that one experience that’s the most intense in that moment, because, then that will help you then deal with the other, the other response that’s kind of being activated right now.

Suanne: The next question is around burnout and stress versus something more serious like an undiagnosed depression or anxiety disorder, how do you know the difference between the two?

Sandeep: That’s a great question, and so one of the ways that I kind of, that we want to look at it, is that when there is a diagnosable mental illness, what’s happening is that the individual is struggling to function in several areas of their life, so that includes difficulties functioning in their personal self care, the personal wellbeing, their struggles in their interpersonal relationships, occupational functioning, so it’s a bit kind of widespread right so that’s when we’re looking at a little bit, like again I can’t diagnose that’s not within my scope, but often when people are dealing with you know, an anxiety disorder or depressive disorder, the difficulties in functioning are a bit broad in kind of in several areas of their life versus say burnout. Sometimes you know, you may be burnt out at work, right so some of those symptoms of exhaustion and depersonalization are showing up at work, but in your life outside of work you’re doing okay right, so your relationships are still functioning, you’re still able to engage in your day-to-day tasks, and you’re able to get things done. And so, it doesn’t mean that that burnout at work isn’t serious, it’s still very serious and it needs to be addressed, because if it’s not address it can then bleed into other areas of your life, which then is kind of what leads to that more of that severe diagnosis or disorder that we really want to make sure we address. I hope that helps.

Suanne: Yep, I think so, and there was a slight kind of, another person who asked a follow up question to that, and so, if you, if you define you know someone who has stress or burnout versus you know, for depression or anxiety disorder, what would be kind of your difference in approach from the clinical perspective?

Sandeep: So, one of the main pieces I would do is ensure with them, if it is more of a clinical disorder, ensuring that we’ve got like physicians and a medical team involved as well because you know, we may want to explore whether this individual could benefit from some medications. The other piece is to do like a proper physical checkup and explore whether there are any other reasons, maybe for why this mood disorder or difficulties can be showing up and so definitely wanting to get like I said the medical team involved to do a full kind of examination. What would happen is, I guess, and the other piece would be in terms of my approach you know, with individuals who have to have that mood disorder is really ensuring that sense of safety so if somebody is quite depressed, ensuring you know, assessing for suicidality, assessing for risk of self harm, and ensuring that they have adequate support should they start to feel increasingly unsafe, and otherwise, you know I feel like my approach might be a little bit similar in terms of looking at you know, people’s schedules right, so their routines. Are you taking adequate care of yourself? And so, with somebody who is quite depressed, one of the first lines of intervention is activation, so let’s start to engage in small activities, let’s start to have small routines, just to kind of get you engaged and active again, but then also for people who are burnt out and stressed,
it’s again ensuring, like are there any part of your routine that you’ve dropped out because you’ve been so stressed? Have you stopped exercising or not exercising as much? Is your diet kind of all over the place because your schedule is so wild? So really kind of looking at what’s happening on a day-to-day basis. What are the things that we can control, so kind of like let’s plant the seeds, let’s ensure that our seeds are planted and watered. And then kind of getting into more of the psychotherapy in terms of okay, so what are the typical thoughts, feelings, and sensations that you’re struggling with and how are they contributing to your current difficulties? So how are they contributing to your stress and burnout or how are they contributing to your depressive and anxious emotions?

Suanne: Thank you, so I think we only have time for one question, so the last question is around resilience and are there ways or tools to be able to measure different levels of resilience?

Sandeep: So there are there are different measures, unfortunately I don’t know them off the top of my head right now, but maybe one thing I can do is maybe like when the presentation is sent out again, maybe I can include like a link in the last slide, because I included a couple of references, but maybe what I can do is include a couple of links and then that can be sent out with the presentation, the recorded presentation.

Suanne: That would be wonderful, thank you.

Sandeep: No problem

Suanne: Okay, and also, very just quick thing, but somebody asked just the name of the book on burnout, I think that you mentioned at the beginning.

Sandeep: Yeah, it is in the references, let me just go to the next one ah, and so it’s right here Burnout: The secret to unlocking a stress cycle and for anybody that listens to podcasts, Emily and Amelia were actually on one of Brene Brown’s podcast where they were talking about this book, so maybe what I’ll do as well is include a link to that podcast because it was a great podcast that was really helpful. Yeah, and I may include another link to another podcast as well. I love podcasts.

Suanne: Amazing, okay, so it sounds like a couple more resources coming your way everyone, and like I said that’s all the time we’ve got for today. Thank you so much Sandeep for joining us and for sharing your knowledge and your passion and thank you everyone in the audience for joining us today as well, and taking the time.
Again, if you do have any questions about our programs or our treatment centers, please visit our website ehncanada.com. You can also always send any questions to [email protected] as well and we’ll get that to the right place and get your answers back to you. Otherwise, I hope everyone stays safe and well and that we see you again on another webinar soon, thank you.