Season 1, Episode 2: Behavioral Health and Safety Education
Self-regulation training
Welcome and Introduction to Brad Chapin
Jenny:
Here. Thank you so much. Okay, Alex, why don’t you take us away, please?
Alex:
Hi, my name’s Alex. Welcome to The Gravity. Well, where we break down heavy ideas into small buckets anyone can handle in our work and at play, we seek the wisdom of elders, individuals, and communities that share our knowledge to care for our water, air, land, life, and resource needs. Caring for our homeland will be our guide.
Jenny:
Thank you for that introduction, Alex. Thank you everyone for joining us. Really appreciate you being here. Hi Michele. Thank you so much for being here. I am excited about this conversation today. Just going to take a moment though to reflect on last week. Angie and Merrill, thank you so much for being here. We had a great conversation. We spoke about why we’re doing The Gravity Well. We spoke about our mission statement, then we talked through what we see. Hi Dion. Thank you for joining us. We talked through how we want to handle problems that come up in conversations. We wanted to work through our method, the method that Alex and I took in this complex decision-making course, which helps us work through the six W approach to all of the problems we want to talk about in this room. Both Angie and Melanie helped us talk through building a community agreement, making sure that we have space for people to offer suggestions, and making sure that we’re using the tools in this room.
Brad, for your information, if you hold down on your image, you can do things like add emojis or images or things like that to help kickstart, just show support of a comment or anything like that. Awesome. Great job. We’re just going to use the tools in the room. There is a chat in the bottom left feature as well. Hi Merrill, thank you so much for being such a great supporter. and for being here. We’re going to use those tools to help us work through these conversations. And if we have any challenges, we’re going to look to our community and to our rules to make sure that we stay on course. This particular conversation has been a long time coming, not necessarily for Brad, but certainly for me. I met a woman that is from Calgary and she offered me her story.
Her name is Mary. She’s a mutual friend of Brad and I’s. And Mary grew up in Ontario. She moved to Alberta and had an accident on her bike almost immediately after moving to Alberta. And that accident put her life on a different course. One of the things that it meant for her was that she could no longer afford to drive or ride her bike because she was hurt. She took the bus and while using transit, ended up getting, she had, what ended up being, a stalker for quite some years, or certainly a significant amount of time. And the threats that this person put on her caused her tremendous PTSD. Mary was suffering from PTSD and started to get suicidal thoughts from that experience. And she thankfully wasn’t successful in that, but was because she was struggling with this for so long and she decided that she was going to just research and understand what she was going through.
She researched, and Brad, you can help me expand upon this story if you know it differently. She researched for years, or at least for a significant amount of time, and found Brad and Brad’s work. What Mary described from learning from Brad is that she was able to see what was happening to her in real-time, like physically. She said, that she remembers Brad walking through a diagram, which I’m going to share with you once I stop talking here. I’ll put a link in this chat so you guys can see the images that Brad presented to share for us to walk through today, but that his work changed her life and she feels that this work is vital in terms of helping people work through their fears and helping them shape a healthy life and make sure that we each have the tools to look after ourselves. That’s what Brad’s work is trying to do. I’ll stop there. Brad, if you please unmute yourself and just introduce yourself a little bit and what you’re hoping to bring to the conversation today, as well? Thank you.
About Brad Chapin and his behavioral health/self-regulation work
Brad:
Yeah, thank you Jenny for that introduction. Thank you for telling Mary’s story. I work with a lot of people from all over the United States and other countries too, but Mary’s story sort of sticks with you and we’ve stayed in contact for a number of years and she’s just been such an advocate, just a passionate advocate for mental health. And just also I think one of the things I’ve gotten from her, and it really pushes a person like that, pushes professionals to do work better too. She’s a motivator for me, but just to hear a person with lived experience and how the system is difficult for them to navigate and get where they need to be and how can we do things better for people who are looking for ways to help themselves. That’s really where I’ve spent the 20-some years of my career in the applied setting. I don’t sit on a university campus somewhere and tell people how we’ve been doing things for the last hundred years. And I think I appreciate those people and I read those journal articles and the work that they do, but there’s definitely something to be said and working in an applied setting. I don’t know, Jenny, if you want me to introduce myself a little bit here or
Jenny:
Yeah, please, Brad, if you wouldn’t mind. I have you in, is it Topeka, Kansas? Is that how you say it?
Brad:
It’s Topeka, Kansas, yes.
Jenny:
It’s great. Yeah, if you just wouldn’t mind speaking a bit about what you’re doing right now would be awesome.
Brad:
Sure. I’ll just share a little bit. I wish I just had to say right up front, I wish I had Alex’s voice. It would probably sound so much better. I probably could listen to him just report the weather. But for me, I’m a master’s level psychologist and spent a number of years at the beginning of my career doing therapy and psychological evaluations for kids and adults. And then 13 years I worked in what we call here, community mental health centers. Those are places that people go that don’t have very good insurance, sometimes no insurance, and we are set up with some government funding to help those folks be able to afford mental health care. That was 13 years. And then the last eight years I’ve been director of clinical services for large healthcare systems, behavioral health department. I oversee 52 inpatient psychiatric beds, 20 for kids and 32 for adults.
And then we have full outpatient services that we do for behavioral health. We do about 35,000 hours of mental health outpatient services a year for Topeka and the surrounding counties. We go from Frontier, what we call Frontier. Those are very rural areas, also a high Native American population. And then to urban areas, which Topeka, we call it urban. It’s about a hundred thousand people, but not massively urban. But by Kansas standards, it’s urban. That’s what I’ve been doing. And then my biggest passion though is self-regulation training. And I think that’s kind of what Jenny wanted me to come and talk here about, which is getting basic skills. You hear this language around mental health literacy is big right now. It’s getting basic information to people that they can use without having to wait on a list to go see somebody for therapy or maybe not understand what they can do to help themselves. How do we break these skills down into meaningful chunks that people can apply in their lives and see results very quickly? That’s my background.
Jenny:
Yeah, thank you. The piece that has stuck with me, Brad, is the fact that your work, as you’ve noted, is a person only needs six hours of training to have a significant change in their life knowing this work. Is that correct?
Brad:
Yeah, it’s so amazing. We started with kids with these skills because I mean, who doesn’t want to get there earlier? And I started my work with adults and it was just like, gosh, what if we could have gotten to this person 25, 35 years ago? Would they even need to come see me at this point in their life? We worked on developing evidence-based skill training guides for teachers and school counsellors to use with kids. We have an elementary curriculum, a preschool curriculum, and a middle school, and high school curriculum. And then I was reading some, and I knew this all along, but just the basic logic that was telling me, what if the adults aren’t doing well enough to get these skills to the kids? What if the teachers aren’t feeling well enough themselves? We had data to show that our teachers who were able to apply these skills in their own lives, the kids benefited from that, their scores, their self more than those who weren’t applying it in their own lives.
Our data is showing right now. I’ve done, I don’t know how many, we, of course, I’ve done training in 38 states and Canada, five or six times in Singapore, but we have data on over 5,000 kids and adults. But more recently, in our adult data, we’ve been focusing on educators and healthcare professionals. And a lot of that was brought on by Covid. Our health system, we have about 6,000 employees, and we’re a Mayo Clinic. I don’t know if you’ve heard of the Mayo Clinic here in the US, but a large healthcare system, Mayo Clinic care network partner. What we do is teach resilience and self-regulation. And of course, about three months into the pandemic, we realized that our healthcare professionals were not doing well, managing everything they were trying to manage. Our one-day training on self-regulation skills has been yielding a 40% reduction in what we call perceived stress.
And if you think about that concept, it’s really important. That’s how much control you feel like you have over your stress level. It’s not going to magically take your stressors away, but what we’re after is what can we put into your hands in a day so that you can walk away and feel like you have more power and control over the level of stress I’m experiencing? And I was like, what a wonderful way to spend a day. And then just the stories that we hear after the day, just some of the anecdotal stuff like I don’t fight with my teenage daughter anymore, my husband and I are getting along better. We’re having conversations around things that we were angry about before that we couldn’t even sit down and talk about meetings are going better. Just some of these really practical applications when people can manage themselves a little bit better. Some of the other stuff fixes itself to put it short.
Jenny:
Awesome. Before we go too far into your work, I want to just quickly take a moment and let Alex introduce himself as well. And Alex, if you wouldn’t mind just offering what you’ve done a bit of research on Brad’s work too, or just some of your perspective, some of what you’re bringing into this conversation. I’ll stop there.
Alex:
Sure. Won’t dive too deep into it, but I too am a person with lived experience and I’ve had to lean on professionals from time to time to overcome my obstacles and my stress-reactive tendencies. I was looking a bit into the history of some of the work that you do, and please, Dr. Chapin, correct me if I’m incorrect, but is the origin and developmental systems theory? Is it based on the human ability to simply at first acknowledge that there is a physiological stress reaction and in that acknowledgement the developed tools to at least manage or overcome those?
Brad:
Yeah, I love simple and you’re correct. Systems theory has a lot to do with this, and we know from systems theory that organisms systems do perform better when they’re balanced and systems will also seek out balance. It’s just, are the ways that they find healthy or unhealthy? I don’t want to get too deep into that, but yes, since you opened that door, that explains the first domain. We teach skills in three areas, physical regulation, emotion regulation, and cognitive regulation. And I think where you were going with that one was the physical balance of our biological system for great.
Who needs behavioral health/self-regulation training?
Jenny:
Yeah. Thank you. Okay, let’s get into this. Who needs self-regulation training? If you can just sort of expand on, as you’ve already done, you’ve touched on that this is children, this is adults, but just expand on who needs it and a bit more as to why it’s important just before we dive in.
Brad:
Yeah, sure. One of the first things I say in my opening line in my training is that if you’re not experiencing any challenge in your life or you’ve never experienced a challenge or won’t ever experience a challenge, you can probably go ahead and tune out. Experienced challenges in going to regulate in a healthy way or an unhealthy way in the face of challenge. There’s no way around it that I can see. It’s going to happen. And that’s what I think is interesting about when we work with kids. It’s like, well, we don’t have time to teach them or we don’t have time to do this. It’s like, well, they’re going to do it one way or another. They’re going to learn these things. They’re going to learn healthy ways to manage challenges in their life or unhealthy. And that’s as simple as I can put it.
To me, it’s a human skill. I love this topic too, because it’s unifying. If you’re a human being on this planet, you’ve experienced challenges. And also chances are you weren’t formally taught how to do that, especially how to manage social-emotional challenges. I think you probably what happens is if we don’t have a formal system for managing challenges, what we do is we absorb a whole bunch of vague advice or we dish out a bunch of vague advice. And I’m sure many of you on the call can relate to these kinds of things. Oh, for example, if people aren’t getting along, let’s say some people are polarized around an issue, some of the advice we might say is, why don’t you just get along? We all be nice. Let’s be nice. Everybody, be nice to each other and let’s get along and it’ll be just fine. We hear all kinds of vague advice when things aren’t going well, just hang in there, make better choices, and do better next time. I think we can do a lot better than that, but that’s what I hear a lot as far as solutions.
Jenny:
Thank you for saying that. Just so you know who’s in this room, a little bit of colour for you. Brad is Angie Alexander hosts a room on Thursday mornings in Clubhouse. And all of the participants in the audience here are regulars in Angie’s room. And one of the things that we talk about is often, you talked about two things there I just want to send back to you, which is number one that we say a lot of this is what we need, this is what we should be doing, this is what we want. But there isn’t a lot of the show that seems to be absent from what we’re doing. I think that’s what you were touching on. And then the other piece, I was actually, I’ll just stop there. If you could just talk a bit about how this system offers, like you said, some action around that because okay, my other thought was around the reason why we’re having these conversations is precisely because we need to lean into the challenges we’re facing. And like you said, if we’re in this position where we have people that disagree, well, we don’t have the option to just, as you said, get along. We have to talk through the issue. That’s precisely why I wanted to help start our conversations off in a healthy way by understanding a bit more about what you, I’ll stop there. Thanks.
Brad:
Yeah. Can I ask you how to get the little party thing off of me, is that just permanently stuck to my image?
Jenny:
No, it’s just for today, unfortunately, it’s basically celebrating your arrival on the app. Congratulations on joining Clubhouse. It’ll be gone. And actually, it’ll come back annually, just so you know, it’ll be an anniversary thing.
Brad:
Okay. Okay. I didn’t know if you’re recording this, but sometimes not everything we talk about is pleasant and I just didn’t want my picture always with the little party thing.
Jenny:
Yeah, excellent point.
Brad:
I like it, but it might not always be appropriate. I’m sorry, Jenny, you said a lot there, could you, yeah.
Beyond Vague Advice
Jenny:
Thank you, let me frame that up. Yeah, I’ll frame it a little better for you here. As you’re saying, we often are told that we just need to get along, and that’s not giving the how-to, that’s not, that’s not saying we’re going to get along by doing X, Y, Z. Do you know what I mean? I think that’s fine, thank you for clarifying. Okay. I’ll stop there.
Brad:
Yes, thank you for doing that. I probably started to feel a little bit threatened because that was a trigger or a challenge for me. I go to a lot of training too. I don’t just do training. I listen a lot, and I probably shouldn’t say this, but I go to big conferences and I sometimes challenge my listeners to say, Hey, write down how many pieces of vague advice you hear over the next two days of this conference, and then come back and report to me as far as how many hash marks you have. And that’s probably not fair to do to the other speakers, but there is so much of that. And there’s also what I like to talk about, there’s a big difference between knowing and doing. I’m super hooked on the word intentional right now. When you have a skill that you can practice, and I think this is just one of the biggest things that biggest hurdles to get over with people in schools and other systems is that if you don’t see behaviour number one as a skillset, you’re not going to be able to teach it. We see behaviour oftentimes as an expectation of others and without the skill training. I always think, what if reading was that way?
If we just had a poster on reading or like they do for responsibility, for example, there’s a poster, here’s how you’re supposed to be responsible, but no one’s there to teach you the skillset, but the expectation is always there. That’s kind of how it is with self-regulation. I think Alex used the word reactivity, and that’s kind of the opposite of being well-regulated is reactive. And what we know is that reactivity doesn’t work well. If you just take the logical step back from there and say, what is it that helps target reactivity and what are the skills you need to practice to reduce reactivity? I mean, that’s really how simple and logical we’ve kind of made the system. Yes, we don’t need more information and more vague advice. I usually don’t hear people say, yes, please give me more of that. It’s the how-to and intentional practice. Yep.
Jenny:
Okay. Alex, did you have Go ahead?
Alex:
Yeah, I think you kind of touched on something as I’ve been reading through this general systems theory. It introduced key concepts such as open and closed systems, stressing the role and importance of context and environment or the way systems could reach the same goal through different paths and hyper more systems, structural or behavioural or developmental features that are shared across, shared across systems. People may have different approaches to reach the same consensus. Have you found that when you’re working with people in your scope of practice that emphasises that in some cases people are, they may think that they’re arguing with each other, but they’re coming to the same resolution? And once they figure that out, it’s almost like a, how would I describe it, a short circuit. It’s like they’re both speaking English and they think that they’re arguing with each other, but they’re both saying the same thing differently.
Brad:
We see that quite a bit, especially when people are activated. When the fight-or-flight system is activated, they’re really engaged in that fight sometimes just to be engaged in the fight so that the content gets lost because of the process. They start to equate the other person as a threat instead of the content as threatening. That’s one of the benefits that we see when we can calm those two systems down, that becomes a lot more clear.
Jenny:
Yeah, I love that. It’s funny, I think Alex is making, he’s sort of hinting to our work style because Alex and I will find, make a comment on sort of a flip comment on something that’s in the news, and I’ll pause and say, well, what do you mean by that? And he’ll give an answer and I’ll say, well, but I think it’s this, and next thing we’ll find quickly that we agree. But the words he used or perhaps the person, that’s the other thing is potentially making it about an individual rather than an idea itself. I don’t know.
Brad:
Yeah, I think what’s challenging, and just to focus on those first two skills that we teach in self-regulation, the recognition of when or flight is engaged, and then how to create safety to turn that system off so that we can use our whole creative brain that makes us human beings and not a lizard. Yeah.
The skills to behavioral health and self-regulation
Jenny:
Can you walk through that a bit for us, Alex? Oh, sorry, Brad. That would be a great time for you to do that. Thank you.
Brad:
Yeah, for sure. Those are the first two skills we teach in self-regulation training. And this is inside what we call the physical domain. We’re just talking about how our body responds to challenges here, and there are only two skills we teach. The first one is just that self-awareness. What do I feel like physically? What can I notice about myself when I feel threatened when I experience threat? Do I notice my heart rate increase? Do I notice my face feeling hot and red? Does my voice increase in volume? Do my shoulders get tight and tense? Does my jaw get tense because I want to say all these things and I’m holding it in? Does my stomach feel upset? These are real tangible things, and our research shows that three-year-old’s can start to tell us this kind of stuff. I know adults can do it, and I always tell people, if you don’t know what yours are, ask somebody who lives with you.
I bet you they can rattle off three or four of your warning signs in about five seconds. Increasing self-awareness around what those warning signs are, that’s number one. That’s the first skill. Those drawings that I sent you, Jenny, those pictures, those were done by nurses who’ve taken our course, and I’ll apologize, they probably put too much emphasis on the gastrointestinal system, but they are nurses, so that’s where the conversation always seems to go with them. But yeah, what we do is have people label those. What are the two things that you notice about yourself early on in the situation? The challenge. We know that our fight-or-flight system’s kicking in because it’s such a primitive system, it only has one goal, and that’s to eliminate the threat. I usually ask people, Hey, have you ever said terribly hurtful things to somebody that you deeply care about when you’re upset?
And people are reluctant to raise their hand in the room, but if they’re honest, probably everyone would do that. I’ll ask the question again. You guys have said something terribly hurtful and mean to maybe your favorite person on this planet, and they’ll say, yeah, yeah, we’ve done it. And I’d say, well, thankfully it’s not just a Kansas thing. I think my guilt is absolved a little bit because we all do that. But the next question is why? Because I’ll say, you guys look so smart and so empathetic and compassionate. I mean, you care about people, your teachers, your nurses, you care about the planet, you care about animals, you care about the people you work with, your family, you love these people, these compassionate, well-educated people are repeatedly hurting their favorite people on this planet. That logically doesn’t make any sense.
The explanation is that when we have this fight-or-flight system, that’s how powerful. That’s a really good, I think example of how powerful the system is. It can cause you to hurt your favorite person on the planet, and that’s powerful. What else can it do? This is where referencing back to Mary, this is where Mary became a real advocate for how powerful this system can drive someone to suicide or block them from hope and some of the things that could get them out of a suicidal situation. What we know is that, and I don’t want to go too deep into brain science, but when our fight-or-flight system is activated, the bottom part of our brain becomes extremely active. That’s the fight-or-flight, that’s survival mode. And the top part which we need for creativity, problem-solving, compassion, relationships, all that high-level stuff, that higher cortical area of our brain shuts down when we become upset.
This explains a lot of the behaviors we see when people are engaged in fight-or-flight when we feel challenged. And it’s really scary for me in my profession because somebody who’s experiencing anxiety or depression or lots of challenges or lots of failures, maybe a DH Ds driven them to a lot of failure in their life and a lot of restarts and lost relationships. We have people experiencing fight-or-flight. They’re down in that bottom part of their brain and sometimes we’re left with these questions. They do something to hurt themselves, and we’re like, why? They were such a nice person. They had so much potential and all these things going for them. Well, all that information is locked up in that top part of their brain, which they’re not able to access when they’re experiencing that level of challenge. It explains a lot of the behaviors we see, and you can see how it directly relates to people in conflict. Because if you’re sitting across the table from somebody who has a different view from you, different beliefs, different ideas, that’s immediately perceived as a threat by your body, your brain. You are going to behave differently in response to that threat. It’s so predictable. Systems are pretty predictable. Predictable, and human beings are pretty predictable as far as how we respond to threats.
The cure for that, what we talk about then, that’s skill number one, is to become more aware of that system for yourself and practice that identification of that skill. Number two, then how do you cure that threat response we promote safety because you can’t feel threatened and safe at the same time. That next question, what we practice is experiencing or creating a sense of safety so that we can access that upper part of our brain, be compassionate, be empathetic, be problem-solving, have insight, creativity, all that higher level stuff that gets us where we want to be.
Jenny:
Amazing. Okay, what I heard is you start with this training in terms of self-awareness, helping us understand individually how stress shows up for us or how when we’re faced with a challenge, what it looks like for us. And then once we get clear on what that looks like, being able to do it physically, I think I heard you say emotionally and mentally how it shows up for us, then it’s all about promoting safety. Is that right?
Brad:
Yeah, and the cool thing about safety is you can be proactive with it. You don’t have to wait around and say, oh, I’m the token mental health guy for a large healthcare system. When they want to do things like de-escalation training, they call us and say, Brad, can you do de-escalation training? Well, my response to that is, sure, we can do de-escalation training, but wouldn’t it be cool if we could do de-escalation training? If we know some things that promote safety ahead of time, why wouldn’t we want to do that throughout the day? Or if we know we’re going to start tackling a difficult issue or people are going to come into conflict, what can we do to promote safety upfront instead of waiting for people to get escalated and then try to de-escalate it? That system is well-designed to respond to threats. It just makes so much sense to be proactive and try to get ahead of it.
How does behavioral health and self-regulation education set us up for success?
Jenny:
Right on. I’m just going to, before I go on, just offer Michele who’s in the audience, a registered nurse and is focused on psychological safety in the workplace. If you do want to ask us any questions, I’m sure Brad would be happy to hear them, Michele. Thank you for being here. And then, the next thing is around where our self-regulation system takes us. I’ll tee off a question here unless Alex has one, but how does self-regulation, being able to, like you said, have this preemptive safety mechanism, how does it help us be successful in life?
Brad:
Yeah, I think I probably already alluded to that, but what we find is the fight-or-flight system was good for handling existential physical threats like five, 6,000, 10,000 years ago. Most of our threats were physical threats, and there are still definitely areas where people’s threats are still physical a lot of the time, but in today’s world, most, the majority of our threats for most of us are social and emotional threats. And honestly, most of those threats are created internally for us. These are things like self-doubt, all these anxious ruminating thoughts that we have, all the what ifs that we have, all those are threats. We have the interesting thing, human beings have the capacity to not only bring threat for today. Not only the two threats that I have in the next hour coming at me, but I also can bring a threat from three weeks from now, this challenge that I have out there on my calendar that I’m like, oh my gosh, what am I going to do about this?
But okay, that’s not even enough for us human beings. I can drudge up threat from two years ago. I remember what you said to me two years ago, and I can bring that in to today’s threat too. One of the key issues that we promote is something similar, and it doesn’t have to be this, but the one that we’ve had the most luck with is mindfulness, stress reduction training. That’s one of the ways that we promote safety is staying in the present, this practice of staying connected to the present, which I think, and I’ll plug mindfulness based stress reduction here, I was trained formally about 10 years ago in that, and we use it in our health system. I use it daily. I have a formal practice, but we use it with our patients who are suffering. And it’s just a great way to promote safety.
It also promotes gratitude, which fits into our third area of skill training, cognitive regulation. But I think, so Jenny, to answer your question, the best way for us to see success, I really don’t think people, I just don’t think you can be successful without regulating well in the face of challenge. What it brings is success in the face of challenge. And I thought about this a lot as an administrator in a healthcare system during covid. One of my favorite self-regulation or dysregulation stories comes from my wife is also a nurse, and she told me a story from the health system we worked at previously where a nurse had stayed over a shift because the weather was bad. The next shift couldn’t come in, couldn’t make it in. She was doing this really big favour by staying over, she’d already worked a 12 hour shift and happened to be surgery that was taking place in the morning.
The surgeon walked in and she accidentally called the surgeon by the wrong name. He interpreted that as a threat to his ego, or somehow interpreted it as a threat, and started to make some sarcastic, belittling comments toward her. Now she’s experiencing threat too. Now he’s sinking to the bottom part of his brain, and she’s sinking to the bottom part of her brain, which is this lizard brain. And you have a patient in the room who happened to be, this was a procedure that you could stay awake for. They’re listening to this whole thing, where do you think they’re going in their brain? Now you have three in a room with a surgical procedure about to take place and three lizards operating on this person. I think to me, that’s just a really good example of what I worried about during COVID-19, or what I worry about when people are trying to solve big problems is that they need to be in that cortex of their brain to have a chance at getting through complex issues. And when I see people in lizard brain trying to solve problems, I don’t think there’s a shake-my-head emoji on here, but it doesn’t have a very good prognosis.
Jenny:
Do you have a question to ask, Alex?
How does behavioral health and self-regulation education help us in our work?
Alex:
Yeah, I won’t take up too much of your time, but I have a background in heavy-duty construction services and private security services. Part of my detail was to do early morning patrols facing attics in whatever circumstances they happened to be in. In terms of de-escalation, what I was trained to do was always just make sure that I gave them one thing first, which was an acknowledgement of their existence, and then maybe even took some extra time to hear their story and understand their circumstance, who they were, how they got there, what was going on so that I could help facilitate how I could help them. At the same time, my fight-or-flight instinct was always there because I was alone in a dark alleyway with nothing but a stabproof vest, a flashlight and some charm with no backup. The threat metric was extremely high. And having done that for so many years, I found that even though I’m not doing it anymore, I just occasionally have this physiological reaction where my external life, everything that’s going on in my life could be butterflies and unicorns, but it feels like the other shoe is going to drop, right? Because I’m always trying to plan for the worst, but expect the best. And I have difficulty shutting that part of my brain down. I was just wondering if you helped anyone in those occupations too?
Brad:
Yes. I think nurses, so like ER nurses, trauma nurses, and first responders are such a fascinating group to work with on this self-regulation system because what we talk about, is one of the most powerful elements for creating safety and for turning off that fight-or-flight system is predictability. And so when I talk to nurses, when I work with first responders, the gentleman that I teach resilience for or with in the health system where I’m at now, he taught the resilience program for the military for six years. And so that predictability, so you guys are drilling and training and practicing these really intense situations just so, and to me, what that says to me is that you’re practicing that so that it becomes more predictable so that you can stay up in that top part of your brain in those challenging situations. And that’s exactly what we’re trying to do with other people, is to be able to have that level of predictability so that I know I have this confidence that I’ve been through this before. I know what to do if this happens because I’ve practiced it and I’ve been successful at it. It adds that layer of predictability because of the practice. That’s why we’re so hung up on skill development and meaningful intentional practice because it adds that sense of predictability. That to me equals safety.
Jenny:
Amazing. Yeah. Thank you for joining us, Michele. It’s so nice that you have, I’ll hand over the mic to you in just a second. I just wanted to say back what I heard. Yeah, Brad, my husband is also a city firefighter, which is why I think Mary’s work was so resonated with me so much to your point about seeing trauma and quite frankly, being a part of trauma regularly has impacted not only my husband, but others that we know. We’ve lost friends to suicide as Mary has pointed out and how this happened. Yeah, I have a question, but I think I’m going to pause and just see if Michele has one ready for you. And please introduce yourself, Michele. Thank you.
What are the long-term consequences of an engaged fight-or-flight system?
Michele:
Hi, good evening everyone. My name is Michele Thomson. I am a registered nurse. I’m also a leadership coach and consultant, and my goal is to create psychologically safe workplaces that people will never want to leave. The question that I have for you, Brad, and thank you so much, this has been a really enlightening conversation. I’ve quite enjoyed listening as a nurse. I think that what I’ve seen definitely exacerbated by the pandemic and to the scenario that you spoke about earlier around people working a lot of long hours and short, often we’re seeing a lot more compassion fatigue, caregiver burnout and moral injury. And what I’m seeing is a little surprising to me that people seem to be more apathetic, which I think is giving maybe the impression that they’re emotionally regulated, when in fact people are so tired and burnt out that they just kind of feel like I just have it in me. And I’m wondering potentially if you have any thoughts about what the long-term consequences of that would be in terms not really displaying any external capacity of showing that someone is in distress. An employer may not know what to look for to support an individual, employees might not know how to support their colleagues. I’m just curious if you have any thoughts about that.
Brad:
Oh, Michele, I have a lot of thoughts about, thank you so much for that question. I was waiting for you to give me a good one there. This is an area near and dear to my heart. And so I said fight flight. There are also other options here that an organism does when it’s experiencing threats. What Michele’s describing there is what we consider toxic stress, this level of, because this fight-or-flight system originally was designed, and I’m talking like I’m the creator of this, but I’m not. But it was originally designed as an acute response. I see a bear, the system kicks in, I resolve, I either get away or I fight the bear, whatever happens, and then my system returns to baseline. And that all happens within a matter of minutes or at most a few hours. What we’re seeing with a pandemic, which is a physical threat, it’s a physical threat and a social, brings a lot of social-emotional threats, too.
We have a loss, we have unpredictability everywhere. There wasn’t a script for this, especially in healthcare or education. I mean, there were scripts, but they weren’t near what we needed to have for this. What we have are people who are experiencing this level of my fight-or-flight system has been activated since March 2020. And so you can fight for a while, you can flight for a while. And the last sort of another option when an organism is tired of fighting, not able to fight or can’t get away, is this sort of shutting down mechanism. Organisms will shut down, try to conserve energy. And I think you brought up just such an interesting dichotomy with healthcare professionals. It’s the same way for therapists. I spend most of my time supervising therapists these days, and it’s like, how can I as a therapist or as a healthcare provider stay compassionate enough to where I can stay in touch with all this suffering around me and not have so much get on me that I’m constantly in fight-or-flight mode?
And that’s such a delicate balance. With you on that, just because someone is quiet does not mean that they’re well-regulated. Just because they’re not making a lot of noise and don’t look really, really reactive on the outside doesn’t mean they’re not an absolute wreck on the inside. And I have the same discussion and encouragement for teachers, and one of my answers to this is screening people. We do quite a bit of screening in our system for social-emotional stress issues. And I always, here in the United States, it’s recommended that they are screening kiddos three times a year for social-emotional issues. What we’ve found, what research says is that sometimes we’ll catch some of those, what I call internalizers or those people that are struggling, and that might not say anything to their supervisor. Sometimes they will indicate that on a screening tool, and so we can catch them and reach out to them with some tools.
But I totally, that’s why I think we’re seeing so much burnout. It’s that the fight-or-flight system has been activated for so long that it becomes that toxic level and people are pulling away from the profession. This numbness can occur when you don’t look like you have any response period at all to anything. And that’s just such a dangerous place to be. I still think though, there’s hope here. Safety, what you’re doing, promoting psychological safety, not waiting for people to get bad and reach for it, but get that to everybody because I don’t know a person that wasn’t impacted by a significant level of social, emotional or physical threat. Everybody experienced loss, we all had change. You can’t go wrong by promoting that across the board, not waiting for people to get ill and then do it with just this group or just that group.
I like what you’re doing there across the whole system, but also there, and I don’t want to lose sight of this, we have two other skill training areas in this system. Emotion regulation and cognitive regulation, are an entire framework for a reason. For example, emotion regulation has three skills in there. And so one of those skills is ownership of emotion and healthy expression of feelings. Those are skills that what are we going to do with all that emotion they’re carrying around? What’s the outlet for that? What’s the healthy mechanism? What’s the skill for getting that out? I don’t want to lose sight. The first two we talked about and one hour is probably enough. I do six-hour full-day seminars on this. To be able to cover it all in an hour is not going to happen. But I do want to tell you that there are other skills other than those first two that we talked about.
Jenny:
I didn’t mean to be rude there. Sorry, Michele, can I just make sure that answered your question before I move forward?
Michele:
Yeah, it did very much so thank you so much. That was wonderful. And I think that you sort of began touch on another soapbox item for me, which is really around the language we use, and I hear it a lot in the healthcare space around resiliency and people feeling further triggered and burnt out by that word in that if they are feeling challenged by their emotions or overwhelmed by their emotions, we have kind of I think created some language similar to self-care that alludes that if I could just develop more resiliency or be more resilient, how come everybody else is doing okay? I guess I am not resilient enough. That sense of having to take ownership for the fact that people just don’t understand that your brain is not hardwired as you’ve stated, to stay in a constant state of fight-or-flight, and it’s just not sustainable. When you start to feel the effects of that, that’s your brain telling you it’s doing exactly what it’s supposed to do, which is to protect you. Thank you.
Brad:
Yeah, absolutely. And that was one of the things we talked about with our leadership at the beginning of this, my partner and I was that we have to be really careful about this term resilience and going to a group of people who have just been working super hard, nonstop through an incredible experience and making sure that that message is not coming across, that they’re not resilient. These are the most resilient people I’ve ever met. And so to acknowledge what they’ve been through, to acknowledge the challenge, to acknowledge the suffering, and then also to come alongside them with some tools though to provide some hope. And what we’ve found, healthcare professionals love science, they love logic, and they will listen to those things and they’ll give it a shot. When you’re alongside someone practicing along with them, it’s been great. It’s here’s one more thing that you have to do to be more resilient. I agree with you. The messaging is important.
How does our belief system affect our ability to self-regulate?
Jenny:
Awesome. I have a question. I think sort of in this realm, how does our belief system come into play with respect to our fight-or-flight system? I’m going to use the pandemic as an example. There are a lot of people that are just too burned out, as you say, broad from a first responder standpoint to even sort of talk about it anymore. And so it seems like when you talk about the science and people wanting to come together in data, it seems like a void in the system for that. And so I’m using, in this case, I’m using the pandemic as sort of the similar problem we have with the transition that we’re facing. We have this social, environmental, and economic crisis, and we’re talking about it in terms of healthcare in this particular case, but the same thing you could say is happening in other disciplines where people aren’t being set up for success. You’re describing Brad, we have people who repeatedly have to be a part of or their fight-or-flight systems are being challenged. And so I guess the first question I’ll ask out of this is, I’ll back up and ask how does our belief system comes into play. How does it impact how we self-regulate?
Brad:
Yeah, great question. Skill six in this framework of cognitive regulation is about identifying and regulating our beliefs, identifying extreme beliefs that are causing us a lot of pain and seeing if we want to keep those that way. You can use religion, you can use movies, you can use opinions. The basic premise of how beliefs relate to threat is that our beliefs define what’s threatening to us. It’s basically like you drawing a line in the sand in front of you, that’s your belief, whatever it is, whether it’s politics, religion, pandemic, whether you think Star Wars is the best movie ever, whatever that is, if your belief is extreme on that idea and you believe that, and then somebody challenges that, that’s going to be perceived as a threat. And so there you go. That’s the connection that’s going to set off that entire physiological response, and it doesn’t matter. It’s the cool thing about it and what we teach is that who has control of that line? Who’s the only person that controls your line where that’s at? You have the power to adjust that line however you want to. That’s the,
Jenny:
In that example, you used your wife, this patient, and three people in a reptile brain. I know you’ve talked about prevention, which is obviously where we want to lead, but when we’re there when we’re stuck, how do we get ourselves out of it.
Brad:
In fight-or-flight.
Jenny:
Right. I’m picturing that room and I’m picturing everybody sort of in their reptile state. What does your training help people in a moment, in a challenge if your belief systems are being challenged in the moment, if you are feeling threatened in whatever way, what does the skill training teach you to do in those moments?
Brad:
Yeah, so one of the things I want to be really cautious about here is that I get calls all the time, Hey, I have a 15-minute staff meeting can come to help people learn this stuff and be all better? That’s not going to happen. You’re working against a system that’s evolved for thousands of years if you don’t practice. I get emails from teachers that say, Brad, I tried to teach these kids how to calm down when they were upset and it didn’t work. You don’t teach people skills when they’re upset. If you haven’t practiced how to create safety and calm for yourself ahead of time, the chances of you being able to turn off a system that is evolved for the specific reason to keep you safe and to go from zero to a hundred in 0.6 seconds to keep you safe from a bear attack is not good.
Brad:
Prevention to me is really, really important. The other thing is early recognition of those warning signs. I can tell you right now, that one of my biggest warning signs is that I will feel myself in a meeting if someone says something that’s crossing one of my lines, I’ll feel myself start to disconnect and want to shut down. I won’t want to participate. And I know that goes back to some of my belief systems as a kid saying if you can’t say something nice, don’t say anything at all. I know those two are connected.
Jenny:
That’s a big part. That’s a big part of it though, right? Because I think to your point, I think we’ve been raised to, as you said, just get along and raise to just let it go and not engage in religion and not engage in politics. I think this is trying to say, well, this is what you do when we have to, or this is the result of potentially not having skills to deal with those things when we need to.
Brad:
For me, if that happens to me and I can just only really speak for myself, everybody’s plan is a little bit different. Safety looks different for different people. People’s fight-or-flight feels different to them. People who go through the course, end up with their personal plans for each of these seven skills. But for me, if I recognize that, oh my gosh, my jaw’s getting tight, I just push myself back from the table, my head’s down, I’m not even paying attention anymore. I’ll ask for a break. I also am pretty good after 10 years of practicing mindfulness to be able to calm myself without making too much of a scene, and I can do it in the space that I’m in there, but that’s practice at doing that. Intervention is possible. Then I’ll find a way to move through the other skills.
I’ll identify I’m angry, so that’s labelling that feeling. And then how do I want to express that? Do I want to say something about it now? Do I want to say something later? Do I want to write it down and think about it? How do I want that to come out in a healthy way? And then later I’ll of course reflect on that to see if I want to adjust my line or not about what was threatening to me when I’m reflecting on that. But that’s kind of how you step through that process at the moment. But without the training and practice, that’s darn near impossible.
Jenny:
Right. Go ahead, Alex. I think, and this will probably be our last question for you, Brad. I don’t want to keep you too long. Thank you so much.
Alex:
Sure. Well, actually, with what you just said, I think that’s a crucial thing in terms of being self-aware. To be cognizant of the fact that maybe it just woke up on the wrong side of the bed and you’re in a mood. Sounds are a little louder, you’re going to be a little more testy. And then just when you’re around the other people that you care about and you don’t want to be testy with them, you just give ’em a little warning just like, I’m sorry, I’m in a mood preemptive, I’m just going to isolate a little more maybe today just because I don’t know what it is. And I found that in de-escalation practices, just being honest enough with myself so I can be honest enough with other people to say, I don’t know why, I’m just a little impatient today. Something’s not right and not make it into something that is putting an onus on them to walk on eggshells or making them feel threatened.
Just helping them to be aware that it’s like, Hey, I might need to just duck out and listen to a song that’s going to reset me. You know what I mean? I found in terms of dealing with my trauma, that using music to program and reprogram myself has been a great asset. It’s been a motivator. Yeah, I think a lot of what you had to say is extremely valuable. And frankly, I just want to compliment you because we’re limited in time on this conversation, but I’d like to shout out another invite if possible.
How do we create safety or “put more fuel in the tank”?
Brad:
Yeah, thank you, Alex. I appreciate that question, and I love the fact that you mentioned that I love it when my wife can give me warnings like that. I’ve had a tough day, so that gives me a choice that I can either say, okay, I’m going to the garage for the rest of the night. No, I should never do that. Usually, the right thing to say would be, how can I help? How can I be supportive? We have a couple of lessons that we do with kids, one called Lengthening my Fuse, and it’s just like what you just said. It’s okay. Let’s say I did wake up on the wrong side of the bed, or I know that my capacity, how I explain that is we only have so much capacity to deal with threats. It’s not unlimited. How do we put more fuel in the tank?
How do we create more capacity to manage threats? And Michele could probably chime in here though by, how do I add safety? And music is one of yours, Alex, and we promote music a lot because it’s patterned, rhythmic, and repetitive. I bet you listen to the same stuff you probably listened to for years. It’s predictable the words. It’s your go-to the rhythm, the beat, all that is patterned, rhythmic, repetitive. Your brain hears that, and it’s like, I know what’s coming next. All that feeds into safety. Predictability is one of the most powerful ways we can create safety for ourselves. Music’s a great one. Exercise is another great one. Walking, being in familiar spaces, sometimes we just need those things. And if you can recognize when you need it, wow, I can’t think of a better way to meet the definition of self-regulation. And yeah, I would love to come back if you think this information is helpful or specific ways to expand on it to help you all meet your goals.
Jenny:
Amazing. Thank you so much, Brad. Before we do a round a wrap-up, I’m just going to, well, actually I’ll offer some closing takeaways, but also, Michele, if you have an additional question or comment to expand on what Brad was just suggesting in terms of safety tools that you go to, please lead us off. Thank you.
Michele:
Oh, thank you so much, Jenny. That’s very generous. Yeah, I won’t take too much time. I mean, I think that Brad’s the expert here. Some of the things that we look at in terms of psychological safety in the workplace to help people are just creating safe spaces. Spaces where people can go to talk about what they’re experiencing. Helping managers understand what it means to have an open door policy where they are not depleting themselves by literally having an open door policy 24/7. There can still be some healthy boundaries there, but they can offer support and guidance to people on what to look for in terms of when people might be struggling. Again, we already spoke with that a little bit, and coworkers as well. I think that we do a lot of activities between coworkers to understand how they can make someone feel validated and seen and heard when they are struggling and talk a lot about what that looks like.
And like I said, just I think the culture is, this is how we show up for each other. It’s okay if you’re not at a hundred per cent. It’s not normal for you to be at a hundred per cent every day. If you can come at 60%, you’re still valued and appreciated for being here. I think those are kind of the things in terms of self-soothing, we do encourage people to take regular breaks and to do just breathing exercises to do what they find helps to settle them. We know that two and a half minutes is all your brain needs to kind of self-regulate. I think I mentioned in one of Angie’s rooms too, one of the things that I learned in doing some research of other people’s research is that somebody chewing a hard can or sucking on a hard candy brings back a reflux that we had when we were an infant, when we would suck, and we lose that reflex as we grow because it’s no longer necessary for us.
But when you can suck on hard candy, it brings back that reflux or reflux, which helps to calm the central nervous system. I think just coming up with really simple creative things that people can do, we’ve also given out adult colouring books and people on their breaks have coloured, and that has been popular. Thank you for giving me the opportunity to chime in. And I guess my just question to wrap up would be for Brad where can we go to follow you and the work you’re doing and learn more about the amazing work that you’re putting out into the world?
Brad:
Probably the best way, I don’t know why I picked LinkedIn, but I put a lot of stuff out on LinkedIn. I’ve done similar to a masterclass video series for AccuTrain. It’s called AccuEd, and I don’t know Jenny if you want to share some of these links, but my basic website is selfregulationstation.com. There’s also, I’m super excited. I’ve spent most of my time working with people on how to get self-regulation skills to kids, and have an adult book coming out. This will be the first time targeting just adults coming out. This, it’ll be done this summer. We’re on the final rounds of edits right now, but basically, it’s a seven-week self-study course. You could do it individually or with a group of people, and it’s one skill a week. I’ve worked hard to keep it under 70 pages just to make it nonthreatening and manageable in plain language, leaving out all the jargon, and just straight to the real applied skills in the framework in the order that we talked about here tonight. Super excited about that. But I would, Michele, I’d like to hear some more information from you. I think we could probably do a whole session on psychological safety. We’ve got a lot of what you just talked about too, and then some other things. And I bet you’ve got more information there too.
Michele:
Well, please, you can feel free to reach out through Jenny. It would be an honour. Thank you.
Key Takeaways
Jenny:
Yeah, we’ll make sure, Brad, that we’ll include all of your links in our, we’ll do an accompanying blog with this recording as well. Thank you so much. I’m just going to offer some of my key takeaways from this. Angie and Melanie, I know Meryl, you’re mostly a listener, but if I’m mistaken, you’re welcome to come up and quickly offer your thoughts as well. But just for myself, I’ll just offer the key things that I’ve heard. Again, trying to understand your skills in terms of the conversations that we’re trying to host. The key takeaway for me in that regard is being able to acknowledge when we are witnessing people in fight-or-flight, not in an offensive way of course, but in a way that we can just sort of help each other know that we’re not able to see, like you said, from our human brains, from our human perspective, but rather we’re in a place where we’re not able to see.
We’ve talked about gaining perspective with others in conversation. That’s just an opportunity that I see out of this knowledge. Thank you. And the other thing is the predictability piece. That is something that Alex and I are trying to build into this process is to have a regular framework of how we host these discussions so that people can be at least predictable in the topics that we’re having and in the methods and in the way that we break them down for people. I think those are a couple of ways we’re trying to, that we might be honing some of the skills that you offer. Thank you for that. Alex, I’ll offer if you’d like to offer some closing words, as well.
Alex:
Well, the one that I’ve lived by my whole life is planned for the worst and expect the best. I’ve lived in a constant state of running the worst-case scenarios, but I’ve discovered that in most cases, reality doesn’t reflect those things. And through some training and hopefully additional training, I’m just going to become better and better at managing those types of personality traits so that I can just maximize how I can be of benefit to other people. And I think this conversation was extremely valuable and interesting. It didn’t take on the shape that I necessarily thought it would, but I think it gave me a lot to reflect upon. I just want to thank everyone involved, Dr. Chap. And I also want to thank you personally for taking the time, especially in different time zones for coming out and giving your contributions. And I look forward to future dialogues with all of you, whether you’re just listeners or want to contribute directly. There’s a lot of first responders, there’s a lot of people out there who need your help, and I think you’re well on your way to helping us all do that. Good night.
Jenny:
Yeah, thank you so much, Brad. We’ll leave the closing words for you. And yeah, I’m going to try and link this up to some of the first responders that I know as well as in the city here. Yeah, please close us off and thank you again. As Alex said, we really appreciate you doing this with us.
Brad:
Yeah, thank you so much for the invitation. I’ve spent a lot of time sharing this information, and I think like Alex just said, there’s no shortage of people suffering. And if you can give people practical tools, support them with a little bit of education, some room to practice and understanding along the way, this basic information, it goes back to Mary because you opened with Mary Jenny. That was one of the things she told me, is that when you can take some information to understand yourself a little bit better and understand that this is normal, human beings responds to challenge, really follows some normal patterns that is game changing for a person who’s struggling. I appreciate you allowing me to share this further and look forward to future conversations with you all.
Jenny:
Thank you. Hail Mary. Yeah, I’m glad that she connected us. Brad, thank you so much. Okay. Feel free to unmute everyone and say goodnight. Thank you so much for your time, and have a good one.
Michele:
Goodnight everyone. Thank you so much.