Coping With Stress: Cognitive-Behavioral Stress Reduction

This UCSD TV show is brought to you by University of California Television, like what you'll learn, visit our website or follow us on Facebook and Twitter to stay up to date with the latest shows. Also be sure to check out and subscribe to our original YouTube channel, uctv Prime, available only on YouTube, it is my great pleasure to introduce you to Dr. Jason Saterfield, who we have worked with together for at least 10 years, probably 15 15 oh, Thank you for my mental alertness. Dr. Saterfield is an associate professor of medicine and director of the Behavioral Medicine program. in my General Internal Medicine division and I just found out from the bibliography that he is also the author of a book that is about to be published next February, so I have already committed to getting a signed copy.

He is really, really, gifted. professor and, more importantly, an expert in the area you are going to discuss tonight and I already told you that after all your questions two weeks ago, after Dr. Kemy's presentation on the effect of

stress

on the system immunological, you all were very I'm eager to hear about concrete tools and how they manifest in what's called

cognitive

behavioral

therapy, so it's my pleasure to introduce you to Dr. Saterfield. Well, good evening everyone, it's a pleasure for me to be here tonight and I think you can see that tonight's talk is a slight change of pace uh, I think you guys have learned a lot about the basic science, the basic research behind of

stress

and behind

coping

.

They also learned from Dr. Kimy two weeks ago about the physiology of stress, of course, important for disease and is one of the reasons is probably the main reason why we want to learn about stress management. I decided tonight that I would take a very practical, very clinical approach, so we're going to talk about a lot of very practical, practical interventions, which I hope will be helpful. that you can try for yourself or for your loved ones in order in terms of reducing the magnitude of your stress response, where we're going to focus there, there's really a very long menu of different types of stress management ideas that we can We could talk, but we'll really focus on how to use our minds to change the way our bodies feel.

In the broad category of mind-body medicine, but more specifically we will look at

cognitive

-

behavioral

interventions and how they influence our experience. of stress sometimes in a negative way, but hopefully we will learn to use them in a positive way to achieve this. There are several road markings that we must cross along the way. Today we want to talk first. about some of the basics of stress and I want to calibrate our language to make sure the words and terms I'm using match what you've already learned. I want to share some basic cognitive behavioral foundations, so I really give you a little bit.

A little bit of the history and theoretical underpinnings of why we think changing the way you think could change the way your body feels. Let me tell you from the beginning that this is not the Don't Worry Be Happy seminar. About puns is not about mind games or sophistry, it is about understanding the interconnection between how we think and how we feel in the behavioral choices we make. Let's go over some specific examples of how to work with assessments. the way we think about stressors and the way we think about how to cope with them, we'll talk about a specific example of explanatory style, then move on to some present moment

coping

strategies to change the way we feel both emotionally and physically , but from there we will talk about much deeper ways to cope with something I have called deep coping.

It's not necessarily about the present moment, but it helps us lay a stronger foundation for dealing with stressors that might lie ahead there and in the future. We'll talk about Connections, we'll talk about social support, and we'll end up talking about meaning, so this is just a quick review of you, uh, Susan Folman, the first lecture in this series talked about some of your research, uh, uh. with uh uh di Lazarus talked about the stress process and these are some of the main actors or uh stages of this process first on the left we have the emergence of a potential stressor, this could be real or it could be imagined, this could be a test you have to take this could be a deadline at work this could be a conflict a recurring conflict you have with your spouse we think about that stressor in two different ways we have our main appraisals thoughts you have about the stressor Does it matter?

Its a big problem? What are the implications? Should I really worry about this or not? Secondary evaluations. This is how you think about your coping. Resources. Can I face this? I know what to do? Do I have social support? Do I have the money, the time, the energy to do whatever it takes to deal with this potential stressor? For the potential stressor to happen. You think about the stressor. You do an assessment of the stressor. You make an evaluation of your resources to face it. And depending on your type of evaluation. helps us understand the type and magnitude of your stress response assessments help us understand why two people may experience the exact same event one will feel incredibly stressed the other may not feel that stressed at all it is because they probably thought that way different about the importance of the stressor in the primary assessment or perhaps they thought differently about their ability to cope with that stressor.

If we're looking for opportunities for stress management, you should already see that there are a couple of different places we could focus those interventions. uh, change the likelihood that you're 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. stressor in itself or in reality. the framework that we put on the stressor and in general we divide stressors into two categories stress is not bad stress is important we need stress it helps us activate it gives us energy sometimes it gives us a focus that we need to be able to fix or change a problem particular problem, but there is this division that occurs quite early and whether or not we see a stressor as something that is a challenge or something that is a threat, if we see something that is a challenge, yes, it can be difficult, it can require a a lot of time and energy but I feel a little excited about it it's a project at work that I really like and it's going to take a lot of time but I think I'm ready for it I think I'm going to learn something something from this I think I can get help it's a challenge but I don't see it as a threat because it is a threat in general people see it as something whose outcome is something unknown a positive outcome may be unlikely Your ability to deal with it or even if you know what it will take to deal with it is Much less do you see it as a threat, you have little control and much more anxiety as a consequence of your approach or your evaluation of that stressor.

The other thing that What I want to analyze is not only if it is a challenge or a threat, is it chronic or acute? So is it a one-time stressor? Is it something that will recur or be present over a period of time? In the worst case. In times of, in terms of the magnitude of our stress response, it's something that's chronic, so it's going to be there for quite a while and it's something that's seen as a threat. Now we worry about these, we worry about stress and we worry about our habits. coping because it is related to our well-being, it is related to our mental well-being, but also our physical well-being, and we will also talk mainly about stress management as a way to buffer the physiological effects. of stress, but it is important to remember that there are several different ways in which stress can contribute to illness.

These are the three main routes. It's important to remember that when most of us get stressed we do the exact opposite of what we need. what they do to stay healthy, when most people are stressed they sleep less they drink more alcohol they may smoke more cigarettes they withdraw from their social supports they eat less food they don't have time to go out and cook or prepare healthy meals So what they are doing as they get more stressed is actually engaging in more unhealthy behaviors, so that's a behavioral-only path. Another way is that we see changes in medical compliance or medical adherence.

We often see people who have had a flare or relapse of their disease, their diabetes suddenly gets worse because they became stressed and stopped taking their medications, stopped exercising, stopped doing the things they needed to do to control their disease and stay healthy and The last pathway is the physiological pathway and this is what Dr. Kimy was talking about and talking about how stress affects the immune system. All three are important, so we want to help decrease the magnitude of the stress response. We might also want this chart here to help people choose more appropriate, more useful, more constructive ways to cope with the stressor.

This was also in Dr. Folman's talk, the first talk in the series that she talked about when we experience a stressor, we think about the stressor, our coping resources that we have. our response to stress, remember it can be physical, emotional, behavioral, cognitive, we decide what we are going to do and our responses to that stressor generally fit into two categories, problem focused, which means rolling up your sleeves and does whatever it takes to change. or directly address the stressor, so if the stressor is, for example, a license renewal exam coming up at some point, a problem-focused coping mechanism would be studying for that exam, it directly affects the outcome of that stressor, the other category is emotion-focused coping. and uh, it's equally important, but it really has a different focus here.

It's not necessarily about doing something constructive to change the stressor, but rather doing something to change the way you feel if you're in a situation where the stressor is immutable or you have already studied for that test as much as you have. could, but you still feel anxious. A distraction can be helpful. Call a friend. It can be useful. Do something that you find pleasurable and that brings your mind to a more productive state. The state could be useful. The best copers are people who know when to use which type of coping, most stressors require a combination of both types of coping, so you need to know when I use problem focus, when I use emotion focus, and we'll talk. .

We'll talk about that a little later, as I mentioned. Stress management could include interventions at any point along this path, it may include behavioral interventions to prevent you from exposing yourself to a stressor. Let's say that many of your stressors come from your workplace, they come from your boss, they come from your coworkers, they come from the work task itself. A perhaps very effective strategy in terms of managing your stress would be to leave your job and move to another job. different to exchange one set of stressors for a different set of stressors but again you have done something very concrete and behavioral that distances you from those things that are causing you stress that would be here at the level of stressors.

Another intervention would be to look at the primary and secondary assessments that you've made and whether or not, those assessments are useful, whether those assessments are accurate or not, we'll talk about that more, another intervention could directly affect the stress response you're having, and here is really the category of medications, so things like benzo diazines, anxiety pills, that help people reduce the magnitude of the stress response that other interventions are having. They can teach you better ways to cope, whether in terms of problem-solving, rolling up your sleeves, and learning how to approach a problem. more effectively or in terms of building or getting your social supports or mood management strategies more effectively, okay, so let's talk a little bit about some of the basic concepts behind C I nitive therapy uh, we're not really talking about cognitive therapy per se. tonight, but we're talking about cognitive-behavioral interventions that have been drawn from a sort of complete package of therapy.

Now, this entire therapy package was first developed for the treatment of depression and the person who developed them or at least gave them primary care. Credit to Aaron Beck. It's in the top cornerleft or right of the slide. It was the late 1960s. He had probably trained at one of the major psychoanalytic training institutes. His main interest was the treatment of depression, which is incredibly common. uh and at that time also a very difficult and challenging treatment to treat that sometimes required three to four psychoanalytic sessions uh per week for up to two or three years uh and not much evidence to suggest that if a person improved it was the therapy that helped them.

He was helping well despite his frustration with the length of treatment required. He also began to notice that there were many similar patterns in the depressed patients he was seeing; they all tended to have a very negative attitude. self-image they had very negative, mostly hypercritical thoughts about themselves, they had a very pessimistic view of the world and their future and they also had very negative thoughts about other people and other relationships and what other people might or might not do to them could 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 seemed to deepen and worsen their depressive symptoms, the light bulb went on for Beck and he started thinking about what What would happen if I directly addressed a person's way of thinking if I started from the top. how they think in the present moment made them reflect on the way they think changing the way they think that would change the way they feel that would eventually change their relationships that would eventually change them in a biological sense and that they would no longer meet the criteria for this biological disease that we call depression, as you can guess, according to The Story Goes, they found that this was actually quite effective and now, about 40 years later, there were probably over 10,000 or So, studies looking at CBT not just for depression, they actually expand to anxiety, stress, eating disorders and many different disorders, and they have found that there really is a collection of both cognitive and behavioral strategies that can be very effective for either psychopathology or just in general. for mental health some of the general ideas that are important to understand before thinking about cognitive interventions, first, we are not particularly rational, that is not a bad thing, 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 types of things we remember the types of things we pay attention to are very subjective they are very influenced by our personalities they are very influenced by our environment We are even influenced by our current moods at that moment, so it's first of all important that you realize that it's not a question of intelligence, it's not how fast you are, it's just the way people think, what they makes us so fantastic and It's very interesting, but when things are not going so well that it can cause a lot of unnecessary suffering, that suffering or what Beck calls dysfunctional thinking is common to all psychological disorders, there is a kind of different flavor or a different variety in types of distortions.

That tends to happen depending on the type of disorder we're thinking about, so for an individual who has an eating disorder, say anorexia, many of the distortions are thoughts about their appearance or their body image, about the importance of control over what it does. are eating from depression are thoughts about oneself are thoughts about others and are pessimism about the future and about the world the last idea is to remember the interdependence of thoughts, feelings and behaviors represented in this classic triangle that most therapists CBT They draw for them, this is the idea that the way we feel is closely related to the way we think, which is also closely related to our behaviors, so an example of that would be to say that an individual They feel depressed so that's the mood they are in.

They feel depressed so they think about things very negatively. They are remembering all the bad things that happened. They are making negative predictions about the future. They are evaluating themselves. very negatively, what makes them more depressed what makes them think more negatively what makes them more depressed and so on it is not just about thoughts and mood but also about behaviors here in this lower right corner a person feels depressed is having very negative thoughts what tends to be what you should do is shut down and withdraw if things go wrong they are not going to be good they are not going to be pleasant you are not going to be very good at it anyway why would you get up from the bed? bother to try, a person's depression makes them think negatively, which causes them to withdraw and shut down, which makes them more depressed, which makes them think more negatively, etc., and so on.

The good news about this interdependence is that it gives us a couple of different situations. Opportunities for where we can intervene to change how a person feels now again, you can intervene directly with medications, for example, antidepressants, anti-anxiety agents and change the way a person feels. However, you can also look at the level of thoughts, how is a person thinking? Are there ways we can reevaluate, change, or reshape the ways they think to change how they feel? We can also intervene at the behavioral level. Could we build new social supports? Could we change your job? Could we get them to do it? engage in a different combination of activities that would have a more positive or constructive impact on your mood and I will give you some examples of that, but it is important to remember that we have many opportunities, but our two main avenues are to enter the Avenue of thoughts that they come in through the Avenue of Behaviors, so we're going to go through a few different examples and I thought it would be a lot more interesting instead of just talking about this, ask you to do some of these exercises and we could report back to you.

A little bit, you don't have to do it if you don't want to, but I would recommend that you have a place, some space for notes, so we'll do a couple of different exercises as we go through this list. I'll ask for some volunteers to give you an idea of ​​what it's like to do some of these strategies. Let's look at some cognitive interventions. We're going to do something called ABCD. I will then move on to Explanatory Style I. I will describe the activity schedule. It's probably too complex to do it in such a large group, but then I'll move on to talk about sematic silence and then I hope we have time to do a social gathering.

Supporting exercise, towards the end, so to understand the ABCD, we have to understand a kind of cognitive model that explains why we feel and do the things we do, since it is a cognitive model that you can imagine they are going to talk about . the predominance or importance of cognition or thinking of the ways in which we think about situations the non-cognitive model or the typical model is that there is an activating event, something happens around you and it makes you feel, however, you say something in particular. the cognitive therapist would say no, that's actually not entirely true, there's an intermediate 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 comes to us.

Mind you, it is 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 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 clinic. For a couple of weeks I have been seeing patients here at UCSF, in the Behavioral Medicine unit, and I try to arrive on time. I've been on the other side of the desk before and waited a long, long time for my doctors.

So I try to be on time and I try to finish on time just so people can plan their days and leave their jobs and stuff around their appointment times so that the first patient gets there on time and he said, you know? I really appreciate the fact that you always start on time, you always remember what we did before, we always pick up where we left off, it really feels efficient and respectful and I'm so glad that happens and I just wanted to tell you that. so I felt good and that's what I expected the result to be, we have the next patient that came in and it was actually just the next day after we started on time, the patient came in and seemed a little unhappy and I said well, what's going on, he says, you know you're on time to the point.

I don't like this place, it's like a factory, same triggering event, we're starting our date on time, very different reaction and the reason why there was a different one. In the reaction there was a very different interpretation of why we arrived on time. The first patient thinks it is a sign of respect. The second patient thinks it is a sign of dehumanization. It's just a factory they're in, not that one is necessarily better or worse, but. They have different consequences and when I encourage people to look at beliefs, part B of the ABC, it is not to find the truth, it is not about knowing what is right or wrong, but to think about what thoughts are useful, what thoughts are hurtful, If those thoughts are useful.

Pushing you towards reactions that are useful, there is no need to analyze them. If those thoughts push you toward reactions that aren't so helpful, then maybe it's time to take a step back and think about your thoughts. I guess the other point I want to make our uh is so that we just remember that thoughts are not facts uh thoughts are opinions, they are the best guess or subjective reading of a particular situation uh and if we are able to put our ego aside , we'll see I think for all of us our opinions have been wrong at times, our opinions are changeable, in fact hopefully they change many times as we are presented with new information, so all beliefs are changeable, they are not facts just because you feel they are not so.

We don't necessarily make it happen. We've also found in cognitive therapy work that people don't just have these subjective interpretations or these ideas, these opinions, people tend to develop habits and the types of ideas that come up, we all take shortcuts in thinking. That's how the human brain works, but we tend to find habits probably based on disposition. Perhaps I'm drawing on early family history of the types of shortcuts we tend to take. These are some examples of some mental habits. Some of them may look familiar. You or they may seem familiar to some of your family members or friends.

Some people have a habit of overpersonalizing, so sometimes when bad things happen, they assume it was done to them, take it too personally, and get angry or hurt. As a result, there may be a tendency to magnify the negative things that happen or minimize the positive things that happen. You may know people who find it very difficult to acknowledge their successes and who find it very difficult to accept a compliment. They tend to minimize the positive. 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 sometimes focus on the glass that's half full and other people focus on the glass that's half full empty again, not necessarily right or wrong, good or bad, but we just want to see the consequences of that particular habit.

I won't go into all of these, but I think other common ones are all thoughtless, so I'm a success or I'm a complete failure it's all black or all white mind reading probably innate at least that's what social neuroscience tells us it is. mind reading when we are in a social situation and we are picking up those subtle non-verbal cues from people and we imagine what they might be thinking some of us are very good at it others not so good at it we all make mistakes when we try to imagine what What another person might be thinking Some people because they have hurt me a lot in the past because they have rejection sensitivity, they can always assume that the other person thinking negative things about them and of course that has its own set of consequences negatives, so here's our ABCD exercise and I just want to First, walk through an example and then I'll ask you if you're willing to do your own ABCD exercise.

ABCD means the activating event, which is A, B is the beliefs, C is the consequences and those can be emotional. Get to know them. It can also be behavioral and box D in the lower right corner is a dispute box. This is where you roll up your sleeves and start wrestling with your thoughts, so you take a step back and ask yourself if these thoughts are fair, are they balanced? Am I taking shortcuts? Is there another side ofthe story if my friend thought or said this? What would he say to her? Is there a more constructive way to think about this situation?

Well, here the example of the trigger event is me. I'm sitting at work and I get an email from the boss moving forward and an important deadline just the facts just the situation beliefs this is terrible I'll never be able to finish this is a trap for failure I'm doomed uh how selfish unpleasant consequences I feel anxious, worried and angry, I complain to my coworkers, that's the behavior, the dispute, this is going to be difficult, but I can review the calendar with the boss and see what we can work out, maybe my hands are tied. Sharing my concerns with him shows that he trusts me with an important and challenging project, so the same situation takes a very different spin on how you think about that situation, hopefully with different emotional consequences and maybe different behavioral consequences as well. , so what I will ask you What you need to do is make your own ABCD and the good thing about this is that you don't need a special form, you just need a blank space, a square of paper, you put an X in the middle, you divide it in four boxes, activating the event, the beliefs, the consequences and the dispute. so I'm going to ask you to do one of those and I would recommend, if it's the first one you do, that you choose a trigger event that's relatively small, so an example of a trigger event that's small would be, "You pulled into the parking lot." ". and you saw how much it costs to park at Parnassus, so you may have certain beliefs that there could be certain emotional or behavioral consequences, so we can work through the disputes, of course, you can do this with a much larger event, but in a group. environment and we will talk about it as a group.

It's a lot harder to talk about it. Divorce, grief, those big emotionally charged events, uh, it's really hard to resolve some disputes, so why don't you go ahead and take a minute, write down an activating event, write down some beliefs, You write down any emotional or behavioral consequences and I? I'm going to ask for one or two volunteers, so I'll warn you that almost everyone gets stuck in the dispute box the first few times they do this. It's hard, even for a small, low investment triggering event, it can still be hard when you do it as a group, it's a lot easier to resolve someone else's dispute chart because you're not emotionally attached to it, so how about a volunteer?

I know you're not done yet, we can figure this out together. just grab a volunteer, I'll ask them to share the triggering event, we'll bring up some of the beliefs, we'll talk about the consequences and as a group I want to see if we can fill out the dispute chart together, so who would do it? I would like to share a trigger event, yes, what is your trigger event? uh stock market, so the stock market gyration goes up and down in the stock market, okay, very good, and in the trigger event we don't want to have any kind of interpretation. it's just the facts what happened the stock market goes up and down what were some thoughts you had the belief the belief chart uh uncertainty and how to answer so I don't know how to answer I'm not sure how to answer yes What else does it feel associated with? with that anxiety?

Well, in the consequences picture, some of the feelings he had made him feel anxious. What else is good? So let's get a couple more beliefs out there. There is usually a series of thoughts if you start digging. we kind of have a turn in the stock market I'm not sure what to do what does it mean you're not sure what the consequences of being unsure are why do we care if you're not sure well there's there's there's prosecutors they I could lose money. This could be painful if I lose a lot of money. I could have problems with my partner if I lose a lot of money.

Okay, you feel anxious and do something? Do you sell? Shopping Tours? Outside of the computer, what do you mainly do? You try to better understand what is happening. First, okay, getting more information. Then he feels anxious and tries to get more information. Okay, so he decides if you need it or not. making a dispute box is whether the consequences are something that was undesirable or not, so he feels anxious and starts searching for more information. If we question the thoughts he had. You could lose money. This is going to be terrible. This could be bad. I don't want this to happen, if we question those thoughts, an expert is fine, then maybe there is a different behavior, you could consult an expert.

I would say one thing we can do, it seems like his behavior, getting more information, was very constructive. It's probably helpful, it could be consulting an expert, maybe you're just doing more research on the stock of the company you bought, anxiety is something you know, anxiety is a fun thing, a little anxiety can be helpful, it has too much anxiety. and it's not that helpful, it's overwhelming, it's distracting and it's not productive, so we might want to think of disputes or thoughts that you could use to reduce anxiety so that you're at your highest level of functioning, so what might be some thoughts in the dispute box that might help you 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 nothing it's okay it can go up at any time what else I have a tax right Well what else probably no worse than 2 years ago?

Well, so this is a long-term process. I can't focus as much on the immediate and what's happening, so you guys get it, you kind of make sense. of how I could think in different ways to deal with the consequences and in this case we wanted to reduce the anxiety a little bit, probably keep the same coping behavior because it sounds like it was pretty constructive, okay, so that's just a quick look at an intervention. Cognitive ABCD can be done for almost anything, the greater the emotional burden, the more difficult it will be to raise a dispute.

Many times we do this in group therapy settings where people can argue with each other until they get the answer. how to do it on your own, if you remember, when we were talking about stress management we mentioned that you could really intervene at any point along that path in the stress process. The next opportunity we had after the stressors was to observe an individual's evaluations or How do they think about a stressor for primary evaluations? How do you think about the stressor itself? It is important? Is it going to matter how painful it is going to be?

Is this something that is important to me or my family? Should I be worry? Common mistakes people make in terms of unnecessarily amplifying their stress response are overestimating the probability of a bad event occurring. Remember that a stressor can be something you anticipate, it doesn't necessarily have to have happened yet. overestimating the badness or negative consequences of a stressor, so this is a magnification of the possible negative worst-case scenarios that could happen. overestimating the duration or permanence of a stressor and focusing only on worst-case scenarios, so again, this may be a habit or It may just be with this particular event, but teaching someone to step back and look at that assessment primary school and see how accurate that assessment has been.

I know that's a lot of words and I won't go over all these different questions. but they are questions you can ask yourself to reevaluate the accuracy or usefulness of your primary evaluation. You know this isn't, don't worry, be happy, this is just take a step back and say, Am I looking at this in a balanced way? useful way Am I making a realistic assessment of the situation and what this is going to require and what it will mean for me? The answer may be yes. You're taking a very realistic look. The answer may be no.

You can take a step back, reassess and maybe uh uh change that evaluation the other thing we can do is decide whether or not to think about it uh if we look at uh this is from the Healthy Mind healthy body manual by soel and Ornstein um idea is that essentially on this Every day, probably every day, but they talk about how in modern society we have too little time and too many stressors and there's just no way you can pay attention to every possible thing that can go wrong. It takes too much energy. too long and you just wouldn't be able to cope, so they suggest a way to classify or separate or order the different stressors that are in your life and then consciously decide where to direct your attention, where you would start to wind down. your sleeves and what you can really let go recommend that you divide your stressors into two categories important or unimportant you can already see that the unimportant things probably should not take priority look at the things that are changeable or immutable if we are talking about Roll up your sleeves and If you try to change something, you'd better first make sure it can be changed.

What's going to be most important out of those four categories are the things that are important, high priority, and things that can be changed, so if you only have a limited amount of time energy resources. I want to focus on what is most important to you. What will be more changing. Examples include arguments with a partner. Problems with your boss or quitting smoking. They are all important. They are all very changeable. Now it is true that we do not have complete control over. our lives or our choices or the stressors that we have to deal with a lot of times uh maybe at your job maybe uh with the family that you have or the family that you married uh there may be other stressors that you just have to deal with they will be jobs that they ask you to do and that you just have to do uh, I remember uh, I think some very wise advice from an early mentor of mine, uh, who explained that there would be jobs along the way, uh, at the Academy and He at somewhere else that you don't really want to do and he said Jason, I want you to always remember that a job that's not worth doing is not worth doing well if you have to do it, so be it, but don't look for a bonus if it's not that important. , so we can look at the primary evaluations, we can try to recalibrate it, we can step back and decide if we want to think about it, if it's worth some of our time or our energy, we can also look. in secondary assessments and remember that secondary assessments refer to our estimates of our ability to cope with the resources we have to deal with a particular stressor.

These are some of the mistakes that amplify a stress response by overestimating what it will take to cope with a stressor. imagining that something is going to take much longer than it will actually take to solve it underestimating your personal ability to cope with the situation many times people forget that they may have been through a lot, that they may have developed a fairly substantial set of skills and that they may underestimate or underutilize important coping resources such as time, money, energy or knowledge, their friends or family believe that they do not have the support they really have or they may simply not They may or may not be willing to take advantage of those supports to ask for the help they might need, so the question is why do we have this tendency to underestimate or overestimate, could they be primary or secondary assessments, why are we not quite accurate in our assessments? ? you know and I think the reason has to I I don't know if I I know the answer I think it has to do with the fact that we are not perfect information processors we are not computers our estimates are influenced by our emotions they're influenced by our values, They are influenced by our current mood.

State at that time. Many times they are influenced by anxiety, so if you feel very anxious, you feel very vulnerable, maybe other negative things have happened to you recently. your past will affect the types of assessments that you make, the other impact on assessments, uh, if you look at us, there have been studies that ask people to estimate the probability that light will hit them, the probability that be People hit by a car tend to be fine and the terms of their estimates, unless there has been a recent news story or something the media has told them and you see this temporary but fairly replicable problem in overestimating how much is in risk or in what danger. they come from that particular stress or that particular threat, so there are a lot of influences that can drive our estimates around this, it's really just uh uh recommending that people take a step back and say, okay, okay?

What does this estimate imply? Is it my mood? Is it my story? Are they my values? Maybe it's something in my environment that made me overestimate or underestimate the estimate again. I won't read all of these questions, but they are intended to help you improve the accuracy of your secondary assessments.asking realistically what resources are needed. What are the maximum and minimum estimates? So, it's okay to think about the worst case scenario, but you should also be sure to think about the best case scenario. You don't know, no, Rosec colored glasses, not Polyana, but if you're looking at things. uh, worst case scenario, look at the other side, just look at the full spectrum, the full Continuum and then make an estimate of how likely those different outcomes might be.

Let's talk about how to provoke and how to take advantage. social supports a little bit later, but I think learning that skill of knowing who is in your inner circle and what those people in that inner circle can bring to the table can really help us in terms of improving the accuracy of our secondary assessments. Go ahead and do another exercise. This is also a cognitive exercise but a little more specialized. This is explanatory style. I'll explain what that is after we do the exercise. Explanatory style is approximately the explanations we give to ourselves. about why things happen, good things, bad things, neutral things, we always seem to need an explanation of why that happened, so what I have here is a hypothetical event and I just want you to write down what you think caused this event. would happen.

You are just filling in the blank, there is no right or wrong answer, the hypothetical event is that your boss selects you as employee of the month and gives you a big raise. This event occurred because it was blank, so simply write down what you think caused this event to happen. employee of the month you got a big raise, this happened because it's blank and I'll ask for a volunteer and explain to you what those ratings are about, so who wants to share what you wrote? Yeah, so this event happened because what? because I found pictures well 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 great career there's no right or wrong answer again we're interested in the consequences of how that . answer the consequences of coming to that type of response, so we want to see in terms of EXP, an atory style, three different dimensions, internal, stable or global, so was the cause due to something inside me or something that did I do it or is it due to something external? factors like luck, so what would you say on a scale of 1 to seven?

One is totally external. Seven is totally internal. Where would you put that? A one. Well, it's something the boss did. I might bump it up a few notches because you decided to. do something about what the boss did, but you're right, it was triggered by if he had never done that, maybe this wouldn't have happened, so there's definitely a big external piece, the Stable Dimension, is this a one-time event or is it something like that? that will keep happening over and over again in the future, so an unstable explanation is random luck, a stable explanation would be um, I have a lot of intelligence, so that intelligence will follow me in different areas of my life, so you say?

This is stable or unstable, a one-time deal or it will continue to happen. It is a unique agreement, very unstable, a unique and Global agreement is: will it simply affect you in your job or your relationship with your boss or will it affect you everywhere your family your friends your social life what do you think then it is quite isolated so here it's external uh it's unstable and they call it specific, the opposite of global now when you have your actual measure of explanatory style there's a series of different hypothetical events and it's averaged over both positive and negative negative events and the reason why.

This is important because we have discovered that explanatory style is related to an individual's risk of depression and, in general, if a person explains negative events as being my fault, it will never change and it will affect me all the time. parts, that tends to predispose them to depression, depressed people also when a positive event happens to them they say that I can't take any credit for it, nothing positive and it won't happen again. and it was really just a one-time deal, so the attributions, the explanation that you gave us for that event would fit more into the depressogenic category, although it's just one event, so it's not your style, so you would have to average it. a series of other events, so where did this come from?

And I think it's important to understand a little bit of history because it helps us see some of the implications of this and I think it also helps us see sort of the evolution of science or research from animal studies to human levels, so that this was the work of Marty Seligman and many of you have heard of learned helplessness or learned optimism before, in the late '60s and early '70s as well. at the University of Pennsylvania, in a different building than Aaron Beck, they worked completely separately and he was interested in canine studies.

He didn't have a term for the name at the time, but eventually it was called learned helplessness and the paradigm was something like this. So we had a big 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 plush floor and he would place the dog on the metal side of the cage. cage administer a mild electric shock it was unpleasant the dog would jump to the other side it's very thoughtful it doesn't take much to explain why that happens I did several repetitions of it the dog always jumps to the other side in the next part of the experiment you put a divider and a metal wall actually between those two sides of the cage you give him an electric shock CH the dog tries to escape but can't hit the divider he can't go anywhere he keeps trying to escape he can't do several repetitions of that until finally the dog learns not to There is nothing I can do.

I'm going to stop trying, so they just lie down and are helpless. Basically the most important part of the experiment is the last part where you take the divider out of that cage, so now the dog can escape, you administer the electric shock and the dog doesn't do anything, so you actually get physically closer and pulls the dog to the other side to show him. Hey, you can move to the other side. Put the dog back on the metal side. He manages the electricity. shock the dog is not going anywhere the dog has learned to become helpless as a result of those previous experiences of not being able to escape it doesn't take much to extrapolate this to people to see that the people who do may have grown up in circumstances in which Escape was impossible when there was abuse, children are quite helpless, they may have developed the same sense of learned helplessness, so that even though they are adults now, their lives have changed, their environments are different, they now have resources, they can now escape. , they don't have them.

Take advantage of those resources because you learned to be defenseless. There was a flaw in this theory, although despite its appeal, not everyone who has these aversive events (not everyone who has been abused as a child) grows up and develops learned helplessness. In fact, less than the majority there is only a subset of people who become helpless, so why? And the answer that finally emerged was that it has to do with their explanatory style: children who are being abused and who said it's my fault, it's never going to change. It is going to be like this everywhere they became helpless children who said this is a disaster this is not me it will not always be like this there are places where it is different this is not going to last forever they did not become helpless and were able to survive or even transcend the circumstances given to them as children, so the explanatory style helped us understand how some people become resilient and why others cannot.

I want to talk a little about mood. changing in the moment and we have already done a kind of mood exercise. Changing the ABCD exercise can help us have at least temporary changes in our mood. It is not a magic wand, it does not eliminate all anxiety that may exist. I'm still anxious about the stock market, but I hope what it does is at least lessen the severity or intensity of those feelings. When some people do their ABCD, they will often rate the initial feeling of anger, sadness, depression on a scale of 1 to 100. scale, they finish the exercise and rate their feelings and many times they will see a 20 30 50% which reduces the intensity of their negative emotions.

It's certainly better than doing nothing at all. There are a couple of other interventions we can use to at least temporarily change an individual's mood. I want to talk a little bit about cognitive reprocessing or a way of journaling. They want to talk about an exercise in selective attention. So to keep a journal, you know, the idea is not new, it's been around for a long time. that maybe journaling is a good thing journaling is a kind of cathartic experience that can get a lot of the feelings out and put them on paper it's a way to relieve stress maybe it's even a structured way to capture thoughts and make a bit of problem solving, well, finally someone, and that someone is James Pennebaker from the University of Texas, decided to test this particular theory and see if journaling was a useful thing both in terms of mood and also in terms of mood. physical health of an individual, so like many academic psychologists, he first began studying students to see if it was a viable idea and then moved on to more real-world medical populations, so his paradigm was essentially taking students in the lab, half of them are asked to write about a very serious event that happened, to go deeper into it, reflect on it, write about it for about 20 minutes, the other group is also writing, but they are writing about something very neutral about the weather about trees about something that doesn't really have an emotional charge he asks them to do this for several weeks gives them mood measures examined who went to student health during that time did anyone develop symptoms etc. .

As you can imagine, in this healthy population there weren't many effects on the students' health, but there was a marked effect on mood, and in fact, the students who wrote about these negativity-laden events actually reported better mood as a consequence of this journaling process. interestingly enough, they weren't wallowing in it, they were reprocessing, reconsidering, and eventually changing the way they felt about that particular event. Baker was rightly challenged to say well, let's take this to patients who have real illnesses, maybe chronic illnesses, and see. If there are any health effects, identify Baker, his graduate students and others who have adopted this paradigm have looked at several different patients and I'll give you just a couple of examples.

Here was a study that looked at patients who had uh chronic, fairly severe, moderate to severe asthma, put them in the same paradigm: They were told to think about the most negative events in their lives, whether the most negative events recently or in the past, or the larger negative events that were told to others. to write about something relatively neutral and not emotionally charged, they did this over a period of weeks and they measured something called fev1 which is a forced expiratory volume of air, so how much air can you exhale from your lungs very quickly in one second?

The more you can exhale, the greater your lung capacity will be, so this is a sign of improvement. For people who have lung problems, they found that people who wrote about emotionally charged negative events actually had an improvement in feelings about each other. The studies looked at the severity of symptoms in rheumatoid arthritis. Same kind of results. Patients who wrote about the negatively charged events had better outcomes. By looking at patients who are HIV positive, they found that their CD4 count, a type of immune cell, actually increased, there was no difference in terms of their outward appearance in terms of their physical health, who was getting opportunistic infections or no, but there was a difference if you looked at their immune cells under a microscope, they had higher CD4 counts, it's not a Magic Bullet it doesn't work for everyone, it didn't help or hurt grieving people, but I think it's a paradigm interesting one that I'm sure will be researched a lot more in terms of what the exact dosage is, what types of events should be written up.

As to who this will help and whether there is a population that could actually be harmed by doing this type of intervention, we must always remember the potential for harm even in our most promising interventions. Well, the next exercise I wanted to do is one borrowed from Rachel. Rimond here, there are many variants, Marty Singman, who now does research in positive psychology, has also researched a variant of this, this is something to change your selection of attention and, in the process, change your mood, so, what? why not? I ask you to answer threequestions if you can write them down in your notes section, so one question is to name one thing that surprised you today, the second question, name one thing that touched you today and I mean it touched you emotionally, so don't write. lower your car and the third is to describe one thing that inspired you one thing that surprised you one thing that moved you one thing that inspired you now this is an exercise that we have done informally with our medical students and we encourage our third medical students They have a year to do it, they have just left the classrooms, they are in the rooms, incredibly intelligent, motivated, empathetic students, but suddenly they feel incompetent and are terrified of hurting someone because they don't. know what to do so that they go home at the end of each day remembering every 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 improve their mood to which takes 5 seven minutes at the end of each day think about something that surprised you today in your internship rooms think about something that moved you think about something that inspired you but how about we hear from one of you who wants to volunteer?

These three things you wrote How about a volunteer? Yes, something that surprised you today. A client born in a place where I lived abroad. A client was born in a place where you used to live abroad. Yes, one thing that moved you. today's conversation with my husband conversation with your husband and one thing that inspired you today um phone interview for potentially a phone interview for a possible new job and how that was inspiring because I was able to talk about my accomplishments and I realized how much I am . You've done it, you can talk about your accomplishments and realize that you've actually done a lot, so in just a few minutes, very simple exercises, we've cognitively shifted your attention to things that are positive, that are inspiring, that are emotionally moving and helped you savor not something that was made up, not something that is false, false, but something that happened in your day that you may have forgotten because it wasn't negative, and I think we naturally hold on more to the negative things that happen and we forget the things that are positive we forget to savor our successes this is a quick 5 to 7 minute way at the end of each day we can do that there are a couple of examples I wanted to show you about mood change behavior , so change your mood at least temporarily it has nothing to do with cognitive exercises we will talk about activity programming I will remind you of some relaxation exercises that could help uh and I wanted to plug in physical exercise uh we know that it is not only good for your body , it's actually good for your mind, both in terms of improving your emotional state and also in terms of improving cognitive function.

You know, today we talked a lot about how puzzles and kind of cognitive challenges can keep your mind sharp. Actually, aerobic exercise has a larger effect than those cognitive puzzles. You can still do both at the same time, if you want, but physical exercise, I think, is very much an unsunken hero. What somatic means, uh, somatic, it has to do with your body, so somatic calming is how to calm your body, how to reduce the stress response, so it's an exercise that I won't do, but I wanted to show you that It's part of a behavioral exercise for depression, but I think it's also an important way to step back and reflect on the decisions we make in terms of how we spend our lives.

The time and behaviors we engage in many times at the beginning of therapy we ask the patient to make an activity log or a schedule of activities. We give you a calendar, this one is a little shorter just because I ran out. In the room there is a chart for each hour of the week and we simply ask them to fill it out at the end. 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 worst mood, then we have them bring it in and we just look for patterns, we look for days that were good mood days where there were things that you were doing, there were people that you were with that elevated your mood we look for days that were low mood days, there were things you did or didn't do that really brought your mood down, we also looked for opportunities, there may be sections of uneducated time or where there is just fillers and I think about the television as a sort of filler or surfing the Internet as a sort of filler, it can be a major distraction at times, but if there are large amounts of it, I think it's an opportunity for a person to make a different behavioral decision that they may have. a different impact on their mood, so we have them bring in data, we look for patterns, we try to see relationships between behaviors and moods and then the next step is we really want them to schedule a couple of nice things to do and you would be surprised , but for many people, this is a very difficult idea of ​​scheduling something that is fun, it almost seems antithetical to the notion that fun things are just supposed to happen or that social activities or social contacts are just supposed to happen.

I would say that we should give them as much or more attention as we give our appointments that we schedule, they certainly take a lot of time and won't necessarily have a positive effect on mood, but they are not just the pleasurable activities that we want to schedule, actually We want a well-balanced day. activity diet so we want some things that give 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 competition give us a sense of mastery you know an activity What lifted my spirits recently was cleaning out my garage, it was not a pleasant activity.

I'm not one of those clean-up organizer people who likes to do that, but at the end of the activity I thought: wow, I did it, I did it, that's it! achieved, it had a mood-enhancing effect. Now I don't want My week to be full of those types of activities. I probably want at least a few of those in my week, let's talk a little bit about the relaxation response and I know. In Dr. Kim's lectures and others they talked about the stress response and all the negative things that happen when stress appears, fortunately for us, we are made with all these internal mechanisms that help us stay in balance, one of that is the Relaxation response or activation of the parsympathetic nervous system, the Yang to Yin type of stress response system.

Benson herb has been writing about this since the 1970s and has been exploring different ways to help us enter a state of relaxation where it is not just a mental or emotional phenomenon, but we actually see changes in our breathing, heart rate , blood pressure, etc., fortunately for us, there are many different ways to achieve a state of relaxation, different things tend to be. to be preferred by different people, you can make your own decisions about what you like, it tends to involve some form of focused concentration, so it could focus on your breathing, it could focus on a yoga posture, it could focus on a mantra.

You could focus on a sentence, you could focus on a picture, but it's some kind of focused conversation that slows down the chatter of the mind, it usually involves a quiet environment, but I've certainly had patients who can do this in very noisy environments. It's a It's a matter of what you're used to and requires a passive attitude. I've dealt with stress a lot with people and I often have, usually younger men come up and say, This will be the best relaxer you've ever seen. I'm going to learn this better and do it faster than anyone else and right away I know that's where we need to start, that it's not about accomplishments or accomplishments, it's that. the wrong attitude to have, as I mentioned, there are many different paths to achieve the relaxation response and I just have a couple of examples here, there are many fantastic programs in the Bay Area, in fact, the Oer Institute, uh, Uh, finished. at Mount Zan also has a number of programs.

Also on your reference list, the last slide, and also on the first page of the booklet there are a number of books that you can turn to for some ideas about what you can do to achieve a relaxation response, so the last part What I wanted to talk about in the next 10 minutes or so is what I've called deep coping. Sure, it can improve your mood temporarily, so mood in the present, but we're really talking about it. about building that foundation to find a source of sustenance that will fuel you through the tough times that will give you the support you need to get through we will talk about connection in relationships we will talk about the meaning and how Those help promote the perspective of personal growth and balance, so for the connection, if you look at the research on happiness, you look at the research on subjective well-being, you look at the research in positive psychology, really, any way you slice it further.

The common and most consistently replicated predictor of well-being is that relationships don'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. We and perhaps our children are doing a disservice by not spending as much time teaching how to have relationships as we do teaching reading, writing and arithmetic. We should definitely add a relationships class or more, those relationships, although they're not necessarily just about relationships with other people, they could be relationships with pets, they could be relationships with plants, there's even interesting literature in there, they could be relationships with a higher power , however you choose to define that higher power or your spirituality, but I wanted to do it first. staying grounded and looking at our social supports or our relationships with other people and we wanted to do just a quick exercise, we won't go into this one, but I want you to try it and see.

If you can write this on the slide that is on your page, what you do for this exercise is a series of concentric circles, here you are, right in the center of the circle, and I want you to think about your social support network, so , people. who you can turn to for help when you need it and I want you to write them down somewhere in this circle for the people closest to you, maybe your partner, your best friend, they may be in your inner circle, someone who is a friend, but they still have some walls around them they will be on the next level someone who is an acquaintance may be a little further away than outside the circle are all the other people in the world or coworkers or people you just don't know So why don't you go ahead and write down the names of those important people who are in your social support network?

You will write your name and their position will depend on how close they are to you. Well, why not? Can't you go ahead and write them down and I'll tell you how we use this exercise clinically? In a clinical setting, after a person has been given some time to write down the names in the social support circle, the first thing I look for is If there are no names, I certainly had the experience that there are no names that a person person can put on the sheet or you can notice that all the names are on the outside, so no one has gotten to these. outer rings for other people, they may have a lot of people outside but they are very cautious, they don't have many intimate relationships so there is no one in the inner circle, so first I look for the number or the amount of social support then I look for the quality I look for the level of intimacy now there is no correct number of close friends that a person is supposed to have it seems that you really only need one close friend to give you the health protective effects that you need social support in general, however it is recommended that have at least two close social supports, uh, and I think the idea is that if you put all your eggs in one basket and something happens to that basket, you're in trouble, so if you want at least a couple of different supports, the Another thing I look at is not only who is on the map and how close they are to you, but then I get the person to think about what kind of support they are good at providing. many different types of support some very practical supports can you give me money?

Can you give me the right to see a doctor? Can you help me wash clothes? Part could be informational support. Can you give me advice? can you help me with my problem? Solve and work out loud and brainstorm this problem. Some people are very good at that and other types of support can be emotional support. Who is a very good listener? Which shoulder do I want to use to cry on when I need to do that? Your work. How the person who needs support is to know what kind of support they need and then turn tothe right person to get that kind of support.

There are few things more frustrating than needing emotional support and going to your problem solver and everything he tries. What you have to do is find 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 expressing it or maybe going to the wrong person to begin with. The last thing I wanted to talk about is meaning in our search for meaning, the importance of meaning in our lives and as I was thinking about meaning, the classic book that came to mind is a book called Man's Search for Meaning . book written by Victor uh Frankle uh actually about 50 almost almost 50 years ago uh more or less uh and let me tell you a little bit of history about Victor Victor Frankle for those of you who don't know uh he was a Jewish psychiatrist, he lived in Germany before After World War II, he and his large extended family were arrested, put in a Jewish ghetto, and eventually taken to concentration camps.

He, as a psychiatrist, began to observe the individuals who are in the camp, mostly men in his particular camp, and noticed that some of them died very quickly, some of them actually survived even though it seemed like they should not have survived, so he began to wonder what gives a person the will to do it. To live, what gives a person the ability to move forward despite the circumstances around them? What occurs to him is that this life has meaning until the last breath, the possibility of realizing values ​​through the very attitude with which we deal. our destined suffering exists until the last moment he who has a reason to live can endure almost any how he who has a reason to live can endure 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 his second wedding ceremony where he would propose who he would invite what the guest list would be what the menu would be those of you who have had weddings know how much detail goes into and how much time consuming it takes, but that was his purpose: to reunite with his wife, his family, his parents, his children, uh, with his brothers, that's what brought Victor Frankle to the camps when the war ended and he was liberated from the concentration camp.

He found out that he and his sister were the only two who had survived, so he was once again forced to try to find a new meaning, a new why, a new reason to keep living and that reason became that he wanted to share his ideas. with the rest. With the rest of the world he wanted to share what he had learned about the importance of meaning and help us endure or perhaps even transcend suffering, so he wrote the book Man's Search for Meaning. He then founded his own school of therapy called logotherapy. I think it's been so successful that there is still a school of logotherapy in Germany and actually a couple in Europe, but it's really been so successful that this idea of ​​the importance of the meaning of searching for the why has really been absorbed and integrated.

In almost every therapeutic school of thought, finding the why or finding that source of meaning helps us endure not only great suffering but also small suffering and certainly also the daily annoyances of life when I think about it more in the diary. discomfort or stress level I think of a story that Steve MC shared, he is a physician here at UCSF, founder of our friend at Care Service, a much loved, respected, compassionate teacher, mentor and clinician, his story for the students of medicine and I believe in their white coat. ceremony where they get their white coats and take the Hippocratic Oath, it's very moving and meaningful to them, um, it tells a story about the decisions they have to make, uh, and the story is more or less like that, it begins and this is the first day. from school, so everyone is taking notes and everyone is very serious and saying that you know you have some options ahead of you and that probably the most important decision you have to make is what kind of doctor you are going to go to.

Being sounds normal so far and what I mean by doctor type is that you have to decide if you are going to have a gas tank or if you are going to have solar panels. Some of the feathers fall and now they wonder. What's wrong with this guy? he said. what do I want to say with that? If you're a doctor with one tank of gas and you're going to see your first patient and maybe it's going to be a challenge, it takes some energy. Burn some fuel. You do a good job. The next patient you burn a little more fuel, it's exhausting, but you do a good job, you move on to the next patient, you burn a little more fuel and at the end of the day you've done a good job, but your gas tank is empty. and that is what you take home with your family the alternative is to be a doctor who has solar panels you see your first patient it is difficult it is a challenge it requires energy but in the moment you realize what a privilege it is to be invited so intimately to someone else's life for the opportunity to make a meaningful and lasting difference that privilege Shine on you radiates from your solar panels and feeds your soul you go to the next patient energy is needed go to the next patient energy is needed and at the end of the day you are physically tired but your soul is fully charged and that is what you take home to your family, so you decide to go back to having solar panels with a gas tank, in that situation you still have a stressful job, it is still physically exhausting, but There has been a shift in perspective, there has been a reconnection with that source of meaning, there has been an appreciation of the why, there has been an appreciation of the privilege of honor that I truly believe each of us can find in our everyday lives, so I hope over the course of today's talk I know it's been kind of a quick whirlwind, um, you have some ideas of things that maybe you can try at home, just pick one of them, try it a couple of times on your own, They may be ABCD, they may be daily.

It could be reading more about the explanatory style, it could be looking at your assessments and reading those questions, it could also be scheduling activities, finding a way to reach the relaxation response or, hopefully, it made you think a little about the importance of relationships and especially about the importance of meaning and connection. Thank you. We have some time for questions. If people have any questions, I'll be happy to say yes. So the question is if you have two children who have been abused. Why does one of them say it's not my fault that it's going to change?

There are other things out there, while the other child says it's me, you know, we don't know exactly what relationship exists between the parents. Explanatory style. and your child's explanatory style may be learned, perhaps it may be innate. If you look at qualitative studies of people who have been abused but who have been resilient, they have found a couple of different things and probably the most important factor is that they found a substitute of some kind, so there is a teacher there is a coach there is a minister there is a neighbor there is someone who maybe sees what is happening and says hey you know what it is not you we are going to get you out of this things are going to change maybe you don't know that the abuse is happening, but they provide that alternative theory, that alternative explanation that hopefully the child can learn, use and apply to their own life.

Yeah, so the question is with cognitive behavioral therapy what age range is it good for, essentially, you know. the youngest ones I've seen used are for kids who are five or six years old or so, it changes in nature because you know it's complicated to resolve disputes and in some ways there's a lot of language involved when they do it. It's with kids, they use comics and cartoon characters and they come up with stories, and they talk about you trying to remember some of them. They had, Poli, the pessimist and Ali, the optimist, and good things happen and bad things happen. both characters and they come up with different explanations, so they learn through narratives, they learn through stories, then they make their own comics and their own stories, then they talk about the relationship to their own life, a slightly different methodology but the same.

General principles are used, yes, so the question is really about the value of optimism or pessimism and is there some kind of optimal range. The bias is to say optimism good, pessimism bad, that's actually not true. We did a study with Marty. selling to Seligman and I did a study of law students and we had the idea that pessimism might actually be a constructive trait in law school to always see the flaw to always see the crack to always amplify the negative to do that actually found that the students who were most successful in law school were mildly pessimistic now if they were they were very pessimistic they didn't do well they were more on the depressed side but mild pessimism at least in that profession was useful it would be interesting to do that study to doctors, if you think about it, you might want your doctor to be a little pessimistic to think about all the bad things that could be happening, take care of them, test for them, and hopefully prevent them, but that study doesn't. has done.

It hasn't been done, so I think there's a role for pessimism, there's a role for optimism, but probably in a slight range and in either direction, yeah, so it's a great question, it's a question about the point of fit, you know when we hear about weight. 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 emotions? Some people are just born happy and some people are born sad, uh, and I think you know for anyone who's had maybe more than one child or more than one niece and nephew, you know they come into the world with dispositions, uh, so I think definitely.

There's a genetic or innate component to that, although I'd like to think that's not a set point, it's a set range, so there's an amount of variability within the range that you're biologically capable of achieving. Now the study that Ellen is referring to is a study done by Ronnie Janof Bulman, she is a social psychologist and she observed two groups of quite unusual patients, the first group were people who had recently won the lottery, they have become new millionaires, very happy, it's a big event for most people, they think it will make all their dreams come true, what she actually found is you get this temporary increase in happiness and excitement and all the things you can imagine, they buy houses and cars bigger, etc., and within a period of 12 months their level of self-reported happiness is back to the same as before.

In fact, they won the lottery and I think that maybe has to do 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. Actually, if it helped you have better relationships, you could see a bigger difference. The other group he looked at were people who had a very negative event happen to them. These were people who had been in a car accident and who had been converted. a paraplegic, so he was paralyzed from the waist down, as you can imagine, they became very depressed, very distressed, this causes big changes in your life, great stress in your family, so you see a big drop in their condition spirits, but within about 12 months after they had adjusted to their new way of life, they had returned to approximately the same level of functioning and happiness as they had before the accident occurred.

Those are pretty specialized patient groups, but I think it's a pretty persuasive argument that "We're at a particular level and even if big events happen, there's this pressure to get back to that same level. I'd like to think we can improve that a little." little, but it doesn't take accidents, illness or money to To do that, I think it really takes relationships, it takes connection and it takes meaning to do that, yeah, so she's asking about exercise, who's there to support you and it seems like you're in the circles of a lot of other people who turn to you for support and sometimes that feels like a privilege but sometimes it feels like a burden really um and I think you know you have to decide for yourself on. any socially supportive relationship with those people in your circle there should be a reciprocity, there should be times when you are the listener and they are the ones talking, but there should be other times when they listen and if not there is that sense of reciprocity, it's probably time to reexamine and rethink that relationship if you can.

That doesn't work, maybe they should move to the farther circles, the further away you are from your core supports, yeah, so an important strategy is going to be ahead of time if you can anticipate that a stressor is happening to do it a little bit. of preparation, some advanced planning to deal with that stressor, you can do some advanced thinkingabout assessments and hopefully rally your supports to be ready if that stressor occurs. You're right, that can certainly minimize the magnitude of a stress response you might have. and very important, if the stressor is very strong, you are right, how about one more question at the end?

So, then, the question is about an individual's willingness to participate, whether he can still get positive results or not, and I. I truly believe that the basis of cognitive therapy is a collaborative partnership between therapist and patient, so there has to be real involvement to achieve the types of gains you would expect if you were stuck in a difficult situation. Situation where you have someone who needs help and is not willing to receive that help. Can? Know? Encourage him to see a cognitive therapist. You can buy him the right books. Maybe you can share behavioral interventions with them.

We know he is a physicist. This activity is a good stressful intervention between stress. Take them for a walk. You can help them schedule two enjoyable activities between them that might help give them a break or some relief from a stressful situation, but in real terms, it's sitting down and doing. the task if they are not willing to do it. I'm not sure you'll gain much from that, so thank you very much for your time and attention again. I encourage you to try this.