Welcome! Welcome! I can't tell you how delighted I am truly, to have you here.
This, as I said at the beginning, for the people who are here, when I first started
a few minutes ago, this is really the culmination of five years of hard work
and a dream that I had about helping people, who also have cardiac disease as
I do, to be able to learn how to thrive with that disease. And it really started
with just an idea. I'm a psychotherapist by profession. My area of expertise is in
loss and specifically, traumatic loss and bereavement and also helping people, who
are dealing with really significant life challenges, be able to navigate those
challenges. I also work with anxiety and depression but I had, prior to my own
cardiac event, I had worked with a number of people who had illnesses and
chronic illnesses and sometimes short, you know, traumas and then oftentimes
people, who were having extended traumas over time. And so, I really thought that
this made me an expert in the field of how to navigate ongoing difficulties.
There's nothing like experiencing your own difficulty to to be able to
understand how much you don't know and I really became aware of the gaps in my
own knowledge and I became deeply committed to filling those gaps
both intellectually, you know, for my own understanding point of view, academically,
I actually went back to school and got a second graduate degree, and I'll talk a
little bit about that in a minute, and also just in terms of experience itself.
And so, I decided about five years ago to do this really deep dive into the areas
of resilience and optimal human functioning and all of these areas and
then to figure out very specifically how to apply it to people with chronic
disease and most specially, people with inherited or any kind of cardiac disease
because that's an area that's near and dear to my own heart, no pun intended. So,
let me start with just a minute or two of my own story and that is, I was a very
healthy and very fit forty-four-year-old in 2010, so now
you know how old I am, when I was out for a long distance run. I
was actually preparing for a half-marathon with a group of friends and I
had just passed the six mile mark, we were running the course that we were
going to be racing on in another week or two and so they had set up a kind of
mock-up course and I had just passed the six mile mark and I actually had not
been feeling well during that run that morning but decided to press on because
I was meeting this group of friends there and I was about six and a half,
maybe, seven miles in, when all of a sudden I felt extremely shaky and very
heavy and before I knew what happened I was on the ground. And it turned out, I
was in a very very fast, and as my cardiologist likes to call it, a wildfire
of tachycardia. I would eventually learn that my beats per minute were around 300
around 300 beats per minute at that point in time and I was only one block
from a trauma center and fortunately to the medical people that showed up on the
scene they realized I was really in critical condition and instead of doing
anything there and then, they whisked me, I think they call it a wrap and run, to
this trauma center, where I coded as I was pushed through the emergency room.
And so I was defibrillated and survived this sudden cardiac arrest,
and within a couple of days, I spent a few days in CCU there in that hospital. Then
I was transferred to another hospital in New Jersey and was in their cardiac
intensive care unit for about two days, and then finally, cumulatively
they decided that whatever I had was really serious and I needed to be
transported to a specialty Hospital in New York, which is where I was diagnosed
with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), it just rolls
right off the tongue there, and implanted with a cardioverting defibrillator and
and really I was told to go home, that I was incredibly lucky to have survived
the event that I survived. Every person, from the nurses
and doctors that I met in the emergency room on that first encounter in April of
2010, all the way through to, really people, who have even heard my story in
the last couple of years, have all talked about, from a medical perspective that I
was remarkably lucky. And truly having heard the stories over the years and now
knowing directly some of the families, who have lost loved ones to sudden cardiac
death, I do understand how lucky I am and it doesn't make any sense why I
would survive and an incredibly healthy 17 year old like my son's dear friend,
Albert Martin wouldn't survive in the middle of a basketball game, makes
absolutely no sense to me whatsoever but these are the cards, this is how it was
dealt, here I am and so, part of what I did was, I remember thinking I have to do
something with this in my life. And so home I came from the hospital
and basically, I had been told to go home and live my life. Go back to my life, I
was really lucky I now had this ICD. But you know, only a week later, the
ground that I was standing on was entirely different than the one I had
been on just a week earlier, when I had been out for that run. Yes I was home, yes
I was alive, yes I was beyond grateful for all of this but things
had changed profoundly. I was a different person than I had been just a
week before. I suddenly find out that I have this, in my case, inherited cardiac
disease that has you know, most often is diagnosed in autopsy and has a high
propensity for potentially fatal ventricular arrhythmias. I have this ICD
that is, on the one hand, going to save my life but it's really terrifying to me
about how it's going to do that. And then I would find out about a week
later, so that since it was inherited, my family members had to be tested as well -
my mother, my father, my children, my siblings. And my sons, my then young
sons - adolescent ages and my mother, all came back positive.
And so that profoundly shifted the landscape as well. But as a
psychotherapist and given the areas of specialty that I explained to you a few
minutes before, really my thought was, well if anybody is capable of navigating
this ground, it's going to be me, because I've done this work, I've walked other
people through it, I know so much about it but there is there's nothing like
being on the inside of an experience like this, as I said to teach you, really
what you don't know. And not only that, I did have a tremendous amount of
knowledge and I still do and still it wasn't enough to keep me from waking
up in the middle of the night in cold sweats and being terrified about what
was going to happen. It certainly didn't keep me from being shocked by my own
device and having to navigate what that was like as well, and also from what
it meant. Again I was so grateful to survive but what does it mean to live
with a chronic disease and how do you pick up the pieces and go forward with
your life when you have this experience that's walking parallel with
you every minute. When you open your eyes maybe the first thought is, oh I have
this cardiac condition or this other chronic disease that I have to live with
and navigate and if it's an inherited disease, maybe I have to live with it in
terms of helping my children navigate with it as well. So it really helped
me to understand how incredibly complex this was and that if I was struggling
with it, what in God's name were other people doing with it and a whole area
opened up to me that I had never really considered before which is what I called
Everyday Heroes - the people who wake up every single morning, 167 million people
in the United States who wake up every single morning with a chronic disease,
many of whom have silent diseases as we do with cardiac illness, so nobody on the
outside would even know what's happening and have to, before they even start their
day, wrap their head around that and navigate the challenges of that in their
lives and what an added stressor that is in life. So, I started to think about
suffering and well-being and what does that really
look like, you know, and one of the things that I know from my own work and my own
research, is that the truth is, most people, not just in the United States but
in the world, don't live at the side of thriving, which is positive six, seven,
eight, nine and ten. Most people live somewhere between
around a two and a negative two - meaning they're not suffering but they're not
necessarily thriving either. They're just kind of hovering in the middle and this
is what David Thoreau would have called, you know, "Most men live lives of quiet
desperation", this idea of "quiet desperation". It doesn't mean that we
don't have moments of happiness because we certainly can and do but what it
traditionally means is that, kind of hovering in this very delicate area,
where if enough stressors show up, we can slide into this side of suffering
relatively easily, meaning that it's a little bit of a fragile state from a
psychological perspective. Now this isn't a hundred percent of the population by
any stretch, but it really is somewhere in the neighborhood of around sixty
percent, that people live somewhere between positive two and around a
negative seven, eight, you know, six, seven, eight, and if you look at that far left
side of the of the number scale - negative ten, this is what we would call clinical
levels of anxiety and depression, This is often the point at which people maybe
seek out help from somebody like me, maybe they'll go on medication but
usually they have to be around a negative seven, eight, nine, ten in order
to be able to do that. And one of the things that I started to really think
about when I was looking at my own issue with chronic illness, and I started to
think about other people's process as well, is what if most of us,
including myself, are living somewhere between a negative 2 and a positive 2
and then you get hit with a chronic disease and you have sort of the ongoing
stressors of that plus some of the acute things, you know, if you have these acute
flare-ups, where does that leave people on the
scale. If people, (if not) if everybody isn't clinically depressed, well where
are they? And most people find themselves sliding to the left of
that scale, meaning just getting to a positive two on some days, takes every
ounce of energy that you have and that it doesn't take much at all to find
yourself in these sub-clinical levels of anxiety and depression,
meaning not intense enough that you're being referred for psychotherapy or
medication but enough that it's significantly compromised the quality
of your life. And in the case let's say, of an ICD, an implanted cardioverting
defibrillator, we know what the relationship is between reduced quality
of life and having this life-saving device because it can create a lot of
anxiety for people. So if you have somebody who's ordinarily super
optimistic and has these very high levels of optimism and they're at a
positive eight, nine or ten and then they're experiencing chronic disease,
maybe they're going to shift somewhere to a positive four, three or
two, right on the positive side. But what about the rest of us? I mean I certainly
wouldn't call myself some kind of a super optimist. I didn't arrive in this
world with this incredibly high level of well-being. I would say I fall pretty
much in the average, somewhere between the positive two and the negative two, at
least prior to this research and the work that I started to do, which meant
that it didn't take much for me to move into that suffering level as soon as I
started to get worried about my kids, as soon as I started to have extra PVCs,
which in my case, I have all the time, somewhere between 2,000 and 20,000 a day,
and how that can impact our sense of vitality and our sense of well-being and
so one of the gaps that I saw in the healthcare system was that when people
are diagnosed with chronic disease, we know that that has a negative impact on
quality of life but what we don't do is give people the skills and tools to be
able to improve or increase that well-being until they end up in these
clinical levels of or pathological levels of suffering. So you have to
present with a considerable amount of anxiety or depression, what would be
considered a diagnosable level, typically before you even get referred
for help. So the idea that you have to break before we offer you some kind of
support, seems very backwards to me. This is a
very interventive kind of model of medicine but it certainly doesn't do
anything to address the fact that we already know that if you have a chronic
disease, you're going to have a higher than average propensity for moving into
that level of languishing and suffering and if we already know that how come
we're not addressing this at the point at which people are diagnosed or long
before they end up in a clinical state of depression? And so that's the work
that I decided I wanted to invest my life in, (which) was teaching people the skills
and tools for being able to cultivate well-being and to cultivate
resilience long before they even needed it but certainly long before they ever
reach clinical levels of anxiety and depression, that we can move everybody to
the right side of that scale. And so let's say you're even at a positive two
most of the time - that's fantastic but imagine if we could move you to a
positive four or a positive six, then when those crises come and if you have a
chronic disease, you're navigating a lifetime ahead of you of challenges and
and navigating ground that's changing all the time, that then when you hit
those crisis periods, rather than going from say, a zero to a negative five or
eight or ten, you can take yourself maybe from a positive six to a positive two
or even a zero but you don't go spiral so far down that it takes so long
to come back again. So here are some numbers that I thought would be really
interesting to look at and that is what are the levels of if we look at this as
a overall sense of our capacity for good quality of life for a high level of
well-being. How much of that is influenced by our genetics, how much of
it is influenced by our environment and how much is influenced by our attitude
or interpretations about life and I'd like you, before I go ahead and reveal
the next slide, to just assign a number to that for yourself. When you look at
those numbers - fifty percent, forty percent and ten, in your own mind, what
would you think, represents the influence of genetics on your capacity for
well-being in your life, the influence of environmental factors
and the influence of attitudes or beliefs. And if you're like most people,
chances are, that most people imagine that genetics make up about 50% and in
that case, you would be absolutely right, if that was what you chose, that
environmental factors or situations that happen to you in your life, represent
about 40%, and that beliefs or attitude or the way we respond to something
represents about 10% and that's the place that I find most interesting
because the actual statistics on it are that the event or the environmental
factors represent about 10% and the beliefs and reactions represent about
40%. And why is that important to know? Well it's important because it helps us
to understand that we often invest the majority of our energy in things that we
actually can't control, which is trying to control outside events or
environments, wishing that things were different than they are, when the truth
of the matter is that if we could harness that same energy and turn it
toward our reactions to what's happening and even more importantly or equally
importantly, to our interpretation of what's happening, we could have a
profoundly different effect on our outcome and our experiences with
something with negative things that are happening in our life. So, part of what I
did was I wanted to integrate an area of science that I was already very invested
in, which was in resilience theory and I wanted to look at it in relationship to
what's called the Science of Optimal Human Functioning and at that, by the way,
which is called Applied Positive Psychology, is the degree that I went
back to school for. I already had a degree in advanced clinical practice
from Columbia University in social work. I had had a practice for, at that point,
about ten years but I realized there were so much more I wanted to know and
understand about the science of human flourishing and there was this whole
field that had erupted sometime in the late 1990s and early 2000s called
Applied Positive Psychology. It originated with Martin Seligman at the
University of Pennsylvania and I applied to that program and was
accepted. So it already, really redoubled my efforts and looking at the theory of
human resilience and the science around that and why was that important to me?
Because one of the things I wanted to do was go back and look at the risk factors
for complicated reactions or increased levels of suffering or reduced
levels of functioning, relative to the challenges that we face in our life. And
so through resilience theory, we really had, and the studies that they've done
over about the last 50 years, we really have some really clear understanding of
what many of those risk factors are. This is, by no means a comprehensive list but
I just wanted to give you a little bit of an overview, okay? So, (we have), we
definitely know that poverty is a risk factor for negative outcomes in people's
life. Sexual and emotional and physical abuse are a risk factor. Being raised by
a parent, who has addiction or having addiction yourself are risk factors. And
if we think about in terms of being raised by a parent who has addiction or
the absence of a caring parent figure because maybe they have mental illness
or somebody is simply not present in your life, we're looking there at all of
these environmental factors and these factors are really important but they're
not nearly as important as we originally thought that they were in terms of being
able to reverse our own outcomes. In other words, this is not a fait accompli,
where if you have these things, and one of the things I don't have on here, I'm
sorry that I forgot to put it on, with something called, oh I think it's
concussive stressors, or I don't think concussive is the right word, but think
of like one stress on top of the next, on top of the next, on top of the next. So
when I looked at that piece, I thought well isn't that chronic illness for a
lot of people? The stressors might not always be at a 10, right, like they might
not always be catastrophic but there is always this sort of ongoing crisis, not
crisis, but challenges that people have to face, sometimes of a crisis level and
sometimes, at a much lower level, but what does that do, in terms of helping people
develop good or dysfunctional outcomes? And so, when I looked at this, I
looked at, okay, these are the environmental factors - if you were raised
in poverty and there was nothing you could do about that, if you were raised
in abuse, if you had an addicted parent, if there was an absence of a caring
parent figure, right - these things are incredibly
important but when I look at the bottom three, and I don't mean to dismiss them
at all but I'm saying even if that is the setup for your whole life, long
before you're diagnosed with chronic illness, that still does not guarantee a
negative outcome. When we looked at these bottom three - social and emotional
avoidance, meaning in the presence of suffering or struggling, to withdraw
yourself from potential support, something called negative attribution
style, which is how do we think about what's happening to us, and a locus
of control, which is how much do I believe that I can influence my own life.
So when you see external locus of control, that's where people believe that
they really don't have any power in their own life, that external events are
really going to be the determining factor over whether they're okay or not
in the world. I found these pieces to be incredibly
important for people dealing with chronic illness and really wanted to
understand, well what would happen if we could focus on these things that we have
some control over - avoidance, attribution style, which is the way that we talk to
ourselves about what's happening, and that sense of locus of control that
everything is outside of ourselves.
So, when something negative happens in
somebody's life, and there are a number of different studies that I could talk
about that are relative to this but just to say it very briefly, and you have
those risk factors that I just talked about here, right, what we would
traditionally expect is that people who have a combination of negative
experiences that happen in their life, stressors that happen, and have those
risk factors would fall at that left side of this bell curve, meaning that
they would have the poorest outcomes and maybe they might even get to the, you
know, the left side of the top part of the bell curve but you're looking at a
group of people, for whom we would expect the worst outcomes but what we've
seen through the science of resilience, is that actually isn't the case. It
is for many people, (but) we've seen a number of people, who
have had all of those risk factor or many of those external risk factors,
meaning the environmental ones - growing up in poverty, growing up without a
significant caregiver or at least not a primary mother or father who's able to
be a good caregiver, growing up in with addiction around them, who actually end
up becoming about a third of the people, who have all of those environmental
issues become what are called our highest performers. And that became the
basis of the study of resilience, which is, well, why is that? What is happening for
that particular group of people? Is there some kind of immunity that they have
that keeps them from having these anticipated worst-case scenario outcomes?
And so, it helped us to identify what are called protective factors. And I
want you to just notice, how much this is the opposite of that original list, which
are the risk factors, from an internal perspective. So not necessarily the
external things. We're not talking about poverty, although certainly it's good if
you don't grow up in poverty. We're not talking about addiction or abuse,
although certainly it's good if you grow up and those are not things that you had
to contend with in your earlier life, but that these become the greatest
protective factors that you can have in terms of being able to have what's
called an internal sense of resilience. What's resilience? Our capacity to be
able to rise in the face of real challenges and difficulties and even
thrive in the face of them. So, not just survive but being able to actually move
beyond surviving, think of the number line right, not just get to a point of
zero but to be able to begin to move to the right side of that scale. And here
are the things that we noted were the single greatest, were the greatest
protective factors - people who had not just connections with others, but a real
sense that there were people that they could lean on or turn to in their world.
So even if they weren't parent figures, the idea that there was a teacher or a
pastor or the parent of a friend who was there for you or sibling,
to know what your own personal strengths are and then how to be able to use those
strengths to your greatest capacity. People, who had a sense of meaning in
their life, in other words, they weren't only reduced to whatever it was they
were experiencing in the moment. And I'll give you an example of that from my own
life. I really think that I could have, at a period of time, sort of collapsed under
the pressure of things that were happening in 2010. Not only was I
diagnosed and had had a sudden cardiac arrest and was given a defibrillator
and that defibrillator went off, but I was diagnosed with breast cancer in the
same year, like you've got to be kidding, nine months later. And then very very
sadly and very tragically, my mother died of a sudden cardiac event, all in the
same, yes, in a nine-month period of time! But my sense of meaning was my
sons, my children. I mean I have a daughter too but my two sons were
genetically positive for the same exact disease that I had
and I thought I might be the only example they ever see of what it looks
like to rise in the face of something this difficult. And so this idea of a
meaning beyond myself - spiritual grounding, which might be religious, but
often is not as well, but this sense that there's something beyond yourself, you
know, that there might be some forces beyond yourself that can work in your
favor, what's called a positive attribution style, the way that you tell
the story to yourself, and an internal locus of control, which is whether or not
you believe you can have any influence over the outcome of your life. I wanted
to give you a really brief, this is only four minutes, so I hope you'll indulge me -
this small video about Epigenetics.
Meet Lucky Lyle and Trouble Tim. Now, you might think they look a lot alike. That's
because they're identical twins but imagine them being raised in completely
different environments. As adults, they turn out very differently.
Lucky Lyle is a model citizen - he goes to work, pays his taxes, treats others well
and gets an education. Trouble Tim is on a different path - he robs banks, doesn't
pay taxes and gets his first prison sentence at the same time as Lyle gets
his diploma. Their genes are identical, so it must be their separate environments
that have made them so different, right? Well, there's more to it than that, much more.
We need to rewind a bit in time. You see,
one of the great questions of humanity is - what makes us, 'us'? Huh.
Early explanations had a hint of the supernatural about them.
As the centuries whisked by, science emerged and fought a tough battle to
gain credibility. Eventually, social science emerged with a popular theory
that our environment is what makes us, 'us'. Let's call this, "Nurture". Undaunted, the
biological sciences presented another theory - "Genes", an unchangeable blueprint ,
in you from birth, decides everything. Let's call this one - "Nature". So, are we a
product of our genes or of our environment? The battle raged on.
Observations in a newer field of study suggest that both are partly right. This
field is called "Epigenetics". It means - "above genetics" and has to do with how
nature and nurture interact. At the heart of this discussion, is one simple
question asked by researcher Michael Meany - "What makes a good rat mama?"
Well, for rat mother, nothing says love and care like some nice, vigorous licking.
The higher the number of licks, the more love and the better the mama. With this in
mind, the researchers compared two groups of rat mothers - one that licked their
babies a lot and another that didn't. They found that when babies grew up, they
carried their mamas behavior with them, and passed it on to the next generation,
and the next one and so on. But could it simply be that this particular group of
rats, was genetically predisposed to produce caring mothers? Well, to test this,
the researchers took newborn babies from low-licking mothers and fostered them
with high-licking mothers, and vice versa. It turns out that if the mother is a
high-licker, the rat baby becomes a high-licker too, regardless of whether it's
genetically related to her or not! So, genes really don't have anything to do
with it then? In true scientific fashion, the researchers dove right into the
brains of these rats to see what, if anything, was different in the brains of
the babies of high-licking versus low-licking mothers.
When they looked at genes that possibly play a role in motherly care, they found
crucial differences. Newborn rat babies have clusters of molecules called methyl groups
attached to these genes. These methyl groups silenced the gene,
effectively, switching it off. The researchers discovered that while the
methyl groups in rats from low-licking mothers were still attached, in the rats
from high-licking mothers these methyl groups had disappeared.
This was also true for the rats that had been adopted by high-licking
rat mothers. The care these rats received from their mothers, actually,
physically altered their genetic expression. Now that's all fine and good
for rats but what about people? Well, the same is true for Lucky Lyle and
Trouble Tim, and for you and me. The genes you're born with, are the genes
you've got but lifestyle and environmental influences such as
nutrition, exercise, smoking, stress and love greatly affect your biology. These
changes can actually be observed at the DNA level. The bright side is that
epigenetic changes happen throughout our lives and our choices can make real
differences in how we develop as human beings.
So, the thing that I really found
inspiring about epigenetics and also about neuroscience, was our capacity now,
to understand how our reactions and responses to things turn on and off
different areas not only of our brain, but even of our cellular structure, our
genetic structure, and again, we go back to that idea, remember the 50%, 40%, 10%?
So even from a genetic perspective, the idea that that 50% is simply a set
number, and has some determination on our outcome, is no longer the case. And so
personally, I get super excited about that especially, when it comes to cardiac
disease because I understand the powerful relationship between these two
energy centers of the body. This is the, really, the two electrical centers that
we have inside of us are - our brain and our heart,
and how the brain impacts the heart is undeniable. We know that things like
increased capacity for self-regulation and for managing the autonomic
nervous system, has an impact on heart and on PVCs and on the way that the
heart functions itself. But the idea that we might be able to have some kind of
influence over the way genes get expressed as well, only adds to my level
of excitement over really increasing our capacity to do what we can with what
we've got and to be able to do it with an optimal level of functioning because
not only can we change the way our brains are wired and thus, change the way
things are expressed, even perhaps through symptomatology, but at the very
least, we have the capacity to profoundly change the way that we psychologically
and emotionally experience what's happening. Imagine that's the least case
scenario that we can have a profound positive impact on our own psychology
and on the way that our the neurons in our brain are wiring together and then
possibly, even on the way that genes are being expressed in our bodies. And when
you're dealing with things like chronic disease and cardiac disease, I think this
kind of prevention and promotion, understanding it and then understanding
how to be able to utilize it, is absolutely critical. The idea that we
have to wait until people are clinically depressed, and then we're not really
offering them these kinds of tools. What we're doing, and I'm talking about my own
profession here, is offering people, oftentimes, just enough to get back to a
point of zero. Not suffering is not the same as thriving or flourishing - the same
way, by the way, not being ill, is not the same as being well. And what I've
learned is that you can have a chronic disease and still have, what I call,
positive health, which is the capacity to flourish even in the face of a chronic
disease, to be able to live optimally, even in the face of chronic disease, if
we're able to take our energy, focus and attention and put it in the places, where
not only do we have some control, but where that control can have a
a cascading kind of influence over our psychology, over our physiology.
Okay, so the HEART Initiative really teaches the elements of emotional fitness and
very briefly, here they are - self awareness, which are your thoughts, your
emotions and your behavior, self-regulation, which is the ability to
manage those thoughts and emotions and behavior, so that we can
reduce levels of anxiety, we can reduce the way in which our our bodies respond
to anger, it's like managing reactivity. Optimism, which ( to build optimism), allows
us then to build our confidence that we can actually have a better future.
Something called causal analysis, which is thoughts and emotions and how those
patterns together create certain kinds of outcomes. Really being able to engage
in what's called a personal agency right, and personal agency is, if optimism is
confidence about the future, personal agency is our sense of understanding how
we can positively impact that confidence for the future. And then, connections and
that's our ability to be able to utilize and reach out to other people
for the purposes of offering and receiving support because one of the
things that we know from one of the longest-running studies, which is called
the "Harvard Human Development Study", which is now in its eighth decade, I
think or seventh decade of research, is that the single biggest causative factor
for positive outcomes in people's lives turns out not to be, you know, the kind of
emotional, I mean, the financial circumstances that you are raised in and
if you happen to be somebody of an advantaged life. It turns out not to be
education. It ends up not being cholesterol level. It actually, ends up
being the single most consistent feature in positive outcomes in people's lives
are the qualities of their relationships.
So, just very briefly, a couple of things that I teach in the HEART Initiative,
is Explanatory Style - how the way in which we explain something to ourselves.
This is when we looked at the risk factors and protective factors, this was what was
called attribution style - the way that we attribute something to the outcome, that
our explanatory style is one of the very significant features in how we
experience what's happening to us. So, I like to use this child's nursery
rhyme because I think it's something that everybody knows and I think it's kind of
fun and it helps us to remember the relationship between an event that
happens and our experience of that event and then the outcome. So if I were to say
to you - "Old MacDonald had a farm", most people
know to say E I E I O. So, "Old MacDonald had a farm, E I E I O".
If we think of that first 'E' as the Event that happens in our life, and the 'O' as the
Outcome, we often understand, we imagine that the event is what causes the
outcome in our lives but what we often miss is that there's actually this
slalom that it has to go through - the 'I', the 'E', the 'I', before we get to the outcome.
An event itself, does not actually determine the outcome but usually those
things are wired so closely together in our own brain, we're so quickly reactive
to that, that we don't realize that there's actually this process that's
happening, that is really the cause of the outcome. And that process is - there's
an event and then there's an interpretation of that event. Most events,
not all, certainly not all, most events are neutral until we provide an
interpretation - "this is good", "this is bad", "this means something terrible", "this means
something great is about to happen". We're the ones who apply those
interpretations. That interpretation drives an emotion and depending on the
intensity of that emotion, we end up with a certain kind of outcome. So, there is an
event and there's an outcome but there's a slalom of things that that event goes
through - our interpretation, the emotional reaction and the intensity, that create
the outcome. So, we never say "Old MacDonald had a farm, EOEOEO." If we can
remember that, wait a second, now we really do have a place where we can
focus some energy, to be able to influence the way that we experience
what's happening to us in the world. So, no longer are
we just subject to whatever's happening outside of ourselves. So, this is one of
the key pieces of helping people to learn how to be able to cultivate and
develop what's called emotional fitness and emotional agility,
learning how to be able to navigate stressful events in your life - this is an example of
(parasympathetic nervous system), I mean, the central nervous system, right,
we have these reactions to things, not just psychologically, although remember
the psychology is really helping to drive it as well, we have actual
physiological reactions. I'm sure everybody has heard fight-or-flight
reactions, right? So, the sympathetic nervous system is kind of like the
accelerator in the car, the parasympathetic nervous system is like
the brake in the car and if we have these, when we are in a stressful
situation, of course that accelerator gets pressed, right, and we have this
flood of chemicals that go through our bodies. But if we have a single event
that happens, and it happens once a month, and then we go back and our life becomes
this incredibly calm and baseline place, this is not a problem. But if instead we
live in a world and because of the way that we interpret what's happening and
where we're focused and the situations that are happening in our life, we're
constantly in these low levels of anxiety or stress and we're constantly
it's like somebody's put a cinder block on that accelerator, maybe it's only
low-grade, maybe it's extremely high-grade but it is having a profound
effect not just psychologically, but physiologically on our bodies. So,
teaching people how to regulate central nervous system through things like
meditation or I'm showing a picture here, of what's called "Pranayama breathing" -
alternate nostril breathing. Well, we know from fMRI that when people practice a
couple of minutes of Pranayama breathing, which is - you inhale through one nostril,
you pinch off the nostril you just inhaled through, you exhale very slowly
through the alternate nostril and you inhale through the alternate nostril
that you just exhaled out of and then switch and open the other side. By
switching from left to right breathing, inhalation-exhalation,
inhalation-exhalation, by going back and forth this way, it has a profound effect on
regulating the central nervous system, on bringing us back to this
sort of calm baseline. But most often people aren't doing that, we're just
running from one stressful event to the next and again the reason that I find
this important is because, you know, life is stressful enough, if on top of it, you
have a chronic disease and so every day you're waking up and you sort of have
this low-lying stress always there under all circumstances, then the potential for
being negatively impacted by the other events in life, by the other stressful
events in life, is significantly higher. And so teaching people how to be able to
regulate central nervous system is critical to helping people get to a
place of flourishing or higher levels of functioning. This is the science of human flourishing
that I've been referring to, the field of applied positive psychology,
where they talk about five pillars of well-being and if you think about them
like gauges in your car, you can monitor them and see where you are or how am I
doing in terms of cultivating positive emotion or experiencing positive emotion, how
am I doing, in terms of a sense of engagement in my life, how are my
relationships, how's my sense of meaning, how's my sense of accomplishment. Meaning
that, the field of positive psychology and the science of human
flourishing has just exploded and the amount of research that we have from a
whole host of different areas of social and hard sciences, it shows us that when
we use these kinds of models of well-being and people are balancing
their lives in in these five areas, or there's a couple of other models of
well-being that have six or seven areas in them, that really what we're
doing is, we're creating a much stronger foundation internally with which to
weather the storms going forward. So, I just wanted to show you, really briefly,
again there are intentional interventions to increase a sense of
hope or pride or serenity or gratitude or joy or love - these are some of the
positive emotions, and when you have these intentional small doses of
positive emotion throughout the course of your day, because you go out of your
way to recognize the things you're grateful in your life or because you
offer help to somebody and as a result of that, feel an increased sense of love
or serenity or pride in your life, that what we're doing is we're creating these
upward spirals and those upward spirals are not only protective against the
stresses that we experience in life including ongoing stresses, but they also
are promotive in terms of helping us to experience greater well-being. The same
is true for our relationships in our life. By not just sort of knowing that we
have these relationships and waiting for the opportunity to present itself to
cultivate those relationships, but when we go out of our way to cultivate them,
we are again increasing another one of those foundations of well-being.
So, I was just using this as an example of how we really go out of our way when
there's a crisis to, kind of, come together very organically and help each
other. That's because we were being driven by something very innate and
primal inside of us, which is that pulling together when we are troubled or
in need but remember one of the risk factors for negative outcomes was when
people use, what's called an avoidance style - when they pull away from people
when they're suffering. I don't know about you but I know that when I was
going through that year and I was, you know, just every time I came up, I got hit
by another wave, one of the things I started to do was to withdraw from
people, which is the exact opposite of what we need to be doing at that point
in time, but it's hard to be vulnerable, and so, I really want to offer an
encouragement and the backup of some science that says not only do we need to
be reaching out, but it's incredibly, it's critical to our overall sense of
health and well-being to do so. This withdrawal is actually intensifying,
all of those comorbidities that increase the possibility or the
probability of negative outcomes. And creating a sense of meaning in your life,
usually after some kind of a seismic shift, some kind of a crisis, we can lose
our sense of meaning for a period of time and really understanding how
important it is to come back to that sense of meaning, whatever that is to you.
In my case, I remember was my initial sense of meaning was my children and
still is but very much wanting to be an example to the other people in my family
who were suffering from the same thing
and then wanting to be able to offer it to the larger world as well, has become a
really driving force for me. I was using this as a sense of like
accomplishment, this ability to be able to harness our strengths to do things
that are beyond our day-to-day kind of actions. So, when we look at this idea of
moving from surviving to thriving right, I just wanted to show you that it's not
a single event, it's a series of events that are cumulative over time, many of
which, seem like incredibly small shifts and change that are happening but when
they come together, they really shift our whole sense of well-being from the left
side or that languishing side of the scale to this sense of flourishing
in our lives. And so some of the interventions, many of them,
really feel like small, almost imperceptible kinds of things like
gratitude, for instance. There's a lot of research that one of the single
greatest things we can do is write down three things that we are most grateful
for at the end of every day. That happened throughout the course of that
day. I could read to you a litany of research about the reasons why that has
a positive influence on us, but oftentimes people kind of dismiss it
because it seems too simple and too much like something your grandmother
would have told you to do. But the truth is it has a powerful influence and
impact, and so really understanding how these, almost micro changes that we're
making, have the potential to create this incredible flourishing outcome in our lives.
This was just an example of that idea of teaching people how to
bend without breaking.Trees that have really weathered difficult
storms and lots of winds, tend to have roots that go deeper and deeper into the
soil and make these trees incredibly resilient and almost resistant to the
storms and weather patterns that come. But they're not trees that
stand stiffly, you know, they tend to really sway and
bend without breaking, and that's part of what this integration of
resilience and optimal human functioning and epigenetics and neuroscience, that is
the HEART Initiative, is teaching and offering. So here's a here's one of
my favorite videos to share with people and we're sort of going to end on this
piece but by Jerry White about trauma and what we do with trauma in our
lives that I thought you'd enjoy. My name is Jerry White. I grew up in a relatively
religious home and I always wanted to go to the place where all this stuff
happened - Jerusalem, the Sea of Galilee - these beautiful places, where I could
walk in the footsteps of the prophets, that was my goal. So when I was a junior
at Brown University and I went camping in the Sinai and also into the Golan
Heights and that's where the accident took place. If you can picture a day,
sunny, nothing could have been more beautiful, wonderful, I actually couldn't
have been happier. I think I was even humming that morning when suddenly - boom!
So, I looked down after this explosion, I see that my lower right leg was blown
off and I then was in shock of course, and - "where's my foot?" I couldn't get
my mind to compute the loss. "Where's my foot? Where's my foot? Where's my foot?" And then
when the dust settled and I saw that you know my left leg was blown open and my
right leg was in shambles, it dawned on us we're in a minefield left over from the
60s, from the Six-Day War but it was in that moment of blood and fear and horror
that I did have a recollection, for some reason, I knew I didn't die. I remember
the first few weeks I was lying in a hospital in Israel, I was faced with the
choice - do I want to fly home to a hospital in Boston? My father happened to
be president of one of the hospitals and they thought bring the boy home we'll
get the best care, the best doctors and I said - "no". I was in a room with four or
five guys my age, who were blown up - missing eyes, limbs - they had gone through
explosions in the Lebanese war. In Israel, it struck a little balance of being in
your face tough love like "hello that's life, we've
been living with this for a long time", and so I was choosing to stay with
people, who understood what I went through
as opposed to going home and being precious. I felt like I moved forward and
graduated. I resumed life. I really just wanted to do things I used to do - play
tennis, go skiing, have girlfriends - figure it out!
Did that - check, and I wouldn't say I was such a great giver back in the day but
the opportunity came up, to help the survivors and the victims, you know, the
children, the families, the parents, the farmers, that they would have a leg up,
an opportunity to move on in life and so once I started, it was like a wildfire
of giving. I think if we look back at our lives and you connect the dots of your
crises or scarring moments, in fact the universe is trying to wake you up
because each time there's an opportunity to awaken, I think spiritually,
emotionally, physically but as a giver in particular. So, that's the interesting
thing about trauma. Is it bad? Is it good? Who knows? What are you doing with it?
What I love about using Jerry's video, is that idea, again, of not just not
suffering, but how to be able to thrive in the face of whatever it is that life
gives us, that the events themselves are not the determining factor of the
outcome but that we actually have so much more control over that and the
question becomes what do we do with it. And so I love this quote by Masten -
"Resilience does not happen by magical force, but occurs when ordinary people
discover their best or highest selves under extraordinary circumstances." I
don't know about you, but when I think of heroes in my own life, never are they
people who haven't faced significant challenges, but every hero, every person
I've ever admired, has been somebody, who has faced something unimaginable in
terms of the difficulties of their life. But they are the people, who found a way
to take that pain and to turn it into something incredibly purposeful in their
life. And so, the the HEART Initiative is a program that I've put together to
teach people the skills of emotional agility, to really put together those
four elements of resilience and what we know
about not only risk factor and promotive factors, but also optimal human
functioning and how to be able to really use the science of optimal human
functioning, to be able to cultivate our highest possible selves, this area of
epigenetics and and how we can influence even our own genetic outcome and the
field of neuroscience and how what we believe and what we do, impacts our brain
and how our brain then impacts our body but most especially, the heart for heart
patients. So, here are some of the things that I teach people in the HEART Initiative -
building optimism, which is cognitive flexibility and adaptive
coping skills and effective problem-solving, helping people to tap
into their personal agency to be able to recognize what they can control and how
to effectively use that, engaging positively with people in their lives so
they can cultivate those relationships and utilize support systems, and also to
really identify their own sense of purpose.
So here would be the three
things that I would recommend, if you're interested in, even just experimenting
with some of this. Here are three intentional interventions that you could
use and you can sort of measure for yourself, wait a second, does this help to
improve things in my life? These are these little seeds, none of them are
going to feel quite remarkable in and of themselves, but collectively, do they
begin to move me in the direction of the right side of that arrow. And the first
would be, I would really recommend that you get a journal or in my case, I have a
jar - t's actually behind me on the table there. I call it my "Joy Jar", and I write
down three good things every day and then I fold them up and I drop them in
the jar. The reason I do that, is because I want next year, New Year's Eve, I'll
dump it all out and I'll read all of these things and so I'll get like a
second sort of dose of joy out of it. But traditionally, the way that I teach the
three good things is, asking people to keep a journal - a gratitude journal and
at the end of every day, go through the course of that day and we call it -
"hunting for the good", and actually, sort of, scan through the day, no matter how
difficult the day was. Even on the day that I collapsed, there are so many good
things - being a mile from the hospital, having
people on that course with me, who stopped and immediately called and got
me help, the people that I encountered in the emergency room, the doctor, who
saved my life, is somebody I'm still in contact with today - John Checton, who I
have such deep gratitude and admiration for. So, even on that day, there were good
things. So, no matter what the day is, the ability to be able to draw on that. Why
is that important? Well, not only because of the way that the mind influences the
heart and the heart influences the body and all of those things, but also what
happens is, it begins to train the mind to start scanning for the good.
We have this natural inclination to look for the negative - all of us do. It's the
reason that we are still here as human beings. Our ancestors were the people who
were the most anxious, the most cautious maybe is a better word for it, who were
kind of anticipating that that thing moving out there in the bush,
was a saber-toothed tiger or something, not the ones skipping along walking out
there thinking - oh, it's probably nothing. They were the people who had a healthy
sense of of caution, and realistic optimism, but not an overuse of
optimism. So, we have this negative predisposition in our thinking, but when
you live in a culture and in a time in the world where we are bombarded by
negative influences, I mean negative stories, negative newscast, where
everything is so sensationalized, it can really retrain our brain to imagine that
this is all there is in the world. Well, by doing these three good things
exercise at the end of every day, and if you have children, one of the ways you
might want to do it, is do it over dinner together - have everybody talk about the
three best things that happened that day, is that it allows us to begin to really
balance that scale in our mind - okay, wait a second, things aren't all bad and I'm
not going to just take the good for granted, I'm actually going to stop and
call it up. So that's one thing. The second thing is that alternate nostril
breathing. I went through it very fast. I'm sorry if it wasn't clear but you can
certainly go online and look up alternate nostril breathing and you'll
get a video on how to do it, or really, any kind of meditation. I like this one
because we know through some fMRI research how it actually helps to
regulate the central nervous system, how it regulates that parasympathetic and
sympathetic reaction and helps to bring everything sort of back down to this
much calmer baseline. I know that when I do ANS breathing with people, in about
three minutes or so, they start to notice a significant change in how they feel -
that they feel much calmer and like they've hit this baseline that they
don't typically find themselves at. So, then the third piece I would offer
is simply what's called a thought disputation, which is when you find
something negative or kind of catastrophic, a thought coming in - "Oh my
God, I've had this symptom, this probably means my disease is progressing,"
just catch yourself and ask yourself - "wait a second, what do I know for sure, "
and that act, in and of itself, can begin to help take that kind of catastrophic
thinking, which we all can easily go to, and begin to reduce it and bring us back
to a place of like - "okay, wait a second, if I come back to the facts, what do I know
for sure, " and there's another element to this, which is, "I know what the worst case
scenario is, but what's the best case scenario, " which is an alternate kind of
thinking that we rarely ever go to. So, I'm gonna leave you with that. I offer
you those three pieces. If you haven't registered at the HEART Initiative to
learn more about the HEART Initiative, I hope that you'll go to
the website that's at the bottom of the page here and register. The HEART
Initiative is, we're starting a pilot program, so that we can do research with
people who have cardiac disease, to see what the influence of all of these
interventions are. It's a 10-week program and the program is free. All we ask is
that you be willing to join the research for us, so that we can collect,
anonymously, collect the data and be able to measure pre and post outcomes.
It's a free program. We're offering it this summer. We would love, love, love to
have you join us and I can promise you that if you learn and then apply these
strategies that I've put together in the HEART Initiative, that your life
will only improve, it will only get better. Your sense of being able to
control things in your own life will improve. And I know how it's changed
things for me. So, I told you in the beginning that I
started out at around a somewhere around, probably, a two, with moments of
getting to a positive four but it wasn't so uncommon for me to get to a zero or
even a negative two with moments of getting to a negative four at times. But if
you ask me where I am today, five years later, into doing this research, the last
two or three years into practicing all of these principles in my own life, I can
tell you that I am regularly at a positive eight.
I often hit a positive ten, which was a place I rarely ever knew before, and even
under the most difficult of circumstances, and as you all know they
continue to come, even under the most difficult circumstances, I lost my father,
I lost my best friend in the past few years, maybe I find myself at a zero or
negative two, but rarely do I ever find myself at a negative eight or nine or
ten ever anymore, and I would so love to be able to offer you the same opportunity.
Okay, so we're opening up to questions.
I know we're sort of over time here, but I'd love to answer any questions that
you have. If you want, you can just raise your hand and we'll unmute you and you
can ask the question and if you ask it through chat, then Budha will ask it on
your behalf. And so, again, anything that you have, I'm happy to to address.
My heart disease is passed down to daughter and granddaughter. So, I'm
wondering about how to talk about life-threatening conditions with a, say a
seven-year-old child?
That's such a great question, Mary. Where are you from?
Arkansas.
Wonderful and thanks for joining us this morning. It's a
really great question and I think the key is to remember what's appropriate, both in
terms of age and the amount of information that's actually needed, right.
And so, what you might talk to a 15 or a 20 year old about, is going to be very
different than what you speak to a seven-year-old about. Now, if she's
already experiencing the signs and symptoms of progressive cardiac disease
or life threatening disease?
She's been on medication since she was day one.
She has to take a defibrillator to school and it's carried from class to
class. She has not had any, you know, episodes but it is
constantly there, so we have to warn people everywhere we go. Plus, she has
life-threatening allergies. So, on top of this, the food allergies. So, it's
just becoming, where her friends are aware that she's "weird" because of, you
know, she can't eat anything with eggs and such. So, in the heart condition, we really just
sort of, don't talk about because well, we just don't. She knows she has to take
heart medication and we all three do. And mother and grandmother have
defibrillators and pace makers but, I don't know, we feel like sort of, the less attention
we bring to it, maybe the better, instead of making her the kid with the heart
problem, you know, just to have more normal activities but yet she can't
just go off and do things regular kids can do.
This is true, Mary, absolutely.
And I think, helping her to understand that everybody has something, and even
though we don't always see it on the outside - not everybody's walking around
carrying their defibrillator, that everybody has something, everybody's
going to deal with something in their life. The thing that I
think is almost the benefit here, is that you get to say - "this is our something,"
not just "hers" but "ours", because she doesn't have peers that are
also carrying around a defibrillator and so, for her to know that this is part of
her family's experience, makes her less alone in this process. So, I agree with
you, I don't know that I would say not to speak about it at all, but I think at the
very least, to normalize it for her by talking about this as "our family thing
that we have to deal with," and also to really focus on building those positive
emotions that I was just talking about, like imagine if at the end of every day,
you asked her and I think in her case, I probably would say - "Tell me what the
hardest thing about today was." Now, she may talk about being the only one with
the defibrillator and she may not. But at least, she has an opportunity to say.
And then - "Tell me the three best things and I'm gonna tell you mine too," will
really help her to see the balance of, "Yes, I have this difficulty in my life
but I've got all these riches."
Does that help?
I think so, thank you.
You're welcome! Thank you.
I want to thank you all for being here. I can't tell you how much I
appreciate the opportunity to talk with you. I hope I didn't overwhelm you with
information, trying to kind of cram in as much as I can, so that you have a real
sense of the kind of work that I'm doing and what the possibilities are, what the
foundations for flourishing and thriving are - that there's actually a science
behind it. We don't have to guess and we don't have to wonder. There's a real
science behind it and that, you know, the thing about this is, it's not like -
"Okay, so here's what you must do," it's not like an ingredient list, it's more like a
toolbox - here are all the possibilities. We can't even change what we don't know
is possible and so, by offering that wealth of possibilities, people have an
opportunity to be able to make a choice about the things that they want to use
and implement, just as I was saying to Mary about, okay, here's something that
you could do with your granddaughter, something not only concrete, but
something that we know has been researched and we know has positive
outcomes. And so, I'd like to be able to offer those kinds of really rich,
concrete tools, so that you have the option of utilizing those interventions
in a very intentional way.
Well, we think we're going to say goodbye, unless anybody has a comment or a question?
I just want to say thank you because I know when I left the
hospital and they said, "You have 'sudden death syndrome', go home!" It's difficult!
That's an understatement right there, and I remember that feeling - kind of a pat on
the back like, "Wow! Lucky you! Go home!" and I was like, "What!? Okay."
It's so disorienting, I know, that's the best word for it. I was just like, "Okay!" and as I
said, I thought if I'm feeling this disoriented, what the hell are other
people doing, you know? And I'm supposed to know this stuff. So, I totally
understand, Mary. Thanks for stating it.
All right, well, this video is going to be made available. If you've registered with
us, then we have your email address and we'll be sending it out. So you'll have
it and you can share it with other people and we'll let you know as soon as
that course is going to be up and running. It'll probably be, more like, the
end of July or beginning of August because I have some traveling that I'm
going to be doing. And we really look forward to to connecting with you and to
helping you on your journey. Helping us on our journey!
Thank you so much!
Have a wonderful weekend!
www.heartinitiative.net
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