Ep035: Deal with stress, how? -- With Dr. Adriana Miu

 
deepintosleep.co

Dr. Adriana Miu

with Dr. Yishan Xu

 

TODAY’S GUEST

Dr. Adriana Miu, Assistant professor and licensed clinical psychologist in the Psychiatry Department at University of Texas Southwestern Medical Center in Dallas, TX. She is specializes in CBT for trauma and early psychosis. Also integrative approach that draws from DBT, ACT, and mindfulness. She earned PhD in clinical psychology at Emory University and postdoctoral fellowship at Stanford Psychiatry Department. Also served as clinical instructor at Stanford Psychiatry Department for 2 years prior to joining UT Southwestern. 

WHAT WILL WE LEARN

Trauma-informed coping strategies for COVID-19

  • Trauma-Informed Approach : ongoing approach with awareness and sensitivity to understand the impact of trauma on people

  • Safety

    • Prepare ahead in things within your control (social distancing, washing hands, work remotely, have at least 2-week supply of food, medications;

    • Practice good self-care (sleep, exercise, social interaction, work-life balance)

    • Maintain as much routine as possible

  • Trustworthiness & Transparency

    • Know signs of COVID-19 and get accurate information on the illness 

    • Know trusted information rather than being blind sighted later

    • BUT need to restrict amount of time spent on researching 

    • If you’re in a management level, try to be as transparent as possible with your employees about potential changes. This reduces uncertainty and helps staff know what to expect. 

  • Peer support

    • Connect with family and friends

    • Connect with colleagues whom you trust

    • Connect with neighbors / other communities 

  • Collaboration

    • Coordinate childcare with partners  

    • Coordinate with neighbors on helping elderly/ vulnerable population get groceries 

    • If in management, consult with employees who have different needs(e.g., those with young children at home, caregivers for elderly/ children with special needs)

  • Empowerment & Choice

    • Provide more flexibility at work

    • Provide more choice whenever possible (e.g., choosing grocery items/ takeouts)

  • Cultural sensitivity

    • Understanding that certain groups are more impacted

    • Financial impact on those whose jobs are threatened, whose pay is reduced, or businesses who might go under. Validate their distress

    • Racial discrimination for Asian American community 

    • Check in and validate these impacted groups and offer support 

RESOURCES

Find more about Dr. Miu’s work:

Reference and other resources in the show:

Thank You for Listening!

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CBT-I Courses:

Podcast Links:

Transcript

-  0:00  

Money, house, appetite, sleep, happiness, when there are huge life stress around you, which one would go down first for you? Several years ago, when I first got my license, I still remembered how struggled I was trying to figure out, do I want to stay in a large hospital just for stability? Or do I want to try to risk it to open up my own practice, that way I can really explore and try to do whatever I want to do. As my money, my savings draining out, I got more and more anxious. The stress level around me just build up so much. And of course, not surprisingly, around that time, my sleep really went down. I could not fall asleep easily. And it was really difficult for me To wake up in the morning, the struggle with stress was so real, then what can we do to deal with the stress? Today, our guest, Dr. Miele shared quite a lot of practical skills for us. After I talk to her, I really feel like this could be helpful. If I knew this back then several years ago, I possibly could deal with the stress much better. And my sleep wouldn't suffer so much back then. Stay with us and find out more. Hi, welcome to deep into sleep. I am mission. So today we have Dr. andriana. New from Texas. She earned her PhD in Emory University and she did her postdoctoral fellowship in Stanford psychiatry department. Now she's a licensed psychologist. Hi, Dr. Moon. Welcome. Hi. Thanks for having me. Yeah, I know actually you are a psychologist who used to work in San Francisco Bay area which where I am right now and now you move to Texas you work there and doing clinical work and research the same time, right?

-  2:20  

Yeah. I am mostly working in the adult outpatient clinic at UT Southwestern Medical Center. It is a academic medical setting. But we see a lot of people in the general clinic.

-  2:36  

So I know you are an expert in the area of trauma informed care. I think we all experience a lot of daily stress or global stress, such as the Coronavirus pandemic, what you think the general public could really learn from this professional area of knowledge to really help them cope with the situation better.

-  3:04  

Yeah, one of the core things about trauma coping or trauma informed coping is safety. So safety can come in different ways. And it may look like making sure that you have all the things that you need for the upcoming period. Rather than feeling like all of a sudden you have to, like be blindsided from some changes. So this may look like appropriately like stocking up your pantry and getting the medications and have at least two weeks supply or one month supply if you can, so that you feel like there's this like there so the system rescue mode like something if something were to happen, you can rely on that supply of food and medications. And you're not going to need to go into this like panic react mode. Other things that can help people feel safer, maybe just general good practice of self care. And this like, I think you can share more about the police mastery, which is a really nice way of breaking down what are the core important components of self care. So please like it stands for physical illness and a PL that may be taking care of your body. Taking prescribed medications and making sure that we don't we take care of our body and have good immune system in that seconds, and then he have the please is eating and usually when we are stuck at home, that might be the time to overeat because we're bored Or we might be too tired or too stressed out to cook. But this is actually one of the most important thing to do is to make sure we do balance eating, so that we take in good nutrients and we are having a good immune system. The A in the please is avoided with altering drugs. So that may be making sure that we reduce the amount of drugs or alcohol that we use so that we're in the best shape. And we're more grounded and more stable in our life. And the more grounded and more even we feel, that's the time when we feel the safest. And that's what I would recommend in terms of the traumatic time of the COVID-19 when there's just so much uncertainties. The more we feel more grounded and safe, the more stable And certainly like or feel more in control. And then after the a part in part, the S part and the please is sleep. So this is one of the hardest thing. And as you, Shawn, you mentioned that be my weight, the news, we might be doing a lot of things right before sleep and we might just stay up worrying about what will happen. But sleep is going to be the most important things. And later on we can talk more about leading to reduced exposure to news so that we are not constantly thinking that the threat is near us or that we're under constant threat. Besides of sleep, it's exercise. And this is also another major challenging area because we can't go out as much as harder to exercise at the gym. or run outside. And this might be the time to consider other forms of exercise like yoga or hit exercises, something that you can do at home so that again, you can vote up the immune system.

-  7:16  

Right. I definitely do that a lot more right now actually feels like I am exercising more often than before.

-  7:24  

That is so vital. That is exactly my situation. I have been thinking, Well, I'm not commuting as much. So I might as well use that commute time that I gain those two chats a little bit. And it's been kind of fun to try out something new, because I don't usually follow an app to exercise. But this Coronavirus has definitely forced me to do that.

-  7:51  

Yeah, I actually liked one of the small points you just mentioned. Save up the commute time we had before. Use it for seven Small daily self care routines, right? Surprisingly, I have some clients coming in, they be using that time to work more, and then feel like burned out exhausted, and not happy. But when they when we talk about that they realize, Oh, my commute time before I used to listen to podcast music. Now I don't have that time. So I just end up overworking.

-  8:27  

Yeah, and actually, I mean, I don't even need to monitor myself because I noticed I was. Sometimes it's harder to cut an end of the workday because you are you have been working from home all day long. So you might forget to Like shut off the computer, or to stop checking the work messages after a few hours. But I would really recommend like setting a good routine with beginning of the workday and end of workday. So that we don't end up actually losing the hours for self care,

-  9:06  

right like that.

-  9:08  

And then the very last part of the self care is trying to find ways for mastery, or building mastery. And we can't even think of this as being any silver lining because in the past when we used to go to work is harder to fit in time. Like, the time you use in commuting, especially in a bay area is so long, and now you have this extra time that could be a nice time to try something new at home. And when you don't get to go out at all, you might actually find other things that you have been postponing or procrastinating on. That could be a time to try something new.

-  9:57  

Yes, definitely. Okay. Yeah, really like This handout, I think it's from DBT, right? dialectical behavior therapy, very good coping

-  10:05  

strategy. And I kind of like that is all in one word. So it's easier to remember. Mm hmm.

-  10:13  

Yeah, I will definitely put this on the website and the link to it in the show notes. So for people to have access to it, and I think everyone can also Google it. There are a lot of handouts like this out there.

-  10:28  

Yeah. And people don't have to strictly follow this. But this can be a good one minder of what are the different areas of self care? Or self care is not about like, being just too nice or ourselves to eat two cookies a day. But self care is really to take good care of our bodies and our mind.

-  10:50  

Yes, definitely. I really like that. I think we want to remind everyone, I'm glad you mentioned that that self care does not need a lot of time. To do, it's it can really be the daily, little routine small things we do for ourselves. Similarly to mindfulness, be mindful to every small moment, day to day, you don't have to meditate for an hour or two per day.

-  11:18  

Wow. And actually think that the mindfulness is another really good strategy to help people feel more in control. When they are paying attention to the present moment, they are not so on autopilot about what's going on outside the world or having those ruminating thoughts, but they're able to kind of pause and notice what's really happening now.

-  11:45  

Yes, great. So this is one of the coping strategies I think is very structured, it's easy for people to remember and I totally agree, I think we all want to remind ourselves safety. self care, those are so important and so basic.

-  12:03  

Yeah. And there is another handout on is from action for happiness is actually a calendar of what are some of the small little things we can do during this Corona virus. And I really like that the things that they mentioned are something small, achievable. So for example, there was a make a plan or write down 10 things you feel grateful for.

-  12:43  

Jeremy to

-  12:45  

Yeah, and pulling it out or you can share it. Okay, let me see. Let me see. Oh, I got it. I think

-  12:53  

this one, right.

-  12:57  

Yeah, so actually, if some of these things are somewhere along the line of mindfulness. Typically, when people think about mindfulness or meditation, it's like you need to be in a super like Zen mode in this super setting where you can just totally be in that moment. That's actually kind of hard when you're working from home with other people. So these might be a little bit more doable. Like, for example, in the day 11. Notice five things that are beautiful in the world in the world around you. That could be a fun thing to do, so that we're not just focusing on Coronavirus, we can notice the plants we might have or the trees outside and the scraping that's going on right now that we didn't get to enjoy as an example for example number 16. It could be we discover your favorite music mistake that really lifts your spirits. So this calendar kind of gives people one idea one day to try. And this might be a more achievable way of dealing with the by dealing with the crisis rather than feeling like, Oh, I need to check off this and this and that.

-  14:23  

Yeah, like that, especially when you have one thing every day. It's very easy to follow, right? I don't have to think much. I can just come to this calendar and think about Okay, today's Monday, which one wants to do? Okay, that's it. That's me try it.

-  14:40  

Yeah, yeah.

-  14:42  

Yeah, I definitely had a lot of people. After we practice different psychological skills. They start forgetting what we have learned,

-  14:50  

right? Yeah, I know. It's like, we introduce so many different ones that they it's hard to keep track. But the good thing is I think from therapy, they tend to remember some of it. So if you will mind them, they will know or they will pick it up really quickly. But these things are actually doable, even if you're working remotely. Right, right. There's also other parts of trauma informed care to consider, for example, trying to get good, trustworthy information. We mentioned earlier about reading news and not not over being overexposed or not spending way too much time on news. So we talked about safety and the second part is really about being transparent and getting the right information. So I've had people who turn on the news station for the whole day. Like for example on NBC They actually become really overwhelmed because they are exposed to the news out today all the time. And actually, at the beginning of the Coronavirus outbreak, I used to track the number of cases in my area pretty closely. But later on, I decided, wow, that's just like way too much information. And having an additional 100 cases is not going to change my preparation plan. So I just decided, like at this point, like after you already know all the key information you need, and the trusted information, then it's probably good to restrict the amount of time you spend on researching. Right?

-  16:49  

Yeah, definitely. Especially when sleep is a problem, right? Mm hmm. Yeah, reading too much. And yeah, that that can turning into nightmares turned into difficulties falling asleep or I even have time I have people trigger they're like panic attacks in the middle of the night they just wake up often.

-  17:15  

Yeah. Another part about trauma or traumatic experiences is because the the situation is so uncertain. We tend to want to find a lot of information. We want to be as knowledgeable as we can so that we feel more in control. But that could backfire. Or at the same time, I think if you are in a position where you're in management or leadership, that could be a time to think about being as transparent as you can. There are employees who might worry about their financial security or what's gonna happen with the company and if they think Don't know, but they are guessing the worst case scenario and that can actually add on to the traumatic experience of the Coronavirus itself.

-  18:10  

Hmm. When we don't know anything we are guessing we are predicting that can trigger a lot of imaginations.

-  18:20  

Usually the predictions are more of the negative time, especially during this time. I can't imagine someone thinking like, Oh, I'm gonna get a bonus at work.

-  18:30  

Exactly. So it's more like catastrophizing, possibly.

-  18:34  

Yeah. So if you're in a situation of management or leadership, if you can kind of help them set the right expectation like, well, the company like we might not be able to keep all the hours but we expect this and that, that may actually help some of the anxiety for the employees. Huh?

-  18:56  

Yes, definitely. I think that's a good guideline. For a lot of managers for leadership positions, what you can do to really manage people's mental house and sense of securities is have like, a low lower their anxiety right now.

-  19:15  

And actually, if we think about the transparency in the US responds, initially, the mixed messages of hearing someone say that it's going to be bad and then hearing somebody say, it's not that bad. It actually is worse than just telling people exactly where it is. Right and so people can know and trust that information. Mm hmm.

-  19:42  

Yeah. Yeah. Now look back. I think we all learn a lot from this process, and surprisingly, see this pattern how they're triggered people's emotional reactions over time.

-  19:54  

Yeah. And it's kind of funny how like, we might come from a good intention of wanting To calm people down, not too worried on too much. But actually that can backfire when inflammation might be the thing that people really want and need for the transparency and trustworthiness,

-  20:15  

right, that's such a good point. Yeah.

-  20:18  

Well in the other parts of trauma informed care, also include the idea of peer support. And I know we talked a lot about social distancing. And that is kind of the opposite of like the idea of distancing from social connections. It's actually opposite of what's good for people

-  20:41  

out to mental physical distance, but psychological connections, right.

-  20:48  

Yeah, and especially people are already feeling like stressed out or loss of control, having some pure support either from family, friends or even people. Colleagues could be really helpful in managing the uncertainties of the situation in the rest of the trauma informed model from samsa. There's also collaboration and empowerment and choice and cultural sensitivity. needed maybe I can talk more about empowerment and choice. Because during this time so many people didn't have to choice about going to work or I mean like, going to the work building or going out and about, it's kind of like their choice is taken away from them because of the shelter in place orders or stay at home. So this is a time that actually makes people feel more stuck and helpless, when they don't get to choose. And this could be in ways coping with that. Some people Think about having more choices in ways that are within your control. So if you are in a family where you can't really go out to eat that much that may be to ask like the kids like, oh, what choices would you like and choosing which restaurant to get takeout? Or what, like what would be a fun item to get during this time, so people could still have some sort of choice and control and part of their live during this time when we don't get to say whether we go out as much.

-  22:34  

I like that. So when the whole outside environment cannot offer us the same thing we can do try to create some choices and empower ourselves and empower people around us with other choices.

-  22:54  

Wow, yeah. And that might also look like in work. You might think about giving people more flexibility in terms of when they submit something. Understanding that some parents, they have a lot of young kids at home and they need to kind of help them with school. So their deadline, maybe like their ability to meet a deadline will be more later at night than during normal business hours. And being more flexible and giving people the choice to choose something would likely be really helpful at this time.

-  23:33  

Right? I feel like a lot of people working from home. Do you feel more control of their own schedule? Is there any strategies people can start practicing day to day that does not take a lot of time? It's easy to remember, you know, really help with this kind of stress.

-  23:55  

Wow. Yeah, I would say really sticking to a good routine.

-  24:01  

In your daily schedule would be great. So starting with like getting up by a certain time, starting work at a certain time, and then ending work at a certain time. I think ending is one of the most important thing like shutting off the computer or really unwinding rather than staying on it. And then the other thing is to be limiting the amount of information we get about the Coronavirus because at a certain point is not really helpful. Right, right.

-  24:40  

Yeah. And any like, oh, before we go to the resources, actually, I have one question about the cultural sensitivity. Because our clinic is collaborating with the county locally. We are trying to have an online free support group for the agent In community to deal with all this extra stress right now we are all facing. Yeah. So from your point of view, I think that's part of this. This stress right one of the stressors for a lot of people no matter what kind of ethnicity background you're from. So how can we understand this cultural sensitivity this culture piece in all this situation we are dealing with?

-  25:27  

Yeah, I'm so glad you brought it up because sir Broderick and there is some discrimination on particularly Asian American groups, and that can further we traumatized or add on the whole stressful experience of the Coronavirus. So a big part is to recognize by your Asian or not to recognize that this Coronavirus is not just like stressful because of the illness is also so stressful because of the impacts and the discrimination on the Asian American groups. And what that could look like is even if you don't identify as Asian, but understanding that maybe your Asian American neighbors are worried about going to the grocery store or being outside walking around and facing either verbal or physical, like discrimination. And I'm sure everyone would appreciate checking in and just knowing that someone else is speaking about them and recognizing that they're not like, just like everyone else, like they're not just worried about the cone of virus, they were worried about how other people are treating them what they say when they're being blamed for the virus, whether they are being discriminated or seen as the Coronavirus carrier. Being able to to like, I think like if there's more empathy and recognition of the impact this has on Asian American population that will be really helpful as just coping.

-  27:14  

So awareness is as important as coping itself.

-  27:19  

And if you are Asian American, that may be a time to check in with yourself. How do you feel about all this discrimination going on? Are you worried about your own safety. And while we don't want to always jump to conclusion of what might happen, it's good to normalize and validate our own feelings, especially given what's going on. And this could also be a time to brainstorm different ways of helping you feel safer. So maybe instead of going to the grocery store physically, it could be getting Online deliveries. It could be instead of taking a walk at a certain time, when there are a lot of people, you might choose a time when you feel like is more protected, like safe far. So this might be a time to really check in with yourself. Like, when you might feel safest, where you might feel safest.

-  28:25  

Hmm, yeah, so we all have the ability to create some safety space for ourselves or for to create a sense of security for ourselves. So we really want sounds like we want to look into ourselves to find out where it's a comfort zone in this situation, how we can protect that, and how we can help ourselves to be able to function. Do what wherever we need to do at the same time, protect ourselves. Well, yeah, and be gentle with ourselves. If we do feel unsafe to recognize that makes a lot of sense. Because typically we feel bad or feeling bad. We need to really take good care of ourselves and be more like aware of what's going on around us and take it slow, take it gentle, be gentle to ourselves and be gentle to people around us.

-  29:24  

Because safety is a core of dealing with trauma.

-  29:29  

Right, right. I really like that core of safety. Yeah, after hearing this, I am sure a lot of people want to know more about this like trauma informed coping or other psychological coping strategies. What are some good resources you recommend to people who you know, have this need to continue to get more learn more and use more to cope with the situation

-  30:01  

Yeah, I can send you a few links that will be on trauma informed coping for COVID-19. Right. I can. There's also other strategies and handouts that I use in my clinical practice, especially on Coronavirus in xiety workbook that I found really helpful because they break down unhelpful thinking and activities that people can do, and ways to identify what's within our control how we can ensure that safety in ourselves, while recognizing we can't control everything outside.

-  30:41  

Wow, that sounds awesome. That sounds very practical, that down to earth skills people can really understand and use and I especially like that point you mentioned, to identify what is in our control what it is out of our control. What really we can do for ourselves right now? Mm hmm.

-  31:06  

Yeah, this is definitely a weird time for all of us.

-  31:11  

Definitely. Yeah. I think it's also important for us to normalize it to validate our own feelings, right. If we feel unsafe, we feel insecure. We feel anxious. I think we are not alone. Mm hmm.

-  31:27  

Yeah, definitely. Mm hmm.

-  31:29  

Great. So andriana if if people want to find you or if they want know more about your clinical work, your research, how can they find you or read more about you or contact you?

-  31:45  

Yeah, so I have a faculty profile. So people book, UT Southwestern.

-  31:54  

And my name is Brianna mew. They should be able to look up my faculty profile. And which includes information on contacts anyway. Mm hmm.

-  32:04  

Right. So in the medical field field you are working in, Can people directly make appointment with you or it just have to go through the clinic and they are assigned

-  32:17  

a part about working in a clinic because I can't I'm not the one to control everyone's referrals and there's sometimes a waitlist. So the clinic handles all that.

-  32:28  

Yeah. Thank you for coming today. Very nice talking to you. Hopefully, we get a chance to chat again. Yeah, same here. Bye. Have a good day. Bye. So this is my conversation with Dr. Miele. I don't know whether any of you had similar opinion with me before. That trauma is such a heavy word. It's not something we need to worry about day to day. It's not often seen in everyone's life, but right now Now under this pandemic, were all under some kind of traumatic experience, we are facing a huge amount of stress. And this is a not a normal situation for us all. So hopefully the strategies Dr. mew shared here can really inspire you to practice to really start learning how to deal with the day to day stress right now, I will put all the informations, the links, the book she mentioned, on the show notes as deep into sleep.co slash episode slash 035. And you can find all the information there. So there actually are more information in this interview. And you actually can find the video version of this interview on our YouTube channel. If you just search ask a question, you will find the channel and you will be able to watch the full way do of this Interview with her. So next week we will have a sleep specialist sharing her expertise in menopause and sleep. Again, I'm your host yishan Thanks for listening to our show deep into sleep. I will see you next week.

-  34:19  

Sleep is an individual thing. We all sleep differently, and there are so much we can do to improve sleep quality. Keep hope and carry on. This podcast is for general informational purposes only and does not include the practice of medicine or other health professional services. usage of the information we share is the listeners own risk. And our content does not intend to be a substitute for any medical and professional services, diagnosis and treatment. please seek professional health services as needed.

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Dr. Yishan Xuanxiety, stress, COVID-19, coronavirus, trauma, sleep, trauma informed therapy, cope1 Comment