Dealing With Trauma During COVID-19, with Dr. Mark Goulston | EDB 229

Author & psychiatrist Dr. Mark Goulston returns to share tips for overcoming trauma.

(VIDEO – 35 mins) Originally a UCLA professor of psychiatry for over 25 years, and a former FBI and police hostage negotiation trainer, Dr. Mark Goulston’s expertise has been forged and proven in the crucible of real-life, high stakes situations. An influencer who helps influencers become more influential, his unique background has made him an indispensable and sought after resource and change facilitator to Fortune 500 leaders, entrepreneurs and educators across the nation. His latest book is “Why Cope When You Can Heal?”.

Dr. Goulston will be giving a free webinar on behalf of Different Brains Thursday, January 14th at 7:00pm ET. To learn more and register click here!

For more about Dr. Goulston: markgoulston.com

For more about his latest book: whycopewhenyoucanheal.com

  AUDIO PODCAST VERSION:

Or look for us on your favorite podcast provider:

iTunes | Stitcher | SoundCloud

FULL TRANSCRIPTION

DR HACKIE REITMAN (HR):

Hi, welcome to another episode of Exploring Different Brains. I’m Dr. Hackie Reitman. And today we have returning to us my old friend of my old classmate, all the way from California, a wonderful psychiatrist, neuropsychiatry he does everything with the brain. Dr. Mark Goulston. Mark, welcome back.

DR MARK GOULSTON (MG):

So good to be back with you Hackie. Thanks for having me back.

HR:

Well, I’m so excited because I just read your new book that’s coming out “why cope when you can heal?”. Why do it? Why do it. So that’s, I want you to first introduce yourself properly to our audience who had may not have seen our first interview.

MG:

Yeah, so I’m a psychiatrist. I was a psychiatrist for 40 years, I’m retired status. So I go around the world now, trying to teach people how to connect with other people how to empathize. And when I was a psychiatrist, made part of my focus was suicide prevention. One of my mentors was a fella named Dr. Ed Shneidman. And anyone who’s studied suicide will know that name, and he was the founder of the American Association of Suicidology. And for 30 years, I saw suicidal patients, and none of them died by suicide. And I’ve been trying to think what I did that might have assisted that. And it’s finally come to me, and we finally put it out in this latest book called “why cope when you can heal”. And I’m introducing to the world and to your audience, something called “surgical empathy”. And what I discovered as a suicide prevention specialist, is I discovered that when people are suicidal, they are locked inside. And you can give them treatments you can and I think medication psychotherapy, it’s all very helpful. But what I learned very quickly, as I learned to listen into their eyes, and what they were telling me with their eyes was, you’re checking boxes, and I’m running out of time. So I had a choice to keep checking boxes, or just see what else their eyes wanted to tell me in where their eyes wanted to take me.

HR:

And what I got out of it when I was reading it was your approach was and correct me if I’m wrong. Let’s get it on the table. Let’s go back to that worst moment. Let’s see what it is. Let’s get it out and look at it. Am I on the right track with that?

MG:

You’re totally on the right track. And something that I’ll bring up that doesn’t appear that you have it but you know, people who have it’s called “burnout”. burnout is huge. And we need our health care workers to not burn out because we’re still a long way before we get through this pandemic.

HR:

Which is a segue when I see that the fact that your book is coming out at a time where as we sit here speaking, we’re in the middle of this pandemic, this coronavirus, outbreak and pandemic and you’re talking about the mental health conditions of our frontline health workers who are so traumatized directly. And they are number one, they are number on. we were all having mental health issues. We’re all under stress. We’re all having some element of these, but you are focusing if I’m correct. On our frontline health workers expound on that.

MG:

Well, absolutely. Look, when you go into an airplane in the days when we used to fly somewhere, what do they say put the oxygen on you before you put it on your child. So if we don’t take care of our health care workers, who there’s a shortage of now if you listen to any of the news, there’s a shortage that there seems to be enough ventilators finally but there’s a shortage of people to operate them and so the book is directed at how do we help shore them up? How do we keep our mental health workers being able to continue to do things and and the book is already out Hackie so thank you for saying it’s coming out but it is out it just was recently released. And right. And the whole idea but I would like your viewers and listeners in you to imagine is here the mind of a healthcare worker or a doctor and see if you can track along with me Hackie. When you’re used to seeing in the ER You know, maybe one or two deaths a month, and you suddenly see five in a day, including one of your colleagues. When you’re used to, you know, allowing loved ones to be by the bedside, and you respectfully let them be together, and instead you have to do FaceTime interventions between them. What happens and we talk about this and why cope when you can heal, you’re horrified. And you’re horrified because it’s beyond anything that you can imagine. And then what goes on in your mind when you’re horrified, especially when you go home and you stay in the garage, because you don’t want to infect your family, is you start to feel terrified, oh, my God, how can I do this. And when you go from horrified to terrified, you can begin to feel fragile. But you’re so duty bound, you’re so committed to your patients, and you’re committed to your colleagues, they wouldn’t let you down so you can’t let them down. So what happens is, instead of going to panic, from feeling fragile, something called adrenaline comes in. And adrenaline enables you to push away your thoughts, push away your feelings and just focus. You know, NBA athletes can play a half a game on a fractured leg, because adrenaline is just powering them through it. So picture this there, you are a health care worker. And you’re powering through these horrific and terrifying scenes. And the adrenaline is insulating you from all those thoughts and feelings. But then what happens is that eventually the danger is going to go away. I mean, think of veterans, why is it they’re having PTSD, when they’re safe, they’re no longer in a war zone. Why is that they’re depressed and killing themselves. It’s because when the danger goes away, the adrenaline goes away, and you’re no longer insulated from everything you pushed away. And the problem is, you’re afraid that if you open a little bit of a crock, everything you pushed away, is going to explode, and destroy you. And so surgical empathy, is a way of letting a little of it out at a time. So you can finish thinking what you couldn’t think and finish feeling which you couldn’t feel safely.

HR:

That’s very, very well put. And we should mention to our audience, at when that adrenaline is surging, it’s moving everything to a different part of the brain. And could you expound on that, so that when they when, when that adrenaline is flowing, it goes one place, and then when the adrenaline goes away, now it’s getting calculated in another area, enlighten our audience on that.

MG:

So what happens is, when we’re under stress, a part of our brain, called the pituitary sends a signal to another part of our body, called the adrenal glands, and it releases cortisol. So cortisol basically says to your body, be injury ready. And then what happens is, that starts to trigger up back in a part of our brain. And since this is different brains, you’ve heard the term the amygdala. And what happens is, the high cortisol starts to want to trigger the amygdala. And the amygdala can do something that we call an amygdala hijack, and the amygdala is part of our emotional brain. And when it gets overloaded with the high cortisol, blood actually preferentially goes to your lower brain, your survival brain. So the expression deer in a head deer in the headlights, when, when our blood flow goes to our survival brain, it’s flight, fight, or freeze. And, and so what happens is, because we’re well trained, we don’t freeze and we do fight, we don’t flee because we’re duty bound, that’s part of our identity. And you keep doing this for a while, and you resort to your training, and you can manage through it. But when it becomes totally overwhelming, it feels like you can’t do it anymore. And so that’s why when we’re watching healthcare workers be interviewed in the media. Now the media is a little sensationalistic, but still you, you’ll hear from doctors and nurses, when they get out of the ICU with the ER, they just break down, they just start crying. And the crying is good. It’s a little bit of the release. But they can’t allow a lot of that because they have to go back into the emergency room with the ICU and do more. And so what happens is, as time goes on, and hopefully the danger will pass that hopefully it will pass. We’re gonna all make it through this. What happens is that adrenaline starts to lessen. And here’s something that most people don’t know, even most doctors don’t know. High oxytocin, which is a bonding hormone counteracts high cortisol. So when people not only when people feel felt by others, when people can name the feeling, express the feeling and feel it, especially when someone else is listening to it the oxytocin.

MG:

Yeah, I, I think that that was my oxy coding has slipped. oxytocin goes up, and cortisol goes down. So it’s interesting one of the exercises in “why cope and you can heal” is something called the distress release, exercising journal, and what we instruct people to do, and you can do this by yourself, you can do this with a therapist in or you can do it with what we advise, think of a mentor in your life. Now you and I share the same mentor, one of our mentors, Dean, Liam McNary, he was the Dean of Students at our medical school. And so actually, I have actually a, a distress relief journal with a picture of him inside the inside cover. So when I’m about to feel overwhelmed, when I’m about to confront something that horrified me or terrified me. I imagine Mac talking me down this way. And this will bring emotion to you because I’m going to do my Mac imitation. He was an Irish Catholic from Boston. And in in my mind’s eye, if I run into an obstacle, or if I’m trying to confront the horror, or confront the terror that I went through, he says three Mark, Mark, write down the date already. Hmm. Mark, write down the time and date just happen. Okay, write down the time and date. Mark. What happened? I just saw this scene and it just it just freaked me out. Mark, legit think when when you saw that scene Mark? I thought I don’t know how much more of this I can take. This is too much. Mark, Mark, it’ll be okay. Mark what you feel

MG:

when they happen? I just felt like I wanted to panic. I just wanted to run Mark, Mark, it’s going to be okay. What does it make you want to do? Mark This is the most important thing. Because if you if you get into that impulse is going to be a mess. So what do you really feel like doing? I feel like running away and not going back to the hospital? Mark. I know you feel that way. You’ve been feeling that a lot, but you always go back. So it’s going to be okay. So Mark, take a deep breath. Thank you Mac. Mark, what would be a better thing to do? You know, a better thing to do is talking to you. Because when I think of you, I miss you. I remember you. I’m grateful to you. I appreciate you. I just I feel like crying with how much you cared about me. And finally Mac Mac. Okay, good. Thanks for the compliment. Why is that a great thing. Because when I feel less alone in this when I feel you’re talking to me when I feel like I’m expressing it when I feel like I’m feeling it. And I feel like you’re hearing me. I feel better. I feel better. And when I think of how much I appreciate you, I’m grateful to you and I miss you suddenly is not so bad. So that’s kind of a an example of how you would use the distress relief exercise in journal if you could track with a Hackie.

HR:

Great example and really felt like I was right there with you with Dr. McNamara great man. Now society seems to discount trauma and what we’re talking about and there seems to be a lot of stigma around PTSD. Okay, which is, of course, in part what we’re talking about, enlighten our audience about the PTSD in our frontline health care workers.

MG:

Well, I’ve been trying to change the diagnosis of PTSD to something that people with it live. But I’ve given up on that when I’ve tried to change it to is “re-traumatization avoidance” “RTA”. Why because if you talk To anyone who has been deeply traumatized, by COVID, by violence, by rape, maybe by cancer, bankruptcy, a messy divorce. And if it was a deep trauma, and you look them in the eye, and you say Good for you, you’re so courageous. She got over and telling you Hackie, they’ll look back at you. And they’ll say, I didn’t get over. I got past it. And then if you say, What do you mean, you got past that? They’ll say, I’m not the same as I was before. I’m tentative. I don’t lower my guard. I know, exhaustion. I don’t really know peace. I have fun. But I don’t really feel joy because I’m on guard. And then when you ask some of those people, especially veterans, do you think you could go through it again? Many of them will look at you and say, absolutely not. I don’t know why it didn’t take me down the first time. So see, what happens is when you’re surviving a trauma as a veteran or a healthcare worker, you’re pushing away everything to survive. You don’t even know how you’re surviving. And so what re-traumatization avoidance means is, you will do anything to avoid feeling those feelings that you didn’t have the time to feel because you’re afraid they’ll explode through you. So the numbing the startle reflex, what is your startle reflex, it’s when you lower your guard. If you’re a veteran or a healthcare worker, and you feel comfortable driving in your pickup truck, you lower your guard, nobody’s nagging you and suddenly a car backfires next to you. You jump out of your skin. You have nightmares? Why do you have nightmares, because the nightmares are all the unfinished thoughts and feelings that you don’t have any control over in your sleep in their pushing to come out. So our whole approach and we’re starting pilot programs, is to get health care workers together in a, or veterans in a fire team. And we have them go back to those moments that they went through, what was the first horrific thing you saw.

And then if they start to get agitated, we apply the distress relief exercise. You know what happened, once you feel what you think, what you do. And then in the book, we also have something called the 12 words. And there’s research that shows it’s called “affect labeling”, that when you can name what you’re feeling, express it and feel it. It relieves it. So the 12 words include words like “anxious, overwhelmed, numb, frayed, depressed, angry, ashamed, alone, lonely”. And so what happens if you can imagine, you can do this with a therapist in the journal but you go back to that horrific moment? Or when did you get terrified? And then you can apply the stress relief exercise we talked about. But then you zoom in and said, What did you feel most? And, and if what you say and express and feel, is, I felt overwhelmed. And then if you’re doing this with a therapist, you want to expand on it in your journal. And see, it’s great to use a picture of a mentor. See, I could have gone through those prompts without Dean McNary. There. And that would have helped. But when you do it in your mind with someone who cared about you, and you’re talking with them, and they’re asking you the questions, it’s an oxytocin experience.

HR:

And you can extrapolate that to so many other things where you have to go through the experience, however, you can do it, particularly in this issue. But can it also apply to other issues?

MG:

Totally. So I’m going to give you a because this is different brains and families watch this. I’m going to give you another example of surgical empathy that you can use with any kids that you’re worried about teenagers, young adults, you know, we’re all locked in, we’re going stir crazy. There’s a huge increase in depression, anxiety, and sadly, suicide. So here’s an example of surgical empathy. Use this with one of your children when you’re doing something together, Do not have heart to heart talks with your kids. When you initiate it. They hate it. You know, face To face, the they can’t stand it, it’s part of being a teenager, if they initiate it, have the talk. But while you’re doing something with them, could be cleaning up something could be going to pick up food or whatever, squeeze into the conversation. And you have to gently squeeze it and say, ask it sort of a weird question, because I know we’re all going under stress. Hopefully they’ll say, Okay, yeah. Okay. They’re not happy about it. And then you say to them at its absolute worst, how awful Are you capable of feeling during these times? And they’re going to say what? Yeah, and I don’t mean awful behavior. I mean, during these times, how awful Are you capable of feeling? And if your child says pretty awful, say pretty awful, or very awful. Okay, very awful. Then the second question and see this is surgical empathy. You’re pulling it out of them. The second question is, and when you’re feeling that, how alone do you feel? Pretty alone. Pretty alone are all alone. Okay, okay, all alone. But they’re getting out that out. And then, and each of those cases, you can say, tell me more about that, because you’re drawing it out of them, you’re surgically pulling it off them? And then the third question is, take me to the last time you felt that, and they’re gonna say what your Take me to the last time was at 2:30 in the morning.

MG:

Take me to the last time when you felt awful, and you felt all alone with it? Why are you asking me these things? Because you’re my kid, I love you. And I don’t want, I don’t want you to be alone there. And here’s an interesting thing that happens and therapists know this intuitively, is when they start to describe something so clearly that you can see it. If you’re the parent. If they say okay, it was 2:30 I couldn’t get to sleep, you know, I was wandering around my bedroom. You know, I felt like hitting the pillow. I felt like, you know, punching a hole in the wall. You know what else happened? I kept looking around for some cough medicine maybe would get me to sleep. What else happened? You know, there’s a point at which I felt like yelling or crying and, and then the sun rose. And I was okay. But as they’re describing it to you that vividly, and you’re listening to it, they really feel it, but they don’t feel it alone. And then what you say to them, if you’re following it. So this is surgical empathy, is I have a favor to ask you. Sometimes your mom and I, sometimes your dad and I, you know, we were busy with all kinds of things. If you’re feeling that way, get our attention. Find a way to get our attention, you can say to me, Mom, Dad, I had another one of those moments. Because there’s nothing more important to us than your being able to tell us and seeing if that helps you feel a little better. So could you follow that Hackie?

HR:

I certainly could. And I wonder if as a parent, without professional training like yours, if this is a teachable thing, to a lay person, relatively person like myself, it sounds like you’re taking a civilian. Okay. And you’re having them, having them play a little bit with dynamite, you know, they’re, they’re taking their child to their darkest place. And then you have to know what to do, I would assume to me, again, this is just the way it hits my ears. It takes a lot of guts for that parent to do it without being mentored, so to speak. by a professional like yourself.

MG:

Well, I think if you review this video, those steps Yeah, yes, it is scary. But you have to ask yourself, if they’re in there alone, and they’re wanting to explode, and they’re all alone, isn’t that worse? There’s a video I want to refer to you and your viewers and your listeners, I may have sent it to you if you look up “teen mental health webinar”, teen mental health webinar on YouTube, you might have to search around, but a friend of mine named Jason Reed. He became a friend of mine because his 14 year old son died by suicide two years ago. And he reached out to me because he knew of my interest in suicide. And he did a video for an organization called “Gold Casts”. Goal cast produces these nine minute videos. Some of them have 150 million views, his had 9 million views. And what he did, it was fascinating and riveting and sad. He spoke to 12 male entrepreneur founders. And he basically spoke to them because he said, Now I think he’s taking too much self blame. He said, It was my fault that my son killed himself. And what he said is, to these men, is he said, I think was my fault. Because when he killed himself, my wife and I were away celebrating our lives, and we got a text from him. And it said, Don’t blame yourself, I’m so sorry, goodbye. And Jason started screaming, and he called his mother in law back at the home and to go find Ryan. And she ran around the house, and he had hung himself in the attic, left two suicide notes. The first one, had his pass codes for his computer. And they checked his computer, he’d been looking for ways to kill himself for six months. And the second thing was tell my story. So Jason created a documentary called “tell my story”, it’s on “chooselife.org”. And, but what he shared with these men, is he said, You know, I’m a dad, you know, I’m not supposed to share my problems and my worries with my family, I don’t want to make them worry. And he said, I’ve failed many times as an entrepreneur, but I’m not gonna share that with my family. But in essence, I made it impossible for my son to feel that I could understand them. Because all I did was give him solutions. I didn’t really go into How are you feeling? How bad is it? And it was interesting. So in the short video that he does with these with these founder entrepreneurs, you know, he basically asked them, you know, at times how, how badly they felt and how often they told anybody, and they all felt badly, and they never told anybody. And he said, there’s a difference between sharing a vulnerability and dumping it on someone else. And he said, when you share how you felt, they may feel safe to share what they felt. And you’re seeing, thankfully, because the psychiatric profession and psychological profession can’t handle all this, you’re seeing a bunch of communities open up a peer to peer sharing, and people are sharing these things. People are sharing horrendous things. But what’s happening is because they’re not being judged by the other people, they’re feeling better.

HR:

And they’re positive. And not alone is your point is, well, they’ve got a community. You’re not just by yourself. And the best disinfectant for darkness is light. So let’s get it out in the open and let’s confront it and let’s deal with it with what you’re calling surgical empathy, which is a great concept. And I’d highly recommend your book to any of our audience who are watching. “Why cope when you can heal?” Because the principles are right there. The principles weren’t there. What’s the best way for our audience to learn more about you?

MG:

If you want to find out more about me go to my website, Mark goulston.com. Or go to our latest book’s website. Why cope when you can heal.com or check out my podcast my wakeup call available at all podcast venues. Or check out our LinkedIn live weekly show no strings attached.

HR:

If someone has experienced trauma, what is the first thing they can do to start healing?

MG:

If someone has experienced trauma, the first thing they can do to start healing is to not deny it. And to not feel less about themselves for having it because many people are having it. And the key is to reach out to resources that might help you understand it, deal with it, get through it and get over with it. So you can look on the internet for trauma resources, and you will find all kinds of things to help you.

HR:

Is there any other advice you have for those in our audience who might be themselves? frontline health care workers?

MG:

Yeah, yes, there’s some basic stuff if you’re thinking you know that that’s Thank you, Doctor Mark, that’s a little too deep for me. So watch the video again. But proper exercise, make sure you exercise every day, it’s amazing how it may be the last thing you want to do. But once you just get moving one foot in front of the other, it’s amazing how that can shake things. shake things up a little bit. Also healthy eating, do your best to not fall prey to compulsive behaviors. Because a lot of times when we’re feeling stressed, we drink too much. We eat too much, because it gives us comfort, also find a way to reach out to other people. I know you don’t want to, but find a way. Also, if you can see if you can initiate ways to support health care workers at your health care center. I know you’re hesitant to do that, because you don’t want to admit that you’re having problems just like 90% of the other people there. But you might be able to say, you know, is there anything that we might do? That could that could help us. I did something with an organization wasn’t a healthcare organization. And it was it blew them away. So imagine this, this was an international organization, I coached the CEO. And you know, the employees were just feeling zoomed out. And I’m pretty good at establishing a rapport in some way. And so imagine this, you get 150 people in a zoom call. And you can try, you can try and pump them up, you know, say something, you know, that made you happy. The problem with pumping people up is that as soon as you go back off the call and the pump leaves you deflate. So what we did, if you can picture the zoom call, I said, I want each of you to imagine the most challenging moment in the last week. The most challenging moment, remember it, and I want you in the chat room to list up which word fits that challenging moment. Afraid, exhausted, overwhelmed, angry, numb. And they looked at me Hackie like deers in the headlights. And then one by one. The chat room started filling, you know, john: anxious. Nancy: overwhelmed, Betty: afraid. And what happened is it started to be floodgates, and you look on the zoom call, and people were crying with relief. And it just kept going. And then at the end, then at the end of it, I asked the group, I said, How many of you felt better because of that exercise? 80% felt better? How many of you felt worse? Zero. How many of you felt no change? 20%. And then here’s the icing on the cake. I said how many of you feel that you’re in a group of special people. 100%. And that’s because they weren’t any more special than they were an hour ago.

But they shared a special moment. They shared a moment of just honest vulnerability and nobody judged them. Everybody accepted each other. And I asked the CEO afterwards, I said, a couple days later, I said any follow up. He said six people came up to him contact him and said it was the best exercise they’d ever done to improve their culture in the history of the company. And he said two people came up and said it was the best exercise they’d ever done in their life. Wow. Amazing. Can you picture that? So there’s ways to get this stuff going? I understand. Yeah. Healthcare administrators. No, no, no, we want them to soldier on. Well, the point is they’re breaking down. And, and this can be facilitated. But I think once you get the feeling, see here’s what you have to realize when you’re sharing a feeling but you keep it your responsibility. To figure out you’re not dumping on anyone you’re not burdening anyone when you’re sharing a feeling and holding on to it is you’re not making it their problem. But a lot of people, especially healthcare workers, they don’t get that. Well. If I share a feeling I’m burdening someone No, no, you’re not burdening people. You’re just opening up and then when you and then what happens is when you see that not only Aren’t you burdening people, people welcome the fact that you’re just sharing that with them and they’ll share back. It creates a caring community.

HR:

Dr. Mark Goulston, thank you for all your insight. sights. Keep those books coming out. Why cope when you can heal being the latest. And we hope to see you again soon here at Exploring Different Brains.

MG:

Thanks. I can’t wait to be back