#28: Asian Americans in Pop Culture with Dr. Oliver Wang

Transcript

Dr.  Wendy Slusser  00:05

Culture writer, DJ, sociology professor and co-host of the album appreciation podcast Heat Rocks, Dr. Oliver Wang joins us to share his research on the ways in which Asian-Americans participate in different forms of popular culture. Oliver has made his mission and work to share the stories that have yet to be told, like the story of the Filipino-American mobile DJs in the Bay Area, or the story behind the travel patterns of the Kogi food trucks in Los Angeles. Keep listening to hear some of these untold stories. Oliver, thank you so much for joining this podcast today. We’re doubly excited, because usually, you’re the one doing the interviewing. And so, I don’t know, I feel a little self-conscious, I suppose, but.

Dr. Oliver Wang  01:00

It’s nice being on the other side of things for change.

Dr.  Wendy Slusser  01:02

Is that right? Oh, good. And I know most of what you do in terms of interviewing is around music. Is that right?

Dr. Oliver Wang  01:09

Yeah, I have a long history of music journalism going back about this point almost, or not even almost, but over 25 years. And in more recent times, I get to hone that or keep it honed by hosting a music podcast called Heat Rocks, where myself and my co-host, Morgan Rhodes, invite guests on to talk about their favorite albums. And so we usually record that weekly. So I get to have an intelligent conversation about music at least once a week. And that is incredibly pleasurable.

Dr.  Wendy Slusser  01:38

Now you as an admirer of musicians, are you also a creator of music yourself?

Dr. Oliver Wang  01:44

I DJ. So to that extent, I “play music,” but I have not played an instrument since I was in middle school marching band, and I played the flute, and never continued with music lessons after the eighth grade. So I do not consider myself to be terribly musically proficient, even though I am certainly a deep lover and scholar and writer about music.

Dr.  Wendy Slusser  02:07

Aha. Now this sort of brings us to how I know your DJ experience led you to, I think, the scholarly work that you have done. You shared this in your food studies presentation in our food studies colloquium at UCLA for our graduate students. And I’d love you to share that with the listeners of your DJ, how that informs you to move into where you are now.

Dr. Oliver Wang  02:33

Right. So I wrote a book that came out in 2015 on Duke University Press called Legions of Boom, Filipino-American mobile DJ crews of the San Francisco Bay Area. And this was based on my dissertation research when I was a graduate student in Ethnic Studies at UC Berkeley. And the way that I got an interested in this particular community of DJs is that when I first went up to the Bay Area in 1990, to attend college to attend Berkeley as an undergraduate student, it became very quickly clear to me that the Bay Area and specifically Filipino-American DJs in the Bay Area were amongst the best in the world. And right in the early 90s is when DJs such as Qbert, Mix Master Mike, Apollo, these are all Bay Area Filipino-American DJs, they began winning these world international competitions and really distinguished themselves as being some of the finest DJs in the world. So as someone who was living in the Bay Area, was interested in hip-hop as a listener and as a very, very young scholar, and that is an undergraduate I guess. And as someone who is also happens to be Asian-American, I was certainly very familiar with this phenomenon of these world-class Bay Arean DJs, who were all happened to be a Filipino descent. And like many people, was curious to understand. So what is it about the Bay Area, and specifically the Bay Area’s Filipino community that produces all of these world-class disc jockeys? And by the mid 90s, I had the opportunity to begin my career in music journalism, and began interviewing a lot of the DJs from this community, and quickly learned that one commonality that they all had was prior to the 1990s. So the 90s is when they really became much more visible on the national and global stage. But when they were younger, as just high school teenagers. all of these DJs had been heavily involved in a mobile disc jockey scene of basically high school and local community DJ groups that would throw parties, such as school dances, they would DJ weddings, they would DJs quinceaneras, church parties, etc. And that they all were competing for business and competing for reputation with each other as these young high school teenage crews and it was a fascinating phenomenon that I realized very, very few people had written about and as both a music journalist and then later as a graduate student, when you come upon a really fascinating story that you don’t see other people talking about, that light bulb went up over my head that, oh, there’s something here. And that’s how it became first of all, my dissertation topic, and then later became the subject of my book.

Dr.  Wendy Slusser  05:10

Well I think it just shows how being observant and also blending your interests and passion with a scholarly pursuit can be so productive and also, so eye-opening to others. I love the fact that you took that perspective on something that none of us, I would never have known about, which is kind of like what you’ve done with food trucks.

Dr. Oliver Wang  05:34

At the time in which I first started to study the movement of new, kind of, fusion taco trucks, it was at a pretty early stage where I didn’t see a lot of other existing work on it.

Dr.  Wendy Slusser  05:46

So driving your research was this kind of premise, like, let’s look into something that others haven’t really explored or evaluated.

Dr. Oliver Wang  05:55

Right. And I think this is a case where having both a background in academia as well as journalism helps because, as a journalist, you’re always chasing after the story somebody else hasn’t already done. And I don’t necessarily feel like academia always runs along the same principle. Because especially as a social scientist, of course, there’s a very long methodological tradition in replicating studies to confirm, you know, previous results. And of course, from the scientific process point of view, that totally makes sense. But I think for me, when it comes to the things that I’m interested in studying, if I feel like someone else has already covered that territory, then I figure, well, I don’t need to reinvent the wheel, my efforts are probably spent in places where there hasn’t been as much research. And given that I’m primarily interested, not exclusively, but I’m heavily interested in Asian-American popular culture formations and forms of participation. That’s just a general area where there is not a lot of existing scholarship on, no matter what. So given that that’s my general field of interest, it’s not that common that I’m likely to overlap with other people. Since I’m interested in aspects of pop culture, which historically speaking within the academy, Asian-American pop culture has not been a real hot topic for a lot of folks. And so it does make it easier for me to find things that haven’t been done, simply given the nature of, you know, the history of racial exclusion in a variety of fields, including within the academy.

Dr.  Wendy Slusser  07:24

Well, that, you know, it’s really interesting that you’ve made that observation, not just about the Asian population, but about how to find areas that haven’t been well-described or observed and, and share it with others. Because, you know, when I first went to UCLA, and I went to a wonderful professor who’s since passed away prematurely. But he told me, I said, how can I make a difference in my field, you know, I’m medical, pediatrics, whatever. He said, Wendy, find something that’s really common sense that no one ever studied and study it and publish it. And the policymakers will run with it.

Dr. Oliver Wang  08:01

Yeah.

Dr.  Wendy Slusser  08:02

I mean, our academic folks want to have these multiple hundred studies, two hundred, whatever. But look, you know, it’s sort of a similar kind of approach to research. There are ways of doing research that can really capture people’s imaginations and also make difference in, you know, potentially their lives, right? So I think like your research in food trucks, I think is particularly fascinating, because it brings to light the complexity of food trucks, and I’d love us to focus on this today. Tell me how you’re interested in Asian-American culture and food trucks. How did that blend itself together?

Dr. Oliver Wang  08:39

So the the project that you’re talking about is a small research project that I undertook, God, now it would have been about 12 years ago, so this would have been starting around, I think, 2008 or 2009. But it happened at the time in which the Kogi BBQ truck which in Los Angeles really helped to ignite this wave of what I describe as nuevo catering trucks, nuevo taco trucks popped off around again 12 years ago, marking this difference between the older traditional taco trucks and lunch trucks that have been around and have been part of the food landscape of Los Angeles since at least the 1970s. But what began happening about, you know, 10, 12 years ago is that this wave of younger entrepreneurs came to the realization that the catering truck model allowed them to be able to get put a foot into the door of opening up a restaurant, but with lower overhead, lower initial investment, and that by, in the case of Kogi, by creating this fusion food creation. In their case, that creation was these Korean-inspired short rib tacos that combine both the city’s Korean and Mexican culinary heritages in a single dish, that it was a way of introducing new forms of food that didn’t have the same perhaps financial risk involved as trying to open up a brick-and-mortar. And the other thing that Kogi did that was so pioneering at the time, because again, you got to remember when we’re talking about here is, rather than being a stationary truck with an address that that you could find day-in, day-out, they would move locations throughout the day, and then update their location using Twitter. And this was at a time in which Twitter had been around for a couple of years, but it certainly wasn’t to the degree in which it’s become such a vital part, for better or for worse, of our contemporary communications systems, that them using Twitter was really considered the time very innovative, as a way of leveraging the power of social media as a marketing tool for their new business. And so Kogi, for a lot of reasons, became this, kind of, avatar of the perception of these new food movements that were happening amongst a younger generation of entrepreneurs. And so the way I got interested in this, because partly I am a journalist is I’m always looking to see what are other people writing about. And especially when it comes to issues of food and identity and community, I’m always curious when I hear people purporting either how it’s being described by others, or their own self description, where they’re talking about the ways in which food or business represents a neighborhood or a city or a community. Because I mean, those are bold claims. And I think part of me is always curious to see to well, to what degree do things live up to the ideal that they purport to exemplify based on, as in terms of their mission or identity. And with Kogi, there was so much intense press, I mean, really, within just a matter of months after they opened, they were not just getting local coverage from the likes of Jonathan Gold, the late Jonathan Gold, who at the time, was still writing at the LA Weekly. They got big write-ups in the LA Times, but outlets like Newsweek, and I think it might have been Time Magazine, or maybe was the New York Times, but they were sending reporters out to do stories on this very local Los Angeles food truck serving these Korean short rib tacos. And a lot of the language in which they would write about it was very, you know, very idealistic, very much, you know, and you got to remember that this is right after Obama gets elected, and so the kind of sense of power of multiculturalism is perhaps at its peak, at this moment in American society. And so Kogi is seen as as tapping into all of these different things. And sorry, I feel like I’m rambling here. But the way in which I turned this into a research project is given their very conceit of we’re going to move locations throughout the Southland, and we’re going to tweet where we’re going to be, I realized that Twitter feed was a source of geotagged data. So for every address that they’d say, okay, we’re going to be at this address at this time, I could basically copy that down, put it into a database, and then map it using Google Maps, and then create a map of where does the truck go. And part of what I was looking for was not only is what areas of Los Angeles, and Orange County, is the truck going to, but also by extension, where’s it not going to? And then you get this kind of social geography of this particular company that I think might be reflective of other similar, newer nuevo trucks that were really becoming a part of this massive trend that began to pop off in the late 20-odds, I guess.

Dr.  Wendy Slusser  13:40

Hmm, where did it not go?

Dr. Oliver Wang  13:42

It did not go into a very large part of Los Angeles, which historically tends to be ignored by a lot of people who write about food. In other words, if you were to compare the map of where Kogi went with a map of what restaurants, you know, Los Angeles magazine reviews, or if you were to, you know, map, the Zagat’s Guide to Los Angeles, the areas that are missing all happened to overlap with one another. And it tends to be the neighborhoods that are south of the 10 freeway, and east of the 405. And again, for your listeners who are not from Los Angeles, this may be utterly meaningless. But if anything, if people know anything about Los Angeles, it’s that the freeway system does mark a lot of our geography, in this case that, so what I’m describing are the neighborhoods that fill South Los Angeles, Southeast Los Angeles, and also parts of East Los Angeles were the areas that I found that the truck didn’t go to. And these are, I think, not coincidentally, the most brown and black parts of Los Angeles and they also happen to be the most working-class parts of Los Angeles. And these are neighborhoods in which taco trucks, the old fashioned traditional taco trucks, are not hard to find. They cover the area, yet it seemed like a lot of the nuevo trucks were avoiding them. And my guess is, it’s a combination of class dynamics on one hand. I’ve heard the argument that it’s a palatte concern, which I don’t know if I put as much validity into the idea that somehow immigrant, you know, Latino populations, or African-American populations are not interested in fusion food concepts. I don’t see enough evidence around that to sort of buy that as a reason. I think a lot of it is because these nuevo trucks were charging a higher price point than a lot of the traditional taco trucks and maybe made the assumption that by going to these poor neighborhoods, they’re less likely to be able to turn a profit. Again, and that’s just an educated guess. But what’s interesting, I’d love to hear your sociologist perspective, what is it that the mobile truck, what’s that role and what is it bringing to the food truck culture? Like being mobile, what is that? Is that just because it’s novel? Or is there something else about it that you think is contributing to people’s interest in that kind of habit of a truck? Yeah, I think it’s a great question. I think there’s a few things going on. You know, one thing that others who are much I think, more studied in just the catering truck phenomenon than I am, have pointed out, the one thing that trucks do, just given the nature of their mobility is that they, the phrase that often gets used, that they activate public space. And so if you’re setting up a food truck in a, let’s say, a warehouse district that otherwise doesn’t have a lot of residential properties, then you don’t have people who typically live there. And maybe they’re doing it after hours. So it’s not like you’re getting people on lunch break. And yet, if you’re able to bring people out there, it temporarily, at least in a very ephemeral way, it activates this public space that otherwise would be deserted or unused. And so I do think there’s a way in which that the taco truck phenomenon, not just in Los Angeles, but a lot of cities is a way of creating a new version of street food, that historically, at least in Los Angeles, certainly there’s kind of have long been sidewalk street food stands. But I think that the catering truck phenomenon really grew a kind of street food culture that perhaps didn’t exist as robustly in a city like LA, compared to, let’s say, New York City, where you’ve had, you know, hotdog stands and knish stands and pretzel stands and everything, you know, when I think Halal food carts, right. I mean, every corner of Manhattan feels like there’s a food stand, and LA is is nowhere near that. But I think having the addition of newer food trucks, in addition to the more traditional food trucks, was a way of creating more of a public street sense of food. And I think that quality is appealing to people that falls in line with the ways in which there has been renewed interest in the urban landscape. You know, now that cities are hip to live in and again, and people aren’t afraid of moving into central cities anymore. the food culture of it has gone hand-in-hand with the, and you can’t really see me, I’m putting scare quotes around the word “rehabilitation” here. But around the rehabilitation of urban space, I think food and culinary foodways have played a pretty key role in that rehabilitation of image. And I think the other thing, too, is going back to what I was saying earlier, it’s because if you are trying to launch a new food concept, it’s probably easier from a financial point of view, or at least a little bit less risky to do that by investing in a food truck than it would be paying rent or leasing a physical brick-and-mortar space. Which means that if you are an adventurous food eater, and you’re seeking novelty, you’re more likely to find examples of that novelty in the food truck as opposed to going to a more traditional brick-and-mortar restaurant. I do think that phenomenon is beginning to change a little bit because one of the big newer trends that we’ve seen in Los Angeles over the last few years have been so-called food halls, which to me are just food courts with different PR, but they’re effectively the same thing. You just have a bunch of food stands inside of the same shared space. But you’re now seeing a lot of these newer concepts appearing in food halls, maybe either in addition to a truck or in place of a truck, because I think what we’ve seen over time, and I don’t have the numbers on this, but I think you’ve seen fewer trucks now than there might have been 10 years ago, as the truck economy has kind of worked out its kinks and maybe wasn’t able to support as many trucks on the road as we originally thought it might.

Dr.  Wendy Slusser  19:35

Yeah. And also like, at farmer’s markets, I see a lot of pop-up experimental foods being sold.

Dr. Oliver Wang  19:41

Right, that’s another place that, again it requires a low relative initial investment to get interested in that. So yeah, I think if you’re a food eater, then you’re looking to these trucks seeking that novelty, looking for dishes that you haven’t experienced before. And I think that’s also contributed to their popularity.

Dr.  Wendy Slusser  19:58

Now if you had somebody come to you and ask for advice on starting up their own food truck, what would you give? What kind of advice would you give?

Dr. Oliver Wang  20:10

Oh god, I’m sure I would just be helping a lot of people go out of business much sooner. I’ll say this much, and this is a very small but I think significant thing for any truck that is contemplating operating any kind of thing that involves the taco. And this is one thing that I think Kogi got really right, which is that if you’re going to serve a proper truck taco, you have to griddle it with a little bit of fat or oil. I remember and I’m not going to name the truck, because I don’t want to be mean about this, but remember, in the post-Kogi era, there was a another fusion truck concept, basically serving non-Mexican, non-Latino food inside of a taco, a soft taco wrap. And they just serve the the tortilla without any heat and without any fat. It’s like they just took it out of a bag, slapped some ingredients in it, and then served it. And it’s basically like eating through, you know, a thin piece of cardboard, like without the fat, the corn tortilla itself, there’s no unctousness to it, and it just creates this terrible mouthfeel.

Dr.  Wendy Slusser  21:18

Mmm, I agree.

Dr. Oliver Wang  21:20

And I just came away thinking like, have you never had a taco before? Like, why wouldn’t you throw this on? Like, apply some heat, put some fat into it and make it more pliable and just make it more delicious. So that would be the only simple piece of advice is make sure that there’s a little bit of heat, and hopefully fat getting into that corn tortilla.

Dr.  Wendy Slusser  21:40

You’re making me hungry, actually. Maybe I’ll move into something that’s not talking about food, or tangentially, about your research and writings. You’ve talked a lot about the growing role and presence of Asian-Americans’ Los Angeles cultural foodie scene, can you talk a little bit about this, or a little bit more about this?

Dr. Oliver Wang  22:00

One of the things that I feel like has been explained is the amount of Asian Americans who you can really see being heavily involved at the forefront of where American food culture is going. And so I’m thinking of people like, certainly David Chang, who has now created a mini media empire based around his exploits in the world of food. If we’re talking about Kogi, as we have been, certainly Roy Choi has been one of the very visible people there. And I’m just naming two very obvious people, but there are hundreds, if not thousands, of Asian Americans out there writing cookbooks, opening restaurants, writing food blogs, etc, who’ve really taken to throwing themselves in full-force into pushing where American food culture is going. And I think a big reason why is that, given the history of racial exclusion that Asian Americans have faced going back, you know, well into the 19th century. You know, the common thing that that people in our community face is that were seen as these perpetual foreigners. So it doesn’t matter how many generations or families have been here, it’s simply because we look the way that we look, people just assume that we’re not really American. And so I think because of that, in a lot of other areas of American pop culture, whether you’re talking about pop music, or professional sports, or what have you, the presence of Asian Americans within it is always met with at least some degree of initial skepticism in a way that may not exist if you are white or Black, because those are seen as being kind of racially authentic. Being Asian within those spaces as being seen as racially inauthentic. And so as I was saying, there’s this initial perception of skepticism that confronts them. But that doesn’t to me exist in the realm of food, because thanks to there being about 170 years of Chinese food in the United States, to say nothing about Japanese and Korean and Thai food that have come about in more recent decades, Americans in general are well-prepared to see an Asian face in a restaurant or in a kitchen and it doesn’t faze them. At no point do you think, oh, this is unusual, I don’t know how to make sense of this, in comparison to seeing someone like Jeremy Lin, as a professional NBA player on a basketball court. That sometimes there’s a cognitive dissonance that people have around that, or seeing an Asian-American rock musician or hip-hop artist, there’s that cognitive dissonance. You see an Asian-American running a restaurant, there is no cognitive dissonance there. People just understand like, sure, that makes sense to us. And so whether or not Asian-Americans realize this or not, I do think that on some level, because food is a lane, culturally speaking, that we’re allowed to run in, if you will, that it partly helps to explain why all of this energy is going into Asian-Americans exploring all of the different options out there in terms of the different kinds of food ways they want to get involved in. I mean, certainly the backdrop of all of this has just been the explosion of interest in food culture as becoming this formative part of American popular culture. So the ways in which, I’m certainly not the first person to make this comparison, you know, chefs being the new rock stars, for example. So to the degree that food culture now is connected with forms of cultural capital in ways that perhaps didn’t exist one or two generations ago, I think Asian-Americans have really taken advantage of those changes because again, food is an area that we are allowed to exist in without that kind of cognitive dissonance, skepticism. And we are trying to thrive as best as we can within that field.

Dr.  Wendy Slusser  25:39

And what is your next research? Is there something that’s going to be cropping out of this observation that you just described?

Dr. Oliver Wang  25:45

Probably somewhere. Just to use a food metaphor, it’s certainly somewhere on the backburner. Though the actual project that I’m in the midst of right now, and it’s going to be taking over my life for the next couple of years. is actually looking at Japanese-Americans involved in Southern California car culture, so not about food, but about automobiles, and the ways in which Japanese-Americans who are the, at least in the LA area, the oldest/largest community. Chinese-Americans would have predated them, but they had the most significant population in Southern California for many decades. And they have been really central in different aspects of car culture going back a hundred years. So whether that’s racing hot rods up in the desert lake beds back in the 1930s or 40s, whether it’s customizing classic cars of the 40s and 50s, whether it was becoming part of the whole street racing scene that popped off the, well, kind of existed for many decades but there was a very robust street racing scene in the 70s and 80s, before the LAPD cracked down on it. But Japanese-Americans were thoroughly involved with that. And in more recent years and decades they helped to launch what is now thought of as the import car scene that was partially inspired things like the Fast and Furious film franchise, for example. And so my research is basically looking at all of the different generations of Japanese-Americans involved in aspects of car culture here in the LA area. And hopefully, this will be a museum exhibit in 2022, which is what I’m currently in discussion with folks about to make happen.

Dr.  Wendy Slusser  27:22

So I guess from food trucks to cars. So how did you get, how did that interest you? How did you find that idea?

Dr. Oliver Wang  27:35

It actually stems from a very long-time chip on my shoulder as someone who’s certainly considers himself as a scholar, I certainly consider myself to be an Asian-Americanist, which is to say that, you know, a lot of my initial training was in Asian-American Studies. I see my work as being very much part of this tradition of Asian-American Studies, that is, in many ways, celebrating its 50th anniversary right around now. But one blind spot that I felt like has always existed within discipline has been around number one, around popular culture in general. We have dozens and dozens, if not hundreds of people studying Asian American literature. We have, in comparison, very few people, I think, really committed to studying forms of Asian-American popular culture. And in particular, it always struck me as bizarre that no one has ever written a book about Asian Americans in cars, even though if we’re talking about just stereotypical things that people associate with Asian American communities, car culture, I think is one of those things. And yet, for whatever reason, within our community of of Asian-American scholars, it has not been an area of much research outside of some important journal and anthology articles that came out about 15, 20 years ago. But it’s just, there’s been such a dearth, and I always find it to be such a strange phenomenon that we have a gazillion books about Asian-American literature, and no one’s bothered to write a book about Asian Americans and cars. And a good friend of mine, who noted that I had been basically making this observation, by what she meant, you’ve been complaining about this for 20 years, and you’re a sociology professor, you could just fill in that void by doing the research yourself. And I thought about that for a moment, I’m like, okay, that’s actually a fair point. I mean, partly, I’m not really a car guy. And so I got interested partly in DJ culture, because I was and am a DJ. My interest in food is partly because I’m a big lover of both cooking and eating food. With cars, you know, I enjoy their aesthetics, and I enjoy driving them, but I’m not someone who memorizes different car models or can tell you about the provenance about a particular vehicle. So it never really occurred to me to make it part of my own research until my friend said, look, rather than complain about this for the 21st year, why don’t you go out and at least see what’s out there? And, you know, my wife, who is a fourth generation Japanese-American said, well, you should interview my dad. In other words, my father in law, because he and his friends started a car club when they were high school students in the San Fernando Valley. And so I interviewed him, and very quickly realized that there were a series of, I think, really compelling stories there. And so that really got the ball rolling in terms of, so I spoke to him, then I spoke to a couple other folks. And then they recommended me to other people to talk. Then I published something about what I discovered about car clubs from the 1950s and 60s, in the newsletter for the Japanese-American National Museum, which is based here in Los Angeles. And then someone who was part of a racing club, a Japanese-American racing club from the 1980s saw that article, got in touch with me, and then I began interviewing him in his community and generation of folks. And that’s basically how things kind of snowballed from there. And again, I think what connects all of my different interests as a scholar, and as a writer of culture is, I’m interested in the ways in which Asian-Americans participate in different forms of popular culture. And so to that degree, whether it’s DJing, whether it’s taco trucks, or whether it’s cars, those are all just examples of, again, examples of participation in pop culture, which is ultimately what interests me, regardless of my own individual level of interest in any of those areas of activity.

Dr.  Wendy Slusser  31:32

So, I mean, you’re such an extraordinary storyteller, since it’s a journey just to listen to you describe how you get into a different subject matter. And I’d love to know, what’s your bucket list of pop-culture phenomenon that you want to research with the American Asian population?

Dr. Oliver Wang  31:51

That’s a really good question. I think one thing that I joke about with my wife is that, you know, I wrote a book about Filipino-Americans. I’m currently in the midst of doing this research around Japanese-Americans, and my own personal background is I’m Chinese-American, but I’ve never really made it a point to study a Chinese-American phenomenon. I’ve written about specific Chinese American personalities, but not in terms of a scene that I would associate with people from my own ethnic community. And so I feel like at some point, maybe just to, you know, honor my roots, I should figure out something along those lines. But I think partly because the Filipino-American DJ scene was something that I was aware of, but I didn’t grow up in. In the same way that I did not grow up within the Japanese-American car scene, I think that partly what is interesting to me, because there’s something that is novel that draws my initial curiosity. Whereas with Chinese-Americans, it may simply be on a subconscious level, my presumed familiarity with my community makes it actually less interesting or less compelling, simply because it’s too familiar to me.

Dr.  Wendy Slusser  33:02

That makes sense.

Dr. Oliver Wang  33:03

Right, maybe there’s something out there down the road. But I mean, what’s what’s interesting is I’m raising a, at this point, a 15-year-old, you know, half-Japanese-American, half-Chinese-American. Basically, she’s fifth-generation Asian-American, and at least on her mom’s side. And so I’m very curious to see the kinds of things that she and people of her generation, so I guess, the Asian-American Gen Z, get interested in. And it may be that whatever my next next research project ends up being, it’s going to be something that my daughter turned me onto, because it’s something that’s going to be if not fully unique, it’s going to be something that that that generation is driving.

Dr.  Wendy Slusser  33:42

Truly fusion.

Dr. Oliver Wang  33:43

Yeah, to some extent, right. You know, whether that’s in the realm of food, or in music, or in some, you know, some other form of pop culture, I don’t know, I think in general, because you were asking what my bucket list is, and I’m the type of personality where, if I have an interest in something, I usually try to, instead of keeping it on the list, I just jump in to whatever degree I can. So something on a bucket list would suggest there’s something that I’m interested in that I haven’t actually looked at, and right now, I don’t know if there’s anything that I’m interested in that I’m not also actively looking at. So it really would have to be something that I haven’t discovered or come across yet. That would be the bucket list item and maybe I just need to spend a little bit more time out there to see what’s on the the incoming wave of new cultural formations that’s something up my alley.

Dr.  Wendy Slusser  34:31

Oh, that actually is a perfect lead-in to the one of my last and final questions, which is, since you are such a good researcher, I’d love to know what your go-to food truck spot is.

Dr. Oliver Wang  34:41

Well, number one, I tell people go to Kogi. I mean, anything else I have to say, but they make an extraordinarily good short rib taco. And I do think that, to the extent that that one dish does capture some aspect of different LA food cultures within its tangible form, I think that’s actually true to a large extent. And I think that if you’re an out-of-towner, and you’ve never tried one, you should take the time out to get on Twitter, figure out where their truck is going to be, and then find a way to get there and to try it. I think it’s certainly worthwhile. In terms of my other favorite food trucks, the two that come to mind is there’s a place called Tacos Leo, which is actually throughout, they have a couple locations throughout Mid City. But the one that that I know best and is their most popular spot is located at the corner of Venice Boulevard and La Brea. And they’re best known for their al pastor tacos, and I think, on the weekends, at least weekends only from my recollection, is they serve it straight off of the trompo, which is the spit. And the people who work that spit clearly have mastered the art of the efficiency of the cut. And it’s almost like a little bit of performance when they put the tacos together. But those are really, really, really delicious. And then the other one would be, this is kind of a Jonathan Gold classic, because he was one of the first people to really help put it on the map outside of the East LA Latino community, which is the Mariscos Jalisco truck. They serve, they’re a seafood, a Mexican seafood truck, and one of their specialties is a hardshell shrimp taco, which is filled with this, kind of this, I know  it’s not gonna sound inherently appetizing, but I think it’s a mash of mashed potatoes with shrimp in it. So it kind of has this creaminess to it with the chewiness of the shrimp, and then it’s inside of a deep fried hard shell. And so you get these layers of texture, it’s seasoned very well. But it’s really just this experience of the crunchiness of the exterior with the creaminess and the chewiness of the interior, you get all this wonderful contrast. I took a friend there for the first time and she actually said it was reminiscent of East Coast Chinese egg rolls, which are very distinctive to cities like New York and Boston, because they’re much bigger than what you usually find out here. And they also have that kind of crunchy exterior, creamy interior. And I never thought about that comparison, except after she mentioned it every time I’ve been back to Mariscos Jalisco, that reference really does come to mind as I’m biting through it. But those things are so, they’re so infectious, I usually joke that you’re going to order two, you’re going to want to go back and order another two, but really, you only want one more because four is too much. But your body is going to crave and want to have as many of those as possible, because once you start to bite into it, they are addictive.

Dr.  Wendy Slusser  37:43

Oh my gosh, well, I don’t know, I guess that’s a good way to end because I’m starving now. I gotta go grab a bite to eat. But before we end, is there anything else that you want to share with our listeners?

Dr. Oliver Wang  37:56

No, I really appreciate the time to be able to chat with you and share some of the stuff that I’ve been working on. And thank you so much for having me on.

Dr.  Wendy Slusser  38:02

It’s just been a pleasure. And also, thank you so much for being such an inspiration to all our students at UCLA. You’ve really picked their curiosity and imagination.

Dr. Oliver Wang  38:12

Well, thank you. I really appreciate hearing that.

Dr.  Wendy Slusser  38:14

Fantastic, thank you. Thank you, Oliver. Thank you for tuning into UCLA Live Well. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyUCLA. If you think you know the perfect person for us to interview next, tweet your idea to us, please. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.

#22: Past to Present- Archaeology & Today’s Diet

Transcript

Dr.  Wendy Slusser  00:02

Today I’m travelling back in time with UCLA’s Dr. Amr Shahat to discover what Ancient Egyptians ate, and learn about how the scientific analysis of food remnants can tell us the stories of how Ancient Egyptians lived. Join me as Dr. Shahat explains how racism and gender inequality intersect with archeology, and how studying what is left in the stomach of mummies over the centuries can tell us how much fiber we should eat. So great to have you join us today. I met you last winter quarter in the food studies colloquium at UCLA that I was teaching, and you brought such a unique perspective to the class with your research in Egyptian archaeology. The first week or two of class, you were actually still in Egypt on a dig. Can you share with our listeners what you were doing there?

Dr. Amr Shahat  00:56

Yes, I was excavating an ancient Egyptian site with colleagues of mine. We were in a central part of Egypt, in the Qena region, north of the famous Luxor area. This is a place where the Nile bends and gives quick access to the land route to the Red Sea and interactions for long distance trade. Whether going down into Africa, like Eritrea or Ethiopia, or crossing the other side for Indian Ocean trade. That region is actually very important for me because my father comes from that region, in Qena.  The second significance of this site is that I am interested in social history. Most of the time, when we write about the ancient history of people, especially from a feminist perspective, we think of famous queens like Cleopatra and Hatshepsut, and will give little attention to the history of other women and their contribution to history in other ways. So I wrote a proposal to the UCLA Center for the Study of Women that we still can learn the history of women from non elite classes or not famous tombs, even if they don’t have text, or big decorations in their tomb, by studying the food remains that were buried as offerings with them, and by actually analyzing the body through scientific method, like stable isotopes on their teeth and hair, to know what water they grew up drinking, where they are from, what food they were eating, and estimate their health. And then, after taking two classes in the UCLA Fielding School of Public Health, one with Professor William McCarthy, and the second was your class, there was a beautiful synergy that changed the way I think about and approach this very same data.  It was my first time learning about the gut microbiota, and how they are important for our immune system. It was my first lesson about the traditional diet, rich in fiber which was helpful to reduce gut inflammation, which is a precursor for multiple diseases: obesity, diabetes, and cancer. So I started to redirect my research to also ask health related questions that serve modern food sciences. My bridge here was a critical article published by Zang et al in 2019, where he spoke about the direct relationship between fiber intake and the gut microbiota. The conclusion of his research was that he recommended 40 grams of fiber as a daily intake to improve the health of gut microbiota. And then I found other research, actually published from the public health side, finding the big difference between the traditional diet and the modern diet on the gut microbiota, and hence the correlation between our modern diet rich in fat and processed sugar and processed food and the increase in diabetes, obesity and intestinal tumors.  I said okay, let’s see what the traditional diet looked like in the past. I had the mummies preserved, I have the food preserved. The first thing I noticed is that most archaeologists from my side ignore the importance of wild plants. In an archaeological context, we overlook them, and if we find them, we don’t give them much attention or analysis. We usually focus on domesticated plants that are important for the modern economy like wheat and barley, and how they were domesticated, and how they were important for making bread and beer. But then I found that the wild fruits and wild nuts, indigenous to a region in Egypt or out of Egypt, they were never ignored. They were never dropped out of the diet. It is only in modern times, when we’re faced with this big advertisement of the Western diet as the diet of the elite. Having Western restaurants increasing, in Cairo, for example, McDonald’s, Kentucky Fried Chicken, and even Subway came over to Egypt. Right in front of the pyramids and the Sphinx, you have Pizza Hut and KFC. So only after this increase, it is more denigrating for people to consume these wild plants and wild fruits.

Dr.  Wendy Slusser  06:14

People aren’t eating as many wild nuts?

Dr. Amr Shahat  06:16

Yes. And the connotation of eating them now is actually bad, socially speaking.

Dr.  Wendy Slusser  06:22

What are the wild nuts and wild fruits?

Dr. Amr Shahat  06:25

Sycamore fig is one of the native fruits and is also depicted on the wall of the tombs in ancient Egyptian, associated with the goddess of love, goddess Hathor. I also discovered a lot of Christ’s Thorn fruit, which is a wild fruit native to Upper Egypt, or the south part of Egypt. We call it Nabaq in the local language. I also discovered many Persea nuts, and they look amazing. They looked fresh when I discovered them. They are pretty much extinct today or alarmingly decreasing. So every time I discovered them, I really wanted to eat one to test how this fruit tastes. I also discovered two types of dates, two species of palm trees, the one famous for us is the date palm, and another species of palm tree that has two heads, called dome palm. And this is native to the Nile region. It grows along the Nile in Kenya, in Sudan, in Ethiopia, and in Egypt. And it is part of the shared diet, or wild fruit that grows along the Nile. And it stops in the south regions of Egypt, it does not exist in the north. And this plant when I tried to test it in the lab, it pretty much soaked all the tests in water and fluids because it is really, really rich in fiber.

Dr.  Wendy Slusser  07:59

What you’re describing is so rich in information, how does this contribute to your knowledge building for social history, learning about all these different foods?

Dr. Amr Shahat  08:10

That is a great question. Because archaeology started in a colonial tradition, and British and French colonialism before it. Basically the consequences of this is still on going in terms of focusing on large tombs of famous kings and individuals, or high officials. The history of other people who contributed to, for example, the history of the pyramids- there was a discovery of the whole village of workers and the social system dynamics of these workers who built the pyramids. But we don’t see this celebrated either in public literature or movies like in Hollywood, we only see famous figures. Besides the post-colonial stance in this research, as a native Egyptian, I want to highlight the original diversity in Egyptian cultures, even in ancient Egypt, and the diversity of the regions of the world that Egypt interacted with. For example, I discovered the first evidence of watermelon in the same site, which is of origin in tropical Africa- with debate Some people say West Africa. I also discovered juniper berry that comes from the Eastern Mediterranean. So it shows you that Egypt’s cultural interactions were multifaceted.  So after that, I took the feminist stance I said okay, I TA here for a class of Women in Power with Professor Kara Cooney. And here is where we open the eyes of students to feminism, with a look into the past of how different women in different societies transcended social justice and leveled up. And even some of them came into power. And this site is critical. This very same site where I show you this plant is critical, because the cemetery where I found this tomb is associated with the Palace of the Queen called Ahhotep. And this Queen had led a war after her husband died. We found in her tomb, a symbol of flies, made out of gold. House flies are annoying, but in ancient Egypt, when you find them in ancient tomb, it’s actually a symbol of valeur, that this woman was known for her bravery and her valeur.

Dr.  Wendy Slusser  10:50

Why do flies have that symbolism?

Dr. Amr Shahat  10:52

Because they are very persistent. If you can’t hit it, and you tell the fly to go away, it tells you back “go away.” It’s a metaphor, but they are really persistent, they keep coming back to you. So they are insistent on achieving their goal.

Dr.  Wendy Slusser  11:12

That’s great symbolism. So this particular person that was in this site you found was a person, a woman, who was empowered after her husband died, and therefore, in history would be considered a strong person.

Dr. Amr Shahat  11:34

I’m giving you the context of the site. So I know that this woman had owned the palace, but the tombs I excavated are the women that we don’t know anything about their history. These were women associated with the palace, working for her, and they had  graves, or a cemetery, nearby associated with the palace. But they were small graves, we don’t have any texts buried with them to tell us who they are. We don’t have any clues from tomb decorations, for example. We don’t have coffins that depict how they look like or their names. My argument is that by analyzing the food offerings like this- but we will not find them randomly, we have to look for them using scientific tools, and being empowered with different research questions that combine social science and life sciences together. In this way we can serve understanding the social history of these women, and we can also serve modern food sciences and concerns about food to the society today. So to land with that, I found here that this big diversity of wild fruits and plants that we used to eat and have given up in modern time have correlation with the increase in diabetes, high blood pressure, and obesity in Egypt. And it was observed by other public health specialists in Mexico and here in Loma Linda, in California, that traditional diet, which was more rich in fiber, was associated with less cases of obesity and intestinal tumors.

Dr.  Wendy Slusser  13:21

Yes, that’s a very long term observation of change in the food system. And how do you relate your work to feminism? What creates your your hypothesis that there was feminism during those ancient times?

Dr. Amr Shahat  13:37

Oh, what I’m speaking of is that we are making a feminist class today. We started at the same time as the Me Too movement, Professor Cooney launched it at UCLA. And this research was just from my side to contribute to this class to say, “Okay, we have some ancient data that contributes to our modern thought of feminism.” And one of the big honors I received is the UCLA Center for the Study of Women Award. It was last May in 2019, and it actually supported this research.

Dr.  Wendy Slusser  14:16

Why was your research contributing to the feminist movement of our time?

Dr. Amr Shahat  14:24

That is a great question. So, in modern times, the feminist movement, not only argues for the lack of recognition, but also the current feminist movements argue for the diversity of voices that need to be heard. And some of these voices coming from a diversity of people who come from everywhere, have different cultural affiliations, and we homogenized sometimes who they are. We homogenized them, we give them their names, for example. That is part of, actually, the intersection of racism and gender inequality. Instead of knowing you from you, I know you by hearing about you, not knowing you by hearing you. So here I say, okay, in modern society, I would go to one of these women, and I make oral history. But how about this ancient women who are buried here next to the palace, and evidently contributed to Egyptian civilization in different ways. And we don’t have anything about their history. For elite women, we have texts, buried with them in their coffins, we have their coffins decorated with their names and their titles, we have them depicted on the tomb walls, saying who they are, what they were doing. But how about these women buried in small graves?  My suggestion here was to use life science methods, like stable isotope analysis, and botany, by analyzing the food species buried with them, to learn at least their identity, how they grew up, and where they grew up. So striking data came out here. First, the food offerings buried with them showed that they ate the wild taxa of the region, so it gives me where they come from, and it also shows that they were involved in long distance trade, having imported food remains coming to them. And sometimes, I found a gift coming from a royal, like a scarab or a figure inscribed with the name of Queen Hatshepsut, or King Tut Moses the Third. So it tells me, that this person was gifted something or had association with the elite, or she has served something and she received a gift from the royal court.  The second thing here, with stable isotope analysis, basically, I did oxygen on their teeth to know the water source where they grew up. And then, luckily, I have also the hair preserved, which when I measured the oxygen, tells me the water source for the last few years where they lived. Here another striking evidence happened. Some of them were Egyptians, because the oxygen of the Nile River is very, very distinct from any other water source, and it is very rich in oxygen 18. And some of the Egyptians were clear when I did it on the teeth and hair, but some of them actually were not Egyptian. There was a striking example of a woman who grew up in Southwest Asia based on the oxygen in the teeth- because the teeth gives me the water source for the first 10 years of your life. And because the hair remodels and it will be cut and grow again like one centimeter every month, I cut it month by month, one centimeter by one centimeter. And it tells me like her passport, where she was for these past years. So I have her food and her water source to know who she is, where she’s coming from, and where she died. So striking social history to unpack here.  One final surprise for us came from the life science side. I said how about doing the stable isotope on the food to know the water source and the climate condition where the food itself was grown. Because it’s the same thing, we are like walking plants. When I measured the oxygen and carbon to know the efficiency of water used by the plants and the climate conditions, I got very shocking news. I found that the ancient plants had grown up in better humidity conditions, except for one Juniper species that came from the Mediterranean and was imported. It showed evidence of high drought, but then all of the plants consistently showed evidence of very high and rich soil fertility based on the nitrogen isotope, and this of course, determined the nutritive content of the food and their health and immunity. What was shocking when I got the modern samples collected from the farms and the spice shops in the area and did a test on them, I found them all very low in soil fertility, all of the plants that date after the construction of the High Dam. The bridging thing for me was a sample of wheat from the Charleston museum taken right before the High Dam and it showed the high soil fertility, like the ancient Egyptian one. It is only after the dam, where we see the terrible decrease in soil fertility levels and decrease in the nutrition content of the food growing along the Nile.

Dr.  Wendy Slusser  20:04

And why do you think the dam contributed to this degredation of the soil?

Dr. Amr Shahat  20:09

That’s another great question, Wendy! Every July, the monsoon rain comes from Ethiopia and Eritrea regions and filled in Lake Victoria, or the native name, Lake Nyanza, and then it brings not only the water, Nile flood coming down to Egypt, but while bringing the water it also brings rich minerals and clay all along. So we get water high in oxygen 18 because it is coming from monsoon rain, not like in California or Northern California, coming from a snow melt. And it gives us also fertile soil that deposits on both banks of the Nile, free, so we don’t need to use any fertilizers. Sometimes they used dung of cattle and cows and sheep and goat, and I discovered those dungs too, in the settlement. But the shocking thing is that after the dam, there is a decrease in soil fertility because this fertile soil is behind the dam. Now we don’t have access to it, we banned it. But the second shock is that the industrialism of food increased the use of fossil fuel based fertilisers and these are close to zero in their nitrogen isotope. So when I see lower nitrogen in my modern food samples, I know, here’s evidence of lower soil fertility, and most likely the use of fossil fuel based fertilizers.

Dr.  Wendy Slusser  21:50

So, I have a couple of follow up questions on that because I’m not actually that familiar with the differences between monsoon rain quality versus the oxygen that’s in the H2O of the rain from California. Explain to me what that means?

Dr. Amr Shahat  22:09

That’s a great question too. Usually, most rivers in the world get their water from rain of the snow melt. So the water source is coming from a cold source, from snow melt. And the heavier isotope will have different oxygen isotope, oxygen 16. And oxygen 18 is mostly studied in water research. And oxygen 18 is very low in waters that come from snow melt. Like in California, Northern California, I think I measured it, the oxygen 18 was around minus 9 to minus 12. And in Vancouver,was close to minus 12, minus 14, because it’s also coming from snowmelt. But when the water flood comes to you from a monsoon rain, monsoon rain comes in hot and desiccating conditions. So in a very hot climate, the light isotope, oxygen 18, is like a small ball compared to a big ball. And the small ball dessicates faster in the air, and the heavier isotope, oxygen 18, rests in the water that comes down. So this is one of the reasons why the oxygen 18 in the Nile water is so high, and I thought that this is in modern time. But a colleague from Florida, Tosha Dupras, the Chair of Archaeology there, actually used that evidence of the high oxygen Nile water to differentiate between people growing up along the Nile and people who came from the Nile but went to exile in the oasis because they had leprosy, because in the oasis, they have water coming from closed wells. And they have way lower oxygen 18 in the water, again, like minus 12. And she found that the Egyptians have plus 2 oxygen 18 in the Nile water, so she said okay, I have the Egyptian population and I have people in the Oasis, and the people who came from the Nile and ended up in the Oasis, their teeth shows where they grew up drinking.

Dr.  Wendy Slusser  24:32

So it’s really more the difference of oxygen 18, high levels versus low levels is more significant just in terms of you understanding where people are coming from. Is there any significance in terms of health from that?

Dr. Amr Shahat  24:47

This is a question that I am still thinking about, but I did not experiment yet. There is an on going discussion in life sciences that the alkaline water, richer in 18 O is good for the membrane of the cells, our cell membrane is sensitive to the oxygen 18 level. So that’s why here in California, they make advertisement for alkaline water, etc. But I did not test this yet. I want to add that Nile, water is naturally alkaline. So the pH is over 7.8 sometimes, and sometimes 8.2, really high. We can brand Nile water here in California.

Dr.  Wendy Slusser  25:33

Why besides the oxygen 18? Why else is it so alkaline in the Nile?

Dr. Amr Shahat  25:38

This is probably again, because of the source of the water, coming from a monsoon rain. I’m still thinking of the reasons but it is helpful for me to write social history, because it’s easier for me to say where plants and food and people come from.

Dr.  Wendy Slusser  25:56

So this knowledge that you are really gleaning in such a fascinating and  transdisciplinary way, you mentioned the food now is low in nitrogen compared to in ancient times, and probably related to this, the dam and also the artificial fertilizing that we do. How do you think this relates to the same food that we’re eating now compared to then? What are you interpreting this as for our for our own current situation?

Dr. Amr Shahat  26:29

For our current situation, we were all tested by the quarantine situation. Suddenly, we have to be at home, no restaurants, and we have to cook ourselves. And here, the healthy choice is not in the hands of the restaurants, but in the hands of every individual in society. So my role was to summarize my research, in two-three sentences to the public. I volunteered in the Kindness Task Force group. And I was basically helping families who lost their spouses or dear people during the virus, and couldn’t even have funerals. So besides the emotional support, I was trying to give the summary of my research. If you at least increase your fiber intake, and if we take the recommendation of Zheng et al 2019 paper of having 40 grams of fiber- of course, it’s difficult for them to understand, but I tell them how I apply it. I said if you go to Trader Joe’s and buy a packet of dates, one piece of that is four grams of fiber. So if you have 10 a day, like five in your morning yogurt, or something on a fruit salad, and 5 in the evening as a snack, you have your 40g fiber intake, and you have a healthy snack. But I give examples for something meaningful to my culture. But of course for them, you may think of other plant species that are rich in fiber, and native here to California or America, in general. I just summarized them in simple words as much as possible.  And when sometimes they argue about the evidence- “how did you know, the relation between the gut microbiota in the past? And did you go into the stomach of an ancient Egyptian”, I say actually, luckily I do! I have the mummies, and sometimes if I don’t find the plant remains buried next to them in a pot, I go dig for them inside their stomach or between their teeth (they didn’t floss). All evidence from the mummies, physically showed fibers  in their bread. We could find in the intestines, fibers that did not get digested. So this tells us that the bread I discovered in Egyptian tombs, and rich in fiber, was not processed fast or not cleaned well because it will be buried in a tomb, as some archaeologists argued. Now, we actually find these fibers inside their stomach. They did not remove the chaff from the bread and we see association of the diversity of families in their gut microbiota, around 13,000 families of bacteria in their gut. How many families we have in our modern gut with our overconsumption of processed sugar and processed meat and fat? It’s around 5000 families, from 13,000 in the past to 5000. So see the dramatic decline of the gut microbiota diversity in our stomach because of our modern food habits.

Dr.  Wendy Slusser  29:44

So if you were to be an ancient Egyptian, how would you comment on our current diet?

Dr. Amr Shahat  29:53

It is really wonderful. I would say stick to your identity food. But also enjoy interactions with other people and their food culture by understanding them and understanding their food. And this is actually the title of my dissertation, “The Archaeologies of Diversity and Interaction in Ancient Egypt”. What inspired me for the diversity part is first, the original diversity. My mother came from the north, they had different wild fruits than the south, where my dad came from, and there was interaction between both but also there were new food species that came from Egypt’s social interaction with other regions. Queen Hatshepsut, launched long distance trade to bring incense trees, for example, to make a garden in front of her temple. And the text shows here, that the leaders from the Egyptian side met the leaders from the land of Ponte side, under the shrine of God Amman, and they shared food. So they got introduced to each other’s tradition and food. But at the same time, we found evidence of Egyptian wild fruits from Upper Egypt like this dome fruit and Persea nuts and Balanites dates. We found them  along the ports, all the way. So the upper Egyptians here traveling down to Africa, dropped the date pits that carry markers of their identity, showing that they were there and interacting with other people. Keeping your identity doesn’t mean you’re closed, you will still interact and engage and and even in the very close, intimate context, in the food offering in the tomb, people don’t just bring in their tombs random life histories, but they bring things that were meaningful to them. So they brought their identity food, they buried it with them. And they also buried the foods they were introduced to by other cultures. In this case, I had pomegranite and Juniper coming from the Mediterranean, and I had watermelon coming from tropical Africa, and frankincense, also coming from tropical Africa.  This was also useful for me during the quarantine, as I treated myself many times without going to the doctor by food. I brought my samples from the lab, and I started to eat some of the modern ones, not the ancient. So one time I got a gum infection, I knew that the tree species Hatshepsut brought from tropical Africa, one of their uses is having it as a gum, and it is healthy for your for your gum infection. And actually for your throat, the smell goes down in your throat, and it cleans your lungs. Of course, this is not completely tested in lab. But I’m building on some educated guesses from published research, better than none. I cannot go to my lab and test the efficiency right now. But at least I have some educated guesses. And what inspired me of this, my mom before she passed away, when I grew up as a child, she avoided me from eating like this gum full of sugar, processed sugar. And she had me eat this traditional myrrh and mastic gums that were actually not native to Egypt, but one of the most common imports from tropical Africa or south east Africa, that Hatshepsut depicted on her wall and made propaganda about interacting with these people.

Dr.  Wendy Slusser  33:41

Wow, I have a feeling that you’re going to be going in so many different directions in your next phase of your research and your life. And I can see you even being a consultant on the next version of Game of Thrones! You’re full of data and facts and information that they didn’t even get into. So before we wrap up, I’d love you to tell us what is your dream for the future? And where do you hope your work and research will go and build on?

Dr. Amr Shahat  34:23

You ask a lot of wonderful questions. And before I actually say this, you and Dr. May, and I should also credit Dr. William McCarthy, were among the most inspiring people I have ever met, not only in the Fielding School of Public Health, but in UCLA, or actually in my life. Because it is the synergy between the three of you that opened this whole new way to think of my data completely differently. I was just digging, bringing these plants, identifying them botanically, and I say what their significance is for history. I never thought that I would even say anything helpful for food scientists, for cancer researchers, like Dr. William McCarthy was in the Center for Cancer Prevention. So and when my mom actually passed away from cancer, and I started to connect, my dream was to do anything helpful with archaeology, and you made me feel I found a home for my ideas. Now, I can bring the past to serve the present in a way that heals my heart for the loss of my mother to cancer. And I knew the underpinning causes because it was a cancer related to obesity and diabetes. So here in a kind of divine timing, all the phases I experienced in my life growing up in Egypt and coming to America, from  Memphis, Tennessee, and then to UCLA. I felt everything coming in a full circle that makes sense now.

Dr.  Wendy Slusser  36:05

Wow, I’m looking forward to seeing and hearing the next steps. And thank you so much for your kind words, and most of all, your incredible passion and ability to communicate complicated subjects in a way that is digestible, and relatable. And I hope that maybe we’ll be able to find that the nutrients in the soil along the Nile and other places can be rejuvenated to go back to a healthier time so we can grow healthier food. Because I think a lot of people don’t realize that even though you might be growing wheat or other foods in and producing it doesn’t necessarily mean it’s as nutritious as it could be or was in the past. That’s problem for us for our current food system. And we need to recover from that. And it’s possible regenerative practices for soil have been shown to be effective. It just takes patience and time.

Dr. Amr Shahat  37:08

That is true, and your class was actually an eye opener to this.

Dr.  Wendy Slusser  37:12

Fantastic. Well, thank you again, and we’re going to post some of your research on the web for all the listeners that want to learn more, and follow your career. Thank you.

Dr. Amr Shahat  37:27

Thank you so much.

Dr.  Wendy Slusser  37:31

Thank you for tuning into UCLA Live Well. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA live well on Apple podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyUCLA. If you think you know the perfect person for us to interview next, tweet your idea to us, please. Have a wonderful rest of your day, and we hope you join us for our next episode as we explore new perspectives on health and well being.

#21: The Circuitry Behind our Social World

Transcript

Dr.  Wendy Slusser  00:03

Today we’re excited to share the second part of an episode recorded before the COVID-19 pandemic with UCLA social well-being expert, Dr. Ted Robles. In last week’s episode, Ted defined and discussed the importance of social well-being as a social determinant of health. Join us, as Ted and I continue our conversation, where we will be exploring how social well-being affects the biological processes behind stress, how social media can hijack our reward systems, and much more. In your research, in your lab, you talk about two sets of biological processes. And I’d love you to describe what you mean by allostatic processes and restorative.

Dr. Ted Robles  00:50

Yeah, well allostatic is a term that – I believe he was a physiologist by trade – Peter Sterling coined. I want to say in the late 1980s, and then one of the big researchers in our field who study stress, Bruce McEwen, really took that up and coined the term allostatic load. Now, what allostasis basically is – is when we are faced with challenges in life, we have to change; and we have to change physiologically in order to deal with those changes. And so this – the sort of classic thing would be any kind of physiological changes that occur because you’re being chased by a scary person or animal; or because you’re facing an impending – you have to give a lecture to your class, and you’re sort of nervous to talk in front of people. So these are all kind of changes in our environment. We have to adapt to them in some way, whether through increasing the amount of energy that our brain and our body needs to manage those challenges to prepare for threats like getting wounded, to increase the amount of blood oxygenation, because I need to use blood oxygen in order to fight or flee. So all of those changes that we go through when we face some change in the environment, those are what others and myself term allostatic processes: maintaining survival through change. But of course, usually those things end. So you know, it’s not that I’m running from a lion that’s chasing me forever. At some point, the lion goes away. And so now I’m left back to recover and restore stored energy, or start to store energy again – I should say – repair any wounds that I’ve encumbered as a result of fighting off the lion. And so restorative processes have to do with the things that are involved in repairing and bringing our systems back to before we faced whatever challenge it was. A lot of repair-related things from the level of wound healing to DNA repair would be included; mechanisms involved in energy storage, so instead of breaking down glycogen to make glucose, storing it back up again, and storing back up the, you know, energy in the form of lipids. Those are all restorative processes. And so sometimes you’re going to need to engage in allostatic processes to cope with change, and then there’s going to be a lot of other times where you’re just going to need to prepare and restore back. And that’s what the restorative processes are.

Dr.  Wendy Slusser  03:19

So how will your body respond to a constant threat? Can you actually –

Dr. Ted Robles  03:27

That is a great question.

Dr.  Wendy Slusser  03:28

– deal and actually trigger restorative processes if you recognize this and can like through meditation…? I don’t know what it would be, but –

Dr. Ted Robles  03:37

Yeah. And that sort of – so I think about something like noise pollution, for example. If you live in an area where, you know, you’re constantly being exposed to pretty high levels of noise, all the time, and it never remits, right? Can one truly ever have a period where, you know, your systems are at a point where you could start to reengage those processes again? And probably the answer is, to some degree, no. So when I think about how factors could disrupt these restorative processes, I usually like to think of like a home remodeling analogy and how home remodeling can go wrong. So one is that –

Dr.  Wendy Slusser  04:13

Doesn’t it always go wrong? That’s why I’ve never done that.

Dr. Ted Robles  04:17

Right, right. So one possibility is that the materials that you use, they just don’t work as well, right? So, like you get some drywall that’s defective for some reason, or maybe some screws wear too much, or something like that. And so likewise, some of the materials that we might be using to, or the processes that we use to repair ourselves, might not go as well as we would like. So DNA repair mechanisms, for example. So you can imagine that under conditions of constant exposure to, you know, you name the problematic thing, that while we have mechanisms to repair DNA, they may not work as well, all the time. And so you may not get repair as reliable as you would like, and then you have cells running around that have some slight, you know, slight mutations in the code that they use when they’re doing their regular activities. And then, you know –

Dr.  Wendy Slusser  05:11

And what happens then?

Dr. Ted Robles  05:13

And then later on – and then maybe at worst, you have cells that accumulate enough mutations where they develop into, say, cancer cells or something like that. That’s kind of, you know, the accumulation of multiple mutations. But certainly, all of that kind of starts with faulty DNA repair.

Dr.  Wendy Slusser  05:29

And that’s what you hear a lot more people say, “Oh, this person was in a lot of stress, and they developed cancer.”

Dr. Ted Robles  05:36

Right, right. It’s got to be one – it has to be one, among many things that go wrong.

Dr.  Wendy Slusser  05:40

Right.

Dr. Ted Robles  05:40

But certainly, it could be one things that go wrong. Another possibility is that the repair just takes – now this is a very common, you know, kind of home remodeling complaint, which is that the repair just takes longer than I would have wanted to. So I think that’s where a lot of the delayed wound healing becomes really – it is relevant. So in wound healing, if your innate immune system is busy cleaning up all the bacteria that have invaded your wound, and they’re not cleaning it up in a timely manner, that wound is gonna take longer to heal. And so, again, this is where this repair process is supposed to happen. Ideally, we’d like it to happen within a certain timeframe, but it takes longer. And so if you’re exposed to chronic conditions, you could imagine things being prolonged. And then the third thing is that sort of normal processes that you would use to kind of do things, like store energy, that they go awry. So my favorite example of this is disruptions to sleep and what they do to insulin resistance. So you could imagine that we evolved a mechanism where, sure, after a short night of sleep in our ancestral environment, it was really important for us to maintain high circulating levels of glucose, because maybe that was adaptive. You know, the reason I wasn’t sleeping was because, you know, some kind of problem was happening in my environment. Maybe there was an invading tribe, or something like that, and we had to move quickly to get to another place to safety. And because I’m not sure I’m safe yet, it would be helpful for me to have high levels of circulating blood glucose. Well nowadays, why don’t we get enough sleep? It’s because I stayed up late looking at my phone, and you know, doing some other things; it wasn’t because I was really concerned about my well-being, but my body doesn’t – you know, like about my survival – but my body doesn’t know that. And so my body still reacts to sleep deprivation with insulin resistance. And if you accrue that over time, it’s a normal thing, to some degree, and it has a purpose. But then you end up running into problems later. And then there’s other interesting things related to how sleep deprivation might impact your appetite. And so again, if I am in an environment where I’m sleep deprived, perhaps it’s because I’m in an uncertain environment, so I need to have energy. But in the current environment, where food is readily available, my increased appetite might actually work against me. And so those are some examples of how, again, the chronic exposure to stressful experiences can short-circuit, or maybe kind of hijack, some of these restorative processes that ultimately hurts our health.

Dr.  Wendy Slusser  08:20

So in a circumstance, for instance, of somebody who is living in a world where there – there’s bias against them, how does that play into it?

Dr. Ted Robles  08:29

Well again, so just like feeling unsafe, you could imagine the same kind of thing where if I – so this is another important piece about social relationships and health and related to the smoking thing. You know, the reason why smoking is pernicious and problematic is because it happens every day. And so, you can imagine the same thing happening if I’m in an environment where I feel bias, both explicitly, but also where I – some of this may be internalized, where I don’t view myself favorably, because of what society has taught me. You could imagine those same experiences on a day-to-day basis where I feel under threat. I’m worried that I’m going to do something that then shows people that “yep, you know, people like me are not smart, or they are not capable,” that kind of thing. And every day of living in that manner activates my sympathetic nervous system, which then activates, you know, my immune system to be more vigilant, and that’s my daily experience, and then that might have long-term cardiometabolic costs.

Dr.  Wendy Slusser  09:41

So if we dissect your definition of social well-being, and I want to make sure I don’t forget some of the important aspects that you shared, which I thought were so very insightful for me is the high quality relationships that allows you to be able to feel like you can depend on someone; that you can turn to them for help; that you can get advice from them; and then also that you can do the same back. Maybe not to the same person, but maybe to another person. And I always sort of equate this to, if I was on a deserted island, who would I want to end up with?

Dr. Ted Robles  10:25

Right, right.

Dr.  Wendy Slusser  10:26

And I’m just wondering, there’s also the definition that you have common interests or you have – so is there any data out there that talks about how to promote or reduce bias?

Dr. Ted Robles  10:42

Sure. Right, right.

Dr.  Wendy Slusser  10:43

And how – would that be sort of just relying on what you’ve just described as the definition is building those kinds – so what is it?

Dr. Ted Robles  10:52

I’d like to, again, if you think about – I’m using the lens of our kind of the study of social relationships and this idea of being understood, for example, and valued –

Dr.  Wendy Slusser  11:06

Yeah. Understood. That’s so important, right?

Dr. Ted Robles  11:08

Yeah. And when you imagine that you are working together towards a common goal, you know, that brings with it some –

Dr.  Wendy Slusser  11:15

Well common values, right?

Dr. Ted Robles  11:16

Yeah, yeah. Right.

Dr.  Wendy Slusser  11:17

If you’re working on the same thing.

Dr. Ted Robles  11:18

Exactly. So I know that this person who’s with me knows that I think “x” is important, that I think social justice is important, or the environment, or that I think education is really important; and I know that person knows that. And because we work together on these common things, I know that person values my contribution, for example. And maybe, there are times when, in the process of working on these things together, that I need help from this person from time to time, and I know that that person can be there for me when I need it. And so I think there’s definitely something to be said, for working together on common goals and objectives, and cooperating around those things. That is sort of critical to fostering connection and critical to fostering feeling like you’re, you know, included, and combating, you know, many of the sort of bias problems that we’ve been talking about. And again, if you think about it, small, we evolved in small groups of people, and where we were doing nothing, but trying to solve common problems together, like, what are we going to eat? Are we going to stay safe? You know, what is our shelter gonna look like? What How can we keep everybody is sort of, you know, alive as possible. And so we were, you know, that I’m not the one who’s made this argument, there’s been plenty of others to really talk about this. But, you know, the idea that we evolved as social species to solve problems together, I think that’s something that in our kind of attempt to be self reliant, ends up being lost, in some ways. Right, and also our attempt to include others. Again, it’s not enough to have everybody around the table, we all have to like work on something together around this table.

Dr.  Wendy Slusser  13:10

Yeah. Well, the cultural part about being self reliant, I mean, it’s not completely adopted by everyone in the United States. I mean, we’ve got right many cultures that are much more collective.

Dr. Ted Robles  13:21

Yeah, absolutely. Right. Right.

Dr.  Wendy Slusser  13:23

Yeah. So what are you seeing the difference – what’s the differences between a collective versus individualistic?

Dr. Ted Robles  13:31

So some of it has to do with how you see yourself relative to other people. And so there are certainly some cultures where I’m not defined by standing apart from how I’m different from everybody, but I’m also defined by who I’m with, essentially, so that I am part and parcel of, you know, a bigger, other group of people. And how I function in that group – well, it’s really not about how I function in that group; it’s how we sort of function together. That’s a lot of how I think about that, is how – and that’s work from people like Hazel Marcus, for example. And so yeah, you’re right. And that idea that people are separate from others, so independent – you see that in some groups, but there are other groups, for instance – and I know she’s done work to this effect – where more blue collar, sort of lower income, people in society who are lower income, for example, they do tend to see themselves as sort of interwoven with another.

Dr.  Wendy Slusser  14:28

I didn’t realize there was a socio-ecoomic aspect.

Dr. Ted Robles  14:29

Yeah, there’s an interesting socio-economic aspect.

Dr.  Wendy Slusser  14:33

My observation, having taken care of predominantly Mexican-American families, is in Mexican culture a collective culture is much more dominant and very much family-focused, and not necessarily just the nuclear family either.

Dr. Ted Robles  14:53

Right. And that’s totally, absolutely true. Yeah, exactly. And then what I know less of and will be interesting to think about is, if you looked at that across the entire spectrum within that culture, in terms of socio-economic status, for example.

Dr.  Wendy Slusser  15:05

Yes. I don’t know that, yeah.

Dr. Ted Robles  15:06

But at least – I know she’s studied, at least in the States, you do see -and again, some of this is also because who tends to be more lower income in the United States because of history, and discrimination, and prejudice? That tends to be underrepresented minority groups, who also tend to have much more collectivistic beliefs, as well.

Dr.  Wendy Slusser  15:28

From the cultural aspect. That’s more room for research, right? Every time you have a conversation with a researcher, you always come up with more questions, right? That’s the great thing about research, though – lots of questions, lots of answers. And so, you know, speaking of sort of the new, sort of where we’re heading. You know, the smartphone, or some people call the dumb phones. Gosh, I don’t use that word. But, you know, the not-so-smartphone. But what is it – you know, where does this land in terms of social well-being?

Dr. Ted Robles  16:02

Right, right. I mean, certainly technology – it’s certainly a tool – and just like any other technology or tool, it can be used in both the right and wrong ways. And I think one of the challenges we face – I’m thinking a lot about some writing that some of my colleagues have done. So, one of my co-authors on the American Psychologist paper where we were looking at social connections and health, he has a really nice piece coming out soon on smartphones, and technology, and relationships. And the way they describe it is kind of like – I guess a good analogy would be something like sugar. So sugar – processed, refined sugar – is a technology; it’s a tool that we use to make food. It’s certainly something that would not have developed, were it not for, you know, the industrial process, right? And it’s something that, for better or for worse, we can easily misuse. And the way we misuse it is, we hijack our existing circuitry – our neural circuitry, our physiology. Sugar hijacks that, right? It’s highly palatable, we like it, we have systems evolved to really want it, because we didn’t get it very much when we were evolving.

Dr.  Wendy Slusser  17:15

And also masks the flavor of salt?

Dr. Ted Robles  17:17

Yeah, right. Exactly. So it has all these things that it does, that we want. And we have created a world where we are – we’re sort of hijacking and taking advantage of that in some ways. You can say that a food company, for instance, is taking advantage of that and making a high density, you know, processed food and testing out what flavors work, etc. So the reason I say sugar is because, if we think about, you know – I alluded earlier to social relationships and social well-being as involving circuitry that includes pain, and hunger, and reward. And we have circuitry that is sort of built for social rewards. I mean, there’s something highly rewarding about having a wonderful connection with somebody, and being able to have a good conversation, feel understood, valued, and cared for, etc. And what the smartphone has done is it is, kind of like sugar, it’s hijacking that circuitry in some ways. On one hand, you can hijack that circuitry for good. So if you’ve got someone who – so using sugar as analogy – like if I’ve got a child who’s really having trouble with gaining weight, and in order to be healthy, like, I can give them and ensure something, you know, that has a lot of sugar to help them get the nutrients they need. Likewise, you know, if I have someone who’s really socially isolated, like the smartphone is a really great way to kind of get them connected in some ways. But I think what people are finding is that the hijacking has much more cost right now, particularly when there’s cost to our sort of offline relationships. And if a smartphone can help us connect better with the people that we’re with, together, like offline, that’s good; but when it disrupts those offline relationships, that’s where it’s a problem. And it’s really good at doing that, because it pushes all our buttons related to social connection, right? It makes it really easy for me to see what’s happening with my friend in Pittsburgh that I haven’t seen in a long time. “And boy, look at those pictures, they’re really interesting.” Or let me watch this video of my friend jumping into a pool. And that, unfortunately, can then take me out of my offline relationship – the person I’m sitting with right now – and can make me less responsive to them. And their whole argument is that technology is a problem when you become less responsive to the people that you’re actually with physically, and that that’s the problem that we have to reckon with. It’s still good in terms of – it can be good in terms of deepening those relationships, but you have a kind of unbalance. There may be more of a problem right now than the benefits in terms of deepening. And then if you have wholesale replacement of offline relationships, that’s even worse. Right? So now my only social connections are online, and that’s problematic.

Dr.  Wendy Slusser  20:08

And that’s what people are concerned about for college students; which it’s nice they’re keeping up with their high school friends, but they then don’t get engaged with their immediate surroundings.

Dr. Ted Robles  20:18

Right, right. And in terms of developing skills and developing new in-person relationships – that’s what our brains evolved for. And that’s, to some degree, what we probably want ultimately, as a species.

Dr.  Wendy Slusser  20:33

Although it can be uncomfortable, to create new friendships.

Dr. Ted Robles  20:36

Exactly. Yeah. But again, we struggle through that, right, and then we benefit through that struggle.

Dr.  Wendy Slusser  20:43

And why do we benefit through that struggle? Why do we –

Dr. Ted Robles  20:46

You learn how to become more adaptable to other people in your environment. You know, you learn how to – you can attune to people better, in some ways.

Dr.  Wendy Slusser  20:55

Which means you learn cues?

Dr. Ted Robles  20:56

Exactly. You learn cues. You learn what works, what doesn’t work, you know, those kinds of things. But when, you know, likewise, I suppose – I’m trying to think of a good food analogy that involves sugar. But, you know, sugar can, to some degree, be a little bit of a shortcut to flavor, so to speak. I guess maybe one way to think about it would be like you’re trying to – maybe you decide not to try making the really awesome-tasting mole because it’s just too complicated, and instead, you just, you know, eat the candy bar; when maybe, over the long-term, it might be more beneficial to learn how to make the mole or something like that.

Dr.  Wendy Slusser  21:31

Like I used to make carrot cake, and then I decided I just like the frosting – I just made the frosting.

Dr. Ted Robles  21:39

Yeah, yeah. So they argue that this – they use this term called technoference – that the big problem is when the phone takes us out of our ability to be responsive to others.

Dr.  Wendy Slusser  21:53

Where it concerns me, and I know it’s a transitional period, but I feel that that’s what’s going on with the medical record – the electronic medical record.

Dr. Ted Robles  22:02

Yeah, well, that’s interesting.

Dr.  Wendy Slusser  22:04

As I practice with the electronic medical record, I see how people and physicians are not able to connect. And there is data out there, now that’s reporting that physician burnout since the electronic medical record has come around. There’s a huge burnout, and I think that’s probably because physicians, I mean, the hypothesis is that they’re missing that social connection.

Dr. Ted Robles  22:33

Right, right. Exactly.

Dr.  Wendy Slusser  22:34

Yeah. I’m sure the patients are feeling the same way, but from a physician’s point of view it’s really tough.

Dr. Ted Robles  22:40

And being a developing physician, you know, someone who’s learning – so like a first or second year resident – you’re not developing the cues to things to attend to, the skills.

Dr.  Wendy Slusser  22:49

That’s a tough one, especially in my field, pediatrics. Because it’s very much – you always had to tell the residents, when I was training them, to trust your instincts. You walk in, and some kid with an 104 fever is going to ride through, because it’s a virus; and the next one could be at death’s door.

Dr. Ted Robles  23:10

Right, right. But your got to –

Dr.  Wendy Slusser  23:11

I know it, and you know it, because you get good at it.

Dr. Ted Robles  23:14

Yeah. Yeah, exactly. Well, and the sort of depressing news about that is that, in terms of the technology piece, is that – there haven’t been as many studies of this yet, but from what I was reading, and I mean, it sort of jives with my experience, too, is – when we’re on our phones, we’re not really, or when we’re typing on the electronic medical record, we’re not really aware of how not responsive we’re being, right? Because, you know, I’m doing something really important, right? I don’t realize that I’m not being as responsive as I should be. And you see that in surveys. So, I think it’s something like a pretty low percentage of individuals describe that they are not attending to people when they’re on their phones. You know, it’s kind of the same thing – I’m trying to think of an analogy where, you know, we often don’t think we’re doing something when, in fact, you know, that’s harmful, when in fact we are. I feel like driving, or something like that would be good example.

Dr.  Wendy Slusser  24:10

Very good example. Because people think they can text at stop signs, or things like that.

Dr. Ted Robles  24:18

Right, right. Yeah, yeah.

Dr.  Wendy Slusser  24:22

My daughter taught me way back before electronic medical records that I couldn’t be on my computer and doctor at the same time. And she still catches me sometimes when I’m on the phone with her, and she goes, “What are you doing? Are you doing something else?” She can totally pick it up. So I’m busted and I – thankfully, she’s very acutely aware of the circumstances. You know, I’d love to read that paper you just described to me. Yeah, I think this information’s cool. We’ll have to have it – we’ll have it online, too, so people can read it.

Dr. Ted Robles  24:58

Yeah, it’s freely available, too, through this service, or this site called PsyArXiv, so preprint – it’s a preprint.

Dr.  Wendy Slusser  25:06

Fantastic. And getting to papers, you’re – one of your recent papers, you talk about the relationship between between culture and social support across different communication contacts – face-to-face and text messaging. Can you talk about that?

Dr. Ted Robles  25:22

Yeah, sure. So this is a project by a developmental psychology student who – so she had a long-standing interest in culture and communication, and what forms of communication might be more beneficial to others. So one of the really interesting findings in work on culture and social support is, you know, the idea of asking for help, depending on what culture you’re in, can be very threatening – it’s just like something you don’t do. So if you tend to be in an interdependent culture, so Asian cultures tend to be kind of the prototype here, you know, asking for help is incredibly threatening. And some really interesting work actually done by a former colleague here at UCLA, Shelly Taylor, finding that if you were – so participants who were randomly assigned to either write a letter asking for help, versus just describe the people in your social network, versus don’t do anything at all. Those folks did that – so they either wrote a letter asking for help, they either wrote a letter describing their social network, or they didn’t do anything at all. They were then asked to give a speech and do some mental arithmetic, a typical laboratory stressor.

Dr.  Wendy Slusser  26:29

Really? Arithmetic? That relaxes me.

Dr. Ted Robles  26:33

Yeah. “So take that number 1792 and subtract 13.” So in this study, there was a group that was either Asian or Asian American, and there were also European Americans, as well. And again, they were randomly assigned to one of these three groups. And the really interesting thing was, for the Asian/Asian American group, writing a letter asking someone for help, those individuals showed physiological responses to the stressor that looked just the same as people who didn’t have to write anything at all; but the European Americans, they showed less of a physiological response to the stressor. And then for the European Americans, asking for help was related to sort of lower physiological responses; and I don’t remember what happened to the European Americans who were just thinking about their social group. So all of this, and there’s some other data to suggest that, again, for certain groups, asking for help, it’s sort of culturally inappropriate and so potentially more stressful. So what about instant messaging? Because it’s not quite the same. So part of this might be just the face-to-face thing – meaning making a request for help.

Dr.  Wendy Slusser  27:38

Even a letter is considered face-to-face?

Dr. Ted Robles  27:40

So, I guess the letter was less face-to-face, certainly; but I think probably the letter was less superficial than the instant messaging. So that’s where the instant messaging becomes interesting, because: 1) you’re not face-to-face; and then 2), I mean, I think there’s something about kind of the act of writing the letter –  It writes more formal – exactly. That was problematic. So what she was really interested in testing was whether face-to-face versus instant messaging versus no support at all, before you do this speech and math stressor, which of these would sort of buffer psychological, and biological, or physiological responses to the stressor? And would you see more benefits for one group versus another? Now what we ended up – I think because of our recruitment – what we looked at was actually, instead, independent versus interdependent self construals, which is exactly what we’re talking about earlier with collectivism versus individualism. So if you see yourself as apart from others – versus to-the-what degree you see yourself as connected with others – and the interesting thing there was that we saw that face-to-face and instant messaging, you saw sort of similar benefits in terms of reducing anxiety, so that was sort of good to know. And then we also saw that for people who were more independent, actually – like who sort of valued seeing themselves as apart from others – that’s where the, I believe, I want to say the face-to-face support was kind of most beneficial in buffering their stress responses. And we didn’t see anything for being more interdependent, but some of that might have been related to the sample that we had. And I’m trying to remember what happened for the Asian/Asian American group, I think their face-to-face and instant messaging ended up looking somewhat similar. So all of this suggesting that, again, for some groups, some types of support might be and requesting support – some modalities may be more helpful than others, and maybe taking some of the psychological distance might be more helpful on the instant messaging sites. So there’s an example of where this tool could potentially have benefits depending on what social group that you’re in.

Dr.  Wendy Slusser  27:59

More formal. And so moving to other forms of communication, like social media, what do you think might –

Dr. Ted Robles  29:56

Yeah, so the challenge with that – I think that’s a little bit different than sort of an instant messaging platform, right? Because now, you know, that’s more bi-directional.  Whereas social media, I think the challenge is that you have more of this – I guess what I’ll call the sugar effect – which is like, you can always come back to it, it’s something that’s persistent, and so it can kind of take you out of your immediate experience. Whereas instant messaging, like it’s still a kind of a very intentional experience.

Dr.  Wendy Slusser  30:28

Right, kind of conversation.

Dr. Ted Robles  30:30

Yeah. And so that’s kind of one of the, I guess, for lack of a better term, kind of dependent or addictive aspects of social media. So Peter, he developed a measure of digital support. And one of the things that is different from social media compared to all other forms of support, is what we’re terming response support – so that’s “likes,” basically. And so I say, you know, I write something, I post something, and I get a bunch of likes. And I think the issue there also is that hijacks, to some degree, our kind of circuits that evolved for processing reward and social reward. There’s some data from one of our colleagues in developmental psychology showing that in areas of the brain that sort of respond to things like pictures of food, and money, and that kind of thing; you see greater responses, when you see a picture that’s got more likes on it, compared to ones that don’t. And so clearly, that phenomenon of likes – what we’re calling response support – takes advantage of the circuitry of valuing things that are highly rewarding, kind of like sugar might, for better or for worse.

Dr.  Wendy Slusser  31:43

And so, explain about social media – how does that become addicting?

Dr. Ted Robles  31:48

I think because we – it’s so easily accessible; it’s easy to get a quick hit, so to speak, of social reward, right?

Dr.  Wendy Slusser  31:59

And what’s the social reward?

Dr. Ted Robles  32:00

So I got a bunch of likes on a picture I just posted, for instance, of something I ate, or of me doing something. And so then we kind of keep coming back to that. And again, they’re sort of empty calories, in a sense. Like, I feel like people like or validate me to some degree, but it’s not the same as a one-on-one or, you know, an experience with a group of actual, physical people.

Dr.  Wendy Slusser  32:24

Right. You might not want to have them all on your desert island.

Dr. Ted Robles  32:27

Right. Exactly.

Dr.  Wendy Slusser  32:29

Or that great New Yorker cartoon that had the one person in the pews of a person’s funeral, and they they said, “Oh, he had 2,000 Facebook friends.”

Dr. Ted Robles  32:38

Yeah. Right, right, right. Exactly.

Dr.  Wendy Slusser  32:40

But only one person shows up at your funeral.

Dr. Ted Robles  32:42

Yeah, exactly. And again, I think sort of viewing – you know, it’s not like they’re empty calories all the time. But when someone’s just posting things, just to get likes – I mean, I’ve seen examples of this in the movies, you know, these sort of extreme examples – you can see where it becomes empty-calorie-like, right?

Dr.  Wendy Slusser  32:59

Yeah, I get it. Well, it’s been an incredible conversation, so I’d like to just wrap it up with something that I’m sure everyone would love to hear from you, which is – what would you consider to be the most important steps that people can take to improve their own social relationships?

Dr. Ted Robles  33:18

Yeah. Well, I’ll go back to what I sort of started with, which I think is always good advice, which is – and I’m sort of stealing this a little bit from some of my colleagues in psychology, because they kind of came up with this first – it’s Tom Bradbury, and Ben Carney. They study couples, and they would hold workshops for couples, people who are interested in relationships. And what I like about this advice is that it’s consistent with what we study in relationship science, and it’s very simple; which is just to find ways to communicate every day to the people that are around you, that you understand, and that you value, and that you care about them, and that you communicate that in ways that they can see. As opposed to – I mean, it’s great to help people out, kind of in ways they don’t notice; but if you kind of make yourself seen and let them know that you get them, that you care about what they do, or that they’re in the world, and that you value them as a person, that’s something that – you know, if we think about not smoking every day is important – this would be something if you can do that every day would help really foster these kinds of high quality connection.

Dr.  Wendy Slusser  34:21

And you receive something from that by giving.

Dr. Ted Robles  34:26

Exactly. Right, right, right.

Dr.  Wendy Slusser  34:28

There was a really great article that – is it Steve Lopez from LA Times? He was interviewing this woman in her 90s, and she has on her business card: “too blessed to be stressed.” And having that attitude – her nickname was Happy.

Dr. Ted Robles  34:47

Yeah. Right, right. Well if you think about resilience, right? You know, part of why she can’t be stressed is because she is too blessed. She has built up this resource of people and that kind of thing, and it can help you withstand the sort of slings and arrows of everyday life.

Dr.  Wendy Slusser  35:04

That’s right. And apparently, up until recently, she was driving other people to church because they couldn’t make it with her – they couldn’t drive anywhere but she was there pooling away at 90 years old. Yeah, anyway – you know, Ted, it’s just remarkable the work you’re doing. And I just find, each time I talk to you, more pearls of wisdom and also things I can just apply to my own daily life so really appreciate –

Dr. Ted Robles  35:34

Well, the feeling is mutual, as well. I always learn more from, and I sort of get more inspiration from interacting with you, as well, so appreciate it.

Dr.  Wendy Slusser  35:42

Oh, thank you, Ted. Thanks for everything you do here at UCLA.

Dr. Ted Robles  35:45

Well, thank you for everything you do.

Dr.  Wendy Slusser  35:50

Thank you for tuning into LiveWell, today. Today’s podcast was brought to you by UCLA’s Semel Healthy Campus Initiative Center. To learn more about Ted’s research, please visit our website @healthy.ucla.edu/livewellpodcast. To stay up to date with our latest podcasts, make sure to follow our Twitter and Instagram @livewell_ucla.

#6: Managing Stress and Anxiety

Transcript

Dr.  Wendy Slusser  00:03

Today I’ll be chatting with UCLA’s Chief of Medical Psychology, Dr. Bob Builder, and Executive Director of UCLA Counseling and Psychological Services, Dr. Nicole Green, about how to take care of our emotional health during these uncertain times. As the co- leaders of the Semel Healthy Campus Initiative MindWell Pod, Nicole and Bob will also share actionable steps and available resources for all of us to help manage stress and anxiety during COVID-19. Nicole Green – Dr. Nicole Green and Dr. Bob Builder, welcome to our podcast today. We’re so grateful you’re here taking time out of your busy days, dealing with COVID-19 and the repercussions on emotional well-being. I’d really like to know, first of all, from your professional viewpoints and standpoints – what are you seeing?

Dr. Bob Bilder  00:57

First, thanks for having us here, Wendy. It’s really great to be able to talk to you today. I can speak about what’s happening down campus at the health system a bit, where we have quite a lot going on throughout the Ronald Reagan University Medical Center in the emergency department, and then, of course, in our Resnick Neuropsychiatric Hospital – we’re coping with a lot of very serious challenges, including patients coming on with COVID-19 infections, our staff having to deal with whether or not patients have COVID-19 infections and also trying to navigate the rest of their lives at the same time. So that’s really challenging, and our health care providers, many in psychiatry and psychology, are not all used to coping with these kinds of medical illnesses, and very few people are. So it’s created a lot of unique challenges for the clinical environment and for the training environments that we all work in, and it’s been really remarkable how people have risen to the occasion and have been unbelievably dedicated and innovative in coming up with solutions to dealing with these challenges.

Dr.  Wendy Slusser  02:09

So what would you say, Bob, that you’ve seen has been the most successful approaches to managing the stresses that these individuals might be undergoing?

Dr. Bob Bilder  02:19

Yeah, I think one of the key things that has been helpful is for people to try to find a sense of community, despite all the isolation that they’re experiencing, because many of our workforce are trying to do what they can from home – they’re doing telehealth – but these workers, like many other people, many of our students, staff, faculty are all also working from home. And so coming up with ways to try to bridge and build in social interactions in the midst of all this disconnected workplace activity is one of the challenges. So you know, try to leverage our technologies, the same way we are for our teleconferencing; and to have zoom dinners and other gatherings is not exactly the same as the high bandwidth person-to-person communication, but we think that it’s particularly important at times like this.

Dr.  Wendy Slusser  03:12

And, Nicole, what are you finding helpful?

Dr. Nicole Green  03:14

Yes. Again, thank you, Wendy, for having me. And we’re predominantly working with the students, obviously. And two interesting things – I don’t know that we’re fully seeing the impact quite yet – but I’ll say last week was finals week of winter quarter, and we saw a significant amount of students not being able to come in or pursue treatment. But this week, which is spring break, our numbers are not that different than last year’s spring breaks, so what it’s telling me is that a number of students who are engaged in treatment, or trying to continue care, are needing care, are initiating care even with all the transition. So I think it’s really a sign of things to come. And I’m aware, just from campus meetings, how intricate and vast and depthful these changes are going to be. In terms of student housing, I know a number of students are trying to get out of leases, because they’re trying to go home; I know that many students are canceling housing contracts, are trying to determine whether or not they’re going to enroll in the fall; I know that they’re still trying to think about ways to honor the different communities around commencement; I know that they’re still trying to have student government elections. So so much of the campus is in so much flux, and given what we’re seeing in terms of students trying to initiate treatment this week, I think it’s only the beginning of sort of the distress that’s probably going to come once people settle down and have more of a routine.

Dr.  Wendy Slusser  04:43

Thank you, Nicole, and thank you, Bob and Nicole, for all that you’re doing to help support people during these transitions. I’m hearing two pieces of advice that you both so well communicated in our Bruin Post – one is social distancing does not mean social isolation; and that was where I think Dr. Builder really worked on describing how you can communicate and build community, even if it means virtual. And what I’m hearing Nicole say is, not only are people willing to reach out to others and also to their therapists, but also that a sense of normalcy in the sense of getting some routines in place for this next quarter for our student bodies, in particular, will be critical for people to have a sense of community, as well. What else would you add to that, Bob or Nicole?

Dr. Nicole Green  05:38

I think I’ll just add – I think there is a balance between, because the students will be online quite a bit because of the classes and then studying online, I will say there is a tension between trying to do as much as we can virtually, but also recognizing the need – there are also so much other data about screentime and not moving, and how important it is to take breaks, to move, to get exercise where you can, and obviously being very safe about it – but that it’s really important to also take breaks and move your body and drink water and take care of all those things; because I think right now, everybody’s trying so hard to get everything moving on a virtual platform. We just want to be mindful of everything in moderation.

Dr. Bob Bilder  06:25

Yeah. And I think that just to add to what Nicole was saying, especially talking about being mindful, I think that building in some of the tools that are available, for example, through the Mindful Awareness Research Center. They’ve been having a virtual retreat over the last few days, and I think that there are a lot of tools now available online that are well-worth seeking out. And so, I know we’re all being deluged with messages, but we’re gonna try to compile some information and put that up on the HCI website. That’ll include some links to different kinds of tools you might be able to seek out and find a way to practice mindfulness on a daily basis, in addition to the other, you know, aspects of making sure you stay physically active and eating well, etc, all the aspects of living well.

Dr. Nicole Green  07:10

And I know that we are thinking with HCI, you know, recipes that you can do. I know RISE will be offering virtual and livestream yoga and meditation and mindfulness, as well, for students and staff and faculty.

Dr.  Wendy Slusser  07:23

Speaking of what you can do – and I know in times of, you know, emergencies, and this is one of them, you want to make sure you’re safe, and your family’s safe, and your loved ones are safe, and then you can be able to help others; and when you get to that stage, I’ve been talking to a lot of people who are feeling almost guilty that there’s nothing they can do to help. And, you know, Dr. Ted Robles talked about, obviously, one great thing to do to help is to stay six feet apart, you know? But what else would you – what kind of advice would you give people who are starting to feel that? Where they feel like they’re not contributing to the solution.

Dr. Bob Bilder  08:02

Well, one thing, I think, you know – I think you said it very well, Wendy, that if you start with yourself, and then think about how you can bridge out to others who are in your peer group, who are in your family, who are in your broader, socially connected community – I think this is a really great time to think about, exactly, who are you connected to, both in terms of your personal social connections and also in terms of your other academic and occupational social connections. But I think that reaching out to those people in a systematic way is particularly important right now. Some people are sick, almost everybody is stressed out. So being very determined about and even making plans – “who am I going to reach out to today? And try to bring a ray of light to them.” And there’s this one other thing I wanted to mention is: the importance of managing the information flow. There was a great article that was circulated by Chris Dunkel Schetter, recently, one of the co-leads of the EngageWell Pod; and one of her colleagues down at University of California, Irvine, Roxie Silver, has worked on trauma and what happens in the public communications of that. And managing the media exposure at this time is really critical, because we can become so overwhelmed with the experiencing of the trauma and immersion in the trauma, that is particularly important to manage that, find a few trusted and credible resources, and really just check them once or twice a day. More frequent checking is not going to help. And I think as the UCLA academic community, we can help our colleagues, our peers, and others to do the same kind of management of information overload.

Dr. Nicole Green  09:41

I would agree. And I think even when reading the social media, it is also important to use some of these mindfulness and techniques of grounding yourself. That, although this is all happening, that you are at home, if you are safe, if you are healthy, or you know people that are – to remind yourself that there’s also other parts of the picture, as well, so that people don’t completely get overwhelmed and really increase their stress and anxiety reaction. I think another thing that people can do, and I’ve started to see people do, is think about ways that they can do GoFundMe pages for food for folks who are in need, or participate in some of the other charities that are popping up around this, and to be thoughtful about where they’re engaging in social media so that they’re able to be productive, as opposed to focused on fear and anxiety all the time.

Dr. Bob Bilder  10:33

There’s another neat resource that was recently disseminated by our Office of Equity, Diversity and Inclusion. And, you know, they’ve caught some ideas of how to help, particularly, folks who are in underserved communities. I mean, you can imagine the stresses we’re going through. Imagine the additional stresses for those who have extended homelessness, people who are now increasingly facing challenges to their livelihoods, unemployment, the financial stressors are only building, so I think now’s a good time to set up channels to give back.

Dr.  Wendy Slusser  11:04

Yeah, so I think that there’s no question: there’s ways to give. And, you know, giving through those channels are really practical. So what I’m hearing is, not only can we give financially through GoFundMe pages, we can also be reaching out to those that we love and care about, or maybe even haven’t been in touch with that for, maybe even for a long time. The other piece I’m hearing is that with the amount of information, overload could be a really big stressor on all of us; and so we really need to maintain sort of the diet that we’ve had in the past, but now a little bit more carefully, because we’re always around a computer. I hear twice – you know, look at things twice a day, but how else could you limit your exposure, besides sort of having good self control?

Dr. Bob Bilder  11:57

One key thing is to really focus just on certain, selected information sources and just look only at those. So, I think that one thing you could do is on your, “i-things,” is turn off news alerts, so you’re not constantly being barraged and tweeted at by all kinds of news alerts that may come up. And then to, you know, if you feel you must, check out the World Health Organization site, the Centers for Disease Control site, and then UCLA Health has a pretty nicely put together website that covers the local situation, and is of immediate relevance to those in our University community. And so I think they’ve been doing a great job of managing, what are the messages, what’s real, what’s not real, and that avoids us going down rabbit holes, that can be exceptionally anxiety-provoking. I mean, I was happy to see today on a news feed that the wild and totally unsupported suspicions that the COVID-19 was created as a rogue virus – this is just insane, but this is the kind of information that’s out there. So, thank God, somebody actually put out a nice document showing, yes, this is a natural virus – not that that makes it much better for us – but I mean, to try to overcome the kind of anxiety and suspiciousness that can occur right now. I think it’s important.

Dr. Nicole Green  13:23

And I think, because, you know, especially for younger folks who are more digital natives, where if you’re not on the computer in one way, you’re on the computer in another – like, you know, Instagram or what-have-you, or looking at general social media. I think one of the other things is to really elicit some support, whether you need to do some blocking, or have a friend put a code in; because I do think that the natural inclination, you’re sitting on your computer, you’re in class, it’s passive, to turn on onto another website or open another browser is so easy. And so I really do think it’s important to think about, what can you do? Can you delay it? Can you set another homepage that’s not just social media, so that’s not where you go first, when you’re just kind of there to kind of zone out? And I do know that the tendencies to want to zone out are going to be high. So where do people turn on? It’s not really their bank page. It’s their social media, you know? So what can you do to set reasonable expectations with yourself about not always going to social media as your automatic response, and I think that that’s where a lot of younger folks really struggle.

Dr.  Wendy Slusser  14:31

Some of these suggestions also lead you to – well, the GoFundMe page, by the way, there is one that’s now for helping to support restaurants to feed our health care workers, and UCLA is part of that. And they’ve just opened up a day and a half ago, and it has a very inspiring story of a group of mothers who put it together. And I think it would be something that we can definitely direct people to, who are listening to this podcast, that they could go and give $10 that will feed one health worker a meal that’s up in the front lines of COVID-19. The other thing that I’m hearing both of you say, too, is how we can rely on others to help us support us in our good habits. And how about some of the do’s that we can do? And I know one of these I’ll hand over to Bob Builder, who had a long time explaining this on one of our other podcasts about music. Tell me what music can do to make us feel better.

Dr. Bob Bilder  15:30

Music has a great capability of transporting us in a way that other kinds of communications do not have. And I’ve seen some incredible innovation among our students and staff and faculty in creating special Coronavirus playlists. So, we have not compiled them yet for the Healthy Campus Initiative, to my knowledge, but it might not be a bad idea; because I think that does help to give us a little bit of a break, and a little bit of perspective, and also some insight into some incredible senses of humor as we face, you know, what’s otherwise a very anxiety-provoking time. But I think that, yeah, finding music, finding other arts, can also be of value. I know a number of major museums around the country have begun to put their content online, so that you can actually enjoy art for free, from some of the leading museums around the world. And a number of music venues are also putting out material that you can get for free. So now’s a good time to be immersed in arts.

Dr.  Wendy Slusser  16:33

That’s right. And I know I’ve quoted this before, but Oliver Sacks writes, “Music can lift us out of depression or move us to tears – it is a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more – it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.” And I think it could be a necessity for all of us in this time of pandemic, this COVID-19 pandemic.

Dr. Bob Bilder  17:04

Yes, beautiful expression. And in building in time for various things – building in some time for music is a great idea. And you know, Dalida Arakelian, of our Mindful Music Program, has continued to put some concerts online, even though some of the artists had to be sequestered, operating independently. Still, I think it’s great for us to be able to come together as a community, and listen to music together, and share that experience.

Dr.  Wendy Slusser  17:32

I know, Nicole, your heart is in really giving people a sense of control, and self-efficacy around their own well-being, and creating resilience, and I’d love to hear what your thoughts are about what one can do near that.

Dr. Nicole Green  17:46

I think this is, you know, from a bigger perspective – I think we’re all kind of on a little bit of a timeout, in a way, to be self-reflective and getting back in touch with who you are and what you love. If you want to think about where there can be silver linings here, where there are very, many fewer distractions there otherwise would be. You know, obviously we’re dealing with a lot of folks who are in a lot of transition and really worried about things. But there are – I think it’s important to take moments to think about what you love. I was thinking about the community garden, and that, you know, many students found a lot of joy in the garden, but are there ways they can, you know, cultivate a small garden where they are? Even if it’s three plants on your desk, you know? Or things like if people did love music or art – where are you making space in your new space to have a space for art, to have a space for drawing, for journaling, for reflecting on who you are and who you want to be in this process and how you want to be helpful and purposeful in this time of, really, global transition. Where can you find your purpose and meaning? And where are you your most self? I think those are really important things to ask as we’re trying to find our new normal.

Dr. Bob Bilder  19:04

Just to jump onto that I just wanted to add that – for those of us who are sequestered with our family members, this actually creates an amazingly great opportunity to really be in touch with those family values and family connections that sometimes are not as attended to as we’re rushing around each doing our own thing. So I think that it’s a component of that finding purpose and meaning. Most of us, often, will affirm the most important thing to us is family and friends, among all of our relationships, and now’s the time that really brings that to the fore.

Dr. Nicole Green  19:36

I think it’s also a time, you know, there’s so much struggle right now. If you have the opportunity to take a moment for gratitude of where you are; but also just to kind of hold for yourself the people that really are in a lot of transition, and a lot of pain, and a lot of grief, and not dismissing it, but taking the opportunity to walk in that life with them, too, so that they’re not alone in it. You know, if you know people who are struggling, I think the tendency is to kind of back away, especially when we’re all in such a time of transition ourselves. But who can you support? Who can you let vent? Who can you validate? Who can you reach out to to say, “I see you?” Even your favorite restaurant place – can you leave a note, you know? And just say, I appreciate you, and I’m thinking of you, so that we are demonstrating that we see each other.

Dr.  Wendy Slusser  20:25

That’s really lovely. Those are really actionable, lovely thoughts. And I’ve heard Governor Cuomo in New York say thank the grocery person, thank the postman, thank the policeman, thank the doctor, thank the nurse, thank the aid – all of these people are putting theirselves out there, keeping the engine running for us. So, I do appreciate also both of your recognition that there are people out there that are in a lot of pain. And basic needs, I know, is one area that really needs all those basic needs need to be met. And I know that some people who were struggling before this are even going to be struggling more, and then there’ll be new members of that struggle, as well. And so what can we do as a community – UCLA community – how can we help support our close and larger community in helping them address some basic needs?

Dr. Nicole Green  21:26

Well, I know on the Student Affairs side, there’s so much that we’re trying to do to make sure that there are basic needs, at least, for the students. I’m worried about staff and faculty – honestly staff probably most. And I know that there are so many students in so much turmoil, and I do think one of the first things is to get the word out; that they should reach out, that they don’t have to struggle with this alone, that the university is working not only amongst the UC system, but also with local government, and federal government, and state government to try to understand what we can do to support students. And, you know, Student Legal Services is waiving fees, CAPS is extending session limits, we’re trying to find appropriate housing for folks who need it. So if students – one thing I would just say to the students listening is to reach out and share what you need. And then beyond that, I do think that, really, the Healthy Campus Initiative can really start to think about “how can we be a resource for students and staff around all of the different needs that are coming down, as a result of the financial crisis around this?”

Dr. Bob Bilder  22:27

Yeah, these are going to be, you know, huge issues as we start the spring quarter, almost immediately, next week. At the same time, I’m really, acutely concerned about our healthcare workforce, as we see, over the next few weeks, probably a major surge, for which, you know, no one can be fully prepared. And, you know, we can all pray that Los Angeles will be doing a great job in mitigating the curve; but at the same time, I think we have to know – I already see our healthcare workforce really being pushed to the limits. And I was inspired to see in Barcelona how everyone got together at 10pm each night, went out on their balconies, and applauded for the healthcare workers who are really at the frontlines of taking care of people. And so I hope that we can carve out special time and effort to recognize and reinforce our healthcare workers at this time.

Dr.  Wendy Slusser  23:24

Yeah, those are all really good comments and insight into what we’re doing currently. And as I said, there is a GoFundMe page now for the health workers, actually for all of Los Angeles – World Central Kitchen, the nonprofit that was started by that famous chef in D.C. is the home for that nonprofit that’s supporting these foods efforts. But also, our leadership is also providing free meals right now, for each shift in both hospitals, Santa Monica and Ronald Reagan. That’s a big step that started on Monday. And I think that there can be other forms and ways that we can support the frontline workers with gestures just like the thank you’s. So great advice. For the faculty who are coming back and going to be teaching, what kind of advice would you give them in terms of, you know, supporting the student bodies and also their own graduate student researchers, or other people, and their own staff.

Dr. Bob Bilder  24:25

So this is going to be a huge issue. I know we were focused a lot on the challenges that students are facing as they return for the spring quarter, but many of our faculty are not as familiar with the technology that they’re going to have to be deploying. They’re for the first time putting all the material online, so it’s compounding the many challenges they have. The one piece of advice that I would give right now is it’s probably most important to just pay attention to the students, and don’t worry about the technology as much. Just reach out to the students and forge that uniquely human, that personal touch – that may be the most important thing. And then, in addition, I think that, you know, working with Nicole, Gabriel Laredo made up a fantastic tip sheet. That’s like a one-pager that we’re going to aim to get out to all the faculty next week that highlights how to help students who are trying to cope with this. What is it that faculty can do? And we’ve heard in the past, that, you know, faculty feel challenged: A) because they don’t know exactly how to recognize the signs of distress among students very well – they’re not trained in it really; and B) if you do recognize those signs, then what do you do about it? So anyhow, Gabriel, Nicole, and the CAPS team, and Student Affairs have put together an amazing tip sheet that digests this information into a single page that faculty can refer to, and I think that will help at this time.

Dr. Nicole Green  25:46

Agreed. And I think, in addition to that, one thing that in this time of students getting bombarded with messages coming from who-knows-where, with no faces to any names; some of the departments could think about town halls where they virtually share information about how their department is thinking about learning, you know, at this time. I think faculty should spend some time in the beginning of their class just going over and explaining why they’re doing what they’re doing, so students can kind of hang on to a rationale and feel some humanity around it. I think that, you know, faculty should make themselves open to suggestions and be clear about what the expectations are. Sometimes transparency goes a long way, and really helping students to understand why you’ve thought about it this way or that way is also very, very helpful. But also, I think, really, what’s probably most meaningful is for people to feel like there’s a human behind this, because we’re just so far apart, yet, you know, with zoom and with having to do this virtually. But I think it’s very important for faculty to be maybe more transparent than they otherwise would be, and more accessible to questions and office hours and things like that, so that we’re all getting a hang of this.

Dr. Bob Bilder  27:06

There’s one other thing just I’ve heard faculty being anxious about what’s going to happen to their tenure decisions or advancement, and they should know that academic personnel is well aware of this. And so it’s going to be possible for people to, you know, put a pause on their tenure clocks, etc. And everyone understands what everyone is going through at this time, and it’s going to be considered seriously. And people, I think, the last thing they should need to worry about is whether or not they’re going to make that next advancement at this time.

Dr. Nicole Green  27:37

And I wanted to say one other thing. I mean, faculty are in this, too. They’re trying to teach classes, and their kids are home, and they’re trying to turn on a dime their curriculum, and trying to figure out: where can I do this? And how can I do this? And so I also want to just inspire some grace around the whole process for everybody; that this is a new normal, it’s not going to be 110%, but everybody’s working hard. And I think it’s important for as much as faculty, staff, and students can be okay with sharing, like, “hey, these are some of the challenges that I’m up against,” it might help everybody feel less that it’s something about “you didn’t see me” – like it’s more that they’re all in their own transition.

Dr.  Wendy Slusser  28:19

This is amazing advice. I think we’ve covered a lot of ground between faculty, staff, students. We’re going to be sure to link resources at the end of this podcast, so you can all get more details about what Dr. Builder and Dr. Green have been talking about. And I’d like to finish this incredibly informative conversation with a question to both of you: what keeps you up at night?

Dr. Bob Bilder  28:44

My dog, barking.

Dr. Nicole Green  28:47

You know, this is just so unprecedented; it’s so surreal. And to be very honest with you, I think just the jarring nature of the complete transition of all of our lives is a lot to process. And it’s taking my brain a lot of time to process this new normal. So if anything, it’s really just thinking about, not just myself, but the whole, really the world, is in a lot of transition, for better or for worse.

Dr. Bob Bilder  29:15

I think that’s a huge challenge is, you know, given that we’re in helping professions, as psychologists, we’re now in a time of crisis, where our biggest responsibility is saying “what can we do that is going to be of the greatest value?” And so, ‘what keeps me up at night?’ is thinking, “Well, what is the thing I should be doing tomorrow?” That is really the most important thing right now. There are just so many opportunities to do things. Prioritizing what’s going to be of the greatest value, to the greatest number of people is really hard.

Dr.  Wendy Slusser  29:43

So what have you been prioritizing?

Dr. Bob Bilder  29:45

Well, for me, it’s – we have a community of neuropsychologists around the country and trying to figure out how to do teleneuropsychology. And for people not familiar with neuropsychological assessment, it’s – you know, it’s designed to be a face-to-face kind of a profession. But it’s a real challenge. How do we help all the people who are getting neuropsychological exams? There’s about 500,000 neuro-psych exams done around the country every year. And so right now we’re working with some inter-organizational work groups to try to put together recommendations that will help neuropsychologists around the country. And then we’ve got our, you know, a couple hundred psychology, you know, faculty, staff and trainees down campus; and we’re trying to figure out how to work with them, how to help the students, how to help the patients, and how to help them help others using telehealth. The entire psychiatry department has gone basically from, you know, 0 to 60 in 1.5 seconds doing telehealth – moved 90 to 95% of visits to tele-psychiatry, tele-psychology, tele-neuropsychology within a two week period.

Dr.  Wendy Slusser  30:53

Congratulations. That’s huge!

Dr. Bob Bilder  30:54

So that’s been time consuming and – but we hope is helpful.

Dr. Nicole Green  30:59

I’ll add to that – the same is true on the CAPS side and the Student Health Services, as well. And I think that’s where my priority is – my staff, we’ve gone completely to telehealth in two weeks. And, you know, now they’re back-to-back in telehealth meetings on Zoom. Hearing the story, after story, of all these transitions and all of the related distress – and you know, we’re thinking about the healthcare workers who are doing the kind of physical health, in-person work, and I’m so grateful to them. But I’m also aware of the mental health workers out there who are holding all these people, and all of this anxiety, and depression, and distress. So those are probably my priority right now – are the mental health clinicians on the ground trying to figure out a way to still support and to continue to support the students here on campus.

Dr.  Wendy Slusser  31:53

Wow. You guys are doing just amazing work out there, keeping your own staff together, but also helping others, students, staff, faculty health professionals. Thank you so much, both of you, because without you two, I think that we wouldn’t have this kind of focus of, not just treatment, but promoting health and well-being in its broadest sense and thinking about some of these upstream solutions that are benefiting all of our campus constituents and beyond. So before we end this podcast, is there anything else that you want to add before we sign off?

Dr. Bob Bilder  32:33

Thanks to you, Wendy, for organizing and leading us in the Healthy Campus Initiative. I think it’s really a model program and is the kind of thing that really is making a difference, so that people are seen, and are heard, and are thought about at times like this; it’s particularly valuable. Thank you, Wendy.

Dr.  Wendy Slusser  32:54

Thank you for tuning in to “6 feet apart,” a special series of the LiveWell podcast. Today’s episode was brought to you by UCLA’s Semel Healthy Campus Initiative Center. To stay up to date with the rest of the episodes in this special series and to get more information on maintaining your emotional, physical, and social well-being during COVID-19, please visit our website@healthy.ucla.edu/livewellpodcast. Thank you, and stay remote.

#38: Finding the Path Back to Meaning & Joy

Transcript

Dr.  Wendy Slusser  00:02

For the past year and a half, we’ve all been challenged to rethink the way we work. We have taken on different roles on our teams, transitioned to different styles of work, and adapted to a rapidly changing environment. Currently, we’re experiencing another transition with many people returning to the physical office. Dr. Brenda Bursch joins us for a three part series about how to optimize your well-being during this workplace transition. She’s an expert in resilience training, and a professor of clinical psychiatry and pediatrics at the David Geffen School of Medicine at UCLA. Over the course of three episodes, Dr. Bursch will cover three themes: remember, recover, and renew. Tune in to learn about actionable and practical tips for how you can prepare for your work transition and optimize your well-being. Hello there, Dr. Brenda Bursch. So great to have you back at the UCLA Live Well podcast to talk about how we can return to the workplace while actually improving our well-being. You’ve identified three themes with our return to workplace: remember, recover and renew. And we started off this series with an episode diving into the first theme, remember, and then discussed the second theme: recover. Today, we’ll be discussing the third and final theme: renew. So getting right into it. What do you mean by renew?

Dr. Brenda Bursch  01:29

Thank you so much for having me back. I appreciate the opportunity to talk about these topics with everybody. So renew, right, the third of our Rs, is really, in my mind, focused on developing an action plan. We’ve reflected on everything you’ve gone through. The different areas that we know really contribute to well-being and give you the best opportunity to flourish. And so now it’s really time to start the planning. It’s really thinking about, “Okay, how am I going to make my way back to the workplace?” And it includes both thinking about not just skills that you’re going to, you know, use as you’re doing that, but others things that you need to plan for. And so I think that, you know, when you think about renew, you can think about it at different levels. So you can think about it at your own personal level. You can think about it at your family system level. You can think about it at your workgroup level, and then you can think about it at the organizational level. And there’s other levels above that, but you probably don’t have much control over things like politics at large levels. So we’ll keep them at those levels. And so really thinking about each of those levels, and what you need to do to prepare yourself and what you can do to put yourself in the right headspace so that you are in a position to experience as much well-being as possible is really the goal of this particular session and this podcast. So to start off, I just want to quickly spend a tiny bit of time talking about self care more broadly. I think that a lot of people have maybe heard other podcasts or talks or read things over the last year and a half. So some of this might be a little bit of a review. But just to put it back on your radar. We all know the importance of healthy routines. When you think of routines, the reason that having routines is helpful is because it trains our body. If we did the same thing the same way each time, we actually alert our body that where we’re going, you know, they know what, our body knows what’s next. So for example, if we have a nighttime routine before we go to sleep, and we follow the same routine every night, then our body starts to relax sooner when it knows we’re starting that routine, because it’s been conditioned to do that. If you’re really haphazard, all over the place, and it’s different every single day, then your body never knows when you’re going to bed. And they can’t start that ramp down process. The other thing about routines is that they help us stay on track. And we do the same thing, you know, every day. When it comes to health, we’re less likely to forget to do it. So that’s another reason. We all know about the importance of having routines related to exercise, our diet, sleep. Many people incorporate mindfulness practices or spiritual practices, gratitude exercises, those types of things, to have opportunity to really reflect and appreciate on some of the good things in our lives, so that we can balance out some of the more challenging moments with being aware of the things that bring us joy and meaning. And then we also know the importance of sharing our stories. And processing through difficult times with others so that we can increase our own awareness and get important feedback from those people and better integrate our emotions with our memories by engaging in those practices or by keeping a journal. We know that having rules for ourselves or personal policies for ourselves that we implement in terms of boundaries and schedules and things like that can be really good for our well-being too. And those are really difficult, especially if you’re among people who have different boundaries or different schedules that requires you to really think about how am I going to communicate to others what my boundaries are, what my personal policies are. And we’ll talk about that more in a minute. And then coping skills. Everybody’s heard of the term coping skills, and there’s all sorts of coping skills that we know have been very well researched, that we know help people be more resilient. We know that setting inspirational goals can help us through difficult times, because there’s meaning attached to what we’re doing, and what we’re doing is helping us reach our goals. We know there’s a variety of ways that we can regulate our emotions so that we’re not just reactive to the things that happen. But we can be thoughtful about how to react when our emotions are triggered. And some of those have to do with what we pay attention to and what we tell ourselves cognitively. There’s all sorts of different techniques that can be used there. Deep breathing, just to regulate our bodies sometimes can help with our emotional control. Sometimes distraction, taking a break, so that we have an opportunity to calm down before we address the problem can be helpful. We know communication skills are enormously helpful. And we all interact with each other. And especially when we’re interacting with somebody who’s distressed, we feel distressed. And so knowing how to best help in that situation without absorbing all of that yourself is a very important skill for resilience. And then connecting to positive others and making sure that we have people that we can go to when we need support. You know, these are all things that we know. When you think about it, in terms of preparing to work, there are things you can think about for yourself, and things you can think about for those that you might report to you. And this applies if you’re a student, and you’re coming back to school, if you’re a faculty, if you’re staff. Doesn’t really matter; all of the same things can be applied to your domain. And so the first one is just thinking about, “What have you really appreciated? And have you been doing over the last year and a half that has been good for your health? Are there things that you’re doing now that you weren’t doing before you started to work remotely that you can continue to do, that you want to keep doing because you found that they are helpful for you? Can you make them a priority? Can you figure out how to fit them into your schedule?” You know, speaking of schedules, the next thing that many of us have to figure out is how to do the schedule changes that are needed now that you’re going to have to be commuting, maybe, or taking public transportation, or doing childcare. So many different things that could impact your schedule. I know that for me personally, because I’ve spent so much of my time now remote, that I’ve packed more into my schedule, because I haven’t been having to commute. So if I’m having to drive around, I have about four different locations that I regularly work at, I have to start cutting things out of my schedule so that I can be live. And have time for transportation, have time between meetings, those types of things. Some people might have to go back to a previous sleep schedule that you’ve had. We all know how hard that is. Just when we have one hour sleep difference for time change. If you are more off of your sleep schedule than that, then you might want to start transitioning now, so it’s easier later. My favorite thought about going back to work is “What would make me excited? Is the workspace I have, is my study space that I have, are the spaces that I’m going to be spending my time in: do I like them? Is there anything that I have control over that I can do to make them more pleasurable, or to change them?” There’s a little bit of research, for example, that shows having plants in the office can decrease your stress level and increase productivity. Not all of us can put plants where we work. But if you can, that’s something to think about as an example. I like the idea of upgrading my wardrobe, you know. I haven’t worn certain things for a year and a half, and I don’t even want to wear them again. If you feel that way, then you might get excited about the idea of doing a little upgrade, or if you gained or lost weight, you know, you might need to do that. You know that might be pleasurable for you. And if so, then any little thing that gets you a little excited about coming back, you want to really try to take advantage of. You know, many people might be fearful. And that’s a legitimate way to feel, you know. There’s a lot of effort being placed into ensuring that everybody will be safe. But everybody has different levels of risk tolerance, and everybody has different practices they engage in, related to what they do to keep safe. And if you’re around somebody that doesn’t have those same strategies you do or same level of comfort that you do, then, you know there’s going to be differences there. And that can be hard to negotiate. And so it’s helpful to think about that ahead of time. You know, what safety protocols will help you feel safe? How are you going to communicate those to other people? Do you need to like put a sign up in your work area? Do you need to practice explaining to others what your boundaries are? You know, those are all things that you can do now that will help you when you transition back. Just like in the beginning of the pandemic, you’re going to want to think about where am I going to get my information from. It could be COVID information. It could be work related information. If you have kids, information related to school. It could be all sorts of different types. If you are somebody who’s kind of ambivalent about coming back, or not very excited about coming back, it might be harder for you. You might have to think, really dredge up like, “What are the advantages? What do you miss? Is there anything you miss? Is there anything that you can interject into the setting that would help you be more excited? Are there things that you’re grateful for? Some people lost their jobs. Are you grateful that you have a job? Some people don’t have the opportunity to go back to school? Are you grateful that you can go back to school?” See if you can figure out what those things are that you’re grateful for. You know, some things will be better. Some things might not be as good as you remembered them. And allowing for that, just kind of being open to that. Change is really stressful and difficult. And, you know, when we had to all go on lockdown before, it all happened very quickly and all at one time. And we were in it together, and we had a common purpose. And now it’s going to be all staggered. And so it’s going to be less united. And that’s going to be a little bit of a challenge. So when you have those moments where you just feel anxious or stressed, just taking some deep breaths, and letting those waves pass can be the most effective thing to do. And if you find that those are coming too much, and they’re just really interfering with your ability to feel well-being, to concentrate into your work, to be functional, then reach out and tell somebody. You are not alone. Many people have been struggling. Many people have been. And so reach out. Tell somebody, and, you know, find out what kind of assistance is available to you. If you’re somebody, who is a supervisor, and you’re thinking about people who are looking up to you, or maybe you’re not even a supervisor, but maybe you’re, you know, a team captain or a club captain or in any leadership role of any type. And you’re thinking about trying to help those in your group transition back, the thing you really want to think about for those folks is how to communicate as much as possible. And really understand what people are going through, realizing that people are going to be very stressed. They’re going to see things differently. You’re going to have to have a lot of diplomacy in your toolbox. And you’re really going to want to look for opportunities to get positive reinforcement, positive feedback, highlight milestones, highlight the good things that are going on, the meaningful things that are going on, the moments of joy, what you appreciate about each other, to make sure you’re a lot more verbal about those. And to try to stay out of the kind of complaining loop that we can sometimes get in. I think the other thing for those who are leaders, that can be more important than all of the other things I’ve said is to be honest and vulnerable. Share, you know, that it’s not been easy for you either, if that’s the truth. And share what’s helped you. Share when you don’t know the answers. That communicates to other people that they’re not alone. And that you will be likely to understand and have empathy if they share their struggles with you. You’ll be more approachable as a leader if you can also be vulnerable and share your emotional experience. So I think that that’s the biggest take-home for people, who are in leadership positions. And if you think about the people in your groups, from a leadership perspective, making sure they also understand what resources are available to them. You know, there’s a lot of resources on our campus. UCLA has really focused on at every level of trying to be responsive and trying to think about what the needs that people in all sorts of jobs and our students have and addressing them. And if we’re not doing it, you know, there’s a great deal of interest in hearing about it, to see if there are things that can be done. And then the last thing I really want to highlight if you’re a leader: you also want to be monitoring those people in your group to see, you know, if they seem like themselves. And if you’re finding that suddenly someone’s quieter than usual or more irritable than usual or not showing up to meetings on time when they normally would or, you know, other behaviors that you’re just not used to seeing out of them, that you don’t just keep it to yourself, but you check in with them. “You don’t see yourself. How are you feeling? I’ve got a few minutes. Do you want to chat about it. Is it okay if I check in with you, again?” Those are all really appreciated. You know, even if someone doesn’t want to chat with you, even if, you know, it’s something that they want to manage on their own, usually, most people appreciate the fact that someone checked in on them. And sometimes people don’t even realize that they’re stressed out until somebody else says something. So you can raise their awareness by saying something like that. So I think that, that is kind of a big long checklist of a lot of things that you can do. But the idea behind it is if you review all of these and develop a toolkit for yourself, a wellness plan for yourself and for those that you might be a leader of, then you have opportunity, not only to transition back to the setting, to UCLA settings, in a, you know, healthy manner with a sense of well-being, but maybe you might be in a, you know, maybe you’ll really thrive. Maybe you’ll find a sense of purpose and joy that you didn’t have before. Maybe you’ll be more appreciative after everything we’ve been through so that the little things will spark greater joy and glee than they even did before. And maybe we will be a kinder and more appreciative set of individuals, because we’ve taken this time to really make such plans. That’s, you know, that’s a lofty goal. But that’s really, you know, what positive psychology is about, right? It’s really going for that, because if you don’t go with that plan, then we’re not going to make it. Doesn’t mean there’s not going to be problems. It doesn’t mean that we’re not going to have setbacks. It doesn’t mean that we’re not going to have feelings of grief, or sorrow, or trauma, or any of those things. But it really is setting us up so that when those do happen, we’re in a position to be more resilient. And we’re in a better position to really derive meaning from them and to be able to use those difficult times to propel ourselves to the next level of what we find meaningful in our life.

Dr.  Wendy Slusser  16:58

Well, what you’ve just covered has been a tremendous roadmap for many of us. And I’m just feeling, this was under the theme of renew, which really, we could all start practicing now in whatever workplace we’re working, whether we’re on site as we speak, or on our way, or do flex work, or even are the group that ends up staying at home, because so much of that is just so basic in terms of self care, like a routine. I know when I try to teach routines for parents, it takes them weeks and months to really capture the ability to really manage that for their children. So sometimes that’s hard, even for ourselves to have our own routines, right? What kind of practical tips would you give people to start with when building routines? You talked about their sleep routine, but just in general, what would you recommend?

Dr. Brenda Bursch  17:59

You know, a couple things that pop into my mind when I think about routines, you know, sometimes we need reminders. So if you are trying to establish routines, and you get sidetracked into other activities, you might need to set reminders on your phone, so that you stop. You might need to put things in your schedule, so that you have, you know, a stop to remind you to do other things. The other thing about routines and other routine hacks, so to speak, is pairing right. So, you know, we’re often talking with our patients about medication adherence. And so, you know, taking your medication right when you do something else. And putting the pills right near something that you already have as a routine, so you just start adding to a routine that already exists, is often effective. The other thing is trying to get your whole family on the same routine, right? Much more difficult when you’re the only one in the family trying to change your routines. But if you can get buy-in from everybody. And then reward yourselves when you make progress and realize you might not be able to achieve everything you want to do, you know. Going for an hour and a half walk every day might be too lofty of a goal. Some people could do something like that, and others can’t. If the whole family goes, it increases your chances. If it’s a half an hour walk, then maybe that increases your chances. But trying to kind of be flexible enough so that you can really settle on something that you can make into a reliable routine. You know, because I think sometimes we give up if we have early frustrations. You mentioned that sometimes it takes months. I’m not that familiar with the research. But there’s some research that’s something like if you do the same thing, 30 days in a row, that there’s an increased chance that you’ll keep doing it. So you know, the more you do something, the more likely you are to do it. And that we know is true. So I think those are some routine hacks that you can consider.

Dr.  Wendy Slusser  19:51

That’s great. That’s good to set a goal. So 30 days could be a really good goal for many people too.

Dr. Brenda Bursch  19:57

Right and then that helps. It’s less overwhelming, right?

Dr.  Wendy Slusser  20:01

Right.

Dr. Brenda Bursch  20:01

Like, okay, I’ll walk for half an hour a day for 30 days, then I’ll reevaluate.

Dr.  Wendy Slusser  20:06

Exactly. The other things that you highlighted that I thought were really strong wisdoms to practice not just at workplace, but at home are things like communication, like your ability to share your feelings. Like as a supervisor, it can help people feel more comfortable about how they might be feeling. Can you elaborate on that in terms of what instances or stories can you tell us about where you’ve seen that work well?

Dr. Brenda Bursch  20:34

You know, it’s interesting. That’s something that I’ve really personally worked on over the course of this pandemic. Because I think, you know, as a health provider, I have always been trained, especially as a mental health provider, to not really talk about myself very much, right, to be very focused on our patients. And then I’m also a professor, so I’m very focused on my students. And, you know, what happens is that by doing that, we accidentally contribute to this inaccurate view that we are in all our accomplishments really impervious to stress and that we don’t struggle. And that makes us impossibly difficult to relate to, you know, and really contributes to our students and our patients and others, to feel like, “Oh, they have such a long way to go to be as perfect as we are.” And so to transition into being more open about myself felt like I was being unprofessional. It felt like I was off task, that I was being indulgent, that I was being, you know, kind of self-centered. So it’s been difficult for me to share, you know, when I had a friend who died of COVID. And I was so grateful; I had recently seen him. He lived out of state, but he’d recovered. And then two months later died. And so I thought that he’d recovered. Like, it was so unexpected, and, you know, so I had emotions about that. And it’s not something necessarily I would normally share with my students. But we were all in it together. And I knew it was going to be helpful. And we started having check-ins, which we didn’t do in the same way before the pandemic. And it gave the space and the time to talk about these things that we don’t normally talk about, because we’re always going so fast. And we’re always so focused on work. And so I was able to share that and then that meant that my trainees felt more comfortable talking to me about what was going on in their families, and who they were worried about and their friends. And then that leads to the next conversation about, you know, differences in the families, about safety practices. And all sorts, you know, one thing leads to another. And not only did that help us feel better connected, but because it’s specific, it really allowed for much stronger support. And, you know, if I think back on the trainees that I had, that were on my service, that first rotation in the first four months of our pandemic, you know, I’ll forever be so connected to them because of that. And so it’s this long lasting benefit to me, as well as to the people that I supervise, who felt a lot more comfortable sharing with me once I shared. One of the topics that I’ve been talking about recently is imposter syndrome. You know, we all remember being a student or transitioning to our jobs and having imposter syndrome. But a lot of our students and a lot of our younger faculty and staff don’t realize is that does not go away. There’s always new topics to have imposter syndrome about, right? And that we all have to ask for help. We all reach out, you know. You and I have reached out to each other when, you know, we’ve had a question or a dilemma or a challenge. And we knew that each other would be helpful in that regard. You know, we all have networks that we rely upon for those types of things. And so recognizing that, communicating across workgroups into those you supervise to your supervisors, across every which direction can only bring us closer together. And improve the work we do, because we’re being clearer about what’s happening, how we’re feeling, what we want, what our limits are, all of those things.

Dr.  Wendy Slusser  24:29

I mean, what you just said about your students and how you have a bond, just from that experience early on, is going to be so valuable for them as they move forward too, because they’ve just been modeled by their professor. And it’s going to have that ripple effect. That’s one of the fortunate aspects of being a professor at UCLA. We have generations of students out there that really are products of how they’re being taught currently. So

Dr. Brenda Bursch  24:58

Exactly.

Dr.  Wendy Slusser  24:59

How they were taught in the past, rather.

Dr. Brenda Bursch  25:01

And I have, you know, I have no plans on reverting back to my old practices, right? I think this is the new normal. We check in on each other now, in a more frequent manner, at a deeper level, as well. And it’s not just checking in about work, it’s, you know, it’s checking in about us as human beings.

Dr.  Wendy Slusser  25:20

Well, it really gets to your last podcast point about creating a workplace or a learning place that is respectful and has the capacity for people to feel heard, and also, potentially, ultimately experience joy so and meaning. Well, Dr. Bursch, once again, thank you so much, not only for sharing so much important information about how we can renew at this stage, but also how we can all be models for others in our ability to share some of the feelings that we might be experiencing as well. So thanks so much and for all you do for UCLA and also the world.

Dr. Brenda Bursch  26:05

Well, thank you for everything you do for UCLA and for the world. I am very appreciative of you and for you offering this platform to me to share with others some of the tidbits that I’ve been collecting over the last year and a half. As I’ve been on the COVID mental wellness taskforce for UCLA and giving these talks all over the place, the best part of that has been, I’ve had to repeat it over and over. So it’s a reminder to myself. And as a result of that I’ve gotten to hear all of these great ideas from others. And those have been incorporated into all of these talks. So it’s really been not just me, but a collective effort. And I appreciate the opportunity to share some of that.

Dr.  Wendy Slusser  26:50

Thank you. Your response and recognition of others is just one of the many ways of your ability be so generous to us. So thank you. Thank you again for joining us. For more information about today’s episode, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episode, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Leave us a rating to tell us how we’re doing. And if you think you know the perfect person for us to interview next. Please tweet your idea to us @HealthyUCLA. Have a wonderful rest of your day. And we hope you join us for our next episode as we explore new perspectives on health and well-being.

#36: Finding the Path Back to Meaning & Joy

Transcript

Dr.  Wendy Slusser  00:02

For the past year and a half, we’ve all been challenged to rethink the way we work. We have taken on different roles on our teams, transitioned to different styles of work, and adapted to a rapidly changing environment. Currently, we’re experiencing another transition with many people returning to the physical office. Dr. Brenda Bursch joins us for a three-part series about how to optimize your well-being during this workplace transition. She’s an expert in resilience training, and a professor of clinical psychiatry and pediatrics at the David Geffen School of Medicine at UCLA. Over the course of three episodes, Dr. Bursch will cover three themes: remember, recover, and renew. Tune in to learn about actionable and practical tips for how you can prepare for your work transition and optimize your well-being. Dr. Brenda Bursch, it’s great to have you join us again on the UCLA Live Well podcast. You’ve joined us for an episode back in March about how we can support our frontline workers and how we can process trauma from the pandemic and find glee in the future. It’s really great to have you back on the podcast to talk about something that’s on all of our minds— how are we going to return to the workplace, and more specifically, how we can optimize our well-being? To start off: Why should we be thinking about well-being as we return to the workplace?

Dr. Brenda Bursch  01:29

Thank you so much for having me here today. I’m very pleased to be invited back and to be able to talk about these topics with you. Yeah, well-being is kind of a general term, right. It’s one that we’ve all heard before, but probably don’t know that much about the research related to it. So, you know, it’s an umbrella term that really is important to not only kind of face value (we all want to have a higher level of well-being), but there’s also a lot of research that shows that there’s benefits of well-being, including having better relationships, performing better at work, having a stronger immune system, living longer, having better cardiovascular health, better sleep, lower levels of burnout, and all sorts of other things. And so it really, there is more meaning behind that term well-being, then you might really think when you just hear it, here and there. Another thing I just want to point out about that well-being research that I find particularly helpful for my own self is that one of the factors that really contributes to well-being is how optimistic you are generally as a person. So you always hear about the glass is half full, or glass is half empty kind of person. And we know that people, you know, who do have a tendency to see the glass as half full, who are a little bit more optimistic, experience less depression and less anxiety. And they tend to do better at work, and they have fewer health problems as well. We don’t want you to ignore problems that are there, and we know that avoidant coping and just pretending like things aren’t there is not helpful. But having an optimistic view that you can conquer those challenges is a really important factor towards well-being.

Dr.  Wendy Slusser  03:00

Well, you’ve sold me. I mean, how could you not want to practice some way of feeling a sense of well-being given all those positive outcomes. Getting to your point about optimism, which sounds like a good path towards promoting your own well-being, I understand that if you’re not naturally optimistic, some people can learn those strategies to become more optimistic. What would you recommend for those people?

Dr. Brenda Bursch  03:44

Oh, gosh, there’s so many ways to go about it. You know, I would say that many of us in our health system and the upper campus and across, you know, all different parts of UCLA, tend to be pretty high achievers, right? And so we’re perfectionistic. We’re critical of ourselves, that’s how we spur ourselves to create and to achieve more and more. But there’s a cost to that, you know, when we’re constantly problem solving and looking for problems, we do have this kind of critical thinking hat on at all times and see the negative. And so we do know that one thing that can be done is make a concerted effort to pay attention to those things that are going well. Look for them. And that can mean at the end of your workday. You know, when 800 things happen, and we’re kind of overwhelmed by the whole day, that feeling of being overwhelmed can color our emotional experience. But if you take the time to think about all the individual things that happened during the day and pull out those things that really brought you some joy, brought you some meaning or fun, those kinds of moments if you can dwell on them actually is one way to become a little bit more optimistic. Another thing you can do is you can challenge your thoughts, you know, when you find yourself saying something negative or being a little bit more pessimistic, you can say, you know, what are the facts here? You know, what is the probability that something negative is really going to happen? You can replace those thoughts with something that’s more positive as an example. There’s all sorts of both cognitive and attentional things that you can do. And you can also try to schedule in time. So there’s like this behavioral aspect to it as well, where you can put into your schedule, just moments during the day that you want to practice these things. So those are a few examples.

Dr.  Wendy Slusser  05:30

Those are very useful. And I love the way you differentiated between cognitive and behavioral. So cognitive is like what you’re thinking and how you can be the master of your own thoughts, so to speak. And then behavioral is perhaps even very simple, was having a routine.

Dr. Brenda Bursch  05:47

Right, you got it.

Dr.  Wendy Slusser  05:48

It’s very reassuring, because, you know, a lot of people will say, well, this person’s being an optimist. This person’s the pessimist. But that doesn’t have to define you. You can change that. And what I’m hearing too, is that you’re saying, pick things that were good part of your day. And that’s sort of like giving gratitude in a way to those moments.

Dr. Brenda Bursch  06:07

Yeah, that’s right. That’s right. If you do a gratitude practice, that details perfectly with what I’m talking about.

Dr.  Wendy Slusser  06:12

Yeah. If they haven’t already started coming into work physically, what would you recommend people start to do either behaviorally, or cognitively or whatever else other strategies you might have?

Dr. Brenda Bursch  06:25

Well, there’s so many things, I have a list of about, I think 40 things that could be done. But I think that it’s helpful to think about it in stages, right? So the way that I’ve been thinking about it is first, really creating space for yourself to reflect on the past year and a half, two years almost now, coming up, you know, in January. I’m thinking of when we first started hearing about the coming of the pandemic, that was when we all, many of us started making plans for how things might shift. And so it varies by person, obviously, but everyone has lost something in the last couple years. We’ve lost opportunities, some of us have lost loved ones, some of us have not been able to see people that we normally do. And so the first set of things that I think about is how can we really honor that past and really process any emotions that we have related to that, that could be still really interfering with our ability to concentrate or to be healthy, or to, you know, that might be, you know, kind of weighing on our mind as we are thinking about going back. And then the second section of suggestions, really, is to kind of ground yourself and think about what do we know about wellness and how to cultivate it. And if you kind of go by each of the buckets of things that we know can help support well-being, thinking about, you know, what you’re currently doing, and things that you can do as you’re preparing to come back. And if you’re a supervisor, also thinking about that on behalf of the people who report to you, and how you can make that transition better for them. And so kind of thinking about it more broadly. And, you know, I guess, academically so to speak, and then really drilling down and making in the third section your personal action plan. And so figuring out how you are going to come back and set yourself up both emotionally and cognitively and behaviorally so that you will have success, and maybe it’ll even be better than before. You know, I think some people are excited to be back. And some people are fearful to be back. And some people are, you know, feeling a little angry that they have to be back. And, you know, it wouldn’t be surprising if you had all of those emotions at one time. And so trying to really sort through how to create a return to work that optimizes the things that you’re excited about, and maybe, you know, allows you to tweak some of the things that you are not looking forward to so that they’re a little bit more appealing.

Dr.  Wendy Slusser  09:01

So let’s today dive more deeply into the first theme: remember. So how can we honor the challenges and sorrow from the past year?

Dr. Brenda Bursch  09:10

So let me start by just saying why that might be important, you know, as I mentioned before, it takes time to really integrate some of our emotions with our memories and things that have happened, especially if they’re painful. And if you haven’t really had that much opportunity to talk about what you’ve gone through or for some people who journal, who write about it. If you’ve really just been mostly spinning in your own head about it, or if you’ve been ignoring it, or you’ve been working too hard to really think about it, then what you might notice is that you might, you know, have some lack of energy, you might have a down mood, you might be more irritable than you normally are. You might find that you’re thinking about it when you really don’t want to be, and, you know, it just makes it harder to do everything. It’s like wearing a 15 pound backpack everywhere you go. It’s just extra weight that you’re carrying at all times. And for some people, they’ve been working really, really hard and haven’t even taken a vacation in the last year and a half. For those people, when you take a vacation, you’ll notice that, oh my gosh, you’re suddenly thinking about all of these things that you haven’t thought about, and it’s not exactly the vacation you intended to have. For some people, they’ve had time, but they haven’t had any opportunity to, you know, actively really process what’s happened. And so to take that time to really do that is helpful. And, you know, I think before I kind of launch into the, how you do it, I want to just kind of take a little detour, if it’s okay with you, and just talk about the concept a little more abstractly in terms of suffering. Is that alright? If I do that for a second?

Dr.  Wendy Slusser  10:44

Yeah, absolutely. And one of the things that you mentioned, this integrating your memories with your emotions, reminded me of our last podcast with you and how that is how you build resilience. So again, this is an opportunity for all of us to build more resilience as we move forward.

Dr. Brenda Bursch  11:02

That’s right. That’s right. We know that if you’re able to talk about some of those stories with people who would understand and be able to provide support to you, or if you journal about them, it’s a better way to tell the story than just to yourself. And when you tell it to yourself, we don’t dive as deep. And so we don’t do as good of a job of integrating our emotions with our memories. And that takes a longer time to move forward. But if we can share those stories in a meaningful way, and have some of those difficult emotions, or, you know, if you’re not someone who likes to chat, you can do it in as a journaling exercise. And for some people, painting or, you know, some other venue can work as well, to just really try to move through some of the suffering that you’ve endured. Yes, that was something we talked about in our last podcast. One of the things that I really started thinking about is the nature of suffering, you know. We in Western culture are, you know, oftentimes so privileged and so comfortable, that we can kind of get into a space where we feel that we should never suffer. And we forget sometimes the value of suffering. And you know, I don’t want to belittle in any way the immense suffering that some people have gone through over this past year. But I do think it is helpful to think about how it is that our frame of reference really can make suffering even worse in certain circumstances. And, you know, it’s all about expectation, right? So, and this is going to sound a little bit contrary to what I said earlier, which is that people who are a little bit more optimistic, you know, they tend to have this protectiveness around them, that helps them be a little bit more resilient. But on the other hand, if you’re so optimistic that you don’t think anything should ever go wrong, then it’s very disturbing when something does, and it feels unfair. It feels unjust. And that adds another layer of suffering. And so one of the first things about suffering that I think is important to kind of reflect on is that there is value there, it’s not easy, but it is possible at times for us to find value from things that we’ve gone through that are very difficult. And, you know, it’s how we learn. How we develop trust from somebody is working through difficult problems together. We suffer together. Some people even choose to suffer. I think it’s, you know, to me, I find it hilarious that some people want to run a marathon. To me, that is torture. But we do know that if you choose that type of suffering, that it’s not quite as bad than if you did not choose it. Some people would say that I was crazy for deciding to get a PhD and suffering through my PhD program, right. But the fact that I chose that helps give me strength and conviction and got me through the difficult times because I had this inspirational goal at the end. So I think that it does help to think, you know, there are times we are going to suffer. It’s kind of amazing that we’ve not been in this type of a global pandemic in our lifetimes. The other thing about suffering is that because we can think about the past and worry about the future, as well as the present, it means that we can suffer in all three time zones, so to speak. And so some people say that when you are worrying excessively about the future, you’re suffering now and you’re suffering when it actually happens. And sometimes when the real thing happens, it’s not as bad as you imagined. So really kind of thinking, am I suffering more than I need to be? Am I worrying too much about things, especially if they’re things that might not happen? And if you are, then you might not be suffering exactly at the right time. If you can put off suffering a little bit until you really know how bad it could be, then you’re reducing your suffering. And then the last thing that I wanted to just kind of mention before I get into the more practical things, is that, you know, one of the ways that we bond with each other, and it can be kind of fun, is by complaining. We all do it, we all engage in it, but sometimes when we’re doing that, we’re not being very action-oriented. And so we’re not actually thinking about “is there any way I can mitigate or fix this problem that’s causing me pain.” Maybe we feel like we’re helpless in this larger system. Maybe we’re just too tired, you know. There could be all sorts of reasons. But, you know, if you’re not focused on the source of the pain, then sometimes we miss opportunities to improve things. And so those are just kind of three different aspects of suffering that I think are helpful to reflect on, as you are thinking about your own suffering over the past year. And as you’re trying to figure out “is there anything, anything that can really come of this that I can take forward, that will enhance my life, bring me more joy, bring me more meaning?” You know, I mean, as I think about it, at a very, very basic level, one of the benefits, very concrete benefits of the pandemic was how overnight, everybody suddenly knows how to use all these electronic communication platforms that I think many of us were pretty clunky on before. And so it allows us to connect to each other in ways that we couldn’t before. And I don’t think there’s any turning the clock back on that. And so, you know, that there’s benefits to that, that we get to keep as an example. But let me get practical. You know, the first thing I’ll say about being practical and thinking about, you know, the things we’ve missed out on over the past year, you know, when you think about grief, it’s not just about losing people or pets. It’s about losing opportunities. It’s about missing big life events. It’s about not having, you know, the vacation you wanted, not having the wedding you wanted, not being able to visit a loved one, not being able to say goodbye to somebody who died, not being able to have a memorial service, not being able to have your normal routines, not being able to just chit chat with your friends at work. I mean, there’s so many big and little things that most people have lost out on over the past year and a half, that it really means that there’s a lot to grieve. And you might not have labeled some of those things that you’ve missed out on and your emotional reaction to them as grief. But if you’re feeling kind of blah, if you’re feeling a lack of energy, if you’re feeling a little bit depressed, it could be because you’ve got kind of layers of some grief there. Might not be heavy grief, or maybe it is. It really depends on what you’ve been through. But if you think about the grief, some of you might be aware of Elisabeth Kübler-Ross, who had five different emotional reactions to loss that might ring a bell for you. So their denial, anger, bargaining, depression, and acceptance. You don’t have to go in order. You don’t have to experience them all. But you might be feeling any number of these. And you might have over the past year and a half. I remember in the beginning, before we went on our first lockdown thinking, “Oh, I remember the H1N1 pandemic, that wasn’t that big of a deal. Like, you know, this virus isn’t going to impact us that much. In fact, if we had to stay home for two weeks, that might be a nice change in routine.” I was looking forward to that, right. I had no idea, I think none of us did, partly didn’t have the information and partly were a little bit in denial, maybe. And then, you know, a lot of people felt very angry. So, you know, I know in the health system that was maybe feeling that there wasn’t enough protective gear available. Maybe in some of their work settings, it was feeling like there weren’t other protections in place, you know. There’s so many different ways that people were fearful, you know, we did not have very much information in the beginning about how this virus transmitted, how lethal it was gonna be, how long it was gonna go on. And it just was impossible to feel adequately supported. And so feeling angry because of that is a totally normal experience. You also might have been angry about the fact that some of your family members or friends were not taking it as seriously, or were taking it more seriously than you. And, you know, were kind of harassing you about it. Then, things started kind of going on for a while. And that’s when the bargaining started, right? It’s like, well, maybe in that first surge, you’re thinking, “Okay, all we have to do is lock down really hard for four weeks, you know, maybe, okay, maybe two months.” And then that just went on and on and on. And so we slowly really had to acclimate to this new reality. And then it’s interesting, too, that when we started hearing about coming back to work, there’s also bargaining thoughts that happen then, “But I’ve been working fine at home, do I really have to go back to the office, like, tell me why this is important. And what if I just do one or two days a week.” You know, so bargaining kind of comes back up again now. Depression, a really common feeling, especially if you’re feeling overwhelmed, if you’re feeling isolated. And the worst part is having some depressive feelings. So just feeling like it’ll never go away. You know, feeling like you’ll never be yourself again. Some people, they acclimated to working remotely, they acclimated to the new normal, they actually like it or they feel like they can do it. And so, you know, a sense of self competency and agency and all of that kind of came along, and it feels like something that could be in the rearview mirror soon. I think, you know, with the Delta surge, there was a little bit of backsliding when people felt like, “Oh, but we were turning the corner, and now here we are, again.” And so I think a lot of people feel kind of a resurgence of, you know, frustration, and sometimes anger, sometimes depression, anxiety, all of those things are kind of going back up a little bit as we’re having a surge. And if we have more surges, I’m sure they’ll happen again. So some people, you might just have lots of those feelings, they might all be interchangeable. We might fly through them, you might be stuck in one, any of that would be normal. But regardless of where you’re at, which of those emotions you might be feeling, and, you know, on top of that, some of you might have some trauma feelings, too, you might have had some pretty traumatic experiences over the last year. For any of those symptoms, it really is helpful to acknowledge that you’re experiencing them, to label it. Because when you label it, that allows you to be kinder to yourself, that allows you to think about what’s helped me in previous times when I’ve been going through grief, and it allows you to get advice from what we know, based on research can be helpful in those situations. And, you know, one of the first things is to remember that you could have reminders and things that trigger your emotions in different ways that you don’t even really expect. And so when those occur, and you’re kind of surprised, like “Why did I get grouchy at that? Why am I getting irritable? Why did I get jumpy? What happened that caused that? What is that reminding me of? Is there something that’s going on that’s triggering me or reminding me of something that I haven’t really spent enough time thinking about or talking about?” You know, some people will get through it quicker than others. For some, it could take months, it could take a year, it could take two years to really process everything that’s happened in the last year and a half. But really central as we were mentioning earlier is finding people that care about you, that you can tell your story to and that you can also reciprocate by listening to their stories. You can physically take care of yourself. Just be patient with yourself and cultivate some of those same skills we talked about earlier in terms of looking for some of those things that bring you joy or meaning, cultivating gratitude, looking for silver linings. So you really like want to go on the hunt, so that you can balance out some of the more difficult emotions you’re having with some little moments of relief. And those are some of the things that you can really do to more thoroughly process everything that’s happened, and have the best chance of really cultivating some value from it in a way that you can translate into helpful new ways of thinking, helpful, new routines, and, you know, helpful new goals for your life.

Dr.  Wendy Slusser  22:53

That summary is so rich in advice and actionable steps. Trying to sum it all up, I mean, one thing that so many people will say when you do have grief or sorrow is that time is your friend. And by you describing all these different stages that you might go through to process your sorrow, that takes time. And also one of the things you highlight is the sense of recognizing, you mentioned recognizing your feeling of sorrow, but really in a way you want to recognize each of those parts of the stages of grieving or sense of loss. So that would allow you not to be feeling hopeless, for instance, in the stage of feeling down in the dumps, you know, and not feeling very excited about your day-to-day life, knowing that is part of a normal healthy process of grieving is sort of like raising a teenager, when they’re a little bit more pushing you back in the middle of their teenage years. You know, that’s okay, that’s part of the stage of growing up. Right?

Dr. Brenda Bursch  23:58

Right, accepting all the different parts. You know, even when we’re talking about the loss of a loved one, you know, and someone’s in the very deep throes of very intense grief, if they’re also able to look at some photos of that person and smile, or tell funny stories about something that they did with that person with other friends or family, you know, and really have that range of emotions so that you can be angry, they died, you could be just utterly tortured, that they died with terrible grief, and sadness, and also have these moments of glee, then I don’t worry about those individuals. I know that, you know, they have access to all of their emotions, and as long as they can continue to tap into all of them, they’re going to move through their grief, and they’re going to be able to go on and, you know, still miss their loved one, but be able to put it in a context where they’re not always overwhelmed with that intense grief over time. And so I think can be said for, you know, the grief of other things as well, not just the loss of a loved one.

Dr.  Wendy Slusser  25:05

That’s very helpful to understand those ranges of emotion. If you can feel all of those, at some point in time, that also is encouraging. That’s good. I like that a lot. So thank you. And wrapping up, I just want to say that this episode that we just covered, the first of the three hours that you’re going to be covering. We’re looking forward to your next episode on the second theme for returning to the workplace called recovering.

Dr. Brenda Bursch  25:34

I look forward to it.

Dr.  Wendy Slusser  25:35

Yeah, you’re always a fountain of information, wise, and also so compelling, and practical at the same time.

Dr. Brenda Bursch  25:44

Thank you so much. Appreciate it.

Dr.  Wendy Slusser  25:51

Thank you again for joining us. For more information about today’s episode, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Leave us a rating to tell us how we’re doing. And if you think you know the perfect person for us to interview next. Please tweet your idea to us @HealthyUCLA. Have a wonderful rest of your day. And we hope you join us for our next episode as we explore new perspectives on health and well-being.

#40: Children’s Health & Well-being During COVID-19

Transcript

Dr.  Wendy Slusser  00:02

With over 1.4 million students in kindergarten through 12th grade, Los Angeles County schools had the enormous task of protecting the health and safety of its children. When the COVID-19 pandemic hit, teachers and administrators quickly became experts in online education, and environmental health and safety. UCLA pediatrician and medical epidemiologist for the LA County Department of Public Health, Dr. Nava Yeganeh, joins us today to address concerns for our children and discuss how schools continue to respond to the pandemic to ensure the safety of their students. Dr. Nava Yeganeh, such a pleasure to have you here on our UCLA Live Well Podcasts. I’m really looking forward to talking to you about concerns regarding children and COVID, something that’s very top of mind for parents as schools are opening back up and in person instruction is taking place. So to start off, what can we look forward to with this return to in person education?

Dr. Nava Yeganeh  01:09

Well, it’s really wonderful to be here. Thank you for having me on this podcast. So we are all very excited to resume in person education. As you know, COVID-19 has obviously had a devastating effect on our society. More than half a million individuals have died in the United States, and millions have fallen into poverty. Some people are losing their homes and livelihoods, struggling to feed their families. But we also appreciate that this devastation has not only been felt by adults, but by the children, especially those low income children and children of color. The silver lining is that we know so much more about the pandemic. And we know exactly how to now mitigate the risk to children and to adults as well. And so we can really, hopefully, help create these safe environments for in person education and allow our children to resume a more normal sense of well-being.

Dr.  Wendy Slusser  02:02

That is really top of mind for so many people with their children having missed a year and a half at school, some two years. And I’d like to know from your point of view, what are some of the main concerns that these parents might have going back to school at this stage?

Dr. Nava Yeganeh  02:18

Yes, I think every parent that things that they want from their child is to be healthy and to be happy. And they want their children to enjoy school, but they also want their child to be safe. And like you mentioned, kids haven’t been in school. Some kids haven’t been in school for 18 months. And although they’re incredibly resilient, it is a scary time for a lot of children and parents. It is going to be a transition, and some families do better with transitions. Some struggle a little longer. And I think it’s very important for all of us to be really patient with each other. And to have a lot of compassion as we all try to navigate, you know, this new change and new time in our lives.

Dr.  Wendy Slusser  02:56

So what I’m hearing you say, Nava, is one, it’s a transition, which might require different kinds of focus areas to work on as a parent or caregiver, or child. And the other is make sure people are safe.

Dr. Nava Yeganeh  03:12

Exactly. I think all of us here, you know, and I work for the Los Angeles County Department of Public Health, as well as being a pediatrician. I’m looking at the epidemiology and trying to figure out how to keep people safe. And that’s really our focus is to create these safe environments for children can thrive and develop more well-being.

Dr.  Wendy Slusser  03:31

And so these health and safety concerns, they’re really now bifurcate, I would think between the under 12 year olds and the over 12 year olds, given the approval of the vaccine. How do you differentiate that in policy? And is there any difference in the way you handle those different age groups at schools?

Dr. Nava Yeganeh  03:52

Yeah, and I think overall, the way that we’ve been thinking about COVID-19 is that there’s not one clear way to mitigate all risk, that you really need to have a layered approach. And so for children less than 12, I think, again, you know, there’s layer strategy. So really improving ventilation in the buildings as much as possible, whether that will be through open windows and doors and affordable HEPA filters and improving filtrations in school systems, which I think many schools are taking advantage of some federal funding to do that. And then we also need masks. So with another layer of protection is, you know, making sure every individual wears a well fitted mask that covers their nose or mouth and their chin. And then finally, you know, even though kids can’t get vaccinated, and that’s, of course, very frustrating. We know that the adults can get vaccinated. We know that the older kids can get vaccinated. We know that the parents and grandparents can get vaccinated. And we’re hoping that, you know, with these high vaccine rates and these vaccine eligible people, we can kind of cocoon the children as much as possible. But it really does require everyone in the community to take advantage of the vaccines. So it is definitely something of concern.

Dr.  Wendy Slusser  05:03

Yeah. Well, clearly, if you look at the national statistics, the vaccination rate really does impact the prevalence and also the hospitalization and even mortality rates from COVID. And so what you’re saying is the onus is on all those eligible to get vaccinated to protect our next generation or less than 12 year olds?

Dr. Nava Yeganeh  05:22

Exactly. I mean, that’s the entire idea behind vaccines. If you are able to get enough people vaccinated, you really do cut the transmission significantly. And even if this vaccine isn’t the perfect vaccine for the Delta variant, there are some breakthrough cases. First of all, it is incredibly powerful to prevent hospitalizations and deaths, like you mentioned. The second it does seem to decrease transmission as well. So if you’re able to get in that high enough level of vaccine, you are going to cut down transmission significantly.

Dr.  Wendy Slusser  05:54

Yes. So you talk about this layered approach, brings to mind Michael Lewis’s book, The Premonition, and his description of that layered approach being thinking about Swiss cheese and putting Swiss cheese on top of each other. So eventually, there’s no way you can go through it from each hole. And one of your layered approaches you mentioned were masks. To the parents listening, what would you recommend them to use for their children?

Dr. Nava Yeganeh  06:22

Yeah, so I think this is a an area of intense interest as well. In general, the mask that I recommend is the mask that your child will wear and is comfortable for them. So something that they can keep on their face for the entire duration of school. And a lot of kids are doing extracurricular activities and sports, and they still have to wear the mask. So they’re, they find the mask uncomfortable, they’re not going to keep it on their face. So number one is comfort. As far as quality of masks, we want masks that have multiple layers. And if you’re able to do it, you know, to have that extra filter. Like there’s the masks that have the area that you can add an extra filter. And then some people’s kids actually tolerate surgical masks, as long as they’re appropriately sized for their face. I think there is some benefit to having a higher quality mask. So it really depends. I think, in general, the mask that I would recommend is the mask that your child will wear and just trying out different masks. And making sure they fit their face comfortably, especially for younger kids, to like be able to teach them how to adjust their masks and pull them on and off. I have a five year old, and I noticed that if I have a certain type of mask, he’ll keep it on. Other masks, the lanyards sometimes slide off his face. And he just doesn’t notice. He doesn’t really, you know, he doesn’t adjust it appropriately. So just making sure that your child is able to keep their mask adjusted on their face in a way that is protective.

Dr.  Wendy Slusser  07:42

That’s really a pediatrician being practical. And I so agree with you. And also being a mother of a five year old and a nine year old, that helps too. You know exactly firsthand how to advise people. I want to back up a little bit about what you said about filters, so people are aware of what you’re describing. Because they’re, the filter you’re describing is one that would fit into a little pocket of the cloth mask that was often made homemade even. But the filter itself you purchase. That’s what you meant, right?

Dr. Nava Yeganeh  08:15

Exactly, that’s what I meant. There’s these little rectangular filters that you can put in a pocket of a mask, and some masks come with that pocket already. And there, so you just slide in the filter to add additional protection.

Dr.  Wendy Slusser  08:27

The other question I have, if you were to use a face covering that was reusable, how often would you wash it?

Dr. Nava Yeganeh  08:33

That’s a good question. I tend to wash my children’s face coverings every day just because they tend to get dirty. They are very active children. They wear them all day. They’re wearing them indoors, outdoors. So, you know, I do like to wash them regularly. I think if the face covering is soiled, if it’s wet, it’s not going to work as well. So I would say to have more than one face covering for each child for their day at school, so they can replace them in case they get wet or dirty.

Dr.  Wendy Slusser  09:02

Ah, so bring an extra one in their backpack. That’s a great tip. And you hand wash them.

Dr. Nava Yeganeh  09:08

Yeah. And now I’m hand washing them. He’s using a type of face covering that is has been really great for him for sports. It’s more of the duckbill. So it doesn’t get into his mouth as much when he’s playing sports. And that one requires hand washing. Yeah, I would just follow the instructions for the face coverings.

Dr.  Wendy Slusser  09:27

You are an infectious disease doctor and also a pediatrician, and you talked about transition. What advice would you give to families with the transition and how to alleviate fears of the child who might also be fearful of infection or safety issues?

Dr. Nava Yeganeh  09:44

Yeah, I think every child is really unique. And I always say that every person has this unique relationship with COVID-19 and the pandemic. So some of course have lost loved ones to the disease. They’ve seen how it can devastate a person they adore, you know, they love. All obviously suffered some losses, but it’s different levels. So I think it’s really important to gauge your child’s concerns and questions about the virus. And so I think, you know, asking probing questions like, “Do you have any questions about this virus that’s going on? What do you understand?” And then, you know, being very calm and reassuring and being able to answer their questions. The other thing that I think is very useful is to try to have your child do specific things to feel in control. So talk about how they can keep people safe, whether it’s through hand washing, wearing their mask, being able to adjust their mask themselves. And then letting them know that even though this is devastating, you know, tragic pandemic, there are a lot of ways to prevent infection. And to make sure they understand that there are vaccines that prevent people from getting sick. There are treatments if someone does get sick, and there’s ways to prevent getting sick. So I think giving that information to children will help them feel a little bit more in control of the situation.

Dr.  Wendy Slusser  11:04

So one is having a sense of control for the child and the parent, sounds like. And also anticipating the day and what the day would bring for their child. What do you advise parents? If you get a question that says, “Well, my child is more of a follower, and if their friends take the mask off, they might take their covering off?” What kind of advice would you give to that parent?

Dr. Nava Yeganeh  11:29

Yeah, I mean, I think that, again, every child is so different. But I think it’s very important to help them understand why we’re recommending masking, and how important it is to just to keep their body safe. That it’s meant as a way to improve the health and safety of everyone in the classroom. That being said, we here in California, especially in Los Angeles, we’re requiring masking. It’s not really an option when you’re indoors. When you’re outdoors, I think some, there’s some more flexibility, especially if you need a mask break. And again, we are trying to have as much flexibility and compassion for people who maybe have a lot of discomfort with the mask. So we do want to acknowledge that and give them a space to take it off and take a few deep breaths. But in general, it is mandated in Los Angeles County that every single person wear a mask for the duration of the school day, especially, you know, indoors.

Dr.  Wendy Slusser  12:22

I like that concept. So instead of recess, you know, go outside, six feet apart, and take your mask off and smile at everyone and wave.

Dr. Nava Yeganeh  12:32

Yeah, and some schools aren’t allowing that. So I don’t want to say every school, but for LA County, we are requiring indoor masking. They’re not requiring outside, so that would be a good time for someone, who’s really struggling with a mask, to take a break. Yeah, we just need to have compassion and empathy for people who might have a more difficult time keeping that mask on. It’s a process for all of us.

Dr.  Wendy Slusser  12:52

Sure is, and it’s an ever changing fluid process, isn’t it? What age do you recommend using a mask?

Dr. Nava Yeganeh  12:59

So I would follow the AAP guidance. To start after the age of two. Again, I think that it is a process. So a two year old is learning how to potty train and learn using, learning how to use their words to ask for things. So there’s a lot of processes going on. So some two year olds will need a little bit more time to learn how to use their mask appropriately, and some get it right away. But just being patient and ensure they know you’re doing it to improve their safety.

Dr.  Wendy Slusser  13:26

There are a couple of areas I’d like to talk a little bit about with you. One is the first stage of sheltering at home in March of 2020. Give us sort of a 18 month, sort of 30,000 foot description of the process that has happened with the school district in regards to COVID.

Dr. Nava Yeganeh  13:47

So as you mentioned, I think was March 12, March 13. That’s when most schools and Los Angeles County, if not most of the world, shut down. And at that time, it was a very quick transition to distance learning. So the buildings shut down. The teachers were trying to navigate this unknown territory of doing a lot of distance education, getting technology to every student. And I think that was a period that was very difficult because there was no preparation. Going into the summer, I think there was a lot of hope that we could reopen schools, that maybe there would be some opportunities for in person education. But unfortunately, some places, again, started having a surge in the summer. And because of those high numbers, especially in Los Angeles County, most districts chose to remain distance. So going into the new year, they had a little bit more time to prepare. There was more resources available to families to do the distance education. And so again, most students stayed at home. As you know, we started reopening in the fall. Unfortunately, then we had our second, very large surge end of 2020, November and December of 2020. So again, there was less enthusiasm about restarting schools at a time when we had such high community case rates. So distance education was continued. Starting in 2021, our case rates started going down. We were able to give vaccines to the most vulnerable in our communities, including and, you know, grandparents and skilled nursing facilities and health care workers. And then by March, we were able to start vaccinating teachers. And I think that really made people feel like going back to in person education would be a safe option. And Los Angeles County, that’s where a lot of schools began opening, was in spring of 2021. Most of the individuals who were in the public school districts decided to continue distance education. They had, you know, a lot of anxiety back going back to school. So children were going to school, but a lot of them were still doing that distance learning.

Dr.  Wendy Slusser  15:51

In your role as an advisor to the school district: What was your role at that stage? And what did you advise? And what did you observe as we were opening?

Dr. Nava Yeganeh  16:02

So in the spring, when our case rates were to a level where we felt very comfortable opening the schools, there was a lot of advice being given about how to maintain safety in the school. Going back to school in the era of the pandemic requires a skill set that many schools had not developed yet. So as a school administrator, you are now holding vaccine events for your faculty, or staff. You are also doing exposure management and contact tracing. So you’re, you know, finding people who are infected, trying to figure out who their close contacts are, and working with the Department of Public Health to identify these individuals and asking them to either isolate if they were infected, or quarantine, if they were exposed. You were also trying to navigate the system of making the school more safe. So you were learning about ventilation, and filtration, and HEPA filters. So you were learning how to encourage masking. There was just a lot we were asking our schools to do in a relatively short amount of time. And again, they went beyond what we asked, often. They really did want to make the school as safe as possible. But it does take time. And again, this was a big transition for us to ask schools to start bringing students back in for in person education. Again, the schools that did it, did it very successfully. With a group at LA County published and MMWR that was out today, that showed that our case rates were actually much lower in the schools as compared to the case rate for children in the community. So schools were very safe and this spring.

Dr.  Wendy Slusser  17:33

Perfect.

Dr. Nava Yeganeh  17:34

Yeah. So going into the summer, we all had a lot of enthusiasm thinking that our case rates were really very low. And we were very excited to reopen schools. Of course, in the middle of summer, as you know, the Delta variant became the predominant strain of the virus and transmission rates went up. Our case rates started going up again, unfortunately, schools had to reopen for all students, kind of in this background of a higher community transmission rate than we hoped. But again, schools are committed to creating safe environments for their student body, and they’ve done everything. And at this point, they’re becoming experts in exposure management, of creating safe school environments, of doing vaccine clinics for their students and their staff. And they’re really looking at different ways to continue to keep kids safe and engaged in schools.

Dr.  Wendy Slusser  18:24

That makes me proud of the Department of Public Health here in Los Angeles and also the partnership that they have with LA schools. I wanted us to go back to the MMWR that you mentioned. Can you please translate the acronym MMWR for our listeners and also the significance of actually publishing something in that journal?

Dr. Nava Yeganeh  18:46

Yes, so the the MMWR is a morbidity and mortality weekly report. It’s a series of publications that the Center for Disease Control publishes every week. And so it really is trying to, it’s so it is a series of reports. They’re usually brief. It’s trying to give you as much information about what’s going on on the ground all over the United States in a very timely manner. So they try to get the publication out quickly, but it does go through a peer review process. So it does go through several different groups at the CDC, the Centers for Disease Control, to make sure that that reporting is accurate.

Dr.  Wendy Slusser  19:23

So your finding: Can you explain it one more time to the audience so that they can really understand and why it’s so important that it did come out at this stage where people are opening up schools.

Dr. Nava Yeganeh  19:35

So the MNWR really looked at COVID-19 case rates, looking at transitional kindergarten through grade 12 and the community, and it looked through the dates of September 2020 to March 2021. And I think it’s important to note that we have 1.7 million children who are age five to 17 years old in Los Angeles County. And what it really looked at was comparing the case rates amongst children and adolescents and adults, who were in school, versus those who did not attend school, who were in the community. And you could really look at the figure where they show that it seemed like the case rates per 100,000 were higher in those who were in the community versus those who are attending in person education.

Dr.  Wendy Slusser  20:18

Wow, that’s really powerful message for everybody to hear, especially parents who are very concerned about returning their child to in person education, that they might be actually safer in the schools based on what you’re describing.

Dr. Nava Yeganeh  20:31

Yeah, I think it’s because we have such a high standard for safety at schools right now in Los Angeles County. We are really recommending every single mitigation strategy layered on top of each other. It’s much harder to do all of that in the home setting, obviously, wearing your mask all the time, being in well ventilated spaces. It’s much easier to do them in a school where children tend to listen to the adults.

Dr.  Wendy Slusser  20:56

I think that that study and that data is really reassuring for parents to hear. I mean, as a parent and a pediatrician, that would be very compelling information for all of us to be sure our children go back to school, not only for the advantages of in person learning that many children really thrive in, but also the fact that it’s also potentially safer for them in the long run.

Dr. Nava Yeganeh  21:24

Exactly.

Dr.  Wendy Slusser  21:25

I’m thinking one point that I think would be important for our listeners to understand is you’re talking about case rates. And are you talking about hospitalization, death, or the prevalence in the community.

Dr. Nava Yeganeh  21:38

Currently, we’re seeing high case rates of people who are diagnosed with COVID-19. We are doing a lot more testing in Los Angeles County. We’re doing hundreds of thousands of tests every single week. You can actually look up the data for how many tests we’re doing. But we are really robustly testing, especially in the schools. So many of our schools are screening children once a week to see if they have COVID-19. So we are expecting that because we’re testing so much we are going to see a higher number of case rate.

Dr.  Wendy Slusser  22:09

Right.

Dr. Nava Yeganeh  22:10

Hospitalizations are creeping upwards. So that is unfortunate. It’s mostly predominantly unvaccinated individuals. And we are seeing a creep upwards in death as well. But again, unvaccinated individuals. So if we were able to get more individuals vaccinated, I think we would not see as many hospitalizations and deaths. And we could really prevent a lot of our transmissions in our cases, and again, keep our school safe. Because if you have lower community rates, you’re going to have less cases in school, you’re going to have less quarantining.

Dr.  Wendy Slusser  22:41

Yeah, that’s a very important point, drill home to everyone. And again, to keep our children safe, and Pfizer’s now approved by the FDA for adults.

Dr. Nava Yeganeh  22:52

Yeah, so they received full licensure for 16 and above. Yeah.

Dr.  Wendy Slusser  22:57

So you know, you also not only have been providing guidance to LA Unified School District about COVID, utilizing your infectious disease expertise in pediatrics, you also provided advice to the pre-K through 12 workgroup at the UCLA COVID-19 Response and Recovery Task Force. I just want to let our listeners know that this workgroup was specifically looking at the needs of pre-K through 12 at UCLA related to COVID issues, which is something that many people might not realize that UCLA also teaches and cares for zero to 19 year olds. But also the goals were discussed, new county guidance documents, track relevant data for reopening pre-K through 12. And I’d love to hear your words of wisdom about what you learned from that experience.

Dr. Nava Yeganeh  23:52

Working with a leadership for the pre-K through grade 12 group was really just such an honor. They’re just a fierce group of leaders, who really were willing to do whatever it took to create a safe environment for children. I would say that the things that I learned is that you have to be flexible, and it is really a very dynamic time. So I remember when we first started the ECE, the Early Childhood Education Group, you know, they reopened very quickly after. I think it was in June, so June 2020, that’s when they reopened. And we didn’t have as many of the guidelines and research showing how to keep schools safe. And that data and that landscape was very much evolving. As we, we were trying to build the plane as we flew type situation. So we learned, you know. Initially, we were just keeping the kids outdoors, but we weren’t using masks. Then data and recommendations came out about mask use, and then we were able to incorporate masking into our guidance. Then there was data and science showing the usefulness of HEPA filters. So again, that was something that we were able to incorporate. And, it just shows how incredible the leadership and the teachers were, that they were able to really roll with the punches and continue to serve the children throughout all of these changes that were almost weekly. So that was a wonderful experience. But I think the flexibility was key. And then also, we were just very lucky because we had the resources and support of UCLA. You know, UCLA has a great testing infrastructure in place. UCLA’s campus is beautiful on and outdoors. They have a engineering team that can come and help us with our ventilation systems. There are physicians who can help with symptoms monitoring, the symptoms tracking, so that, you know, there was so many resources available that maybe other districts would not have at their disposal, so.

Dr.  Wendy Slusser  25:44

As I recall, a lot of those children were the children of first responders, right? So it was really critical to have that resource for people so their children can be watched, while they served either in the hospital system or on the campus itself. And so the lessons learned really sound like bringing together a group of people with varied disciplines to focus on a group or a problem that you did very effectively in terms of opening up the pre-k part of this pre-K through grade 12 system doing in person.

Dr. Nava Yeganeh  26:23

Most of the schools did have in person education last year. But I think that was really nice, because we had principals in that task force. They had a lot of lessons that they learned from each other, but also, they each had their own specific concerns. Even if we couldn’t solve their specific problem, it was good to have a group to hear about what they were experiencing.

Dr.  Wendy Slusser  26:44

Really having this major stakeholders and leaders and at the table during the crisis was a critical piece to the success of reopening.

Dr. Nava Yeganeh  26:53

And I think so much of navigating this pandemic has been about communication. Communicate, not only amongst the leadership, but also with the stakeholders. And that includes the teachers, the labor groups, the parents, and of course, the kids.

Dr.  Wendy Slusser  27:08

Yeah. So Nava, that’s tremendous. And hats off to you and your team for being such good advisors to our school system. We’re really grateful that we have you and your colleagues thinking about this, and really problem solving in a way that’s really giving to all of us. So I’d like to end with two questions. One is, do you think there’s anything that we’ve learned that is positive during this time, from your point of view from this pandemic?

Dr. Nava Yeganeh  27:36

Well, I think we’ve learned again, that we are stronger as a community, if we all think about each other and really work collectively towards shared solutions. You know, we can’t just depend on individuals to do the right thing. We need everyone in the community to work together, whether that’s wearing masks, whether that’s you know, getting vaccinated. We really do require every single person to do their best and do it for everyone else in our community. As far as schools go, I do hope that some of the money that’s being allocated to COVID-19 relief efforts is actually improving the infrastructure of the school. So I’m hoping that some of that funding is going to change the schools in a very positive way that will have lasting implications for years after this pandemic, whether that’s just improving the filtration systems, but also just recognizing the importance of digital technology and how we can actually incorporate that into our education systems.

Dr.  Wendy Slusser  28:32

Yeah, and I’ve heard a lot of schools are also building outdoor spaces for learning, which will totally enhance not just learning, I think, but also well-being.

Dr. Nava Yeganeh  28:42

This is the most important thing, maybe we can do again. Probably the safest school for COVID-19 is one that’s outdoor, so the more we can utilize outdoor education, the better, then the safer we are.

Dr.  Wendy Slusser  28:53

Well, to end this, what keeps you up at night?

Dr. Nava Yeganeh  28:56

You know, I think the the thing that keeps me up at night is that inequities. We just know that a lot of times, the pandemic has widened the inequalities between those who have resources and those that don’t. And I really hope that we can start addressing some of these gaps. So I think that’s really what my focus and the focus of the Department of Public Health is, is to make sure that everyone has the same opportunities for things like in person education, for vaccinations, for appropriate access to health care, things of that nature, so.

Dr.  Wendy Slusser  29:30

Yeah, that’s really important. And you were talking a little bit before we started this podcast also about sport opportunities, or athletic opportunities, need to be equally available to all.

Dr. Nava Yeganeh  29:43

Exactly. And also, people have fallen out of their regular routine. So they’re not going to their pediatricians quite as often. They’re not up to date on some of their vaccines. They’re not getting their well child checks, which are really important for helping prevent health issues. So I think that’s the other concern I have is making sure that everyone, every child has a medical home and is able to get appropriate preventative care, as well as treatment.

Dr.  Wendy Slusser  30:10

Yeah, that’s a really important message. All those parents who’ve deferred the checkups, please go. Because your child might even need a pair of glasses. And they’ll learn better with those if they can go and have their eyes checked even. And of course, vaccinations not only for COVID, but they are eligible for all sorts of other vaccinations. And that’s something that we could pursue at this stage, flu vaccine being one of them.

Dr. Nava Yeganeh  30:36

Exactly. And, you know, there’s a lot of vaccines that are required for schools, and a lot of children still haven’t been able to catch up. So really trying to get you, get kids back into their medical homes to get all these really important and preventative checks.

Dr.  Wendy Slusser  30:50

Well, Nava, this was a really informative, powerful conversation with you. Thank you so much for everything you do. And you are a real treasure for all of us to have a resource like you to be able to guide all those millions of children, who really need to be cared for not only by their parents, but by our community and our public health system. So thank you for that.

Dr. Nava Yeganeh  31:15

Thank you. Thank you so much for all you’re doing to improve the health of kids as well.

Dr.  Wendy Slusser  31:22

Thank you again for joining us. For more information about today’s episode, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episode, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Leave us a rating to tell us how we’re doing. And if you think you know the perfect person for us to interview next, please tweet your idea to us @HealthyUCLA. Have a wonderful rest of your day. And we hope you join us for our next episode as we explore new perspectives on health and well-being.

Episode 39: Getting a Good Night’s Sleep with Dr. Alon Avidan

Transcript

Dr.  Wendy Slusser  00:02

When is the best time to nap? And what is the ideal length? How can you rethink your diet to help you get a better night’s sleep? What does COVIDsomnia mean? Today, sleep neurologist and the director of the UCLA Sleep Disorder Center, Dr. Alon Avidan, explains the impact of COVID-19 on our sleep behavior, and share strategies to get a better night’s sleep. Dr. Alon Avidan, such a pleasure to have you here today. And I was so grateful when I opened up your email a couple of weeks ago, and one of the things you sent me and really piqued my curiosity and made me want to interview you for this podcast was this concept of COVIDsomnia. Before we talk about COVIDsomnia, I’d like to have you explain to me why quantity and quality of sleep is so important for us all.

Dr. Alon Avidan  01:03

Thank you so much Dr. Slusser for having me on board. And it’s always nice to speak on a topic that is near and dear to my heart. It’s Sleep Medicine. And this is such an important period of time in everyone’s lives, say when things are not the same. And something we take for granted, sleep, is nothing but routine since a pandemic, and I’m so delighted that you are having me on the show to talk about sleep. Your first question is a very important one. Sleep duration and sleep regularity. Sleep duration is by age and duration of sleep, we mean specifically how much time the patient is actually sleeping. And oftentimes patients, they forgot that we’re not really talking about the time in bed. We’re talking about the time in which you’re actually sleeping. And for people over age 18, their recommendation by the American Academy of Sleep Medicine, the Sleep Reearch Society, and the National Sleep Foundation all recommend seven to eight hours of sleep duration on a regular basis. So the duration is ideally about eight hours. Regular sleep implies that you go to bed and wake up at the same time every single night. Now why is that important? Well, it turns out that having a regularly occurring sleep timing aligned to the outside environment to the light and dark cycles outside is important for proper circadian function. And what do I mean by that? Well, you all know that the eye serves two functions, specifically, vision and circadian regularity. And when we’re getting light and darkness signals from the environment, we’re using the eye to tell the circadian clock in the brain when to go to bed and when to wake up. So typically speaking, when the sun goes down, and people kind of have dinner and relax and socialize, watch TV, etc. And by 11 o’clock, 12 midnight to the latest, most people go to bed and having an established normal pattern that is aligned with the outside environment is very important to maintain proper circadian function. This is really critical because every cellular process that takes place in the body is tied to that circadian clock. So when growth hormone is produced in children is timed when slow wave sleep occurs. And that’s regulated by the circadian patterns. Timing of immune response, immune function, very critical during the pandemic. Low sleep, less than six hours of sleep, reduces your immune response. Lower immunity, you’re going to be at higher risk for the pandemic, particularly even after getting vaccinated. The vaccine may not work as well. Timing of the turning on and off of certain physiological functions that relate to metabolism and handling of sugar in the bloodstream is all related to that circadian function. And delay or abnormal advancement of that circadian pattern is often associated with more abnormalities in normal physiology. Take for example, I’m going to, I’m not going to be very specific. I’m just going to give you one specific example, which relate to how you do when you have jetlag. Just two hours or three hour of difference between here in LA and New York City and the first day, the first day or two, most people feel a bit lousy. They’re tired the next day. They can’t think right. They often have stomach issues. And it all starts because our bodies need to adjust to a new level of physiology to handle when we usually eat, when we’re having conversations, and we make sense during the conversations, that all has to do with when the circadian function and how quickly it’s able to adjust to that new time zone. And of course, with the pandemic, things have gotten fairly abnormal in terms of the sleep duration, and equally and perhaps more abnormal related to abnormalities in circadian timing of one’s bedtime. So I know this is a very long winded answer to a rather simple question, but it’s very critical question that is really fundamental. We can’t talk about sleep without talking about, well, what is normal sleep?

Dr.  Wendy Slusser  05:47

Well, starting with the basics, like what you just described to us: duration and routine. It sounds so simple. So let’s start with a few follow ups on duration. What happens if you aren’t sleeping through, like, you might get seven hours, but you wake up in the middle of the night?

Dr. Alon Avidan  06:04

Really, really important. So sleep duration, and the fact that you have uninterrupted sleep, that is absolutely critical. Give you an analogy. Imagine that you’re putting a cake in an oven, and the instructions are, you have to leave it for an hour. And you shouldn’t take it out and just leave it, and it will rise. Same with sleep. If you take that cake every 10 minutes, every 20 minutes and check on it, it will never rise. With Sleep Medicine, the same principle applies. When you go to bed, and hopefully you go to bed at a regular time, and you wake up at a regular time. But during that seven or eight hour interval that you’re in bed, it’s preferred and it’s physiologically more normal to have continuous sleep, uninterrupted sleep. What happens when sleep is interrupted, and why would sleep be interrupted? Well, sleep may be interrupted in the beginning of the night. We call this sleep onset insomnia. It may get interrupted in the middle of the night. We call this sleep maintenance insomnia, or it may be disrupted towards the tail end of the early morning. We call this early morning awakening. And knowing the timing, when one wakes up can tell us some very interesting anecdotes about the conditions that it may have that might precipitate this. So for example, early morning awakening is depression until proven otherwise. We see that very often that individuals who have awakenings at 3, 4, 5 in the morning, way before the alarm are often may have an underlying history of depression. Now, sleep onset insomnia, on the other hand, is often related to anxiety, stress, and we call it sleep onset insomnia. It’s often related to a condition type response in that the individual is associating the bedroom and the bed itself with not good sleep. That is they associate the environment as a place where they should worry and plan and make all kinds of lists in your mind, and it’s hard for them to shut their brain off. That is often what manifests as sleep onset insomnia. Now in the middle of the night, if you have a hard time maintaining sleep, that is often related to even noise coming from the environment or the bedroom not being at the right temperature being a bit on the cooler or a more hot side. We like the temperature to be about 60 to 65 degrees. I know that’s a bit cold, but that’s the ideal proper temperature for your bedroom. And they’re noises, also environmental insomnia. If you live by the airport, the noise, the outside environmental noise is sufficient to create environmental insomnia. And adding top of that is the fact that many people will have other medical conditions, primary sleep conditions and medical conditions, that can disrupt your sleep continuity. Some examples include untreated sleep apnea, pain, problems related to nocturia, which is excessive urination at night. Medications that may disrupt sleep architecture, as well as conditions related to menopause. Women going through menopause experience hot flashes and very unstable sleep and disrupted sleep during the menopausal and perimenopausal period. Now when we’re talking about the proper and the ideal time that someone spends in bed, it’s all about spending seven to eight hours in bed and taking it one chunk. And the other thing, when they, is we often see patients who tell us, “Yes, we’re sleeping for seven or eight hours.” But it’s not all in at night. It may be four or five hours at night, and then two or three hour power nap in the middle of the day. Sleep isn’t that additive. Sleep is not a bank account. You can’t average time of sleep you get in a 24 hour period, and say that it all averages to about seven or eight hours. If it’s very fragmented, it doesn’t work the same. It’s like that cake that never rises. If you’re sleeping less than that seven or eight hour period, you’re never going to wake up feeling refreshed, irrespective of the fact that you got seven or eight hours during the 24 hour period. It has to be taken all at once at night for that particular duration without having too many interruptions.

Dr.  Wendy Slusser  10:47

Well, that just picked my curiosity for so many more questions. For instance, what else would we be doing in bed that might create a longer latency before we go to sleep?

Dr. Alon Avidan  10:58

Well, I can tell you about my patients, many of whom are students, as well as faculty. And, so the bedroom becomes a place for work. The mobile devices are often used before bedtime to check the news, and answer email, text. And sure enough, you find that people are often relying on electronics and gadgets that emit blue light. That’s the danger of this devices is that when people are using them, the light intensity and the light wavelength that the devices emit is enough to stimulate the circadian clock and turns it on, and often delay the release of melatonin, which is often ideal when darkness, and light exposure stimulates the circadian clock. And hence, it often creates a situation where the patient may actually find it hard to fall asleep. And they may end up waking up prematurely, 20 minutes, one hour flight explorer. But you know, most of my patients, say that they’re doing homework late at night, and they often delay and push and make all those requirements that often require them to use a computer to be pushed towards say 11pm, midnight. And we all know that that’s very detrimental to the normal cyclicity of the circadian rhythm. So blue light is absolutely an enemy. And I usually tell people, you know, by nine o’clock, 10 o’clock, you should probably put it away. And if you need to read, you can read by dim light, but not watching TV, working on computers. Electronics are not recommended. And also what you read is important. When I tell patients to read something and before going to bed instead of using a computer. We don’t want them to read novels or the Da Vinci Code. They will not be able to fall asleep until the next day. We often recommend something that’s not interesting. If it’s not interesting to the patient, when they’re reading, it’s actually beneficial. If it’s interesting, the patient keeps reading it, then I think we lose that therapeutic effect of trying to make the patient a bit bored and sleepy so they can go back to bed and actually be able to sleep in their own bed soundly.

Dr.  Wendy Slusser  13:28

That’s great. Well, so I guess in bookstores, if there are some near you, you could have a whole section of boring books that you buy. That could be a part of the wellness section.

Dr. Alon Avidan  13:40

Exactly. Really reserve that time before bed for relaxation, and really for your own ability to unwind. You know, we don’t need to have a electronic device to unwind. That’s a technology that should be put away before you go to bed.

Dr.  Wendy Slusser  13:56

Well, we won’t get into which boring books we would recommend because we might insult someone that’s listening. So we’ll, we’ll pass on that question. But I have a couple of other questions related to duration. And especially given the fact that you’ve mentioned three times you could have trouble sleeping or staying asleep. And one of them comes to mind especially when you think of circadian rhythm, which is food and alcohol. What would you recommend individuals about that?

Dr. Alon Avidan  14:23

Sure. So let me address alcohol first. Alcohol is very enticing, because it makes you relaxed. And when you go to bed, you fall asleep fairly quickly. But then the problem is when you go to bed, you stop drinking. And that’s the problem. Because as the alcohol levels begin to drop, when your body metabolizes the alcohol, you’re wakefulness centers begin to fire up because you’ve just taken a hypnotic in a way. So the problem with alcohol is as the blood alcohol levels drop, your sleep becomes more fragmented. There are many more awakenings and arousals. Two or three hours after you go to bad, sleep apnea becomes worse. You wake up more groggy. When you look at the brainwaves of patients who have taken alcohol, it looks like a brainwave of someone who is in severe pain in the hospital: very fragmented. The deep levels of sleep are often a disproportionately high, REM sleep is delayed, and the entire ability to have a natural rhythm goes into chaos. That’s just one night of having, let’s say one or two glasses of wine. But if you then rely on alcohol to help you fall asleep every single night, well, after a while, you find that one or two glasses of wine is not doing it because you develop tolerance, so you need more. And after a while you find that you, the patient begins to consume more alcohol in a fashion that eradicates any normalcy about their sleep, to have more degree of sleep apnea because alcohol also relaxes the upper airway muscles, making apnea more likely to occur and that can be very disruptive. So we recommend people to give themselves about four or five hours before going to bed if they do have a drink socially, that they should try to give it a little bit of time before going to bed and time the alcohol so it’s not close to bedtime. Let’s talk about dietary items. So definitely chocolate is not allowed.

Dr.  Wendy Slusser  16:42

At night.

Dr. Alon Avidan  16:43

At night. Exactly. Chocolate is of course allowed during the day. And you know, it’s interesting, I’ve seen a children who are having chocolate ice cream and just this chocolate ice cream can do it. And I’ve heard from a parent who I told to stop the chocolate ice cream and her three year old is now sleeping better. So it’s you have to really inquire about you know, not only caffeine, not only chocolate, but foods that contain chocolate, and it doesn’t have to be dark to have caffeine in it. Definitely avoiding caffeine and definitely avoiding a heavy meal, like avoiding fatty foods and heavy foods because that then they tend to create more problems with fake gastric reflux. If patients asked me what diets I would recommend, let’s say if someone’s hungry before bedtime, I recommend having a banana, having a little bit of yogurt, granola, having some nuts. Those are foods that are high in tryptophan. Tryptophan is a precursor to melatonin. And we call those compounds soporific, meaning that they’re very sleep inducing. One other food item that has a lot of tryptophan in it is turkey. And that’s why everyone feels a bit sleepy after Thanksgiving turkey dinner. So those are helpful items to consider. There’s one other recommendation that I often make to patients, which is actually trying tart cherry juice. Tart cherry juice, and you don’t have to have a lot of it. It’s only about two ounces. It has melatonin and a tryptophan sleep inducing substances that is natural, and actually works pretty well for many patients who have problems falling asleep. It cuts down the the latency to sleep, which is the amount of time it takes you to fall asleep. And it’s natural. It’s not the pills. So people are more reassured by the fact that it’s a really a dietary supplement.

Dr.  Wendy Slusser  18:42

That’s a great tip, something I’ve not heard of. Where do you get tart cherry juice?

Dr. Alon Avidan  18:47

Whole Foods, Trader Joe, you probably have it anywhere. You can get it actually in Amazon. You can get tart cherry juice capsules. So if you, if you’re traveling and you don’t want to take any beverage or yeah, you can take the capsules.

Dr.  Wendy Slusser  19:02

So what we’ve just covered is a huge array of not only issues but also opportunities for enhancing your duration of sleep. And you mentioned a few items that actually do make me think of what people have been doing more of in the COVID period. And it really leads us to not just discussions of duration or the latency of going to sleep because we know everyone’s been bingeing or including me on, you know, different series. But the regularity is another piece that you mentioned, and that not only is important for a healthful sleep, but also one area that I’m sure many of us have had challenges during this period of the pandemic. So that might get us to this looming question in all of our brains is what do you mean by COVIDsomnia?

Dr. Alon Avidan  20:01

Yes, so euphemistically COVIDsomnia is a term that’s been applied to the abnormal sleep patterns and insomnia during the duration of this unprecedented pandemic. And it relates the fact that there are specific observations about the pattern of insomnia in that people do experience, have experienced difficulties with say anxiety, stress, fear of the unknown, difficulties falling asleep. And that is specific in relationship to the pandemic, a pattern. Very interestingly, there is a model that helps explain the chronicity of insomnia. It’s for people who really want to know it’s called the Spielman 3 P Model, and it uses the following: predisposing factors, precipitating factors and perpetuating factors. Insomnia is crossed above its threshold to become clinically apparent when one has a precipitating event. After having certain predisposition to insomnia, which is often related to genetics and having a prior history of learn insomnia, that something happens, something both good and bad. Marriage is a positive aspect that can trigger insomnia. The death of a loved one, surgery, pandemic: that’s a trigger. We found that amongst many patients that saw us recently, when we ask them when things started, and the majority went back to March of 2020, when they started to stay at home. They were away from family, friends, social interactions, social cues, that often help provide a signal for maintaining sleep/wake regularity. What else has happened? You have to stay home. You do not go to work. And we found that people are not getting light exposure. So now we have no social cues, no light exposure. People are almost very similar to living in a cave. You begin to lose sight of when it’s dark and when it’s light. And we found that people who have a certain circadian predilection to go to bed later at night, those are called the owls. You know, you have two types of individuals based on their sleep/wake preference. And those are phenotypes, meaning they characterize the sleep/wake patterns in individuals. There are the evening type, which are the owls, and there are morning types, which are the larks. And you’re one or the other. You can’t change an owl to a lark. And you know, that’s part of your genetic package. What we found is that individuals who are relatively prominent owls became even more owl like in having a more delayed pattern of sleep. That’s another aspect of COVIDsomia sort of definition in that in some individuals, there was some preservation. That duration has remained the same, but the patterns have gotten to that people are going to bed late. Now, this is important because the delayed sleep phase pattern is often associated with weight gain. And that is really critical. So despite the fact that they were getting regular sleep, their patterns were delayed in a manner that they were going to bed at 2, 3, 4 in the morning, waking up at 10, 11, midnight, some even later. And they were gaining weight. And that is fascinating, because it talks about the fact that earlier on I mentioned that sleep and circadian patterns are very much aligned in a manner that it has to occur in some degree of regularity. And when you don’t have that regularity, you begin to see metabolic disturbances. And one of those is related to a pre diabetic type condition. And it’s often related to loss of sleep, as well as delayed sleep that often made people more obese, caused them to gain weight, and also became somewhat diabetic. And that may be related to the fine control of blood sugars in the body related to specific hormones that are released in response to light and darkness. Those disturbances in the timing of the release takes place or decrease ability of one ability to control the blood sugars. So that is very problematic, particularly because of the fact that we’ve seen more of a obesity epidemic during this pandemic.

Dr.  Wendy Slusser  24:51

That is a really fascinating interpretation of what I’ve seen in my work where you will see people with less sleep maybe gain weight but not necessarily people who have a healthy duration, but they’ve just created a shift where they’re spending more time sleeping in the daytime. Is that what you’re trying to say so?

Dr. Alon Avidan  25:14

Exactly, exactly.

Dr.  Wendy Slusser  25:16

For these owls, the recommendation even though they might have a tendency to go to sleep later, they really should be trying to sleep during a good portion of the night if they can.

Dr. Alon Avidan  25:27

Yes, and there are ways that we can help them achieve that. So one of the problems of course, is the fact that the individual is getting abnormal signals of excessive light exposure during the nighttime, during the evening time, and lack of light exposure during the morning. Okay, so it’s a, the light therapy is actually phototherapy, we call it, is very effective in trying to mitigate and improve the and align people to a more natural and normal cycle. So we often recommend the avoidance of the blue light after 9 pm. And we often tell patients get up at around seven to eight o’clock and go outside for at least 45 minutes to an hour to soak up some sunrays. The light exposure in the morning is going to help advance the circadian patterns. As well as the recommendation is for light, for very low dose melatonin at 0.5 milligrams taken at around four hours before their bedtime. So if their bedtime is at three in the morning, they should be taking the melatonin at around 11 pm. The problem is, most patients who use melatonin, take it right before they go to bed, which for a lot of people is 3 or 4 in the morning, and they take the wrong dose. They take three or five milligrams. To achieve a realignment, resynchronization of the circadian pattern, we have to use low dose melatonin and time it early in the evening to advance and push this the sleep timing, to an earlier timezone and avoid the light exposure after eight or 9 pm or so. And the other thing that works really well and will know that through the work of Dr. Jerry Siegel is drop in temperature because his work in the looking at the sleep patterns in hunters and gatherers in Africa has shown that the primary signals for sleep was the absence of light and the drop in temperature together was a powerful signal for the timing of sleep. So what we’re trying to do also in our own patient population is create the bedroom is going to be a bit cooler. Now for a lot of people, they can’t turn the AC high enough or that there is a central AC, and one person in the house likes it’s a bit toasty. The other person has insomnia and likes it a bit cooler. So if that’s an issue, there are some cooling pillows that one can get. One of them is called a technogel cooling pillow. And that’s a pillow that has a gel mechanism in it that acts as a heatsink. So it takes away excessive heat from the head and drops the temperature, allowing people to fall asleep and maintain sleep for a longer period of time.

Dr.  Wendy Slusser  28:26

Wow, to unpack what you just said, which has so much information. One is Dr. Jerry Siegel is amazing. And he also taught me how it’s not the light that wakes you up in the morning. It’s the rise in a little bit in the temperature that is happening.

Dr. Alon Avidan  28:42

Exactly.

Dr.  Wendy Slusser  28:43

This is totally what I didn’t understand. You always think it’s the light, right, or the sun rising. I’d like to understand why is the sun so special in the morning or getting morning sun versus afternoon sun?

Dr. Alon Avidan  28:56

Oh, definitely. Remember I mentioned that light is probably the most powerful circadian giver or sight giver. In German, it’s a light giver. It is the signal that turns on the circadian clock. It tells you it’s time to wake up. And the primary time in which the circadian clock is primed to interpreting the light signal is in the morning. And in the evening. During the day, it’s fairly neutral. So after 10 pm and before 5pm or so, the light exposure is very neutral, but light exposure after 6, 7, 8 pm is going to turn the brain on and that’s treatment that we give people go to bed too early. That’s the opposite of delayed sleep phase. So in our population and in older adults, there is the advanced sleep phase circadian rhythm disorder where they go to bed early, and they wake up early, so we give them light therapy in the evening time. For the adolescents, for the extreme owls who need to advance their circadian patterns, we ask them to use a light therapy early in the morning at around seven to eight o’clock, because that’s when you stimulate the circadian clock, keeps the wake centers alert and awake, and allow them to then manifest and that wakes them a single, will exist and persists throughout the day. And you can also then add a power nap if someone is particularly sleepy as long as it’s not more than 10 minutes. But the critical issue is that in the evening time, you want to stop the light exposure after around eight to 9 pm. And to give a bit more signal for sleep, use of supplemental melatonin at 0.5 milligrams will be another chronotherapy that can actually be quite effective for those who are really challenged with delayed sleep phase pattern. To your question is, why is it sunlight? Well, sunlight is our primary light source. It is the one cue in the environment that our retina, the cells in the retina then move on to make up the track it goes and simulates the super cosmetic nucleus. Historically, and evolutionarily, we were adapted to that particular light source. So the problem is you can’t sit in front of a window and say, well, that’s enough light for me for the morning. It has to be outside. And for people who are worried or cannot go outside because immobility issues or because they don’t have enough light because they live in Fairbanks, Alaska, there are some light boxes that you can get. And you can get those on websites. And they cost about $50 to $100 dollars. But you have to make sure that it says 10,000 lux. Lux, L U X is a unit of light intensity. And we want to make sure it’s 10,000 lux, because that’s the light intensity of ambient light exposure in the middle of the day.

Dr.  Wendy Slusser  32:02

So we’ve been talking about the owls and what you’re describing is a way for the owls not to get carried away and go to bed at four in the morning if they get their circadian rhythm awakened by the morning light.

Dr. Alon Avidan  32:15

Exactly.

Dr.  Wendy Slusser  32:16

Okay, so that will help them get into a routine. So what about people who are and this has been a big challenge, especially during the pandemic, where you might be overworked or you’re really working through the night. What kind of recommendations do you give, especially some of our frontline workers who again, are being overworked and overtaxed once again?

Dr. Alon Avidan  32:37

That’s right, Wendy. This is a really, really difficult issue, because work is often a priority. But when I see patients who are frontline workers, there still is a need to maintain a balance between life and work. And the problem is many individuals, the moment they come back after a shift in the hospital, they go, and they check emails, or they spend time in front of computer or watching TV. So the light source is continuing to occur and increase the light exposure during a period which may not be ideal for the patient. What I tell people to do is as much as they can to give themselves some downtime, an hour, two hours, ideally, before going to bed. Many people work through the night, work until they’re done. They go to bed and guess what they do. They sit in bed, and they start thinking, and the bed then becomes a point of where you’re planning things, where you are making lists of things you have to do the next day. And part of the cognitive behavioral therapy for insomnia, which is a very powerful treatment recommendation. For people who have chronic insomnia disorder is the one arm of course is to use hypnotic drugs that just make you sleepy, sedated, but don’t really treat the underlying cause of the insomnia. Cognitive and behavioral therapy, in contrast, the patient learns how to sleep again. The sleep coach who delivers the cognitive and behavioral therapy helps give the patient some powerful tools to help them reassociate the bed in the bedroom with sleep that is minimizing the time that they spend awake in bed, moving away electronics, cell phones, alarms, anything that’s connected to electricity away from the bedroom area, and reassociating the need for sleep with the bed. And one of the techniques we do to make people sleepy is sleep deprivation. So if they only slept for three or four hours on one night, they cannot take naps and they cannot make up for it. We create the sense of sleep deprivation and with that, when they’re a bit more sleep deprived, when they go to bed in their own bad, all of a sudden they fall asleep quickly, and they maintain sleep in that bed. And slowly and surely begin to reassociate the bed with sleep. It takes about a week or two. It’s a bit challenging to do because people do not like to be sleep deprived. But it works wonders. And it’s the one thing we recommend is if you find that you’re taking naps as you’re sleep deprived, or if you’re not sleeping well, and you make up for it the next day, the pattern will just be perpetuated. So the third, the P that I mentioned, part of the Spielman Model is perpetuating factors that include actions and activities that are maladaptive and one of them is a long nap. Another one is worrying about sleep. Another issue is using electronics, alcohol, caffeine, and all outside interference that often perpetuate insomnia and just make it more chronic and more difficult to treat. Going back to the discussion about reassociating the bedroom with sleep through cognitive behavioral therapy is a technique that used to occur in person prior to the pandemic. So one good thing about the pandemic, not the pandemic is anything but a difficult time period, but through the pandemic, we’re able to adapt and innovate. And one of the innovations, of course, is telemedicine. We’re seeing so many more patients say online. Some patients really like to be able to see their patients without driving on the Los Angeles freeways. And they can see us online by video. And cognitive behavioral therapy for insomnia used to be very difficult to achieve before the pandemic because people had to drive and see their providers say five or six times during the course of the therapy. And during the pandemic, when everything is online, it’s easier. People are actually complying with it, and they like it. And there’s more access. There’s more availability of people to actually do it more effectively and efficiently. And the data shows that it’s no less effective compared to in person cognitive and behavioral therapy.

Dr.  Wendy Slusser  37:10

Wow, that’s very encouraging. It’s always nice to have some gratitude even in times of tragedy or pandemic era. I’m sure many people are wondering, you say a long nap. How long can you nap without disrupting your sleep?

Dr. Alon Avidan  37:24

Oh, that’s a question that I always like, because most people know but some people have this misconception about naps. So let me tell you what the power nap is. A power nap is strategic by time and by duration. And guess what a time is ideal. It’s right after lunch time, noon time to about 3 pm, just around that period of time. It’s perfectly fine to take a nap. Now the nap has to be short, 15 or 20 minutes, half an hour max. Once you begin to nap longer, if you nap 45 minutes, an hour, two hours, you’re then likely to wake up when you’re in slow wave sleep. And when you do that, you’re depressed, you’re confused, you’re disoriented. That’s called sleep drunkenness, or increased sleep inertia. Meaning that when you wake up after coming out of slow wave sleep, which occurs an hour after you fall asleep, you’re more likely to be groggy. The nap is not going to be as restorative.You’re more likely to be depressed, tired, and it’s not going to be any benefit to you. So shorter naps partially restore sleep debt, especially early during the day between 12 to 3, 15 to 20 minute power nap equivalent to a tall glass about 20 ounces of caffeine, 200 milligrams of caffeine. And it’s cheaper to do that. And you get the same benefit.

Dr.  Wendy Slusser  38:57

It’s such a tradition in many cultures. So that makes sense. People observed that it must have helped them enhance their well being. You’ve been mentioning different phases while you’re asleep, assuming you’re sleeping in our seven to eight hour period. And there was a number of research reports that you shared with me talking about dreams and how dreams have been disrupted during the COVID period. And I guess at other times as well. I want to understand the power of dreams and the role of dreams. And also there’s a lot of conversation around vividness of dream.

Dr. Alon Avidan  39:32

Sure, sure. So firstly, it’s very interesting that often as we go through the sleep cycle, we start at very light stages of sleeps, stage one and two, and we go into the heavier, slower wave, deep sleep that’s called slow wave sleep or stage three sleep. Stage one and two make up the light sleep. And then after about 90 minutes, you go into REM. REM is rapid eye movement sleep. And that’s when you’re dreaming. That’s when your, when your muscles are paralyzed. That’s when you’re dreaming. That’s when memory consolidation takes place. Same in slow wave sleep. And it’s vital that you go through all the sleep stages in the sequence. We found that during the pandemic, because the patterns of sleep duration, and regularity have been so abnormal, and because people have been more stressed, during this unprecedented period, there have been a number of reports of the so called pandemic dream. I’m just looking at the International Classification of Sleep Disorders that we’re now updating. And there was one area that we wanted to update for the 2021 version is to create a new category of nightmares, called pandemic dreaming, because pandemic dreaming refers to not only abnormalities of dreaming, but alteration of dreaming that is mediated by the lockdown during the pandemic. And individuals who have this problem are often depressed, anxious. They’re generally younger women who suffer from poor sleep quality, disturbed nocturnal behaviors, anxiety, depression, and also very vivid dreaming that is very negative. Now it’s very different than a nightmare, which is often manifested with an arousal and then anxiety reaction to the awakening to the arousal. That doesn’t happen with the pandemic dreaming. So there is definitely an alteration in the content, along with the fact that those patients are also very depressed, very anxious, and have alteration in their dreaming and dream experiences. Why we dream? I wish I knew the answer. You know, we probably need another 90 minutes to discuss the the function of sleep and the function of dreams. But dreaming is probably a way in which the brain learns to take experiences and put vital ones in special compartments to preserve those experiences for later use, because they’re evolutionarily advantageous, and get rid of experiences that may not serve an evolutionary advantage. Now, this is very, very basic and fairly simplistic view to look at dreams. But in essence, it’s a way for the brain to go through like your defragmentation function on a computer and put memories, package them to make room for new and more memories that can be coming in the future, but to also from connections. When those experiences have a commonality and provide an evolutionary advantage to that individual. The alteration of dreaming, of course, is brought by experiences that are fairly dramatic and fairly negative during the day. We know that very profoundly right after 9/11, the population in New York and Washington D.C. recorded significant levels of nightmares and dream alteration. With the pandemic, less nightmare type episodes, but more abnormalities in how patients interpreted what they were dreaming to be very negative, associated with more anxiety, more depression, and alterations of the dreaming to be more negative, in which the patient had to, for example, look for an exit to run away from negative experiences that may have some metaphorical similarity to what they were experiencing during the daytime.

Dr.  Wendy Slusser  43:52

Well Alon, I think you’re right. We might have to do another podcast if you’re willing, because I think that this dream conversation, I have so many more questions, and but you’re describing just so I can understand about what you just mentioned about what you’re experiencing during the day is then expressed through your dreams. One of the solutions would you think would be to address those emotions and worries in the daytime? I mean, would that be one way to address that challenge?

Dr. Alon Avidan  44:21

Absolutely Wendy. It’s so true, that one of the primary theories in how we manage patients with nightmares and abnormal dreaming is through a process through a treatment called imagery rehearsal therapy, in which the patient is allowed to bring experiences that they see or images, visions that they experienced during the hallucination, during the dream experience and talk about it. And form more positive anecdotes and positive associations with those negative emotions. And the patient learns, say, mindfulness techniques and deep breathing exercise. So they’re not going to react as negatively when they see those images and confronted with by similar hallucinations during a dream experience. They’re not going to be as anxious.

Dr.  Wendy Slusser  45:13

That’s hopeful for many people.

Dr. Alon Avidan  45:15

Of course.

Dr.  Wendy Slusser  45:15

That’s really. It sounds like you have a lot of answers. And I’m looking forward to hearing more about the dreams in our next podcast. And I learned so much from you. And I’m looking forward to learning more. And before we end, is there anything that you’d like to add to what we discussed or any pearls of wisdom.

Dr. Alon Avidan  45:36

As people are thinking about sleep, you know, sleep is one of the gifts that we often take away from. And remember, just as you are eating, breathing, sleep is one of those vital functions. Do not forget to sleep. It’s often, sometimes, people forget that it’s two or three in the morning, and they just finished a zoom call, and they have to do homework. But you just have to make sure that you protect your bedtime. It’s so important to your cardiovascular function to make sure you remain healthy, and you retain a proper immune function.

Dr.  Wendy Slusser  46:14

Thank you so much for everything you do. So appreciative Alon and looking forward to our next podcast.

Dr. Alon Avidan  46:21

Thank you so much, Wendy. It’s been a pleasure and happy to participate in the future and good luck to everyone. And stay healthy and well.

Dr.  Wendy Slusser  46:31

Thank you. Thank you again for joining us. For more information about today’s episode, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Leave us a rating to tell us how we’re doing. And if you think you know the perfect person for us to interview next, please tweet your idea to us @HealthyUCLA. Have a wonderful rest of your day. And we hope you join us for our next episode as we explore new perspectives on health and well-being.

Episode 29: Translating COVID-19 Research

Transcript

 

Dr.  Wendy Slusser  00:04

Positivity rate, incubation period, herd immunity. Once only common in conversations among public health experts, these terms have become part of everyday jargon. While we may all be better versed in public health terminology and concepts, we probably still have a lot of questions and may still be wondering how to make sense of it all. Today, we’re excited to share with you a panel discussion with three UCLA public health experts on translating COVID-19 research to our everyday lives. In today’s conversation, dean of the UCLA Fielding School of Public Health and distinguished professor of biostatistics, Dr. Ron Brookmeyer, shares his insights into the data being reported on COVID-19. Public health communications expert and professor of community health sciences Dr. Deb Glik shares her advice for an effective national communication strategy. And UCLA Executive Master of Public Health student and registered nurse Jessica Arzola, shares her experience working on the front lines. We hope you enjoy it. Welcome, everybody to our panel. The panel is called “Translation of COVID-19 Research to the General Public”. And I’d like to introduce today our esteemed panelists, Dr. Ron Brookmeyer, who’s the dean of UCLA Fielding School of Public Health and distinguished professor of biostatistics, Jess Arzola, who is a nurse and also a Fielding School of Public Health candidate, and Dr. Deb Glik, who’s the professor of Department of Community Health Sciences at UCLA in the Fielding School of Public Health. Welcome everyone, to this panel. And so I’d like to start with Dr. Ron Brookmeyer with a question that is top of mind since it dictates what stores are open, what schools are open, and it has to do with statistics. We’ve been hearing a lot about different levels of prevalence of the disease, hospitalizations, deaths. I want to know how we interpret this data and which is the data point that we really should be looking at as we move forward, from your point of view, but also from the public’s point of view?

Dr. Ron Brookmeyer  02:20

Well, Wendy first, thanks very much for having me, it’s really a pleasure to be here. You know, with regard to data, I gotta tell you, it’s been a real roller coaster with the numbers. Let me start by telling you what’s on my mind right now, which is about vaccines, and looking at the percent coverage, percent of people who are getting vaccines. Nationally, right now we’re at about 8% of people who have received one dose, and about 2% who’ve received two doses, but we need to do better. And part of the reason is getting the vaccines into people’s arms, and when we look at how many doses have been delivered, the thing I look at is what fraction of those have actually gotten into people. And we’re at about 60% right now. So there’s still a lot of work to do on that. The second thing right now that I’m looking at, are these variants of the virus, you know, the UK variant, South African, which can be more transmissible and possibly give more serious disease. As far as the data on that, we have to do better, because we need much more systematic public health surveillance for the variants. If you don’t look for it, you’re not going to find it. So you know, at the end of the day, it’s a race with these variants. We have to get the vaccine out before we have more mutations. Now coming back to how we measure, you know, where are we with the pandemic, you know, you mentioned the test positivity rate. So what that is, it’s the percent of tests that come back positive. It takes into account the number of tests that’s in the denominator, and that’s good in terms of standardizing things. In LA county right now, the test positivity rate is about 12%. One of the issues with that number is, it depends upon who’s coming in to get a test. So, you know, early on in the pandemic, the people who were being tested were those who were symptomatic. So what that meant was you have a very high test positivity rate. So it can be skewed and it’s hard to interpret depending upon who’s coming in for a test. So I’ll tell you what I look at, I look at hospitalizations, and I look at deaths. I think they give us an accurate picture of where we are. The good news in LA county is that all three had been coming down since mid-January, the test positivity rate, the hospitalizations, the deaths, were at about 30-40% off the peak that we saw earlier in January. Nationally, we see that decline in cases, we’re not seeing yet in deaths but of course, deaths lag behind cases. The other thing I want to come back to is, sometimes with these numbers, you got to take a deeper dive. And, you know, when we look at the community level, we see real major disparities, you know, the rates can vary three or fourfold more in communities of color, by race, by ethnicity. When we look at poverty level, when we look at some of these numbers by census tract or zip code and stratify by poverty, we see some real disparity. So the bottom line here is that one number doesn’t tell the whole story.

Dr.  Wendy Slusser  05:50

What I’m hearing is the 8% vaccine rate that is currently here is in United States, not worldwide. Is that correct?

Dr. Ron Brookmeyer  05:57

Yeah, that’s the national rates.

Dr.  Wendy Slusser  06:00

And what I’m hearing you say, Ron, is that the hospitalization and death rates are much more sensitive to what we’re potentially seeing in the broader community in terms of the prevalence or the issues around COVID?

Dr. Ron Brookmeyer  06:14

Yeah, because that’s right Wendy, I think it’s because of the different patterns of how people come in for testing, it’s hard to get a relative measure of which way things are going. You just have to be careful in the interpretation, whereas the hospitalizations and deaths, I think, are less sensitive to being skewed by who’s coming in for testing and so forth.

Dr.  Wendy Slusser  06:39

Right, exactly. That makes sense. So a lot of people are wondering that, you know, these variants, which is what you are concerned about, and I think many of us are, right, that we’re not really measuring them very accurately in the United States, compared to other countries like UK. Do you think that there was a variant that is one of the reasons why we had this uptick, besides, you know, the surge of post-Thanksgiving, post-Christmas?

Dr. Ron Brookmeyer  07:06

You know, I don’t think so, I don’t think we’ve seen that yet really, the full impact on variants. I think a lot of the uptick that we saw in January had to do with the holidays, and we know what spreads this, right? It’s travel, it’s, you know, and understandably, wanting to get together and celebrate, it’s been a long year. But that’s what really, that spreads it, being indoors, but we have to be alert for the variants and they are here. The UK variant is in, you know, well over 30 states right now. We need to be monitoring and it is more infectious is what the data is saying. So that’s something we got to be monitoring very, very closely.

Dr.  Wendy Slusser  07:50

You mentioned something that struck me. Dr. Fauci has shared that the four most deadliest areas you could be are bars, indoor dining, gyms, and traveling. Those are the four, so it makes sense then how, you know, cities have had to close down indoor dining and bars and gyms. Well, so moving on to Jess, I would like to know what’s it been like working in a hospital during COVID.

Jessica Arzola  08:18

Thank you for having me here as well. I feel very intimidated to be with all these professionals as a student. I’m so happy to be here and share this space with you all. I was just talking to my coworkers about this, and it was the first time we reflected since March. We talked about how we’re feeling and we could not put a word to it. And even now, as I was preparing to speak with you all, I still cannot put a word to it. I think I’ve been quite scatterbrained since March. It’s a lot like a roller coaster ride as well here in the hospital. There are times where I walk into work with my upbeat music and I’m thinking to myself, I’m going to save a life, I’m going to do my job, I’m going to do great, and I’m going to go home and study afterwards. And then there are days where I’m in the hospital and they have a COVID positive patient and anxiety gets the best of me, fear gets the best of me and I can’t help but feel frustrated, you know, as positive as I want to be. It’s scary having these patients in the hospital and you know, while the surge was happening we did have quite a few more cases and now they’re kind of coming down a bit which is great. But during that first surge in the beginning of January I had my COVID positive patient that I had to take care of and I just remember gowning into the room and being so anxious and thinking to myself, “Did I cover my hair? Did I cover my shoes? Did I hide my phone? Did I silence my phone? Did I I get everything I need for me to be safe?” And then once I’m in the room, “Oh no, did I get everything I need for my patient? Do I need to gown back out? Do I need to get this? Am I treating her right? Am I catching this in time? Am I treating this disease right?” And then gowning out of them is a whole nother mental gymnastics again. “Did I gown out right? Did I touch anything? Did I touch my pen? This pen, is it contaminated? Am I breathing in too much? Did I talk too much in the room and prevent my mask seal from working effectively?” It’s quite the mental gymnastics game. And then leaving the hospital and logging onto Twitter, and seeing how politicized it’s all been, you know, seeing Twitter and seeing social media, seeing people traveling. And you know, it’s been interesting working in the hospital, it’s been challenging at times, it’s been positive at times, I feel great that I’m doing my part. At times, it just feels a little disheartening to see the external world. And whether it’s indifference, acceptance, or kind of challenging of the pandemic and social responsibilities you must take, it’s been an interesting roller coaster ride, and I still can’t even think, “How do I feel?” and “How is it in the hospital?” Aside from it’s been anxiety-ridden. It’s been truly a roller coaster ride. It’s a long winded answer for your question. I think I’m still trying to kind of figure it out myself. Like, what’s it like in the hospital? Because I don’t think we talk about it often, because we’re so busy, that there is really no time.

Dr.  Wendy Slusser  10:54

Yeah, I mean, it seems like a long time for you to first reflect with your coworkers. And, you know, I know that talking to people often helps with coping, what have you been doing to help cope with this?

Jessica Arzola  11:08

I’m trying to figure out how to cope still. I have been trying to exercise and keep normality and keep routine outside of the hospital as much as I can. I’m in graduate school so I’ve also been trying to focus on my studies. Obviously, it’s a lot more difficult to kind of accept that moment and focus on studying when you’re so worried about your work. So I’ve been coping with journaling and watching my coworkers. Just watching the way they relentlessly go into these rooms, watching the way they also make similar sacrifices and knowing that I am not alone in my experiences and knowing that there is camaraderie and our teamwork approach. I think that’s the best way I’ve been coping right now. Just feeling like I’m a part of a team with my coworkers, and talking it out with them. Even if we’re not talking about the pandemic, just talking about, you know, “I couldn’t see family, this sucks.” And, you know, “My hands are bleeding again, from all the hand sanitizing I have to do, this sucks.” And it’s just sharing those moments, no matter how small they are. They’re really effective.

Dr.  Wendy Slusser  12:12

That’s very wise information to tell a lot of people in the pandemic, even people who might not be frontline workers like you. I think people have this feeling of disconnect or suffering, even those that are sheltering at home and I think routine, and you know, journaling, all the, you know, being reflective, those are really great wisdoms. Thank you, that’s really helpful for all of us. I’d like to know now that you are an MPH candidate, how has that framed your view of this pandemic?

Jessica Arzola  12:43

So we always hear about how important communication is, right. Communication to yourself, communication in your interpersonal relationships, communication with school, everything. I didn’t realize how important communication is until this pandemic happened, because a lot of us on the frontlines are wondering, “Okay, so what PPE is required? Is it aerosolized or is not? Is it airborne, is it not?” We weren’t always getting that communication right away, and I think that’s just limited to what we don’t know. We don’t know what we don’t know, right. And research was still forming itself. But that communication was really necessary, not only for ourselves as providers, to take care of ourselves and take care of our patients, answer their questions and answer their family members’ questions, but also for the way the country and the world responded to this pandemic. I’ve had healthcare coworkers who would say, “Hey, why isn’t the CDC telling us this?” and “Why aren’t we being told this information? Why are our leadership in the hospital not telling us something that we want to know?” And a lot of it was just searching for answers. And then that search for answers, you try to find answers elsewhere. You’d tried to find answers from your neighbors, you’d try to find answers through social media, you’d try to find answers through the internet, and whatever way you can find it. Those answers are not always correct. And us as healthcare workers are searching for those answers. I can only imagine the general public as well. So I learned that communication is so important, not only for safety, but just for the functionality of the hospital, the functionality of the nation, and creating that unity to kind of get through this pandemic. Without that communication, it’s a very difficult slope. And I think I saw how necessary it was and I can only imagine for those not in a hospital how also just as necessary it was for them too.

Dr.  Wendy Slusser  14:27

Well Jess, you just teed us up for questions with Deb Glik. So, Deb, you know, you’re an expert in communications. And I’d like to know, what have you found as a challenge here and now during this pandemic for communicating?

Dr. Deb Glik  14:43

You know, this is an excellent, large question, and I’m sure there’ll be books written about it for the decades to come. However, I mean, let me just say, you know, it gets right at the heart of what we call crisis and emergency risk communication, which is communicating to people in a disaster, and a pandemic is like a major disaster that goes on and on and on. Which means that you not only have to get up and running fast, you have to keep running in the risk communication sphere. And so I was thinking, a good way to maybe think about the challenges is really come up with so what are the benchmarks of good communication? And how did we do? And I’m gonna say right up front, we didn’t do so hot. Some people did very well, like Dr. Fauci and Governor Cuomo. Some people didn’t do so well, maybe they were somewhat disengaged or somewhat hesitant. And some people did terribly. We won’t mention those people. But let’s think about what makes a good risk communication? Well, first of all, it has to be consistent and clear. So if you have mixed messaging that gets people confused. Let’s go back and think about masks for a minute. You know, at first it was “We don’t know.” Well, they should have said, “We don’t know.” What they said is, “We don’t think they’re that important.” What they shouldn’t have said is that, they shouldn’t have said, “We don’t know. And when we do know, we’ll come back to you for guidance.” So that kind of thing is really important. And also speaking in a unified voice, and you’re absolutely right. We didn’t have a unified voice. And unfortunately, the people who typically are supposed to be charged with speaking, like CDC, was sort of sidelined. So that’s pulls into the next piece, which is credibility, that you need a certain degree of belief in what is being said, that it’s true. You know, when people question a practice, the risk communicator’s job is to give evidence. So for the vaccines now, the risk communication task is to convince people that they are safe, because that’s what people’s concern is, and that there was really 1000s and 1000s of people in clinical trials, and that’s the gold standard. And another issue in creating good risk communication is this issue of specificity. You know, it’s one thing to say wear a mask, but the real issue is, what’s an appropriate mask wearing behavior, like, you know, it has to be over your nose, or you should wear it, you know, in public, or you got to wash it occasionally. It’s those kinds of things that are more important, actually, for people to remember what they’re supposed to do. And the biggest issue, I think, for me is timeliness and relevance. So let’s think about what risk communication is. It’s part of risk management, it’s part of a bigger risk management issue. So look, you don’t turn the lights on the Christmas tree before you put the tree up, okay. So you have to be part of a plan. So with risk communication, it sort of first you have to have a plan about how you’re going to mitigate risk, what people need to do, what the organizations involved in the risk response are doing. Then the risk communication becomes relevant, because you can talk to people about what the agencies are doing, what they need to do, how it’s all going to work together. So think about lighting up the tree after you put the tree up and you put the lights on. You can practice beforehand, but it’s not ad hoc. It’s all planned out. It really is part of a whole cloth of how we work in the public domain. Finally, disseminated widely -pandemic and everybody’s at risk so everybody needs to hear it. Actually, we did okay, in that piece. You know, this is an amazing time where we had news, social media, everything, all you know, pandemic messages, co-opted everything. The problem was, of course, some of them are true, and some were not. But that is also the job of the risk communicator to come in and dispel rumors and create more of a, you know, validity, truthful, credible, consistent, and well thought-out risk communication plan. So overall, the grade, I’ll let you do that.

Dr.  Wendy Slusser  19:24

Well, that was really well laid out and I think that transparency is really what you’re saying and sort of summing it up. And even saying you don’t know what you know, like what Jess was saying, you know what you know, or don’t know, right? So in terms of, you know, using your knowledge, what kind of message would you advise Jeff Zients and Vivek Murthy, who are now in charge of vaccine rollout? What would be the message you’d like them to say to the public if you were able to write it?

Dr. Deb Glik  19:54

Yeah. Well, I mean, I think the the most important thing is understand your audience. What does your audience need to hear and want to hear? And the big issue with a vaccine is mainly vaccine safety. People are worried about whether it’s safe. So think about that as part of your objective, that you’re really trying to help people understand why the vaccine shouldn’t cause any major harm and actually, will push out a lot of good by having everybody not get COVID whose at risk. So how do you do that? You give stories, you give evidence, you talk about the evolution of the vaccine, you assure people that it didn’t just happen overnight, it was something that was in the works for years and years that is based on real, true, valid science. Now, look, you’re not going to convince everybody, there’s always the doubters. But really, the people they need to pay attention to are the vaccine-hesitant people. Those are the people in the middle. There’s the choir, who are rushing to get their vaccines, and there’s the anti-vaxxers who are protesting, you know, at Dodger Stadium in LA, but really your group that you want to and this is true with all health communication, you’re always going to convince that group in the middle that it’s okay, and they’re going to survive and their families are going to be okay. Not too much jargon, not science-heavy visuals if you can, but really, and finally, what are the characteristics of good risk communicators? They connect, they’re empathic, they’re passionate, they can sort of understand what the audience is going through, they don’t put people down, they don’t diminish the audience. They thank the audience for bringing them their concerns, and addressing them. I think the issue is always that good risk communicators have to really connect well with their audience, they have to understand what the audience’s concerns are not, you know, diss them, not diminish them, but sort of encourage them and help assure them that they’re going to get through this and it’s going to be okay. It is that healing process and we are in recovery now. We’re going into recovery and that’s what people have to be upbeat about.

Dr.  Wendy Slusser  22:30

So, imagine a world where 70% of our population is vaccinated, twice if they need it, depending on the vaccine. How would you communicate to those that are vaccinated to continue some of these safety measures?

Dr. Deb Glik  22:48

I think what we’re going to have to do is continue the drumbeat for a while in terms of all these other things that people are doing. People may have to continue some social distancing, some mask wearing, some teleworking. You know, risk communication doesn’t end just because 70% of population is immunized, it basically has to continue. And I think reinforcement is really important, reinforcing people who are doing the right thing, who are taking this serious way, who are part of the solution. And that again, that’s part of this unified voice, this collective “we” that is part and parcel of good communication. Thanks, Deb. That was very useful. And I’ve already heard some people who have been fully vaccinated and other people saying, “Oh, you don’t have to wear a mask now.” So I know that’s not the message. So we need to continue that drumbeat, as you said. Turning to Ron, this is again, sort of imagining a world where we’re less restricted, so to speak. California has this four tier reopening plan, and LA county has a roadmap to recovery now outlining reopening protocols with criteria for loosening and tightening restrictions and activities. What is the science behind these reopening plans and tiered approaches?

Dr. Ron Brookmeyer  24:14

Thanks, Wendy. Well, we do know what works and the science is clear. And the science is clear about physical distancing. It’s clear about masks. It’s clear about avoiding large gatherings and doing things outside if possible. Now, how all of that comes together in these opening plans, is really risks versus benefits. It’s about reducing risks. It’s not about bringing it to zero because we can’t bring it to zero. And so the bottom line is the cocktail of these opening plans, you know, what’s open, what’s not. It’s not an exact science. The components, we know what the components are and what we need to do to reduce risks. But then it’s at what costs to the society? What about our economy? What about our children? What about our schools? And so, our goal is to reduce risk, can’t bring it to zero. And it’s a balancing act, we have to navigate this and put together the components that we know work in a proportion that as you mix this cocktail, that we have the best chance of reducing risks, but not at a great cost to all of us. Look, early on, you know, at the beginning of all this, we did really have an opportunity to control this. It was a missed opportunity, you know. The infectious period of COVID-19 is no more than a few weeks. So we could have broken the chain, if we had really, really strong control measures, and really good adherence. But we didn’t do that. And that came at great costs. And now we’re at the point a year into this, of having to balance all the other problems and parts of our society that come with closing down activities. So it’s a balancing act, and we have to keep reevaluating, looking at the data. And the word I keep saying is pivoting. We have to keep pivoting as the data comes in, and look at all aspects of our society. Now, what’s changed as we move into these different opening plans? Well, first, we do have an effective vaccine, we have two effective vaccines right now, at 95% vaccine efficacy. That’s amazing. I mean, that is really good. And the other thing that’s changed is everyone knows somebody who is affected by COVID. So the awareness is there now. And we’ve been into this for a year. So these opening plans as they are rolled out, it’s about monitoring, it’s about looking at the data. It’s about adherence, are people adhering to mask wearing? It’s about monitoring our vaccine coverage. It’s about looking at the variants and the economy and our kids in education, and pivot as the data comes in and see what we can do to lower risk but keep things going.

Dr.  Wendy Slusser  27:20

Excellent answer. I was thinking, I kept hearing you say risk reduction. And there’s so many other aspects of public health that we use that strategy, in terms of preventing AIDs transmission, for instance, and other kinds of deadly infectious diseases. I’m wondering, you know, our LA Department of Public Health is very much I think, one of the best in the country. And I think they’ve done a really good job protecting a very large populace here in the county. What are your reflections in terms of, you know, what I’ve been hearing other departments of public health, who have not had as much of a robust infrastructure? And what would you like to see done in the future for our country to enhance the public health infrastructure?

Dr. Ron Brookmeyer  28:06

Well you know, one thing that I think has been overlooked is the stress on our public health workers. You know, I mean, I was reading recently, what’s going on in the New York State Department of Public Health, and a lot of stresses on the employees. And even in the LA County Department of Public Health, I know, the incredible stress that those who are working there are under as they feel pressures coming from all sides, and they feel the politics coming from all sides and the polarization and public health is as a field doing the best they can and our professionals are doing the best they can. And I think, you know, I think we need to pay more attention to all the stress that workers who are dealing with this are under. The other thing that I think we need to be looking at is coming to your question about the infrastructure. And you know, public health gets in the news, when we have an emergency, when we have a problem. And as soon as it goes away, you know, it fades and we can’t let it fade, you know, we have to be looking ahead. And public health infrastructure is what will make us prepared for the next pandemic. And I can guarantee you there will be another pandemic. And we need public health surveillance data to come in, to measure, to be prepared, to alert people, and when that data comes in to translate it, which is what we’re talking about today, and to communicate it to the public and saying what you know, and also saying what you don’t know.

Dr.  Wendy Slusser  29:54

Well, as you said, this might not be the last pandemic. It will probably be one of many, maybe even in our lifetime given it potentially being one of the repercussions of climate change, and we have vectors to worry about as well, and all of those things are picked up by public health surveillance, as you pointed out very wisely. I’d like to know, how would you keep this urgency of public health as a critical member of our team for really the safety of our country? What would be one of the strategies, Ron, that you would think would be important to take at this stage? Given we’re still at the forefront of being up there in terms of getting the bully pulpit?

Dr. Ron Brookmeyer  30:38

Yeah, well, I think leadership, getting the message out is one thing. So public health leadership, communication, and education, education about public health. You know, words that we use, like herd immunity, which now we take for everyone seems to know what herd immunity is now. But about six months ago, most people had never even heard of what herd immunity is. So, you know, the words, you know, incubation period, these are basic words that are not actually part of undergraduate education. It’s not part of high school education, or traditionally has not generally been a part. It might be, you know, for certain majors and in your undergraduate experience, but it is basic education about how we respond to global health problems. And as we can see, it’s affected all of us. And I think education, starting young about these basic things about epidemics, about public health, about health inequities are really very, very critical.

Dr.  Wendy Slusser  31:48

That’s a, I think, great lead into Jess, what made you decide to go and get your MPH as an RN?

Jessica Arzola  31:55

Right. Prior to the pandemic, I just had many questions in healthcare, why am I seeing a pattern with these patients? Why am I seeing these patients loss to follow-up? I’ve seen that with adult patients. I’ve seen that with the pediatric patients and I know health inequities existed. I experienced them myself, my father experienced them himself, too. You know, he had a brain aneurysm years prior, and he had like underlying hypertension that we never knew existed. And he was one of those loss to follow-up patients because of insurance issues before Obamacare. And that kind of motivated me to be a nurse and kind of understand the hospital system. And now that I understand the hospital system, I’ll understand the policy. I want to understand what effect and what change I can have. So that led me to the MPH degree, kind of I know what I know, I know what I’ve seen, I know what I’ve treated, but what can I do about it? And now with this pandemic, my interest in public health has only skyrocketed. How can this be improved? How do we nurses kind of get in there with the health policy changemakers? How do we get in there with the public health professionals? We represent the largest workforce in the country. Why can’t we be a part of that conversation? And why can’t we be influential? So this pandemic has only heightened my interest in public health and preventing these things from happening, preventing voices from being silenced and preventing these unfair patterns. And, you know, helping those patients that medicine traditionally neglects.

Dr.  Wendy Slusser  33:21

Thank you. I hear from Ron and Jess both also it’s about social justice, it’s about health equity. It’s about being fair, and bringing everyone along in terms of health and health and well-being which I think is not a privilege, it’s a right. I mean, it’s something that we should all be raising everyone up to a healthier life. So Deb, what would you say would be how we would keep this sort of drum roll going in terms of the value of public health and like Ron said, prevention. When you prevent something, you don’t get the glory, right. It’s sort of like it’s your job.

Dr. Deb Glik  33:57

Right. I mean, number one, I totally concur with what Ron just said, you know, we need to push for much better public health literacy in this country, meaning, we need to have kids in grade school, and high school and college understand what it means to you know, have an epidemic or pandemic. I agree it’s going to come back or we’ll get another version of this and another time, and helping people understand also the importance of the infrastructure that we do have. I mean, you know, even though it’s been stressful and unclear and uncertain how this you know, is going to play out, you know, we’re blessed. We have infrastructure that supports us. We have energy infrastructure and transportation infrastructure and food systems, and schools and universities and Internet. etc. And public health is front and center of these things. I mean, I go back in my own history at my first epidemic in Africa in the 70s. And it was cholera. And we didn’t have any of that. That’s a very different ballgame. So if we understand what we have and how to use it in the most effective way, we have amazing communication systems. But how do you use it right? How do we sort of mobilize correctly, so that we didn’t go through again, what we went through in the first few months of this. We could have nipped this in the bud if people had understood what it meant to shelter in place and not go out and not have undergrad parties and all that stuff. So this has been a huge, amazing growth experience, I think, for us culturally and socially. Gotta be ready, though.

Dr.  Wendy Slusser  35:57

Yeah, that’s a very good summary of really identifying all our strengths and leveraging and building them to a better good, because we do have a lot of strength, especially here in the states. And I’m going to ask each of you the same question. I’d love to hear whoever wants to answer it first, on a positive note, how are we going to flourish and thrive as we recover from this pandemic? And what would you recommend to help prevent this from happening again? I guess we addressed that last question. So maybe the flourishing part.

Dr. Ron Brookmeyer  36:29

Well, you know, I’ll just say there are some good things that come out of this. And hey, look, we’re all working remotely. You know, that’s something that we, you know, we didn’t know we could do, or we were skeptical, and we’re more efficient than we thought we could be. And I think that’s going to change how we are, how we work together. And I think that’s good. I think remote learning has been embraced. And sure it’s not perfect, but it’s one other option that we have that, you know, there are things we can do, that we didn’t think we could do. And so for me, I’ve learned flexibility and I’ve learned resiliency, that, you know, I could do things that I said, “Nah, I can’t do it.” Yeah, I can work remotely. Yeah, we can teach remotely, we can learn remotely. So I think those are some good things. And I think we’ve learned to cooperate more together. And I think one message is that we’re all in this together. You know, when I walk my dog in the neighborhood and look across and somebody is walking their dog, we’re all wearing masks. It’s an acknowledgment that we’re trying to deal with this, we’re all connected, we’re all interconnected. And you know, that’s a message that I think resonates. And I think it’s going to affect a whole generation of kids. So I think there is some good that will come out of this. Look, microbes are opportunistic. They’re always looking for a way to get in so there will be another pandemic. But I think from this, and if we keep this in our memories, we will be more prepared, and we will be able to respond. And we will have the confidence and resilience that we can rise to the challenge.

Dr.  Wendy Slusser  38:30

That feels good to hear that. I agree. Jess or Deb?

Jessica Arzola  38:35

I’m still kind of thinking through the answer. I think it makes me look at this whole concept of risk differently. Health risk, right, your mental health risk, your social health risk, your physical health risk, I’ve never felt like I was a risk to anyone up until this pandemic. Now I can’t visit anyone because I know I’m a risk. I work with COVID patients. So I’m a risk, but that risk has always existed, you know. There’s always been heart disease, there’s always been infectious diseases, there’s always been the opportunity for some type of accidents to happen. Your risk of some kind of health trauma happening has always been there. But it’s how do you live in relationship to that risk? And how do you live fruitfully and happily in relationship to that risk? How do you respect that risk? How do you live with that risk? That risk will always exist. So it’s being aware of that and knowing how to manage that. And this is not just limited to the pandemic, but any type of risk, even a mental health risk. You know, if you feel like your stress levels are crazy high, what are you doing to help manage that? And then I think like with what Ron said, the social interaction component, I am looking forward to that post-COVID hug with my dad that I have not had since March. I’m looking forward to that moment. And never to this day have I missed just being in a classroom of people, interacting with people, shaking their hand, having lunch with someone, even just sitting next to a stranger on public transportation. You realize how much those social interactions meant and you realize how much they mean right now even if they’re nonverbal and just passing by someone on the street, and you’re both distancing from one another in a form of unity. And those interactions, I cherish them so much. And I will never take that for granted again. But I think those interactions are still alive and they’re still beating, they’re still well, they’re growing. And they will always be there. But maybe we just needed this pandemic to remind us how much that matters and how much we can never take it for granted again, while managing the risks that will always be there and may present themselves differently in the future. I hope they don’t. But pandemics are a real thing. And they happen and they happen again.

Dr.  Wendy Slusser  40:32

That’s lovely.

Dr. Deb Glik  40:35

Yeah, I guess I want to, you know, echo a lot of what Ron andJessica just said, and just say, you know, first of all, it really makes me feel good that I’m in public health. You know, and the fact is that it’s not just about understanding the problem, but thinking about and implementing solutions. That’s our field, it’s a very interesting, applied field. And we’re, like, really important. So that makes me feel good. And I think I know, we learned some humility along the way, as a culture, as a social system. Now, just because we’re America doesn’t mean that we can’t also, you know, not be number one, on some level. We’ve had to really understand and think through who are we? What do we stand for? Do we really stand for what we say we believe in? And yes, we are inequitable, we need to work on that. We need to understand how important everybody is. We are connected. We have all these privileges and we don’t even appreciate sometimes that which we have. So I think appreciating who we are, what we have, the importance of everyone that again, goes back to we’re all in this together. Pandemics are not going away. They’re part of our history. They’re part of our future. Let’s hope people take this lesson to heart and really understand how important it is to minimize our risks for these things.

Dr.  Wendy Slusser  42:13

Yeah.

Semel HCI  42:16

Thank you for tuning in to this panel discussion on translating COVID-19 research. To wrap up today’s rich conversation, I’d like to share three of our main takeaways. Dean of the Fielding School of Public Health and distinguished professor of biostatistics, Dr. Ron Brookmeyer shared that hospitalization rates and deaths are two statistics he likes to look at for an accurate picture of where we are in the pandemic. Professor of community health sciences in the Fielding School of Public Health and communications expert Dr. Deb Glik shared that effective communication should be transparent, timely, consistent and address the audience’s concerns. And UCLA Executive Master of Public Health student and registered nurse Jessica Arzola shared from her personal experiences and decision to pursue a master’s in public health that public health perspective can be highly beneficial for the delivery of healthcare to individuals. Thank you again for joining us. For more information about today’s episode, visit our website  at healthy.ucla.edu/livewellpodcasts. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episode, subscribe to UCLA LiveWell on Apple Podcasts, Spotify, or wherever you listen to podcasts. Leave us a rating to tell us how we’re doing and if you think you know the perfect person for us to interview next, please tweet your idea to us @healthyUCLA. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.

Episode 30: Supporting our Frontline Workers

Transcript

Dr.  Wendy Slusser  00:03

You probably know someone who works in a hospital, a relative, a friend, a roommate, or you may work in a hospital yourself. Our nation’s heroes have been working at breakneck speed for the past year, and have faced countless challenges and hardships. Expert in resilience training and professor of clinical psychiatry and pediatrics at the David Geffen School of Medicine at UCLA, Dr. Brenda Bursch, has been at the forefront of addressing the mental health and emotional well-being challenges our frontline workers in the hospital are facing. In this episode, Brenda shares tips on how we can boost our own resilience and reveals the science behind storytelling as a way to integrate our emotions with our memories. Join us for a conversation about supporting our frontline workers, and build our own gratitude, empathy and finding glee in the future. So Brenda, it’s so great to have you join us today to chat about the challenges our frontline workers are facing. And I’d like to have a conversation about these challenges and how we should be thinking moving forward.

Dr. Brenda Bursch  01:11

Thank you for having me, I’m glad to be here.

Dr.  Wendy Slusser  01:13

Just such a privilege to have you here. Known you for over a decade, maybe two. You always have keen insights into so many different settings, and this setting that we’re talking about are the frontline workers. And that would entail not only health professionals, but also people that are keeping the engine going not only at UCLA, but across the country. So getting right into it. What do you think are some of the main challenges our frontline workers in the hospital are facing today?

Dr. Brenda Bursch  01:41

Well having just come through our biggest surge over the last year, I can say that many of our health professionals are utterly exhausted at this point in time. What they face has been unprecedented in their careers, even for people who’ve worked in the hospital for decades in terms of how much trauma, death, change in normal routines they’ve had to cope with. And even those providers who are not necessarily directly working with our COVID patients have really had to be flexible and change a lot in what they do as well. And many of those individuals feel a sense of helplessness too. So there’s almost like some survivor guilt for not having been on the front line for those who are not, you know, in those situations, in the emergency department or ICUs that really took the biggest brunt of the surge.

Dr.  Wendy Slusser  02:37

Explain to me what survivor guilt means, because I think other people, not even on the front lines, have a sense of guilt that they aren’t able to contribute. What does that mean?

Dr. Brenda Bursch  02:47

Right. So, you know, even this week, I was talking to someone who is, you know, working in our hospital setting with very, very ill patients, but still felt that there was more that he could have done to help his colleagues who were taking on so many COVID patients, and, you know, experiencing so many patient deaths, over and over and over again. And so what I mean by survivor guilt is just the sense of, you know, it should have been me, you know, it could have been me, I should have been able to do more. And so a sense of helplessness that comes along with that, as well as some guilt. So, you know, when I think about those, like the person I spoke to this last week, who feel like they’ve not done enough, you know, those who feel that it should have been them caring for COVID patients in the ICU, I sometimes think of a sports analogy. So for example, on a basketball team, you have starters, and you have bench players, and you have all of the professionals to support those players. And then you have the organizational and the league wide rules and requirements to kind of direct the overall direction of the activity of everybody else. To win a championship or to be COVID, we need all of these pieces to be operational and they ought to be coordinated with each other and they ought to be focused on the same goal. We tend to focus on those starters, you know, they’re the ones who are observably critical to the win. But you know, equally critical, even if they’re less observable, are the rest of the players and the support staff. If they weren’t doing their jobs and ready to fill in when asked to do so, like when someone became ill or injured, then we would have been in a much worse situation. They might have made different types of sacrifices, but it’s important that we recognize and value the sacrifices that they did make. Of course, you know, this analogy falls short in that our frontline professionals have been exposed to higher levels of stress and trauma than many others. But even given this, you know, no health professional or support staff has been unimportant to the efforts to combat COVID during the pandemic. And those people who still have some capacity and a desire to do more will play a profoundly important role during the recovery. And so what my biggest suggestion is, is to find ways to emotionally support your colleagues who have been on the front line. You know, we know from past epidemics and other kinds of disasters, that it is likely to take years for people to really, you know, process everything they’ve been through, there’s not been time to do that. And so there’s going to be after effects for quite a while, you know, certainly the next couple years. And not everybody really wants to hear those stories, or is able to hear the stories due to confidentiality. But if you have people on your team, or within your profession, who you know have gone through a lot, it can be quite helpful for them if you reach out and just ask them if they want to talk about what they’ve been through. And it’s really easy for the listener, because it’s not about problem solving. It’s not about trying to change anything. And the listener doesn’t have to do any kind of fancy techniques other than just listen and try to really, really understand what the emotional experience for the person has been. And to empathize with that. And that’s a very powerful intervention that is extremely helpful to people who’ve gone through something traumatic. To tell your story is very different than just thinking about it in your own head. And we know that to either journal about it, or to talk about it out loud, allows for the integration of your emotions with your memories, which allows you to process the information in a more efficient and effective manner. So it does help you get through it better, to be able to do that with somebody you trust and other health providers. And I mean, when I’m talking about health providers, I’m not talking just about doctors and nurses, but anybody who works in that healthcare setting, who interacts with health providers, or patients or their family members, those people are in a unique situation to really understand what it’s like. You know, I think many health providers feel that they’re almost living in a different universe than a lot of people who don’t have that type of a job. You know, a lot of people are protected from what’s gone on in the hospitals and so it’s hard for them to understand how difficult it’s been.

Dr.  Wendy Slusser  07:15

You said the word empathize, which I think is a really important distinction between that, practicing empathy versus compassion. Empathy is something that we all could practice, compassion is taking action on it. So what exactly does empathy mean or how do you practice it?

Dr. Brenda Bursch  07:31

Well I think in practice, what it means is communicating to somebody that you get it and not doing that by turning the story onto yourself and telling your own stories necessarily, although sometimes that can be helpful if someone knows you’ve been through the same thing. But it can be done in a very basic way, by just repeating something that someone has just told you, you know. “I am so depressed, this has been such a difficult thing,” you can just say, “Wow, this has been really difficult for you.” And that seems kind of silly in a way. It seems like, “Well, you’re just repeating what I just said.” But if you are speaking to somebody, it means that they’re paying attention to you. What they are able to say back to you what you’ve just said, it means they’re really paying attention. So at a very basic level, it’s communicating very directly, almost like a summary of what you’re hearing, especially paying attention to the emotional content of it. As opposed to any other kinds of memories or facts. I think that’s the easiest and most straightforward way. But of course, you’re also expressing empathy in how you are with your nonverbal communication and how engaged you are and how much you are focusing attention and not being distracted. If you have had a very similar situation, you know, it can be helpful to share that as long as you don’t take over the conversation if your goal is really to support someone else.

Dr.  Wendy Slusser  08:59

Well, that kind of practice probably could have been done or should have been done even before COVID. And if you think about, especially with a lot of our health care providers, knowing that there’s been huge burnout in general. And so how do you find the challenges of the pandemic, on top of what was actually already a condition that was happening in our health system relating to emotional well-being?

Dr. Brenda Bursch  09:24

I’m so grateful to you and to others who were able to support some of the work that I’ve done over the last five or six years on the topic of provider burnout and trauma, because we did have some programs in place already that we’ve been able to build upon, and hopefully we’ll continue to do that. But just to give a couple examples. We do have three locations right now where we have peer support programs. So, you know, in the emergency department and anesthesiology, and in one of our medical units, we trained about 15% of the providers in those areas on science-based ways to provide support in many, using many of the skills I just talked about. You know how to reach out to somebody after an adverse event, and provide them support, allow them to vent, give them some resources, if they want to be hooked up for additional education or services, and also just to provide education on what’s normal. And the feedback that we’ve gotten based on those programs, is that it really changes the culture. Even if people don’t want to chat about what they’ve been through, they really appreciate being asked, and it starts to really address some of the stigma associated with mental wellness. You know, we are in an environment where perfection is valued, you know, we want to be perfect for our patients. And because of that, it makes it really difficult to admit if you’re struggling, and you know, to make that more normal, to be able to talk about the fact that we all struggle, and especially among our leaders, to have our leaders share some vulnerability, really makes a huge impact on especially younger health providers who might feel intimidated by more senior people. And, you know, by hearing vulnerability more, having a program within your department that supports this type of communication, it really makes things a lot more transparent and helps people feel more comfortable that their leaders will have empathy for them if they struggle, and that it will be safe to bring it up. So I’ve been very grateful that we had some of that already in place. We’ve had some resilience training programs in place, we’d already developed an app to help our health providers assess how they are feeling, and to get immediate feedback, and coping skills, suggestions as well as connection to resources within that app. So all of those things were already in place, because we already had an issue with you know, burnout, as you know, as is true across the entire country. And then once we got hit with COVID you know, our health system quickly established a COVID mental wellness workgroup, led by Dr. Karen Miotto, and with inputs from professionals from the National Traumatic Stress Network by Pynoos and Melissa Brymer. And folks from our Staff and Faculty Counseling Center, and others from other locations within the health system that got pulled in specifically for this effort. And then we immediately started training mental health providers on disaster psychiatry interventions, so that we could start deploying our own mental health providers to specific units within the hospital and work groups and residency groups so that they could have a go-to embedded person who had some skills that could help them not only process as they go along some of the difficult things they’re facing, but also to hook them up with resources, and to develop resources as requested. So we’ve had quite a large group effort over the last year to do what we can to provide more immediate support for our health staff.

Dr.  Wendy Slusser  13:21

So Brenda, you’re pointing out the fact that in any disaster, you really had to be prepared. And you identified some of the areas that you had already been working on that really set the stage for preparedness and then was able to augment them and branch out according to this particular disasters, being the pandemic. You mentioned resiliency, and you’re a professor in the Department of Psychiatry and Biobehavioral Sciences and Pediatrics at the David Geffen School of Medicine at UCLA. And you’re an expert in training in resilience. What does that entail?

Dr. Brenda Bursch  13:56

Well, I’ll start with the definition of resilience, which is basically the degree to which one can adapt to and recover from difficult situations. Some of these skills are taught in our families as we’re growing up, there’s probably some biological contribution to it as well. But thankfully, you can also augment those skills. So we know that there are certain both individual skills and then also organizational efforts that could be made to try to improve one’s resilience. You know, what I’ve done mostly, is really focused on the individual. So you know, I know that the organization is also you know, looking at policies and procedures and resources and access to care and things like that, that are very important. My focus has been mostly on the individual and what the individual can do to try to boost their own resilience. You know, there are a variety of different types of skills that do that and you know, the idea from my perspective is to teach people some of those skills and to recognize that what will feel natural and normal and helpful to people will vary. And you know, some of them already get it, some of them, and like when I’m doing my training, if I can teach one skill that they haven’t seen or heard of before, then I’m very happy because we have a very resilient health force already. They’re beleaguered right now, but they’re very, very resilient at baseline. So it’s really trying to shore up any areas that could be shored up, you know, so at an individual level, ironically, one of the most important things is really to think about your support system. We know how incredibly important social support is, helpful social support, you know, because you might have a lot of friends or family and some of them might be really supportive, and some of them might not be, they might be more of a drain. So really thinking about who is it that helps me remember who I am? Who is it that helps me feel good and healthy, and lifts me up? And if I’m not having as much interaction with those people, right now, how can I make that happen, because that’s essential. And so for some people, it’s connecting with other people at work, who really understand what’s going on. And for some people, it also means connecting with people outside of work, so that you can have a break. And because we’re not being able to see each other as much, it might be setting up regular phone calls or Zooms, you know, in a way that you didn’t have to before because you would run into each other, or you would see each other socially. And then at an individual level, there are so many different things that can be helpful that range from just basically taking basic care of yourself, you know, am I still eating properly, have I figured out how to move my body even though I am working remotely, as an example. Just very basic, general health things, things that you can do to regulate your emotions better, to communicate better, to give your mind a break from thinking about difficult things all of the time. So for example, one of the skills that many people have gravitated towards in recent times are mindfulness types of interventions, and there’s so many different types you can do. The basic idea, though, is that you want to try to put yourself in a relaxed, calm state. And you don’t want to be thinking about things in the past or things in the future. So you know, if you think about things in the past, we often spend time criticizing ourselves about we could have done something better, or why didn’t I do it this way, or that person aggravated me. And if we’re thinking about the future, sometimes we’re thinking about, oh, I’ve got so much work to do. And when am I going to fit this in and will I hit this deadline, and I’m nervous about that. But if you can try to be present, and instead of using all of those thoughts, try to use your senses to perceive what is right before you, in a relaxed state, it gives your mind a break. And we know that mindfulness interventions have all sorts of physical and mental health outcomes that are positive. And you know, some people say, “Well, I can’t learn to meditate.” You know, they associate mindfulness with meditation. And you know, it’s something you have to practice but you don’t have to do a full on meditation practice to derive benefit from mindfulness type exercises. So there’s all sorts of other things like, you know, mindful walking, or mindful eating. It’s about focusing your attention using your senses, what am I smelling? What am I hearing? What am I seeing? And trying to be as present in the moment as you can. And then when you notice your mind going towards the future, the past, just bringing it back to what am I seeing, hearing, smelling, feeling right now? And so there are a variety of ways to do that. But that’s an example of a popular intervention that does not take that much time, which is really critical. If you’re talking about very busy health providers, you can’t say “Go to a yoga class,” they’ll laugh at you. I mean, they’re like, that’s not possible, it’s not going to happen. You have to figure out things that can be done within the workflow that have an outcome, even if you only have five or 10 minutes a day to do it. And that’s really what, you know, what we’ve tried to prioritize in terms of our skills training.

Dr.  Wendy Slusser  19:12

Brenda, that was really highly informative. And I’m just sort of trying to figure out, one, when you’re doing your educational or outreach, if a person can even identify one skill that they might not have known about, or to practice for resilience, that was a huge success. What skills have you noticed, have been the most common that people have identified as ways that they could build resilience?

Dr. Brenda Bursch  19:38

I think one of the things that’s been the most fascinating to me is that I’ve been in so many situations over the last year where I’m either teaching resilience or giving some sort of a processing space opportunity for people or I’m listening to Schwartz Rounds where our, you know, providers are telling their stories and I also do some work in the community and other settings. And so it’s not always just health providers I’m listening to, you know, I listen to people talk about their own family experiences, which the health providers have, as well. You know, family members who’ve, you know, had COVID, or who’ve died and their childcare challenges and like, there’s so many different things. And the thing that has really been notable to me is that no matter how difficult the story is that I’m listening to, by far, the most common spontaneous expression of a coping skill that I hear is almost invariably, somebody will spontaneously add something that they’re grateful for. They will talk about something and say, “But at least you know, I have a job, I am so grateful I have my family, I am so grateful that I have a place to live, I am so grateful for my colleagues, I’m so grateful to be working at UCLA.” I hear this over and over and over again. And I don’t know that people really realize what an important resilience tool that is. But kind of like I was talking about with mindfulness, attentional focus matters, what your brain is paying attention to impacts how you feel. And you know where most of us in the health care industry are problem solvers, all day long, we’re trying to solve problems. And because of that, we get into this, you know, we’re perfectionistic, we have to be for our jobs. So we’re always looking for problems. So it kind of puts you in this critical mindset, you know. This is a problem, we have to fix it problem, problem, problem problem. And so to counter that, it’s really helpful to spend some time with your brain focused on things that are good, and that you are grateful for, and that are going well and that are positive, to help balance your perception of reality. And, you know, we know from research that gratitude practices are very powerful. And so one of the interventions that I sometimes will recommend is that people spend, again, it can be three or five minutes a day, doing something to reinforce their focus on what they’re grateful for. So that could be sending emails to five people that day that they just really appreciate and just thanking them. It could be writing a list of three things that went really well today. It could be three things, three people you’re grateful for, it could be anything that kind of just reminds you about the goodness of what’s gone on, silver linings. And, you know, I think nobody had ever imagined in their lifetime, they’d be living through something like this. And so I think for many of us, we’re really much more appreciative for so many minor things that we never thought we’d lose before, like going to a restaurant. You know, never imagined that we couldn’t go to a restaurant for so long or, you know, visiting a family member or you know, so many things. And so finding gratitude or appreciation for some of those minor things, I am hoping, you know, once we are more opened up, that that appreciation will lead to feelings of glee as we’re able to be reintroduced all those things we miss right now. Well, that’s a perfect lead into my next question, which is moving forward, what are your recommendations for recovery from this pandemic? Well I think, you know, the first thing that’s worthy of saying, again, is that this is not going to be an on off switch in so many ways. The recovery is going to be in fits and starts, people are going to have different levels of comfort, and people have had different levels of trauma and loss. And so because of all of those things, it will also take different amounts of time for people to recover. And so I think the first thing is being patient with each other. And recognizing that this is going to take some time, and being compassionate towards ourselves. Maybe we can’t complete as many tasks as we normally can. Maybe we need to revise some of our goals and timelines so that they’re a little bit more realistic. But I think, in general, making space to tell those stories, is going to be an important part of recovery.

Dr.  Wendy Slusser  24:13

I hear storytelling a lot in your responses, and the power of storytelling is so profound in so many settings. What is it about the storytelling that is so important to you?

Dr. Brenda Bursch  24:25

Well as I mentioned before, telling one story is a much more effective and efficient way to process trauma than just sitting with it by yourself. Not only do you derive benefit from that social support, but it also allows you to integrate your emotions with your memories in a way that’s helpful and allows you to move forward. When you tell your stories and other people respond to those and you hear other people’s stories, you realize you’re not alone. We’re in this together. And that’s another theme that I hear very frequently, that, you know, even for people who are not telling their own stories yet, maybe they’re not quite ready to, they’re hearing others. It’s very reassuring. It’s like, oh, I’m not the only one struggling. So the more that we can really share all of that with each other, we’re creating a culture of support and safety for everybody.

Dr.  Wendy Slusser  25:23

I’m thinking, you know, a lot of people think, “Oh, you know, you want to be resilient before something bad happens.” But you can build resilience during the bad event as well. How does storytelling play into building resilience?

Dr. Brenda Bursch  25:37

When terrible things happen that you don’t expect, I think that, you know, you discover strengths and skills in yourself that you never thought possible. But we don’t have time. And we don’t make the priority to really think about that, and give ourselves credit for that, or understand it in a way that allows us to package it for future use. And I think that when you tell your stories, it’s a way that you can do that. You can honor you know, the strengths you found and better understand how they developed and how to use them again in the future. I think the other thing that happens with storytelling, especially if you’re storytelling, you know, with others, who have similar experiences to you, is that it, you know, it can remind you about, you know, why it is that you got into your profession to begin with. So, if you are a nurse, for example, and you’re talking to another nurse about everything that you’ve been through, and they understand, because they’ve been through the same thing, it’s really common that that conversation ends up evolving into a place of also remembering, you know, what it is that they went into nursing to accomplish, you know, what their fundamental values are and what their goals were. And, you know, I’m not saying it’s all roses in that, you know, there are times when people might feel like, “Oh, did I make a bad choice. I mean, this was really brutal,” like, “Who would want to live through this.” And that’s a normal feeling. You know, this was extremely disturbing for many, many people. But despite that, it’s remarkable how many people will also in the same storytelling, say that “I’m so glad I was able to do something, I’m so glad I was able,” and it might be small things sometimes too, because many times the care is futile. There are many instances where because of the nature of the disease itself, clinicians who are used to being able to regularly save patients had no tools at their disposal that they could use. The usual tools were either not available, or they just didn’t work. And so to find meaning and to find something where they felt like they were fulfilling their mission, as a physician, or a nurse, or a housekeeper or anybody in that role, means that you might have to switch in other places. So what might be facilitating the conversation with a loved one over, you know, an iPad and Zoom, because they couldn’t visit in the hospital, it could be, you know, trying to find a way to get a patient out onto one of our decks to see sunshine, you know, for a day. It could be a variety of other things, you know, helping getting them to windows, so they can see their dog outside. And, you know, finding meaning in those ways, which is very different than how they’re accustomed to finding meaning. And you know, through those stories, you can find those nuggets. And you can appreciate those moments whereas if you don’t stop and do that, the days, every day is so dense for so many of those micro moments, you never stop and really appreciate the impact that might have had on a patient or a family. And so I think, you know, by sharing the stories, there’s a higher likelihood that somebody will point that out if you’re not seeing it and that you will notice it if you hadn’t before.

Dr.  Wendy Slusser  28:55

You know, putting my white coat on, having you say what kind of advantage there is to tell a story, to build your resilience, makes it more likely that some people that are very sort of not going to dwell on the past and just move forward, it might bring people to the table to be more likely to do that, and then build their resilience more. Because there is something about our profession that makes you say, “Oh, you can’t dwell on the on the bad part, or you can’t feel bad. You just have to go forward and charge ahead,” right? And at least in my generation, so this gives it a purpose that might actually entice more people to participate.

Dr. Brenda Bursch  29:40

Right. Well, and we know that when leaders are a little bit more vulnerable, that younger faculty and trainees and other people who are more junior are more likely to reach out for help. And if it’s your very own leader, they might also be more likely to reach out to that leader for help because they’ll have increased confidence that that leader will understand. Whereas that leader feels like they always have to be the strong tough one, and they never share any of that, then there’s a wall that’s up. I mean, you know, and so it’s harder to approach that person, because you’re comparing yourself to them. And you have this false belief that they don’t struggle, and that they’ve never, they’ve never had some of the same feelings you have.

Dr.  Wendy Slusser  30:20

And that gets to what you were saying, that you had prepared a number of our departments already with the peer counseling, the peer-to-peer support, that helps break down that barrier.

Dr. Brenda Bursch  30:33

That’s the feedback we’re getting. And it’s, you know, it’s something that is evolving nationwide. Joint Commission is interested in peer support programs, you know, the information, the data, you know, is growing over time. So my hope is that, eventually, that will be something that is rolled out across our whole health system, as well as all the other health systems in our country.

Dr.  Wendy Slusser  30:58

That’s excellent. Well, I’m in full support of that, kinda, let’s get our heads together.

Dr. Brenda Bursch  31:02

Alrighty, let’s do it.

Dr.  Wendy Slusser  31:05

So would you say there any silver linings that have come from this pandemic?

Dr. Brenda Bursch  31:09

I think, you know, we kind of been talking some about silver linings along the way, just things that people have been grateful for. I think that it will really be different for different people. Some people really have taken this event, this pandemic, to think about where they’re at in their life, am I on track where I want to be? You know, should I be changing something? So, you know, for some people, they might decide, you know, “I’ve been thinking I want to move back to where my family is, for years now. And this is really pointed out to me how important that is. And so I’m going to make that a priority” as an example. Or “I was waiting to retire to travel. But that seems silly. Like soon as I can, I should start traveling” or, you know, whatever, “I want to have a child,” Whatever major life goals that you have, it might put them into a different perspective than you had before. Some people might feel more confidence, you know, because they now have been through something that they never imagined they would be able to successfully endure. And so just having endured that may give them confidence. You know, we’ve had all sorts of innovation on the science front that has occurred that will forever change all sorts of approaches to medical problems. We’ve had a huge revolution in how we communicate with each other using, you know, electronic platforms for meetings. And, you know, we’ve seen that it’s in some sub specialties in medicine, it’s worked really well and improved access to care. You know, in my own department, in the Department of Psychiatry are no show rates have gone down. And people who normally have to drive for a very long way can just, you know, immediately be on Zoom. And so it doesn’t work in all situations. And it doesn’t have to be Zoom, it can be Webex or you know, another platform. But it does open up all sorts of opportunities in that regard, as well as having meetings without having to travel and recruitment for trainees and all sorts of other avenues that I can’t imagine we’re going to go back to exactly how we were before, because everyone is suddenly now skilled in these tools, whereas before we weren’t. And so it’s much easier now to set those meetings up and be assured that people can manage the technology. So I think that that’s forever transformed, you know, how we will be operating. And I imagine also that there’ll be more people working remotely on a more regular basis, because we’ve seen certain ways in which that can be very effective. You know, those are just a few. There’s so many. But I think, and I think just as I mentioned before, our level of appreciation, I’m hoping that we are able to maintain some of that. We’ll remember these days and maintain some feelings of like, oh, wow, I really am so happy I get to just go visit family or go to a restaurant or whatever it might be.

Dr.  Wendy Slusser  33:57

Well, if you think about the Great Depression of 1929, and how much impact it had on at least my parents generation, that was a long lasting impact.

Dr. Brenda Bursch  34:08

Very good point. I had not thought about that.

Dr.  Wendy Slusser  34:11

Well, to wrap up, what good do you think will come out of this pandemic?

Dr. Brenda Bursch  34:15

You know, this is my hope. You know, I, of course, it’s impossible for me to predict. But I do hope two things. One is, you know, I think that health systems in general, and certainly our health system, was aware of the, you know, importance of mental health and wellness of our workforce. I think there’s more and more data emerging that demonstrates that’s how you give good patient care, that when you have a healthy workforce, both physically and mentally, your patients do better. And this makes good business sense, to really pay attention to this aspect of the well-being of our health force. And I’m hoping that this might even accelerate some of those efforts. You know, I know that we’re already underway, but I’m hoping that some of those efforts will be accelerated. And then you know, as I mentioned before, I’m just hoping that we will live with a renewed sense of appreciation. And time will tell, we’ll see if that’s true.

Dr.  Wendy Slusser  35:10

That’s for sure. I mean, one thing about the need and appreciation of emotional well-being support, is the concern that there are not enough providers. What is going to change in that arena?

Dr. Brenda Bursch  35:24

Wow, you know, that’s a really difficult question to answer. And, you know, it’s an interesting thing, because I think it’s uneven. Right? I think in some areas, we have not enough providers. And then I know, we also have providers that are worried about job security too, because there’s some places in which utilization has gone down, or other models of care are being implemented that might reduce the need for some providers. So I think that there’s concern on both sides. And that means we need to work smarter and more efficiently, right. We need to make sure that everybody is working at the top of their license, that where you are training, I think the best example would be, you know, the peer support we’ve been talking about. Clearly, there’s not enough mental health providers for the need that we have. And so because of that, we have to be really smart, we have to prioritize. We know that, for example, if you have mild to moderate symptoms of anxiety, or depression, self help interventions can be helpful. Peer support interventions can be really helpful. So if we can better equip people to help each other and help themselves, then we can really save the mental health professionals for those who have the most severe problems, who really need that expert care. And, you know, that same model could be replicated in other areas as well, just really thinking about how do we empower people better, and then most strategically use the talent that we have for their talent?

Dr.  Wendy Slusser  37:00

Well, that’s an excellent way to end this talk. I want to thank you so much, Brenda, you are always just an incredible resource for all of us at UCLA and around the country. I know you do a lot of consulting and support for others outside of the health system, and you’re a real gem. And I don’t know if you have any final words that you’d like to share with us or wisdoms before we end this podcast.

Dr. Brenda Bursch  37:24

I’ll just say it’s a mutual admiration society. So I will thank you for your incredible support. You’ve always been a huge advocate and you know, put money behind that and networking. And it’s just, I can’t tell you how much I’ve appreciated that. And, you know, that’s a really good example of how we move forward in these partnerships. So thank you very much for having me today.

Dr.  Wendy Slusser  37:46

Thanks. Yeah, it’s always about the team.

Dr. Brenda Bursch  37:48

That’s right.

Dr.  Wendy Slusser  37:49

Thank you, Brenda. Thank you for tuning into UCLA LiveWell. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA LiveWell on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better, and follow us @healthyUCLA. If you think you know the perfect person for us to interview next, tweet your idea to us please. Have a wonderful rest of your day, and we hope you join us for our next episode as we explore new perspectives on health and well-being.