CASAT Podcast Network

Welcome to season two of CASAT Conversations.

I am your host, Heather Haslem.

This season we will explore the timely and complex topic of resilience for healthcare providers Within each conversation, you will hear from experts, clinicians and providers who will explore and share the latest research, best practices and applications for how to be resilient.

Please enjoy today’s conversation.

We are excited to welcome Dr. Dana Rose Garfin to CASAT conversations today,

Dr. Garfin is faculty in the Sue & Bill Gross School of Nursing and the Program in Public Health at the University of California, Irvine.

Her academic work explores how individual level negative life events and collective trauma affect physical and mental health across the lifespan and how community based interventions can alleviate resulting health disparities.

She is currently the principal investigator of an NIH funded K01 “Mindfulness-based Intervention to Address PTSD in Trauma-exposed, Homeless Women,” which uses a bio psycho social approach to examine how mindfulness can help reduce PTSD depression, substance abuse and improve regulation of the HPA-axis.

She is also co-PI of several National Science Foundation grants that examine how individuals respond and adapt to collective trauma including hurricanes and COVID-19.

Her work has been covered in hundreds of domestic and international media outlets and her 2020 paper on COVID-19 was the 3rd most downloaded article across the 89 journals of the American Psychological Association in 2021.

She was awarded the Outstanding Contribution to Trauma Psychology by an Early Career Psychologist Award by the American Psychological Association.

Dana graduated Suma cum Laude from the University of Colorado, Boulder with BA in Sociology.

She has a master’s in social ecology and a PhD in psychology and social behavior from the University of California, Irvine

Welcome Dr. Garfin.

We are so happy to have you on CASAT conversations today, thank you, Great to be here.

I’d love to hear how you got into this work and all of the research that you’ve done to date.

So I got interested in this work when I was at the University of Colorado Boulder as an undergraduate, I was a sociology and political science major.

So I was very interested in the way large scale events and social structures influenced the way people think and behave.

And so after college I became more interested in sort of the micro level of human feelings, thoughts, cognition behaviors and so then for my and I worked at a research lab at Stanford University on mood and anxiety disorders and I, for my graduate work wanted to combine those interests.

So understanding the psychology of how individuals respond to large scale collective trauma was a really natural synergy of those various interests, Awesome.

So with that what have you learned about how people are responding to COVID-19?

So COVID 19 is not to use an overused word, but it truly is an unprecedented event and that’s because it’s happening at multiple levels of exposure.

So it’s an acute event and that this kind of ongoing event is punctured with these sort of acute traumatic events like you might get sick, you might know someone that’s sick, there’s a stay at home order implemented.

Um schools are closed, there has been a lot of political tension and so there’s this kind of, you know, acute events that are occurring under the umbrella of this long and protracted chronic stressor, Right?

So we sort of have to things occurring at the same time.

Another thing that really makes the COVID-19 pandemic unique is that people are exposed to it directly in their individual lives as well as through media exposure.

So, people have had a lot of Media exposure to the events of 2020 and of course 2021 as well, Um both with COVID-19, as well as all these kind of associated stressors that occurred, economic problems, stay at home, school closures, political upheaval, social upheaval.

So all these things have been happening um in tandem and synergistically and related to each other.

And so that’s really put a strain on people’s mental health.

And what do you what is your research found is the psychological impact of COVID-19.

So, for the psychological impact of COVID-19, the research that I’ve done along with a lot of other folks, there’s been, you know, quite a lot of research on the psychological impacts of COVID-19.

So a few things, first of all, people have reported elevated distress.

So we know that people are reporting more anxiety, they’re reporting more depression, they’re reporting higher levels of stress.

And so we we definitely have seen that.

But you know, another thing that I think it’s important to point out is that people are quite resilient.

And so even though a lot of people are reporting these sort of negative mental health consequences, we also see a lot of people that are quite resilient and able to adapt.

And so I think that there’s something that, you know, we can kind of honor and learn from that side of the coin as well.

Yeah.

And I’m curious, you know, a lot of your research has also focused on the positive impacts of COVID-19.

And really that resilience and our ability to adapt, adapt.

Can you say more about that?

And what you found?

Yes.

So I would say two things.

So, first of all, when we talk about the positive impacts, it’s not it’s not an either or right.

So, and and a lot of research on stress and trauma has found that when you think about people finding positive experiences in traumatic events that actually happens co occurring with psychological distress.

So there’s a lot of research that, you know, when a negative event happens, people try to search for the positive, they try to make sense of it.

They try to find meaning.

And so, you know, saying that people are able to find positive benefits, um doesn’t at all negate the stress and the psychological discomfort and, you know, the trauma that people have experienced.

So, you know, it’s it’s definitely, again, it’s not like an either or it really can happen in tandem even for the same person.

And so what our research has found is that people have been able to report positive benefits.

You know, a lot of people, I mean, you know, there’s been a lot of anecdotal reports as well, you know, people reported um they enjoyed slowing down, they enjoyed spending time with their family, they had a re prioritization of what’s important, you know, feelings of increased gratitude.

So, um you know, there have been there has been an ability of people to kind of see the silver lining, so to speak, even in unfortunate circumstances.

And what are some of the coping mechanisms that you’ve seen that have been supportive for people during this time?

So a lot of people have reported um spending more time outdoors, they’ve been engaged with hobbies, They have again, felt kind of even more connected with some of the people that they are able to interact with.

Um So we do have these kind of positive benefits that people experience, but again, that doesn’t necessarily mean that they’re not experiencing distress and in some cases they can actually report increase positive benefits at the same time, that they’re reporting and increased stress response compared to other people.

Yeah, as we explore the topic of resilience, um one of the things we keep coming across is the complexity and that’s really what you’re pointing towards here, right?

Like it’s not an either or there’s really an and I can be experiencing distress and in the same moment I might be experiencing gratitude.

Yeah, exactly.

And and indeed, I think from the experience of adversity, sometimes those sense those experiences can rise, you know, it’s like when you’re confronted with this loss, it can sometimes make you look at your life and think what is here?

That’s good, right?

And there’s a lot of reasons for that, right?

I mean like that’s very like adaptive, right?

Coping strategy, you know, it’s not it’s not adaptive to have something negative happen and just lay in bed all day for the rest of your life, you know, even if it’s something that’s so overwhelming, you know, that would even make sense, right?

Um so, you know, it’s adaptive to kind of be able to look at the pieces of one’s life when things have fallen apart and think how can I move forward, you know, what do I need to do, what do I need to focus on?

Um you know, to be able to be resilient and to be able to deal with these negative life events in a positive way and be able to move forward, but you know, again, I just think it’s really important and I think, you know, a lot of people have talked about sort of toxic positivity.

So I just want to be clear that that’s not at all what we’re talking about here, right?

And in fact, I think it’s really important that people honor their grief and honor their distress and are aware of their anxiety, depression, anger, you know, that’s actually can open the door for healing, right?

So, you know, you feel anxiety, right?

Anxiety about the future, um lost your job, somebody’s sick.

You know, those are real things to be anxious about, right?

And that’s an adaptive response, right?

You want to have um a little bit more alertness so that you can deal with the event that’s happening, right?

So, but you know, to take a step back and say, oh, anxiety arising.

You know, depression is present.

And that way, you know, if you almost can like label it and identify it.

It can allow you to kind of cognitively separate.

You know?

Oh, this is part of the anxiety response.

This is part of you know, my experience of depression, I can be aware of that.

I can acknowledge it.

You know, how do I make choices in my life that can still allow me to move forward and be supportive to myself as well as the people around me?

Mm hmm.

So it sounds like really acknowledging the different emotions that are present in the moment and then being able to pause and really ask what’s called for right now.

Exactly.

You know, I mean, job losses the perfect example.

I mean that’s incredibly stressful and you know, a lot of research over the decades has really shown that you know, financial difficulties, losing one’s job, you know, that’s one of the most stressful things that anyone can experience, right?

So just saying, oh, like see a silver lining, everything is great.

I mean that’s not adaptive and that’s not true.

You know, you need to be able to say like this is very difficult, I’m having a hard time, you know, so that you can not react to the situation but that you can respond right?

You know, what do I need to do to move forward?

What actions do I need to take to deal with this more effectively.

You know, how can I support the people around me who are also experiencing this this distressing event, right?

Like if someone loses their job, it affects them, it affects their entire family.

You know, often other people in the community may be affected.

So you know, you need to be able to kind of like recognize that stressor um acknowledge that it’s difficult so that you can take the necessary action to deal with it as best you can write whether that is through a proactive coping, there’s something that you can do, right?

Like looking for a supplemental job or um you know trying a new path or whether the response is just this is really hard and difficult and I need to do the best I can to regulate my emotions, you know, and weather the storm until there’s a better time ahead.

You know.

Mm hmm.

I’m curious how does your personal practice, I know you’re a mindfulness practitioner as well as teacher.

How does your personal practice inform your research?

So it informs it informs it a lot.

And you know, over the years I’ve kind of seen it come together even more.

So I spent um I spend kind of the first big chunk of my career looking at how people respond to negative life events from a large scale perspective.

Right?

So I’ve done a lot of studies looking at thousands of people and how they respond to these big, big events like uh the Boston Marathon bombings, earthquakes, hurricanes, shootings.

Um and looking at how people as a whole respond to that.

And then as my career progressed, I became really interested in.

So what can we do to help people, you know, what interventions are helpful for people.

So, one of my major projects right now is looking at how a mindfulness based intervention.

So it’s an intervention that incorporates meditation, different types of body awareness activities and yoga and how that can help regulate this physiological stress response as well as post traumatic stress disorder anxiety and depression in a population who has experienced a lot of trauma.

So, and this particular study looks at trauma exposed homeless women.

And so there’s definitely this link between, you know, I was kind of doing all of this personal work and meditation and yoga to regulate my own stress response.

Um you know, but it took me a few years before I was able to kind of take that piece of my life and really integrate it with all of this scientific work that I had been doing on responses to traumatic events.

That makes so much sense to me in that you had to embody the practices before you actually went out and started studying them in other populations.

Yeah, that was a really exciting project when I started it.

Uh you know, you talked about toxic positivity and I think mindfulness is such a widely used term, it’s sort of like just be grateful, like just being more mindful and I think the term mindfulness can even just sort of bring up a connotation of like there’s that word again.

And so I am curious, you know what you would say to that and um yeah, I guess just what you would say to that.

Yes, so so mindfulness as you know, Jon Kabat Zinn who’s a researcher at the University of Massachusetts, Amherst and I think, you know, most, most long term practitioners have sort of um from that tradition, you know, they would say, you know, mindfulness is being aware of what is happening in the present moment as it unfolds that might be positive and that is oftentimes negative.

Right?

So gratitude may arise in a moment of mindfulness.

But you could also be aware of anxiety.

You could be aware of depression could be aware of anger, you could be aware of grief right?

And all of those could be experiences that occur as well, right?

And being able to tune in and be aware of those experiences Stigned 1 to respond appropriately.

Why would you feel happy when someone you loved died then grief frequently will arise.

Right?

And again, there’s a lot of variability.

So we don’t even want to say that you know, someone experiences grief right in the aftermath of a loss like people have all different types of responses like even to the same event, even too big major tragedies.

Right?

So for that, you know, for for a lot of people to experience the loss, grief is present, sadness is present, right?

That allows a person to honor their experience and adjust and adapt accordingly.

Right, on the other side of the coin too.

Right?

If you’re so focused on um on the future or the past, your mind is going here, your mind is going there.

You know, then you do miss a beautiful moment, right?

You miss that moment with a loved one.

You miss that moment with your spouse or your child or walking the dog.

Right?

So mindfulness, you know, it’s a gift and that it allows you to be present when beautiful moments arise in life.

But you know, the other side of the coin is that it also requires you to be present with life’s difficulties.

You know, and that opens the door to healing.

That opens the door to responding in a way that’s helpful and beneficial and being aware of one’s habitual patterns that are not helpful.

Right?

So, you know, when you see you see it all the time, like if you’re not aware, I’m feeling anxious, you know, people drink, people smoke people overeat people, you know, binge on Netflix.

And and I’m not saying that any of those things, you know couldn’t be a choice.

They could.

But the point is to put yourself in the driver’s seat of how you’re responding to life’s challenges.

Um so that you are able to make a choice.

You know, maybe a choices.

You know what?

I am so overwhelmed.

I just want to lay on the couch and watch a movie today and then get up and take things on you know tomorrow.

But the point is to put yourself in the driver’s seat and being able to make that choice, you know, rather than just responding in a habitual pattern that may or may not be helpful.

Mm hmm.

So making those conscious choices.

And I think the piece that I want to just highlight again is that you know, there’s a myriad of emotions and we all have different responses.

Have a colleague who’s um wife passed away a few years ago from cancer and he is a beautiful writer and so he writes about his experiences as a form of healing and uh he has a very vulnerable piece of writing that talks about even the relief that he experienced when his wife passed and then the shame and the guilt that cut that came with that sense of relief.

And so I think it just speaks to again like this complexity of the human experience and the complexity.

You know, we may be experiencing multiple emotions at one time and they could be layered upon one another.

Yeah, I think that’s a really excellent point because, you know, there’s a lot of myths in society, there’s, you know, stages of grief, everyone has to have the same experience.

You know, there hasn’t been no scientific evidence of any kind that supported that, you know, and what the science and the and the research has shown is that there is not one way that people respond to adversity and there’s not even necessarily one way that’s more adaptive than than the other in terms of the emotions that one can experience in the immediate aftermath, right?

You know?

Um so even even with something like the acute stress response, which is sort of like these early elements of post traumatic stress disorder that people often experience in the immediate aftermath, you know, for example, experiencing that constellation of symptoms is more highly associated with post traumatic stress disorder later.

However many people experience acute stress in the immediate aftermath of a traumatic event and do not go on to develop post traumatic stress disorder.

So even even within something like that, that you know the science does show a link, you know, we need to create the space that for some people that response is normative and many will recover on their own right.

You know that being said, you know, the other side of the coin is we don’t want to say, oh hey people are distressed right away and then you’ll be fine, right?

We want to create the structures and the support that for people who are experiencing that, that protracted response over time that there are resources to support them.

Yeah.

And you know, some people my experience adversity and not really have too much of a reaction either way.

You know, some people feel numb, they don’t feel happy, they don’t feel sad.

Um you know, and and sometimes that can, you know, they you know, when you kind of think about it from like the scientific like evolutionary perspective, you know, a lot of those initial responses can be adaptive in different ways, right?

So they you know, being aware that those can happen, you know differently for different people and even at different times in one’s life, you know, you could think about, you know, a divorce for example, you know, two people in the same marriage could decide to terminate this marriage, One person like you were talking about with the gentleman who lost his wife to cancer could experience like relief and freedom and even happiness.

Other person could be experiencing grief more intensely than they ever have or will again in their life.

You know, responding to that same event, that even same relationship could have two wildly different responses for two different people.

Well, and even um I think for the gentleman that I was just talking about, um it’s day by day, right?

So he will, he’ll talk about his grief journey and, you know, one day it might be the person who is just in such difficult and extreme grief and the next day, maybe it’s a sense of relief.

So there’s also this fluidity in the moment to moment experience.

Yeah, I think that’s really important to acknowledge as well, especially with grief.

I mean, grief is kind of oftentimes people report it comes in waves, you know, it comes something reminds you of the event or the person you’re overwhelmed with grief and sometimes you can experience that, you know, grief arising even without a precipitating event or memory, just who knows where it comes from, you know?

So those types of experiences are, are certainly complex and again, I think just from, you know, a perspective of mindfulness, you know, being able to be aware of those experiences, you know, allows people to respond, you know, because sometimes you can’t go back to bed.

You know, sometimes, you know, grief arises, anxiety arises, depressed situation arises and you have to get the kids to school, You have to show up to work, right?

So you have to be able to acknowledge that that’s what’s happening.

So you can take a step back, regulate and and take a step forward, even even if it is feels almost impossible to do so, mm hmm.

So, as you know, our audience really for this podcast or healthcare professionals and behavioral health professionals, what has your research found about healthcare workers in COVID-19?

Well, it certainly has been a stressful time for everybody.

Um, you know, in society, uh there’s been a lot of variability with healthcare workers as well.

So it might depend on the hospital or the situation you work at.

Um it might depend on how well your organization is preparing people, right?

So, if you’re able to have the resources, take care for the sick people who are coming in, you know, you have the PPE, you have the beds, um, you know, you’re able to help people, you know, people can feel good about being able to help people get better, right?

That’s why a lot of healthcare professionals, you know, chose that industry, you know, So when you’re able to feel that sense of meaning and purpose and, you know, achieving that goal of helping people, you know, that those types of people and in those situations might even be responding better than someone who is at their house and not feeling connected to anyone at all.

Right?

So that could be an experience that arises.

You know?

And then certainly, you know, there’s a lot of research on burnout and stress when when health care workers are overwhelmed, they’re not feeling the support from the community.

You know?

There was I saw on the news, you know, there was a walkout of health care professionals, you know, because they were overwhelmed in their hospital of people who aren’t getting the vaccine and that they have had to deal with the you know, overcrowding, the overwhelmed the loss of patients.

You know, I mean certainly, you know, we talked about in the ICU.

The burnout and the post traumatic stress that a lot of people that care for people in those situations experience, you know like you’re human, you’re a nurse, he’s lost a patient.

That’s very difficult.

Even you know, there isn’t a lot of research that people necessarily like habituate to that you know?

And um you know, for many people it can kind of become a cumulative exposure of loss.

So again, even in those situations, I think there’s like a lot of variability and and how people respond and how people.

Um and even in the situations people are in, right?

So you could be in a community that’s you know highly vaccinated.

Um You do get the occasional covid patient trickling in and you feel good about being able to help them, right?

Because you have the resources both psychologically, um emotionally and then, you know, the the physical beds in the hospital to be able to help that person and, you know, a person can people feel really good about that.

You know, in contrast to a situation where the hospital is overwhelmed, you’re losing patients left and right.

You feel some of these deaths are a lot of these deaths are preventable.

So there’s so much variability and even how healthcare workers respond.

And I think it’s really important to honor that as well.

Mm hmm.

That makes so much sense.

You know, we’ve talked with a number of health care providers and we do hear a lot of variability in how people are experiencing the pandemic.

Um and I just, you want to come back to, you know, you’ve mentioned resources a couple of times.

And one of the things that we find um from all the researchers that were talking to about resilience is the importance of resources in your experience.

What do you see as some of the needed resources for healthcare providers?

Um right now, Yeah.

So I would say that and I think that the hospitals and the health care system has done, you know, has been able to ramp up so that, you know, in the beginning of the pandemic.

You know, people don’t have PPE.

So, you know, I think at least society has been able to address that, you know, to to a large extent um you know, it’s been really hard in situations where they’ve had, you know, shortages of nurses and doctors because I think, you know, for healthcare providers and for everyone that time away to recover emotionally psychologically get sleep, do those kind of self care activities like getting sleep, taking a walk, exercising, eating healthy time with friends and family, you know, those are things that that rejuvenate people, you know, it’s I think it’s really difficult when people are working in a situation where they don’t have time um to to engage in those activities, you know, because that can kind of lead to burnout as well.

Um certainly, you know, we’d recommend that there be psychological resources available for hospital staff.

There’s been a lot of interest in doing um you know, like things like mindfulness based interventions for health care workers, you know, so that, you know, some of those kind of external circumstances cannot be changed, you know?

So in those situations, you know, it’s really important that people have those resources internally to be able to regulate the stress response so that they’re able to do their job and care for other people.

Yeah, absolutely.

I when you said self care, I became aware of, we talked about toxic positivity and people’s response to mindfulness and I think the same is true for self care right now, it’s like, but really what you’re pointing to is the need to take care of our body, our physical body, our emotional body even spiritually.

Um and that, you know, these basic practices of getting sleep of eating nutritious or nourishing foods for your body of taking time to down regulate the nervous system.

Like these are just things that you need to do to function so that you can show up more effectively.

Um But it’s interesting, like I as I said, I get to talk with a lot of health care professionals and you talk about self care and like I can just watch the walls go up and so it’s just an interesting insight.

I think self care can look different for different people, right?

So even when I kind of mentioned earlier like, you know, eating or watching Netflix or you know, drinking, it’s like, you know, there I got this, I feel like there’s been this one size fits all approach to like self care, you know, I mean who says taking a Saturday night and binge watching your favorite show on Netflix so that you can just check out, get, you know, relax and then go to work and who says that’s not self care, You know, self care doesn’t have to just be another thing on your to do list, like oh, baking bread and doing a yoga, like if you don’t like yoga don’t do yoga, you know, and and if there’s not a one size fits all approach, I mean a lot of people find meditation helpful, not everybody does don’t do it, Find something else that services you, you know, maybe maybe you love ice cream and what is helpful for you is to take your family and go to your favorite ice cream shop and enjoy a delicious treat, you know, and not feel guilty about it.

Like who says that’s not self care?

You know, self care is also very individual, you know, and again, that’s where the mindfulness comes in, You know, self care, having some ice cream isn’t mindlessly eating an entire pint of Ben and jerry’s standing up in the kitchen feeling guilty about it the whole time.

That’s not selfish.

It’s just another thing to beat yourself up and feel bad about, you know, but you know, saying, hey, like this is my favorite ice cream I had a rough day, I need to treat and I’m going to enjoy every single bite of it.

This is, it’s not self care, I need to sleep in sleep in, you know, and there’s been a lot of talk about, you know, you kind of like this what kind of perfectionism that, you know, during, and I guess this probably doesn’t relate to health care workers as much that, you know, oh, make good use of your time during the pandemic.

And people were feeling really guilty about it because they didn’t want to do anything, they didn’t want to organize their closets with their time off.

You know, they didn’t want to start a new hobby and so people were kind of feeling you know guilty about that as well.

But I think self care can look a lot of different ways and it’s again that from my perspective of mindfulness it would be like checking in with yourself and understanding what’s helpful for me, you know?

So that looks really different for different people.

Thank you for naming that because I think it’s a really important piece of the conversation and I love your example of like the mindless ice cream and then the mindful ice cream and the difference between the two.

Thank you.

Yeah.

Um and I think the other piece it sounds like is giving yourself permission um to do what’s needed in that moment, right?

If it’s sleeping in that morning um and you’re able to write giving yourself permission to and not beating yourself up over it or giving yourself permission to binge watch whatever tv show it is that you’re loving um to give your mind a break because I think, you know in this time um it is really overwhelming for our brains just based on how we’re wired on the amount of uncertainty that we’re experiencing, especially as we are in this second wave of the pandemic.

Um there is a lot of uncertainty and the impact of that on the brain.

Yeah.

And again, you know mindfulness is being aware, Right?

So again you can think of exercise as another example, you know, compulsively forcing yourself to go to spin at 5:30 AM when you don’t get any sleep.

You know, that’s not how is that helpful?

You know, that’s not helpful.

Of course.

You know, exercise is good for the, you know, research shows, exercise is good for the, you know, your emotion, your health, but you know, doing it in a way that is just punishing.

It’s not helpful for your body, It’s not helpful for your mind.

You know, that’s not that’s just giving yourself another thing to be stressed out about or you know, another thing to feel bad about when you don’t make it, you know?

And so I think there’s really like a balance between checking in and being able to say like what do, what do I need?

You know, or whether it’s like I have not moved my body all week, even though I’m tired, I have to get my, you know, myself out of bed and make it to work out, you know?

So it’s like, it’s it’s not a one size fits all approach to every person and it’s not a one size fits all approach to every person every day.

You know, it’s being able to kind of check in and like put yourself in the driver’s seat um of what you need to do for self care for you in that moment.

I purchased myself a peloton bike recently and um you know I get the bike and I’m like okay I’m going to get up every morning and get on the bike.

So that’s my plan because that fits into the schedule of my day and so like day one of this new schedule I wake up and check it out.

I also practice mindfulness and check in and my body is like you know like I get up, I meditate, I have a cup of coffee, I read maybe journal and moving at that time is not supportive for my body.

And so I was like oh right like we try to fit it into our schedule like based on what makes most like logistical sense.

But checking in, you know for me it’s two or three in the afternoon is the ideal time to work out and scheduling.

That is often a challenge.

So it’s that you know, checking in what what makes sense today, what is called for what’s needed?

Well I wanna thank you for your time.

How can our audience learn more about your work or connect with you.

Um So they can learn more about my work.

Um I have a couple of websites.

The first one is my mindfulness website is DanaRoseGarfin.com.

Um They can also email me at d.garfin@uci.edu.

And then my my professional website with all my research um that’s actually linked.

There’s a link to that on danarosegarfin.com.

So I recommend they reach out, love to talk with anyone and um thank you so much for having me.

Thank you and we’ll make sure that those links get in the show notes.

And again, thank you for your time and sharing all of your research with us today.

Thank you for having me.

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