Our Favorite Coping Skills for Working in Stressful Times

Margaret: [00:00:00] Preston, do you wanna tell our viewer, viewers, listeners how this week has been for you so far? 

Preston: Yeah, so I, I woke up about 15 minutes ago. Um, I'm on nights and I know like some people can flip their schedules really well. I'm not very good at that, so I've just been like sleeping piecemeal, like two hours here.

I get up and do some things and I sleep for another two hours and go to the hospital. So basically every day feels like an overnight flight to Europe that like day after when you're just like jet lagged. But I'm just like living in this like perpetual soup where I don't see where one day ends and the other begins.

Margaret: How long are your night shifts? Are they like 12 hours, 14 hours? 

Preston: They end up being 12 most of the time. I get in around 8 45 to do, sign out at nine, and then, um, I'm supposed to sign out around eight in the morning if I have like new patients to present. But then people come in and they like chit chat and complain about things and I'm like, like, please, should I just present to you in go home?

[00:01:00] We go home. Like one time the other day we were just the, the staff come in, they're just like complaining about how the acs not working properly for like 30 minutes. And I was like, dude, for the love of God, I wanna 

go back home. Lemme bruise that my patient and leave free 

Margaret: me. I feel like there are there like times when you get to like chill for a bit or is it like, kind of like a really busy overnight service?

Preston: Um, there de there are definitely times you get to chill. So the first, um, the first time the unit was capped, we couldn't, um, admit anyone. We were on diversion. So if I got called, it was like for minor stuff, like, hey, this person needs like a new sleep. Sleep medication or they're complaining of pain or something.

So I think I got called like twice that whole night, but then, oh, that's good. There have been nights this week where I've, the phone rings like probably 15 or 16 times, which isn't like bad compared to surgery where they talk about like 40 times in a shift, 50 times, a hundred times. [00:02:00] But it's just like, you don't get meaningful rest either when your schedule's all messed up because you mm-hmm.

It's about 20 every 20 minutes or so, and sometimes it's like, okay, now I have to go see this new console, be another couple hours before I can like sit down again or something. 

Margaret: So would you say that you've had to use your coping skills this week? 

Preston: Yes. Yes. Um, all the time. All the time. It's like, it, it's especially tough when you like just got to sleep around like 4:00 AM and you're like, oh, this will be so nice.

And then the phone rings at four 30 and you're like, you're like, time to center myself and be like. Like the phone rings and you're picking it up and you're like, I wish I could throw this thing through the wall. And then, and then you, then you pull up to your head and you're like, Hey, espresso. A psych, literally, oh, what's going on?

Okay. Yeah, those can be really tough patients, Uhhuh, 

Margaret: those can be tough capacity Consult anyone. Yeah. Little 4:30 AM capacity. 

Preston: So she's not trying to leave. Just what if she thinks about [00:03:00] if she wants to leave. Okay. Yeah. You know, that's really reasonable to be worried about that right now at this time. Um, let me come, let me come talk to you.

Lemme just 

Margaret: put you on hold for one second. 

Preston: Like, lemme put you on a brief. Hold

Margaret: your cat's. Like, what the hell? 

Okay. Yeah. We'll be down in a moment. Yeah. Sounds awesome. Then. What a great opportunity for learning. That's what, what an awesome way. I'm gonna put the. Liaison in, in consult, liaison, psychiatry. 

Preston: Yeah. 

Margaret: Um, yeah, we've got a lot of questions for this episode and then also in general for other episodes to talk about coping with being an intern or being on nights in residency.

And so we today are gonna talk about our favorite coping skills, and maybe favorite's the wrong word for Preston. Maybe it's just most useful coping skills this week. Um, and we are going to do them in an order of, [00:04:00] I'm gonna say my favorite, like plan ahead or cope ahead. Skills in the moment. Skills, and then post.

Skills. Skills. And then you're at Preston. You were gonna talk about, uh, how you talk to patients about coping skills or coach them through them today. Um, what we're gonna start with that I'm nervous to start with, is a little manage for a three minute mindfulness meditation. I'm mainly nervous. I'm afraid Preston's going to fall asleep during that.

Preston: I'm, I'm already, I'm like halfway there, so you just gotta send me home. 

Margaret: You just, I just gotta be like, I, and then I can take over the, this entire episode and tell secrets. 

Preston: Mm-hmm. Well, you, you just have such a, a relaxing voice. It's, thank you. Your vocal chords are like little tran tranquilizers and I'm just, I'm a zebra running around in the safari wave feet.

Hit the dart hitting note. 

Margaret: B 52. Uh, sharp. Okay. So do you think we should do the mindfulness now or at the end of the episode? 

Preston: Let's start with it. 'cause I think if it centers me, then maybe it could help me. 

Margaret: Okay. 

Preston: [00:05:00] Block it for this episode. 

Margaret: Are you gonna trust me to guide you through it? 

Preston: Yep. This is my social trust fall.

Margaret: Okay. Before we do it, tell me, have you done mindfulness before? 

Preston: Yes. 

Margaret: What? What's like your experience level? Would you say? Like you've done it a handful of times in med school. You do it up to, you do it every day. Where are you at? A 

Preston: handful of times in med school, I think. I mean, if you couldn't tell, I'm usually at the class clown in a lot of, uh, educational settings.

So whenever we've done mindfulness, they want everyone to be quiet, you know, 

Margaret: making a fart 

Preston: sound. Yeah, no, no, for real. It's like, alright guys, I want you to picture you're on the beach. That's totally silence. I'm just like, mm.

And then everyone nailed and the teacher's not taking it. She's like, you take it seriously. 

So like, I, I think I was always a bit of a rebel about mindfulness. 'cause I was like, this is lame. Like, I am, I'm driven by a motor. I don't need to sit still[00:06:00] 

Margaret: for nerds. But now, 

Preston: as, as I go further in my training, I see how important mindfulness is. So I'm a bit of a, of an amateur with it. So, so I think before I was a skeptic, but now I'm a bit of an apologist. 

Margaret: Oh, I love it. Okay, I'm gonna prompt you the way I prompt my patients when we do mindfulness for the first time.

Um, and this is for our listeners as well. So I always give people a timeline for how, for like, how long we're gonna do it, because otherwise you can start it and it can be 60 seconds in and people will start panicking or having anxiety of like, how long is this gonna be? Oh my God, how long has it been?

Oh, where's my brain? So the first thing is it's gonna be three minutes. The second part is, the main point is to just be present and allow things to happen in your brain and try to come back to the present moment or sensation that I'm directing you towards. Um, and the last part is there's no wrong way to do mindfulness, so try not to be super mean to yourself, which is usually the hardest part for a lot of people, is they [00:07:00] start self criticizing during it.

So with all of that being said, we're going to do one of my favorites, but one of the many, many ways to practice mindfulness. So the first thing is I want you to sit back. Chill for a second. Even though you're run by a motor, we'll both Sit back. I'm 

sit. I'm sitting back. 

I want you to close your eyes. I'm gonna close my eyes and you're just gonna ground down your feet into the floor, into the chair, and take a deep breath 

in through your nose and let it out.

Take another deep breath and we'll start by just focusing on the sensation of the breath

and let it out.

I'll 

take one more breath in. Preston. I'll kill you. I'll kill you. I'll kill you. We're gonna have to re fucking do that. This is supposed to be a resource.

[00:08:00] Oh my God.

I'm not laughing. 

Okay. You can lead us in mindfulness. So I'm feeling my feet planted on the floor, relaxing into the chair. Each breath I take pushes me a little bit farther into the chair. So focus on the rhythm of your breathing. There's no wrong way to do it. Just learn that.

Now, I want you to start to survey your senses. So starting with your hearing, what, what are things you hear? 

Preston: I hear the drum, the air conditioner, the background. 

Margaret: Oh, we're not doing this. You're, you're not doing this. What you're, you're not [00:09:00] doing it right. 

Preston: Okay. Okay. Margaret. Why, why don't you lead it again?

Margaret: No, you ruined it. Now we just have to talk about it. Okay. You ruined it. You ruined the mindfulness moment. See, this is why, this is why I don't lead things in this. So what drove you, let's come back to that though. What drove you to do that? 

Preston: I thought it would be really funny, 

Margaret: and some people probably laughed.

Not me, but some people probably did. Yeah. 

Preston: And some people were probably pissed that I did that. 

Margaret: So what, what, but what drove you to do that? Why did you need to be funny in that moment? 

Preston: Hmm. Probably because I was like starting to feel uncomfortable. 

Margaret: Okay. 

Preston: With was your brain starting 

Margaret: to kind of like race or like 

Preston: Yeah.

You were get 

Margaret: noticing boredom or, or maybe 

Preston: it was like the, the walls were starting to come down a little bit and I was like, I didn't wanna see what was on the other side of that. 

Margaret: Hmm. What do you mean? So I'm like, I have 

Preston: to sit in this silence. 

Margaret: Ah, 

Preston: this is, this is my punishment. Is Margaret [00:10:00] psychoanalyzing me for disrupting her mindfulness time.

I know this 

Margaret: is actually what we, I do with my patients is like what happened during the mindfulness? So if they don't make a fart noise, which I will say you're the first person in both doing this with patients and teaching it in like group fitness classes at the end, you're the first person to ever do that during this.

That's why I'm taken aback. But a big part of why mindfulness helps people is noticing what their brain does and what they're trying to avoid when they're trying to relax and focus on presence or being attentive to one thing. And so the reason I tell Told said to you that when you were leading it, you were doing it not in a way I would recommend is we were going pretty fast and going through a bunch of different sensations.

What we wanna do is to focus on one sensation for a certain mindfulness activity. We can do the 5, 4, 3, 2, 1 grounding exercise. It's sort of mindfulness, but it's also kind of, you're moving a lot so you can't see [00:11:00] what your mind is doing. Does that make sense? Yeah. Like, you kind of have to stay with something that'll bore you to notice what your brain starts to do.

Preston: Actually, I think, I think you hit the nail on the head there. I was afraid of boring people. 

Margaret: Mm. Oh, well, I I might have bored you guys. Sorry. 

Preston: No, but like, it's, it's funny because that's the point of mindfulness, right? Yeah. Is to like, let yourself experience boredom and then investigate how you're feeling about that boredom.

Yeah. And I was like, as I felt myself start to experience that boredom, I was like, mm-hmm. Oh my gosh. If I was in the car listening to this, I would be bored. And then maybe I wouldn't care about the podcast anymore. So I need to do something funny to stay entertaining. 

Margaret: Yeah. So that's so, so to 

Preston: answer your question, why I do, that's why I did it.

Margaret: Yeah. Well, what's your experience like? So. I, my background with mindfulness is I actually took the like mindfulness based stress reduction like course in college that's like the six sessions or eight [00:12:00] sessions where you do a bunch of different practice techniques in a group of people. 

Hmm. 

And I hated it.

I did, I signed up for it and then I was like, well, I have to complete it now that I have. So I like started out hating mindfulness, but then fourth year of med school during Covid, I, like my therapist, put out like a guide that was free for the community in St. Louis on resiliency. And there were like other ways of practicing mindfulness that were about like nature or like doing something creative.

And I really liked those and then applied it to like working out and now can do it because I feel like I've practiced it and things. I like that I'm not, like, I'm bored and I don't know what I'm doing here. Mm-hmm. Um. And it's why it's one of my favorite cope ahead skills. It's not necessarily my cope during skill.

Um, 

Preston: mm. Maybe way to prime yourself. 

Margaret: Yeah. So I think one of the things that might be useful, um, is [00:13:00] what do you think the purpose of mindfulness is when we're talking about mental health or using it as a coping skill, either in your own personal experience, things you've seen other people use it for, but like how do you view mindfulness?

Because it, it can be a lot of things. 

Preston: Yeah. I, I think this is a bit of a cliche, but I see it as a way to clear your mind. Mm-hmm. Like a lot of us, when we're dealing with anxiety or compulsions or like unpleasant emotions, just almost like full erasure of the 

Margaret: whiteboard can be helpful to, to restart. 

Yeah.

So what happens then when. If, if someone, I feel like a lot of the reasons some people don't like mindfulness, um, is because it's been kind of sold that way, that it's like a mind clearing, almost like anxiety demolish or, and then they'll try and do it when they're having a panic attack and it feels like it worsens the [00:14:00] panic attack or the panic doesn't get any better, and then they feel like they're not doing it correctly or things that are supposed to help don't help them.

And they're like uniquely messed up, none of which are true. Um mm-hmm. But I think it is talked about a lot that way. Like, oh, just be mindful, like be detached, kind of don't let anything impact you. 

Mm-hmm. 

And the way I think about mindfulness, obviously mindfulness is. Much older than psychology, um, and is particularly present, at least in the way that we talk about it in the West, as historically dependent on Buddhism.

Although you could look at other contemplative spiritualities and certainly there may be some overlap there. Um, but mindfulness, as you know, I'm acceptance and commitment therapy based, trained. Mm-hmm. Um, mindfulness is one of the ways they talk about it in a review paper of mindfulness interventions, I think from 2017 is basically that there's two components.

One, you're paying attention to [00:15:00] one thing, sensation experience, but you're trying to be present or mindful of one thing. And two, you're trying to accept whatever comes up while you're doing that present. Mm-hmm. That being mindful to the one thing. So in building that ability to stay with something. And bring yourself gently back without criticism, without judgment, without being like, you're messed up.

'cause you're experiencing sadness or the podcast is bad because you're bored or they're bored. Um, that ability to tolerate that is, is kind of what we think of as a skill of mindfulness, at least in an act, and I think in DBT as well, um, which is really different than the idea that I usually have to talk to people about when we start of like, what do you think of the word mindful?

And we got a question about this on Instagram for this episode of someone asks, why does it feel like whenever people talk about mindfulness, it feels just like, ugh, another thing I have to do. 

Mm-hmm. 

And I, I think it can feel overwhelming in that way. Um, but what does it feel like to [00:16:00] you to consider mindfulness in the way of being able to tolerate whatever comes up and be present to it instead of a way to relax?

Preston: Yeah. It, it, it sounds more like standing in front of a doorway and being open to whatever comes through. And that's not clearing the board, 

Margaret: like I said before, it's, it's just, um, nonjudgmental perception of your 

Preston: existence. 

Margaret: Do you use mindfulness or like something similar with, with patients or with your, when you've been on nights, like you mentioned something of like getting called in the middle of the night.

Preston: Yeah. So, and like, I guess in a roundabout way, one of the, the things I target most of my patients is like helping them pin down what they can and cannot control. Mm-hmm. And then I try to get them to release judgment over the things they can't control about themselves. So 

Margaret: maybe this isn't, it's more like conversational, but [00:17:00] it gets at the same principle 

Preston: as mindfulness.

So, for example, classic scenario, I, I feel nervous all the time and I shouldn't feel nervous. It's wrong of me. It's a sign that I'm weak. And then I say, okay, how should you feel? They're like, well, I should feel happy. I should feel, you know, excited. I, I like my job, but I, but I dread going to work every day.

And then, and then I say, okay, so, so you're just gonna make yourself happy. Can you control that? And they're like, yeah, I can control happiness. I was like, can you, 

Margaret: how's that going? 

Preston: Yeah, no, we, we gotta sit there for a second. And then I say, make yourself the happiest you've ever been right now, like, like right now.

And then they kinda start to laugh and I was like, I thought you said you can control your emotions and you're not happy right now. Like, what's going on? And they're like, okay, well maybe, maybe I can't control my emotions. And then I'm like, can you control your thoughts? Like, what else can we control? And they're like, yeah, I can control my thoughts.

And then I say like, don't think about a monkey. And then, [00:18:00] and the same thing happens. I'm like, did you think about the monkey? They're like, I thought about the monkey. And I'm like, oh, so we can't control our thoughts. They're like, well, that's not true. I'm like, yeah, you're right. Because some of them you can control, but some of you can't.

So we have to kind of find what we can accept there. And then I say, I try to think about emotions the way, same way we think about physical pain. 

Margaret: Hmm. 

Preston: Like if I step on a nail, it's gonna hurt. 

Margaret: I can't will that pain away, but I can change how I direct it and how I accept it. Yeah. And so 

Preston: I kind of practice then I'll say like, so when you feel this emotion of anxiety or fear, try to think about it more as a, a roadmap, something that's going on, rather than a way to punish yourself.

And so then, then we'll sit with that emotion, be like, okay, so where do you think your, your sphere is telling you? And so it, it is funny 'cause like I feel like I've almost like done this back and forth with them to get to this point. And, [00:19:00] and it's the same principle as mindfulness, which is a non-judgmental acceptance of the things that they're feeling.

Mm-hmm. Just in a more roundabout way, I guess. 

Margaret: Yeah. Yeah. I think, you know, it's funny that you mentioned that. So one of the things that mindfulness-based stress reduction was first studied for was for chronic pain. Um, I use this metaphor often too because I think it's just people have less judgment towards their physical pain than their emotional pain, but it kind of almost activates this part of them that knows how to care for themselves, like if they're injured.

Or sometimes I'll talk about like, how do you treat yourself when you're like sick with the flu? Like is there any way to bring, not to be sick every day, but to be able to have that gentleness with yourself, that is usually saved just for when you're feeling your absolute worst. Mm-hmm. Like can there be a point in your day where if you experience intense emotions, like I used to tell first I told myself this in medical school, but then in [00:20:00] residency I've been treated well in residency, so I've had less of this happen.

But basically I remember saying to people like, can you. You should take a mental health, like sick day if you feel like, if you feel like you are on the lookout for where there's a solo bathroom in the hospital because you're, do you think you're gonna cry that day? Maybe you take a mental health day that day.

But I think being able to activate the non-judgmental kindness as like a stance towards your emotions is at the core of mindfulness and what you're saying of acceptance. Mm-hmm. Um, in act one of the things that's we'll say, instead of acceptance, just because acceptance can have a pretty negative connotation, understandably for people, like 

Preston: it can be seen as a way to justify the things that are done to you.

Margaret: So we'll use the word willingness, which may seem semantic and in some ways it is, but I think it's can be helpful for people so it doesn't immediately make them think, you just want me to accept that like. [00:21:00] This person's mistreating me or that this like unjust situation is happening. 

Preston: And, and I guess I wanna inter interject here and say like, just because something semantic does not take away from its value.

Mm-hmm. So it's like, I dunno, this is a pet peeve of mine, but people are like, yeah, the, the difference is just semantic. And I'm like, just semantic. The difference is semantic, like semantics matter a lot. They do. It's like literally 

Margaret: they 

Preston: do in a lot of ways the basis of therapy in psychiatry. Yeah. Yeah.

Sorry, I, anyways, continue. No, 

Margaret: no, you're okay. I see. I said it's not just, it's like I said that, 'cause I'm reading Nancy McWilliams, uh, the psychoanalytic diagnostic book right now. The textbook. And there's a whole chapter on how we like switch words when a word gets too much negative connotation in psychiatry.

And then inevitably it's like the next word gets negatively connotated. So I think that's on my mind. Mm-hmm. 

Preston: Yeah. But 

Margaret: that's also unrelated. Um. But yeah, so the, the willingness, and that's where an act, [00:22:00] that's where like the values kind of comes through. So we're moving a little bit, I guess we're kind of getting into all of the things of like why I am an ACT based therapist, because I like it for me.

So I like doing it with patients. Um, I would say one of the other parts of ACT that I felt was helpful on nights, my third year, our nights were a lot busier than my second year was. Um, it sounds odd, but the kind of like values-based work. So like if I practice willingness of like the hospital and the consults are gonna be the way they are and I'm gonna optimize to be, make them the least bad, and then I am willing to accept whatever theirs there's here.

Then it becomes like, okay, even if I this, even if I don't know that there needs to be a consult on this at five in the morning. Is there a way for me to like live out the value or live out something I'm trying to learn at this point in residency? Whether that's like, 

Preston: okay. Can you explain a [00:23:00] little more what you mean by values based?

Margaret: Yeah. So an act we say like basically an act, the aim of acceptance and the mindfulness is towards building a life that's more in line with your values. Um, so when I talk about it with my patients with chronic pain, they may have been a lifelong gardener and they've been an outdoorsy person. They liked hiking.

They had this, you know, big garden that they would like get down to dirt and tend to, and now they're much older and their mobility is limited by pain and they don't have the ability to like get down in the garden anymore. We might then go in and say, okay, on one hand we can, we can grieve that you can't do this thing in the same way anymore.

And we can say, you love making something grow. You feel so connected to nature. Mm-hmm. Can we bring plants inside? Can we put them up on a table? Can we live this value and what you love about it out in a different way? So for me, for values in the [00:24:00] hospital, it's like, okay, I want to be better at talking with people sensitively about their trauma in multiple settings, which means mm-hmm.

Different things in like the emergency department where they don't have, where they're in a bed in the hallway versus if I'm seeing them outpatient for two years to do trauma work. 

Preston: Yeah. 

Margaret: But I can still live, try to live out, or I want to 

Preston: be good at tolerating my own frustration. 

Margaret: Yeah. When I was on nights my second year, I used to, I jokingly started saying this, but I was like, I'm practicing my radical acceptance.

I'm practicing my distress tolerance skills. 

Preston: Yeah, I mean you say that with Jess, but you are 

Margaret: No, but it, I actually, I am laughing, but if you ask anyone in my residency, you'll know that I was for serious. It did help to think of it that way. So yeah, so that's values work. I think in DVT they would say building a life worth living, so like building value or they, they use some of the value stuff too.

Um, but I think that's also kind of a coppa ahead skill. [00:25:00] So I think mindfulness actually as a coppa ahead skill where it builds the ability to stay present to things and it builds that kind of attentional muscle and ability to stay with like minorly hard things in mindfulness, like boredom, so that when big heart emotions show up, you have a kind of bigger capacity to hold them.

And then I think the values part is saying, I can't control, like you're saying in your work with your patients, I can't control what this night shift's gonna be like, but I can. Talk, I can FaceTime with my nephews before I go into the shift. Mm-hmm. I can bring some food that I really like. I can bring my yoga mat and stretch for a couple minutes or do 300 pushups.

Preston: Uh, 

yeah. I, I can control whether or not I go get those like little watermelon gummy wedges from the bistro before I go down and see the consult. 

Margaret: Yep. Yeah. So I, I think of all three of those as the things that I do before. Um, I [00:26:00] wonder with your experience with nights or how you talk to patients, like when they have something difficult coming up, whether that's because they have to give a presentation at work, or they have to see a family member be in a situation that's been hard for them, or they're struggling with grief, um, that's actually not the grief one.

So things before, how do you think for yourself and your patients, like how to cope ahead and build some. Infrastructure there. 

Preston: Yeah, it's, it's funny you should say infrastructure. 'cause I think I actually called it a scaffolding the other day. I'm, I'm in my PowerPoint era right now in therapy, so I like, I'll, if I'm online, I'll share a screen and make a little PowerPoint and be like, okay.

I'm like, let's get to the root of what you're actually afraid of. And then I kind of try to put them in the driver's seat. I'm like, I'm just gonna put stuff out here and you can agree or disagree with it, or you can make your own suggestions. But like somewhere, there's something that we're truly afraid of.

And I don't think it's just like 

Margaret: your physics professor, and I think it's something else we're kind of like, okay, 

Preston: so we, we kind of, we [00:27:00] build from there. And so a lot of it, I try to kind of follow the, um, in some ways the maladaptive core belief or the true fear to what the person's afraid of and what they're attaching it to.

So, so I'll kind of, I'll start with what it sounds like there's a statement you make about yourself that's, if my son turns out. Um, amoral or misbehaved. I'm a bad parent, right? And I'm like, well, what does being a bad parent say about you? Why is that not okay? Mm-hmm. You know? Mm-hmm. Oh, if, if I'm a bad parent, then I've, I've failed as a, as a person, then I'll live a bad life.

I'm a bad person, you know? So then, so I'll kinda like, we'll, we'll sit with this, and I'll say, 

Margaret: okay, um, what do you think about the statement if my son misbehaves, I failed as a person or failed as a human? They're kinda like, oh, like, that really hits, or it'll be like, no, I don't, I don't think that's it.

Preston: It's not right. [00:28:00] Yeah. You know, it's more about like, I've let other people down or something. So then, so then I, I try to challenge it and say like, okay, well what if, what if, is it possible to be like a good parent or a good person and have your son misbehave? Like maybe these things are attached and they shouldn't be.

Maybe it's possible for you to be like a good scientist and perform poorly on a test. And so by almost like preemptively or anticipating where these reflexive attachments are gonna be made and disentangling them, then if there's a bad performance on the test, the hammer's not gonna come back. Come back as hard.

Margaret: Mm-hmm. Mm-hmm. So I'm 

Preston: saying like, you care a lot about contributing to the world and investigating these things, and one, one of the ways we measure your competency to do that is these like science exams. And also if you do great on them, does that mean you're gonna be a great scientist? No. So maybe like we're, maybe we're too focused on these tests, 

Margaret: so helping them kind of, you know, be aware of the [00:29:00] automatic stories or schemas that come up and make, as we say in the, this is, I think, a metaphor from Buddhism originally, but now it's in mindfulness based things of just like helping people recognize the second arrow, the story being like the first arrow is the pain life throws at you, and the second one is the one that.

Some of these ways of coping or thinking that we come by, honestly. Um, but we can change, make it way worse. Where it's like, you failed a test that sucks. That's really hard already. And then it's like, your dreams are stupid and you're worth nothing. It's like, so that's not gonna help you out during it.

And so you're helping them notice those so when they come back up in the moment, they'll be able to. 

Preston: Right. So, so yeah. So, so we'll practice that, almost like saying like, um, whether I do great on this test or terrible on this test, it doesn't define my value as a scientist or a human or a person. And so like, we'll practice that and then they'll say like, it's, it's helpful because it takes like the wind out of the sails of [00:30:00] this enemy ship right before you go into battle, you know?

And so, so maybe the celebration isn't as great because it doesn't have as much power to it, but also you. You're not giving the power to something outside of yourself. Yeah. For how you're, how you're defining your value. So like I think that's, that's kinda like my preco ritual. I try to really target what, like you said, stories we tell ourselves and, and also where we're placing the value of ourself.

Mm-hmm. And try to kind of move those pieces around so that when the storm comes, like, you know, all the China's not gonna fall off the shelf. Like, we're not storing all the expensive urns on the top shelf. We're like, oh, we, we have a basement. Okay. We can stabilize things here. 

Margaret: Yeah. No, I really like that because I think that, I think I do a lot of that with my patients too, but I think even in like the being on Knights example, like I think there's so much in medicine that we don't, we're given bad scripts during med school of how you should [00:31:00] feel about being a doctor.

How being a resident should feel, how healthcare should feel to be practicing in and. Both the really good and the really bad scripts don't help us. So the ones that are like, residency is only awful, and you're just gonna feel bad and like, doesn't this suck up and suck it 

up? 

We normalize all of that where it's just like, yeah, we complain in medicine a lot.

And it's like, okay, sometimes that's not helpful either. 'cause then you're, there's this cynical jadedness that prevents you from being able to recognize when you've done something that's like meaningful or worthwhile. Uh, and then the, the overly good one that we talk about a lot of like, oh, what do you mean you don't have perfect empathy?

Or, what do you mean you're annoyed or you're tired, or da da da da da. Um, and so I think you're right. It's like it takes out some of these, like, if you did really well and finally get this big reward, maybe you'll be like, my worth is somewhere else. There's not as much of a high from it, but it also takes out this rollercoaster of the highs and honestly more frequently the lows.

Preston: [00:32:00] Mm-hmm. 

Margaret: Um, so that's all of our prepping ahead. After we come back from this break, we're gonna talk about a little bit in the moment, coping skills and maybe kind of post processing skills. And then we're gonna answer a couple of questions people had about this. So we will be right back. 

Preston: Oh, I'm excited. I like answering questions.

Margaret: I love questions.

Okay, so now we're gonna talk about what I'm doing in the current moment, um, which is trying to cope with, with middle of the nights Preston. Right now. 

Preston: I've been antagonizing her a lot. 

Margaret: You have? It's good for my moral character. It's building my radical acceptance. Well, it's, 

Preston: it's, it's really because earlier in the episode, if you were listening, she goes, there's no wrong way to meditate.

And then she's like, okay, Preston, why don't you listen? She doesn't good at, 

Margaret: um, actually you're doing it wrong. You know, it's terrible And I'm okay. Well this, I didn't realize I was talking to an 8-year-old who I had to tell them that you have to actually be [00:33:00] trying at the mindfulness and not making a complete joke out of it For what?

If I was 

Preston: trying, okay. I try not. 

Margaret: I believe in you too much to accept that as the effort you can give. 

Preston: I'm getting smaller 

in my chair. 

Margaret: Just, yeah. Um, anyway, so now we're gonna talk about coping skills in the moment. And I think we should start by saying, you, you mentioned one earlier, you do like on nights and I will agree with you, the 4:30 AM call when you've been super busy and you're like, oh my God, nothing.

I'm gonna x out of Epic and try and get a little bit of sleep tonight. And then it's like pager goes off is like viscerally. I feel that. And it's been a year since I've been on call, so I do not, um, I do not envy you that. What other, what, what ways do you like. If you have like a really hard night where, not that exact moment, but like it's really busy, everyone's mad for some reason, and it's just like everything's going sideways and you have four notes you still need to write.[00:34:00] 

Mm-hmm. How do you feel like what helps you lower that stress and stay like coping? 

Preston: So, I, I learned this during medicine. I'm smiling because like, I can picture moments where I apply this directly. Never underestimate the power of a hot girl walk. It hits, I'm telling you, dude. So like, I, I gotta say a 

Margaret: hot girl and I was like, we're gonna have to cut this process.

Preston: No, I, so. I will plot like my triage, my work and say like, okay, I'm gonna write this note. Then h gw, HGW, this note HG W2. That's hot girl walk. If you're not falling, 

Margaret: if you're 

dumb. That's hot girl walk. 

Preston: Yeah. So, no. Preston, do you wanna 

Margaret: explain the what a hot girl walk is? Yeah. For those listening who are not chronically on TikTok, I 

Preston: have found places in the hospital where I can do like a good lap.

Usually about like 500 steps or so at, at one of the hospitals I stay. It's just like, it's almost like a, a terrace, like the mezzanine level just kind of goes in one big circle. So I just, I just [00:35:00] knock out a lap, write a whole, write a whole consult note, knock out a lap, and then really you wanna spice it up, AirPods in staff with your attending while you're walking if you can.

Margaret: Oh yes. That's a good one. 

Preston: So, and then, dude, nothing makes me feel like, um, like Kendall Roy from succession knocking on a business deal when I'm like, when I'm like, I'm like freaking walking with my headphones, I'm like, kind of punch in the air and I'm like, I'm like, yeah, we're gonna, we're gonna discharge them tonight.

And I don't care what the primary teams, you know, 

like this guy's walked in. Janitor's just like 

watching me go by. He was like, he's like, that's the 16th time that guys walked past me today. I was like, you okay? 

Margaret: I'm just picturing you like ge stipulating wildly in like a big like track suit 

that's like you have a fanny pack, you're just, you're there, you're wearing sunglasses in the hospital.

Preston: Tap, tap. Said hold, hold on for a second. Can I get a, can I get a tall, um, mo ccino venti fra fra situation. Oat milk. [00:36:00] Double shot. Thanks. Yeah. As I was saying, we're not gonna do Prozac. They're qts way too freaking long, bro. 

Margaret: You'll never make it in this hospital. You don't understand what I'm saying. 

Preston: All, all, all five fingers are touching in the middle as a 

Margaret: Yeah, it's so, no, it, it's like the brand 

new intern on service.

The, you're like, it's like 

Preston: intern. Yeah. 

Margaret: Yeah. You're like, I've never heard a stu a stupider question right now. 

Preston: Is there, is there a camera here? Am I, am I getting pranked right now? You, you guys gotta be pranking Leah. You, you know, I only got two legs and it sounds like you're trying to pull a third one right now.

Oh 

Margaret: my God. I mean, like, it's rich that we're a psych saying this. 'cause I know that like, similar to the succession character, I know we're saying shit at three in the morning to like cards surgery or something that's like, well, dramaturg, dramaturgically. I don't think their psychosis has the intrinsic meaning that you think just like, shut up psych.

No. I was like, [00:37:00] oh God. What, what? I say, oh, sorry. My tweed jacket just got stuck on, on the bookshelf next to me at home. 

Preston: I said something like that. I was like, I was like, I think you need to conceptualize their organization of behavior as something coming secondary to more of an organic physical illness rather than, um, like a mental pathology.

And they're like, 

they're like, ims are not, benzos are not. And I'm like, yes or no? 

Like, 

um, okay, 

pump the breaks. It's not that simple. They're like, they're like, yes, it is. I was like, okay, I am adamant and fine. 

Margaret: Well, we take more of a psycho dynamic. Just, just, and they're like, I'll kill you. Like, honestly, that's fair.

You guys haven't slept in two days. 

I know. Um, in the moment I say, I will say like from a night's perspective, just as we've gotten questions on this and maybe it'll be the most helpful, I also found like trying to still hit my step goal. [00:38:00] Huge. I. And like I'm in a hospital system that it's like multiple hospitals connected.

So it like, honestly wasn't hard because it was like, uh, the call room was one place and the other one was like two hospitals over. So I was like, I'm getting my steps and I'm feeling better when they're, I'm getting my steps, my notes are better. 

Preston: Do you ever pick a vending machine that she knows like three hospitals away?

Mm-hmm. And that's kinda like your goal. You're like, oh my God, these gummy bears will be the reward at the end of dude. 

Margaret: Or I'd be like, we get like a, there's, you get like a meal ticket or whatever when we're on call and I was like, these specific sour gummy worms are, I'm not allowed to eat them any other time than when I'm on call.

And I was on call a lot, so it was like, it wasn't like, Ooh, you, it's a cheat meal. It was like, I need these to retain as much ability to give me joy and uniqueness as I can. But, so I was like, I'm gonna power up for my half mile hospital walk. I'm gonna have the gummy bears when I get back while I write those two notes I've been avoiding.[00:39:00] 

Absolutely. 

So I feel like building in little moments of joy on call, um, really hard moments when you can't avoid them. I also found that like I would bring my yoga mat and sometimes just taking five minutes to not, this is more like when you're, it's 3:00 AM and you've been like talking to people all day and night and there's another one waiting for you and you're like, I cannot get these, these three notes.

Like, my brain's not working. I found getting out of my brain and into my body with a walk or with like a yoga with Adrian, like five minutes stretch video. Mm-hmm. Would, mm-hmm. I would feel so much better and so much less overwhelmed when I sat back down at the computer. I still wouldn't feel great, but I would feel like 20% better.

Preston: No, I, I feel it too after the walk, like, after anything that's like getting the blood flowing and, and what sucks and I wish it did this, like doing something like scrolling on Instagram does not do that. No. Like a social media break or anything. It just doesn't help you get back. If anything, it makes you dread more fun, the work that you're gonna have to do.

Yeah. It's 

Margaret: fun in some ways. [00:40:00] 

Preston: Yeah. So, so I found like, okay, if I need to get all this work done, I'm like, I can't go on social media. I can't like, try to do something I enjoy to like get me along. I need to like move or exercise or, or even just like sit quietly. I had this um, senior when I was an an intern on medicine.

I respected him so much because we would be in like the most hectic kind of afternoon. You know, we have like patients that are coding or rapid responses. We've got new admissions coming in that are kind of dumpster fires in the ed. And he'd be like, he would like take stock. He's like, okay, Preston, what are you doing?

What are you doing? What are you doing? Okay, we're waiting on transfer for this guy and we're doing this other thing. He goes, nobody. And then he would just say, nobody talked to me for 90 seconds. And he would just have this blanket and just wrap himself in the blanket and turn around his chair and just go like, I don't know if he was meditating.

I don't know if he was sleeping or whatever, but I was like, this man can freaking cope. And then he'd pop back out of it and he'd be like, all right, let's rock and roll. I was like, God 

damn, Kevin. 

Like 

Margaret: it's always someone, it's always [00:41:00] some dude named Kevin who like whips shit out like that. 

Preston: Yeah. And and I'm pretty sure Kevin has just like, figure this out intuitively.

Yeah. Like, like he's, he's not a big therapy guy. Just someone, it's just a man trying to survive. 

Margaret: Well, I won't say you describing that it doesn't sound like the biggest therapy guy. It sounds like a good coping skill. It 

also sounds like damn. 

Um, yeah. I'm trying to think of other in the moment things I think, you know.

We won't go into the DVT of it all by talking about tips, skills, but there are other sensory ways to help yourself regulate emotion. 

Preston: So I use, um, controlled breathing a decent amount. Yeah. You know about that. I call cops breathing with my patients. Yeah. So one thing I'll do is I'll, is I try to identify like how important in the moment coping is for someone, because, you know, we talked about earlier, someone has a big test coming up, they have a lot of their stressors may be ahead of them.

Mm-hmm. 

Margaret: But then 

Preston: I have some patients that their main stressor is that they just [00:42:00] are like raging in traffic. 

Margaret: Mm-hmm. 

Preston: So in the moment coping is super effective. 

Margaret: Yeah. 

Preston: For them or, or just important. 

Margaret: Yeah. 

Preston: And, and I'm in San Antonio, which is number one in Texas for road rage. So there's a, there's a high demand, someone living Boston.

That's interesting 

Margaret: to me because it feels like here's, yeah. 

Preston: Anyways, so with box breathing, I, I think about having someone draw a box with their breaths. So you want to exhale longer than you inhale. So I think about kind of creating this rectangle where you exhale along the horizontal and then you inhale on the vertical.

So it's like

four seconds exhaling and then two seconds inhaling. And so what I do is to kind of make it more of a game for them. 'cause I, I guess I have to gamify stuff. I say find, look almost like I spy. I'm like, look for rectangles in your environment. 

Margaret: Mm-hmm. 

Preston: And try to trace those. Yeah. 

Margaret: Yeah. 

Preston: And for patients in traffic, it's like license plates.

Mm-hmm. So, [00:43:00] and, and I didn't even come with that. I was just, I'll tell 'em to look for things and they came back and they're like, dude, I was in traffic and I would just be tracing license plates. And it actually helped. 

Margaret: Oh, that's good. I got a bunch of accidents, license plate, and then you 

Preston: trace that one, and then you trace the one in front of you and then you trace the one to your right.

And so like, it was helping them kind of center themselves. 

Margaret: Mm-hmm. 

Preston: And also like activating their parasympathetic nervous system Yeah. To bring down some of that frustration because, and the other thing I'll talk about is there's a physiologic benefit to mm-hmm. That controlled breathing. It's not just like taking a moment.

Yeah. When you slow your breathing down like that, when you fill your chest up like that, that mm-hmm. Expanded chest is gonna stimulate your vagus nerve more. It's gonna slow down your heart rate. 

Margaret: Mm-hmm. 

Preston: It's gonna, it's gonna inhibit a little bit of, that's anxiety as being released into your limb, into your limbic system.

Margaret: Mm-hmm. 

Preston: So it has a physiologic calming effect. And I try to kind of sell that part of it as well, rather than just like, 

Margaret: oh, [00:44:00] so it's something else to focus on as a distractor, you know, it's, it's also medicine, like your breath is medicine that 

way. Yeah. Breath is so interesting because there's like.

There's so much that's said about it online. There's stuff that's said about it in therapy and then there's like the actual relationship between different like length of breath and how it theoretically does or does not impact your kind of like parasympathetic, sympathetic nervous system heart rate and if that actually like applies and I think people get lost in it.

I certainly have gotten lost in it before, but I think yeah, giving people something to anchor on with breath as a way to kind of get through these like short-term moments is super helpful. Um, and maybe different types of breath are more or less helpful. Someone asked us if we could talk about breath work.

If you want us to do a deep dive, please leave us a comment on like the YouTuber podcast and let us know and we'll we'll do it. Uh, [00:45:00] but yeah, I think I give people, before you had interrupted my mindfulness meditation, I give people not a box breath, but a similar like. I work with trauma patients a lot, so I feel like giving as much body autonomy as possible is how I think about breath work.

And so I try to give them like a frame that is pretty flexible in case there's someone like who if they kind of try and do a longer breath, they start suddenly feeling really panicky and anxious that it's like they have freedom to do a shorter breath cycle or whatever feels okay in their body. Um, 'cause some people can feel, and some people in mindfulness in general, even without breath work focus can feel that like increased anxiety or hyper vigilance.

Um, to the other point in terms of like other, I think in the moment sensory, maybe not mindfulness, but attention or distra positive distraction that is not gonna harm you is kind of the core that I think about of in the moment coping skills. [00:46:00] So. If you can go somewhere physically different, if you can distract yourself, like if you're like, I hate writing these notes, or I, like, I'm really stressed right now.

Maybe that was for me eating one of the sour gummies, I was like literally. 

Mm-hmm. 

Sometimes we'll use on the units, if we're doing DBT, we'll use like scent, but that grounding and embodiment in general, I think can be a very powerful tool to reduce the volume of the intensity of an emotion in the moment.

Maybe not take it to zero, maybe not solve it, but bring it down to make it so that you can get through it. 

Preston: I actually, I do that at home, so almost like I employ like a ritual as needed. And it's, and it's interesting because like it, you're making me think about like OCD, which is almost like a natural coping skill that people develop for such intense surges of anxiety.

Mm-hmm. Um, in a lot of ways the compulsions that people have or those like ritualistic behaviors are developed coping skills. And they are adaptive in the [00:47:00] moment, and then they eventually become maladaptive. But the process of using a ritual to relieve yourself of some form of anxiety mm-hmm. It still stands.

Yes. Yeah. So one thing that I'll do is actually like, make espresso. It's, and so many people are like, why don't you just get an espresso press and it can be so much more convenient. And I'm trying to be like, no, like the process mm-hmm. 

Of 

weighing out 18 grams of beans, grinding it, mixing it in with a tamper and like watching come down.

It's therapeutic for me. Mm-hmm. Like it's, it's a set, like, it's like a three minute ritual. Mm-hmm. Mm-hmm. And I, and I do it when I'm like stressed at home or if I'm trying to like, center myself before I go to work or something like that in the moment. So having that like little ritual that I know I can go do mm-hmm.

Is. Is really helpful. It's tough to like prescribe that to someone because Yeah, I can't be like, Hey buddy, like, buy an espresso machine 

Margaret: that's gonna help your anxiety. 

Preston: It goes, it goes crazy, like, trust me. No. But what I [00:48:00] try to do is I try to find if they have something that they enjoy and I say like, what can your ritual be?

Margaret: Yeah. 

Preston: Like, and so for some people, like 

Margaret: it might be doodling or, or maybe it's like,

um, fidgeting or, or even like a small 

Preston: stress ball or something like that. Like they, but they find a way to do it, like intentionally rather than sub subconsciously, if that makes sense. Right. 

Margaret: I think it also offers this non-judgmental perspective. I always tell people like, coping skills are a hammer can be a great hammer, but you probably don't want one to.

Unscrew something, right? But that doesn't mean a hammer is bad at its job or that it's not something you want to have in a toolbox. Similar with like distraction. Distraction is a great tool that is useful at different times and only becomes like the literal meaning of maladaptive when it's the wrong tool for the wrong job or the only tool that we have.

Um, I think, [00:49:00] uh, and I agree with you, I kind of connect this when I'm doing act with people to like values work as well. The val values is like, sounds like a kind of like high flying term. I also use it as like, what do you just like day to day? Like not that you like for some other reason 'cause it makes you somehow better or how you should be or helps you take care of your kids or be a better, you know, spouse or something.

But like what do you just like in and of itself and it sounds like for you, like that is the kind of espresso, um. Process and, but I agree with you and I also often talk to people about mindfulness at first as doing kind of what you do with that, of like, let's start with something you already kind of inherently like and build on the attentional capacity by focusing on something you already like to focus on, and then we'll eventually go to things that you don't like to focus on.

Hmm. 

I like that. Maybe we should have started by making coffee together on the beginning of the episode. 

Preston: That would've been fun. Yeah, so, so mindfulness would've [00:50:00] been me just bringing the camera over and showing you how to make coffee. Oh yeah. Which is one of my favorite things to do. Yeah. I love, I love making lattes for people and having them watch, usually like, they kind of enjoy the process.

It's fun to watch this espresso come out and I'm like, oh, I get to share my coffee with them. 

Margaret: Well, when I visit you and Nice from my friend's wedding, you can, I'll be like, show me the mindfulness. And you'll be like, 

Preston: okay. 

Margaret: And I'll be like, now you need to sit and be silent for 20 minutes. I'll be like, mine's reading.

Quietly alone. Oh, darn it. Um, I do think that like when we do DBT or like, I'm thinking of some of the child units that like making a physical visible coping kind of. Toolkit can be helpful, not because all of your coping skills are literally gonna be physical and in there, but I think sometimes the visual reminder can be really helpful when people are like in the middle of panic or a trigger.

Mm-hmm. Or just feeling bad because it's hard to cognitively pull it back. It's easier than if we'd never talked about these things at all. 

Preston: Yeah. But 

Margaret: it's, but it's even easier if we can have a physical [00:51:00] reminder of it. 

Preston: This is a, a little bit tangential, but one thing that does annoy me about how we conceptualize coping skills in the, like, inpatient or just like in the medical setting in general 

Margaret: mm-hmm.

Preston: Is that like, have you ever made a safety plan where you're fighting with someone to list more than three coping skills? And, and I'm kind of, of the per perspective that one good coping skill is a lot better than a bunch of lip service because Oh yeah, I agree. There's definitely situations where the, the patient's like, listen to music, go drawing, and I'm like, when's the last time you've drawn anything?

They're like. It's been years. I'm like, okay then why this isn't a good coping skill for you? Like when you go back out in the world and you're in crisis and we're writing down, drawing on your safety plan is something right. Like, and it's like for them I'm like, it's okay if just like controlled breathing is your only coping skill for like that acute crisis moment, if that's like affected for you.

But I think that there's like something to be said about how we as a medical system fail to acknowledge like the value of [00:52:00] these like coping skills. And we just kind of want hope to like list them off. Right. To, to continue with like kind of my gripes with the safety plan. Yeah. You go down to like reasons for living for someone and they'll be like, to provide for my family.

And I'm like, okay, we gotta get two more. They're like, what do you mean two more? I'm like, well the sheet says I have to fill out three, otherwise you get like pinged back by my attendings. 'cause they're gonna say we filled out a bad, um, safety plan. Yeah. So, so I don't know. I think. When we try to find good ways to cope or try to find like values or reasons mm-hmm.

It can be effective to, to only search for like the one that's successful to you rather than trying to like expand the toolbox for the sake of expanding it. Right. Which I think is like something that I've been spoonfed a lot of and now I'm like trying to unlearn. 

Margaret: Yeah. I feel like so many of the coping skills, coping tools to continue this metaphor is like people will be like, we okay.

It's like when I first moved into med school, into my like own apartment [00:53:00] after living in like my parents' house or dorms and it was like my dad got me like a little toolkit and it was like, okay, here you go. And it's kind of like what we do with our coping. So we're like, okay guys, here it is, here's your coping skills.

Uh, and then we leave. And similar to me in my apartment in med school, I didn't know how to put a nail in a wall the correct way. Like just 'cause you have been taught, like you've been told here they are, how to actually use them. Mm-hmm. Takes a lot of time and teaching and experiencing. And that's why I think you're gonna really like being full-time outpatient next year, because I feel like only now when I've like worked iteratively with someone over multiple sessions do I feel like their safety plan, I think they're valuable regardless, but I think they become really valuable resources when it, you do have this time to get to know them and that you're like, oh, you mentioned this a couple sessions ago.

Maybe we should put that on as a good way to connect when you're feeling really lonely or isolated in your mm-hmm. Safety plan. Yeah. That takes a lot of time [00:54:00] 

Preston: and, and I think, I have to be honest, a jaded view of a lot of safety plans right now, because most of the ones I perform are like inpatient where someone's just trying to leave the hospital.

Hmm. I'll be like in a landlocked state and they're like, sailing is my number one. I'm like, dude, do you own a boat? You're like, I don't know, sounds nice. You're like, I, I know that you don't care and I don't care and you just wanna leave, but like, we gotta, we gotta do something here. Yeah. You know? And so I think it's kind of just led me to this feeling that a lot of these documents can feel performative and almost like, like a legalese CYA situation.

And so I'm trying to, 

Margaret: I feel kind skimmed off the top. Like, it's like we like took things that maybe worked or were like a marker when people used to be inpatient for more than four days and they meant they were a reflection of the narrative of the relationship that you would formed with them as their clinician.

Whereas when they're there for three days, it's like, okay, we're gonna do this. But it's like, where was the [00:55:00] relationship that was underneath it? And the time that actually maybe was the thing that mattered the most about why this document existed. 

Preston: You spent a grand total of an hour with them, like three 20 minute interviews.

Margaret: Although I do think there's an art to how do we make the most of even. Like, how do we not give into this idea? How do we push for better, more meaningful connections and having the time to be with our patients and how do we not, how do we make the most of the time that we do have? I mean, I'll always ask people, like when I first meet them inpatient, like, what do you do when you're feeling not depressed?

Like, what do you like to do? Mm-hmm. Who do you hang out with? And then come back to those things every time I see them, so that when we make the safety plan, it's like, what about this friend you mentioned who's like always there for you that I, I saw you like light up when you talked about the last time you saw them and you like went to the, sorry, uh, I was about to say, went to the beach because I was gonna flex on your land lasting.

Preston: No, it's fine. 

Margaret: Um, but, but yeah, it's, [00:56:00] I think one of the things of doing this episode is like, I agree with you. I don't want it to feel like people that were like, let's list. 40 things that you could try to do and have it just be like a list of things that like people can blame themselves for. It's like, oh, if you've just done the perfect set of coping skills, then you wouldn't feel sad and it's your fault.

And that's definitely not what we want to be. 

Preston: And, and Friday, Friday, anyone listening, I want you to know I am pro safety plan. Like I recognize that there's value in it. I'm, I'm being kind of a hater right now, but I think it's just because this is an effective clinical tool that we know prevents people from completing suicide, that we apply incorrectly in a lot of settings.

Margaret: Mm-hmm. And 

Preston: that, that's like where my frustration is. 

Margaret: Yeah. 

Preston: I think this is, I feel pretty satisfied with our in the moment coping skills. 

Margaret: Yes. Yeah. Yeah. So 

Preston: now we can move on to questions, question time. 

Margaret: Okay. Are you ready for questions? We're gonna, we'll do a couple questions. I'm gonna challenge us to try and [00:57:00] answer questions in like a couple minute response.

Okay. 

Huh? 

Direct. Direct. Yeah. Okay. Non politician answers 

not. Um, okay. So one I got from Megan Fox, Skidmore, who I will say is my friend, my, uh, friend from St. Louis. Any 

Preston: relation? 

Margaret: Two. 

Preston: Megan Fox? 

Margaret: No. Oh, sad. Sad for you. Uh, tips for balancing mindfulness and overthinking, or are they unrelated? I'll, I'll go first and you can go second.

Okay. Um, I would say that I see a lot of patients and just people in general and certainly myself wonder about like, well, I'm detail oriented and I in some ways overthink, but also the detail oriented part of me I value. Um, and is mindfulness going to kind of make me less able to be kind of really [00:58:00] attuned and noticing things?

'cause sometimes I'm right. I notice things other people don't, or details. Other people don't. I think they can very much be related and I think mindfulness practice, I always think of people on a spectrum of like, not everyone needs the same advice. Not everyone needs to be more mindful or would find it helpful or useful to be more mindful.

But if you're someone who's overthinking and it pulls you out of one things that you wanna be present to, so you don't wanna be thinking at work about work when you're like trying to have dinner with your like partner or something. I think mindfulness can be a really great skill to practice to help you not be overthinking about things that you're not currently in.

Preston: Mm-hmm. 

Margaret: Um, I think the second thing I would say is mindfulness might be hard for people who struggle with overthinking because I think in the word overthinking, it's like there's a thousand thoughts a minute. And so going at the right pace for mindfulness and not being like, I'm gonna sit and have no thoughts for 30 minutes, [00:59:00] or I'm gonna judge myself if I have a lot of thoughts.

Starting slow again, maybe starting with mindfulness in something that you already sort of like, and being really, really gentle with noticing what your mind does. And that if you wanna be more present and less thinking all the time, starting really slow, slow and going, and then noticing and encouraging yourself, like, I'm doing something hard.

This is very hard for me, and I can see myself growing in it slowly. 

Mm-hmm. 

Preston: I don't think I have anything to add to that. Damn. It's that, um, you know, when you're anxious, you're overthinking, which is kind of what I'm picturing. You're entertaining hypothetical situations, which by definition is not being present.

So kind of entertaining hypotheticals and being present in the moment are in a lot of ways opposed to each other. So just try to find that balance 

Margaret: between them and, I don't know, I, I think you have to be the barometer for what that balance is. [01:00:00] Okay. Next question. 

Okay, here's, this one's more of an opinion question.

So do you think the concept of mindfulness has been diluted by influencer wellness space? 

Preston: Yes. 

Margaret: Say more. You're like, yes. Next question. No, I think 

Preston: I've fallen victim to like, seeing it as this chewy granola, um, like vacuous advice given by people that proclaim themselves to be gurus. And, and I think that, like, like you mentioned with Nancy McWilliams earlier, like it's, it's caught in some flack from that.

And I think it, it makes me feel more empowered to kind of just like poo poo it in a lot of situations, but there's still value to it. And I think the only antidote to that is really clarifying, like what mindfulness is. And I don't wanna be like the, oh, this isn't true mindfulness. You know, like, this isn't true social me at the beginning of this episode.

Margaret: Your mindfulness is wrong and you are bad. 

Preston: Yeah, yeah. But, but also like. There, there [01:01:00] are parameters to this. Mm-hmm. 

Margaret: Mm-hmm. 

Preston: So yes, I do think it's diluted and we need to fight back. 

Margaret: The only thing I'll add to that is that I think in there are situations like socioeconomically, when we think about like the social determinants of health that make mindfulness easier or not as easy to do, it can be difficult for anyone.

Right? Mental health can impact. Mm-hmm. Anyone, anyone can have an anxiety disorder OCD, but I do think, like if you don't feel, if you are someone who is more likely to have been through trauma or if you're more likely to be somewhere where you don't feel safe to go on a walk, um, doing mindfulness is a much different thing than for someone who feels super safe in a safe neighborhood.

Like never are targeted in any way by like people in public. So I, I think that's the other part of the wellness thing is that it's often these, and I say this. I say this as a straight sized white woman, like [01:02:00] it's often people who are like, okay, come with me in this stressful day. I'm gonna as an orange, orange County Pilates, ma.

Yeah, exactly. It's like their life can be hard. Don't, I'm not saying twisting it anyway, but I just think getting o like if someone is in a, in a situation that would cause, like if you're afraid you're going to be shot in your neighborhood, it's pretty hard to be like, let me just practice, uh, like not being attached to this.

Like, there are very different situations. Yeah. That impact someone's ability to be like, just be mind. And I agree with you that there's kind of this like floaty, like mindfulness is just like, it's being at peace. It's just, you know, I just, I can disconnect from my emotions and. Kind of has this almost like overly pure Gwyneth Paltrow.

Yeah. And then 

Preston: also like the, it, it leads into like weaponized therapy language to like, yeah, I can't do this thing for you because I need to be mindful and support myself right now. And then you're like, what is this? Is this whole thing just like a tactic for you to get leverage over why you're [01:03:00] like morally superior to people, but also could be like a shitty person?

Margaret: Yeah. So 

Preston: I, I think it, it gets that flack too. 

Margaret: Yeah. No, I think, I think exactly. Um, 

Preston: okay. Next question. 

Margaret: Here's our last question. It's sort of related, but I think especially this is, we're filming this in the winter still, uh, and in the US how can people practice mindfulness with news and media consumption?

Preston: Right. Shanti, are you listening? Shante? 

Margaret: Ask this question. She did not ask. 

Preston: She, she goes, I'm really looking forward to this episode because I spent the entire morning screaming at the tv. She didn't say what she was screaming at, but I, you know, one, the mind wanders. What can only imagine 

Margaret: the mind, the mind wanders.

Um, I talked about, about this with one of my supervisors today who works in trauma and I really like the way she set it up. Um, I think it gets it like a core deeper thing of how we help [01:04:00] patients set themselves up to navigate difficult times. Um, with the particularity around like the new cycle. Being asking that, like going deeper with kinda like the values work and saying what, how much do you think is reasonable for you to check with frequency that would keep you informed enough?

What is the things you can control and can't control? And then for a lot of people right now, a lot of things in the news are setting and so beyond making sure that they're safe asking then. What is my capacity to turn this energy and this righteous anger into action in some small or big, but local way to create more of what I wanna see in the world, invest locally, invest locally, shop small business.

Um, but I think that that all, you have to start there a little bit and then it helps you inform you. Like [01:05:00] maybe someone thinks if I read like the front page of the online like New Yorker or like Atlantic or something, whatever. It's like if I watch 30 minutes of like national news on this channel or I let myself scroll where I like watch news people online, but if they contain it.

But I think you first have to kind of unpack the what the both, I think some of the news media, some of the administration, some of like the technology of these apps are based on the attention economy. Meaning they want, they get, they, they profit more the more you pay attention. So yeah. 

Preston: They, they want clicks and they're playing off your emotions.

Margaret: Yeah. Asking yourself outside of that system, like, what's reasonable to me and what, what accomplishes my goals with this? 

Preston: Yeah. And so I, I think that's like a very reasonable, in a lot of ways, like unsatisfied answer, ask yourself what's reasonable and then do that. Oh, I'm, I'm sure the person reading that is like, thank [01:06:00] you.

Margaret: That's fair. 

Preston: Um, so, so what I would say is, um, to quote Kendrick Lamar, turn that TV off, turn that TV off. Um, I, so I listen to the daily, almost every day on the way to work. And I like the last couple days, like I'll pull up the title and it'll be like, Trump's new export deportation policy. And I'm like, I can't do it.

I can't listen to 30 minute depressing story about like. State of our country right now. I'm like, so, so I'll just listen to Hyper Pop instead. Um, and, and the theme today is to be like, to forgive yourself for what you can cope with. And like, sometimes you're like, okay, I can't change anything about these deportation policies, like we said, but like, I can do like a good job at work today.

So if listening to this is gonna make me depressed or make me more pissed off or something, then I'm, I might be there less for my patients than I'd like to be. Right. So [01:07:00] try so I'm like, okay, if, if this is gonna, if cause me to have negative emotions, then that's enough for me to kind of take it off at this point.

Mm-hmm. Because, and maybe I have a high threshold that for that, but even a lot of negative news, most of it I can consume without feeling a ton of emotion. Mm-hmm. Just like, oh, that's interesting. Mm-hmm. Usually curiosity is what drives it. Yeah. Or like some understanding. Yeah. The other, the other actionable thing that I'll offer is.

American tabloids and news sources are very invested in the attention economy and getting like these controversial clicks within our own issues. So I'll do is instead listen to the bbc. Mm-hmm. So the British broadcasting, um, networks, or like the rest is politics run by a lot of British hosts. Mm-hmm.

They talk about the US in a way that doesn't feel like they're trying to fire you up. Mm-hmm. They're just like, this is what we're seeing from across the pond. Sorry, this is what we're seeing from across the pond. 

Margaret: That's gonna be our intro. [01:08:00] 

Preston: There's Dawn Americans having trouble passing another bill in it.

Right. Welcome to another Tuesday. Rest is politics. And I'm like, I'm like, ah, soothing. But like, but then when I hear them talk about what's going on in our country, I know it's filtered through a bias of a foreign, but also it like pisses me off less. Yeah. Because I, I don't feel like someone's trying to fish a response out of me.

Yeah. So if you really need to consume something, um. Responsibly, you feel obligated to be informed. Mm-hmm. Weirdly enough, like Al Jazeera, BBC, like other countries, news networks can give you different perspectives on the same events that are happening here. Right, 

Margaret: right. Yeah. No, I agree. I agree. But though I'd still have to choose to, this is why I'm saying the macro picture before they do that is pick, think about like, like reasonably, like not Okay.

I hate reasonably. Now the way you said it, I realize how this sounds, 

Preston: Parker Mars answer everything, look at yourself and be reasonable. [01:09:00] 

Margaret: No, I wanna mean like, oh, 

Preston: thanks Margaret. So helpful. I'm 

Margaret: wondering like before you get on your phone, like take 30 minutes on paper. Not every day I am saying once or with your therapist or with a friend and say, why is it so important to me?

Like what is underneath this? Like what do I actually value and what is the anxiety that's being provoked by it? And then you do what you do. Which is then saying, okay, how do we make this concrete? How do we add things so I don't have to rely on my, like willpower when I'm like, mm-hmm. Scared because the news just said this and it's targeting me or someone I love.

Um, but thank you for undermining me. 

Preston: No, of course. It's, it's what I listening. Of course. No worries. Do, do you ever feel like, uh, news is, is like that scene from Harry Potter when, um, Dumbledore was drinking the potion? The horse rock and, and Harry keeps force feeding too. That's keep 

drinking. He's like, like you said, remember you have to keep drinking.

And he's like[01:10:00] 

me to myself. It's like another story about how like federal aid is being cut to national party. It's like psychiatry is made up 

or 

FK Jr is coming for antipsychotics and s 

Margaret: must drink. Please

did put your name in of five. 

Okay. 

Preston: Don't calmly 

Margaret: gonna for the rest of the episode, that's how we cope. 

Preston: One way I've been coping is I'm trying to do that scene that that chess scene, but in a Scottish accent. 

Margaret: No, not me. Not Amani, that one. 

Preston: No, 

Margaret: not me. Not Ani.[01:11:00] 

Preston: No Rhonna there. There must 

Margaret: be another week.

Oh, to live in your brain. Oh, to live in your brain. Not, I have nothing 

Preston: else productive for this episode. Not Harmani. Yeah.

Margaret: Alright guys. Well we hope, 

Preston: oh shoot. We have to do the ending part. You have 

Margaret: to do, you have to do that. 

Preston: Okay. Okay. I'll try it. Thank you so much for listening. Social Hours, the show, you wanna hear what you think, 

come and chat with, come have a chat at our Fun Human Content podcast family on the TikTok at Human Content pods.

Or you can, uh, reach out to the team directly how to be patient porn.com. This is like more Australian. Oh gosh. Um, okay, [01:12:00] I'm going back to my normal, normal voice. Now. If you wanna watch full videos, it's on my YouTube at it's preso new videos every week. You can also watch the videos on the Spotify, but I personally, like when I'm on Spotify, like I prefer the audio version.

Um, so, and the nice thing is on Spotify you can alternate between those two. So if you are watching the video version on Spotify, there's like a switch. Or if you're watching the audio version, listening to audio version, you can also switch back to watch video. Okay. Thanks for listening. Well, your host, Preston Roche and Margaret Duncan, our executive producers are me, Preston Roche, as mentioned before.

Margaret Duncan, will Flannery, Kristen Flannery, Aaron Corny, Rob Goldman and Shanti Brook. Our editor and engineer is Jason Zo. Music is by OER Ben v. To learn more about our program, disclaimer on ethics policy submission, notification and licensing terms, our HIPAA release terms. Go to how do be patient paul.com or reach out to us at how to be patient@humancontent.com.

If any questions or concerns, how to be patient is a human content production. It's Tuesday in it, [01:13:00] mate. Let's. Go have a good one, 

Margaret: right Ry? We'll be back 

Preston: and Aaron's like, and you're fired. I'm canceling 

the 

entire show.

Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, they probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the [01:14:00] background.