RHR: REVAMPing How We Think about Health, with Dr. Jordyn Feingold

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Health is much more than being free of disease. In this episode of Revolution Health Radio, I talk with positive psychology expert Dr. Jordyn Feingold about what health really is and how we can all cultivate more health, well-being, and self-awareness by using the acronym “REVAMP,” a six-ingredient framework consisting of relationships, engagement, vitality, accomplishment, meaning, and positive emotions.

In this episode, we discuss:

  • Jordyn’s background
  • Why relationships are the foundation of the “REVAMP” model for well-being
  • Harnessing the power of the placebo effect
  • The importance of engaging in the flow of life and within ourselves 
  • Using sustainable habit change to increase vitality
  • Reducing burnout by reframing accomplishments
  • Finding meaning and purpose in life
  • Learning how to prolong and deepen positive emotions
  • The importance of post-traumatic growth

Show notes:


RHR with Jordyn Feingold

Intro:

Hey everybody, Chris Kresser. Welcome to another episode of Revolution Health Radio. This week I’m excited to welcome Dr. Jordyn Feingold as my guest. Jordyn is a resident physician in psychiatry, researcher and positive psychology practitioner, and teacher working to bring the work of self-actualization and transcendence to patients and clinicians everywhere.

So, if you remember my previous podcast with psychologist Scott Barry Kaufman, where we talked about self-actualization and transcendence, Scott briefly mentioned Dr. Feingold to me on that podcast and the work that she was doing implementing these tools and practices and concepts in the healthcare professional audience. And so I was really excited to connect with her because as many of you know, in addition to being a clinician myself I’ve also trained functional medicine clinicians since 2016 and I’m very well aware of the need for this kind of work in that audience. A lot of us as clinicians suffer from burnout. We work really long hours, unrealistic schedules in structures and environments that are really not conducive to our own health or our patient’s health. And I think it’s really crucial for us to find ways to cultivate more resilience, more self-awareness, self-actualization, and even transcendence. So I was really excited to connect with Jordyn and talk to her about her work.

As an undergrad, she attended University of Pennsylvania and then also went on to get a master’s degree in Applied Positive Psychology at UPenn, which is where she originally got exposed to positive psychology, took Scott Barry Kaufman’s class. Then she received her MD and her master of science in clinical research from the Icahn School of Medicine at Mount Sinai. And she has since then founded Thrive Rx, which is an online well-being course for clinicians, which we’ll talk a little bit about at the end of the show, and Peers Practice Enhancement, Engagement, Resilience, and Support which is a medical trainee well-being curriculum. And she teaches around the world on positive medicine. She’s also writing a book on post-traumatic growth and post-pandemic growth with Scott Barry Kaufman, which we talk a little bit about.

So even though Dr. Feingold’s work is oriented towards clinicians, her REVAMP model of physician well-being, REVAMP is an acronym, 100 percent applies to all of us, to everybody. It’s a way of looking at health and well-being and what the ingredients are, so to speak, in health and well-being. So much of medicine is focused on disease and dysfunction. And yet we know that health is far more than just the absence of disease or symptoms. And so, in this show, I talk with Jordyn about what health really is, what constitutes health, how do we explicitly work toward more health and well-being instead of it being just this vague concept, and that’s where the REVAMP acronym comes in. It provides a kind of roadmap or a guide that we can use to intentionally cultivate more health and well-being in our lives. And I think that’s always important, but it’s particularly important now in this pandemic era that we’re living in. So I hope you enjoy this conversation as much as I did. Let’s dive in.

Chris Kresser: Jordyn, welcome to the show. It’s a pleasure to have you.

Jordyn Feingold: Thank you so much. I am very honored to be here.
Jordyn’s background

Chris Kresser: So why don’t you start by telling us a little bit about your background, what you’re up to, and how you got interested in this concept of medical and physician well-being and positive psychology applied in medicine.

Jordyn Feingold: Sure, happy to. So my journey started as a young kid in high school growing up. I discovered pretty quickly in my high school biology class that I was fascinated with the human body and it was specifically the digestive tract that totally turned me on to a career in medicine. And I just remember being fascinated by the story that my high school biology teacher told of her bagel being digested throughout the body and all of the different proteins and enzymes that were working on the bagel with cream cheese and how, it was better to have, more nutritious for our bodies to have the carbohydrates with the protein of cream cheese, even though it was more calories to help the body digest, to actually digest the food. So that is what hooked me into human physiology.

And I went to college at the University of Pennsylvania in Philly, which just fortuitously happens to be the birthplace of the formal field of positive psychology. And I had the pleasure of taking Scott Barry Kaufman’s positive psychology course as a senior. And before that, I sang in a college acapella group at Penn called Off The Beat. And we were hired every year by the masters of applied positive psychology program for the last day of their class to come into the classroom and teach the master students a piece of acapella music. And this experience for me was like a peak experience of my life that I got to repeat every year my freshman through senior years of teaching these students a piece of music and through this, singing opportunity, this gig we did every year, I really dipped my toes in the water of positive psychology and understanding what that was. And it was in that performance my junior year, when it really struck me that I think I need, I was like, I need to pursue this, I need to pursue this as an academic focus. I really want to learn more about positive psychology in a formal way. Because it wasn’t until I discovered what positive psychology was really understanding that well-being is more than just the absence of that which afflicts us, that I realized that medicine, the field that I had dreamt of going into, I was pre-med, was so focused on disease and dysfunction.

So that sort of crystallizing experience of being immersed in the MAP program through the singing thing led me to apply for myself and ultimately go to MAP, do the one year Master’s of Applied Positive Psychology program at Penn before I went to medical school. So now I’ve since graduated from medical school, and I am a resident physician in my intern year in psychiatry in New York City. And I’m applying positive psychology and now what I call positive medicine and what I do with patients and how I teach medical students and trainees and clinicians, really every single day

Chris Kresser: That’s a fascinating experience and I really couldn’t agree with you more. It’s always struck me that there’s no real definition of health in the conventional medical paradigm. As you know, having just gone through this, you go to medical school, you’re mostly studying a list of diseases and the ways to treat those diseases and there’s very little discussion about what constitutes health and well-being. As you said, it’s not simply the absence of symptoms or disease, but it’s clearly the presence of something else. And of course, there are people who have symptoms and have diseases, and yet we would unequivocally describe as being incredibly healthy and well. And then there are people, on the other hand, who have no clear symptoms or disease and who most people would assess as being unhealthy and unwell. So it’s such a fascinating thing to explore because beyond what I just said, I don’t think there are within the, I think within the kind of general consciousness, there aren’t clearly defined concepts here.

Jordyn Feingold: Totally. And that was exactly what I was trying to understand when I went through the MAP program, and ultimately dedicated my capstone work to it. The end of the program was understanding that illness is so clearly defined, just as you’ve said, and so is burnout. I became really fascinated by how do we promote well-being for patients, if the doctors and the clinicians who are sort of the conduits of their health care are so ill themselves and lacking well-being themselves. And I started to really study burnout among physicians. And it was so clear to me that since the 1980s, and the concept first came into the literature in the 70s, that burnout was this really well-defined phenomenon of emotional exhaustion, depersonalization, and a low sense of personal accomplishment related to the work that we’re doing, particularly in the health services industry.

And it was so, there was just so much out there. And since 2016, it’s even exploded so much more and especially during COVID. And everyone’s talking about burnout now in every industry, but there was no unifying concept of well-being. And so I scoured the literature and was looking at different concepts from Eastern philosophy and Western philosophy dating back to the 1950s with Marie Jahoda. I was looking at sociological definitions of well-being, and ultimately came up with one that I most proximately is based on Marty Seligman’s work the father of positive psychology, but iterates on it that I define as REVAMP, which I love because I love acronyms [inaudible 07:36]. And it’s an acronym and a call to action for physicians and really for everyone to really revamp the way that we’re thinking about our own well-being with six core ingredients.
Why Relationships Are The Foundation of The “REVAMP” Model for Well-being
Jordyn Feingold: And those ingredients are what we know really comprise. None are sufficient for well-being, but each of them sort of synergistically, and we pursue them all for their own sake, but they’re all sort of required for well-being. And it’s helpful to have a model because well-being is not just something. We don’t just say like, “Oh, let’s just go enhance our well-being,” but we can say “Let’s go work on our relationship.” So that’s the first, that’s the R of REVAMP and engagement, vitality, accomplishment, meaning and positive emotions are sort of these six core ingredients. And you may have heard of perma and I think it’s been discussed on the show, the perma model and REVAMP has vitality at the center of it. And I think starts with relationships. And if you go no further than relationships, I think we get pretty far when it comes to well-being.

Chris Kresser: So how is, this is perhaps a leading question or rhetorical question in some ways. But if we use the REVAMP model as the guide, and we look at the way that conventional medicine is designed and structured now and how is that falling short just starting with relationship?

Jordyn Feingold: Yeah. So as you talk about a ton in your work, and on the show, the medical model is all about treating disease and dysfunction. And really, even for doctors traditionally, it’s like always just putting the patient first before everything that we do, where there’s sort of this like stigma for what we can’t see. So this idea, my mentor, Doug Draftsman calls this illness without disease. So all of these functional disorders or what I focus on, disorders of gut-brain interaction that don’t have a lab value or an imaging test to validate them. When we’re faced with these things as traditionally trained medical doctors, we often get really burned out because we don’t know how to really deal or treat these things that are illness without disease. That really satisfying “Oh yes, this is clearly pancreatitis,” or “Oh yes, this is inflammatory bowel disease.”

So those in between conditions there’s functional things like IBS and functional dyspepsia, even mental illness, which obviously I’m really interested in and focusing on, it can lead to a lot of dissatisfaction in the system, because our job in the medical model is to identify the causal agent and be rid of it. And I think that can really, that really interferes, especially in these cases that are not so clear cut, it’s not just pancreatitis, it’s not just inflammation, that we end up seeing the patient as this obstacle, or this barrier, or this difficult person that is almost preventing us from doing our jobs, rather than leaning into the power of the relationship as the content for healing.

Chris Kresser: Yeah, I think that’s right. And it really strikes me that, I mean, you know that I’m a geek, when it comes to data and science. I love that aspect of medicine. And yet, I think that medicine has really suffered. The art of medicine has really suffered in the past, let’s say 50 years as it has, the pendulum dramatically shifted toward a more quantitative approach, which is kind of what you’re talking about. Where if we can’t quantify something and measure it, and if we don’t see a lab value increase or decrease or we’re not able to assess it in that way, then it doesn’t really exist. And I think that’s such a reductive view of what medicine really is and what the potential of medicine is.

And I think back to this is kind of a cardinal example where my growing up, my dad had like, seriously like Norman Rockwell painting of a doctor that like stepped out of a Norman Rockwell painting and showed up at our house. He did house calls, and he had the medical, he had the bag, the leather, the black leather bag. And my dad would have him come over and he would, like, not be feeling well, and he would examine my dad, he’d be like, “Ah you’re fine. There’s nothing wrong. You’re just a hypochondriac,” or something like that. And he would leave and that was it and it was like, yeah, I mean, it’s so hard to imagine that happening now at that kind of relationship that he built with his physician.

And I used to sometimes go with him when he went into the office and it was just a totally different experience than people generally have today with their primary care doctor where they’re going into a big impersonal office and they spend maybe 10 minutes if you look at the statistics, somewhere between eight and 12 minutes and it’s largely centered around figuring out what medication to prescribe for the various symptoms or issues that someone has and that [crosstalk 13:30], yeah, and that doctor is seeing 25 patients that day and has a panel of 2500 patients and is doing their best to try to relate in a human way. But it’s, when they’re in that kind of environment that’s just like factory, it feels like a factory, it’s almost impossible to focus on the R in that acronym and the relationship being key. And is it any wonder then that doctors feel burned out? And then from the patient perspective, they feel like they’re just a number or they’re just a set of lab values or, they’re not being seen and heard and understood as a whole person.
Harnessing the Power of the Placebo Effect

Chris Kresser: And I love that you started with relationship, because when I was in school, I did, my kind of capstone work was on the placebo effect.

Jordyn Feingold: I wanted to talk to you about the placebo effect. Yes.

Chris Kresser: Yeah. Which I started, ala Ted Kaptchuk out of Harvard, I started to refer to more accurately as the self-healing effect, which I think is a much more accurate term. And then of course, the evil twin, the nocebo effect. And when you spend some time learning about placebo and nocebo, it is impossible to leave that experience without a deep appreciation of the power of relationship and healing, because that’s really what placebo and nocebo are all about.

Jordyn Feingold: And nowhere in med school, of course, we learn how to listen compassionately, and to be empathetic. But in no course in med school anywhere that I know of, do we actually learn how to harness the power of human connection for healing at least in allopathic medical schools.

Chris Kresser: No, there’s such a missed opportunity. And that’s, why Ted Kaptchuk’s work is so great in that regard. Because on the one hand, if you’re a pharmaceutical company, the placebo is your nemesis, right?

Jordyn Feingold: Exactly. And [inaudible 15:42] randomized double blind, controlled study, we’re trying to [inaudible 15:45] the placebo.

Chris Kresser: Right, and it outperforms antidepressants in a lot of cases and lots of other medications, too. So I think placebo has gotten a, it’s almost a pejorative term in a lot of, in medicine, because it’s like this is a non-effect. But it’s not a non-effect at all. It’s an actual measurable effect and so why aren’t we asking the question of how to harness this self-healing ability, and promote it, rather than to denigrate it and try to make it go away.

Jordyn Feingold: It’s so funny that when I was sitting in the resident room, I’m on my internal medicine rotation right now. So I’m working in the hospital, and managing the medicine floors. And these residents. I’m like an off-service resident, so everyone knows I’m a psychiatry resident. And it’s funny, because we’re sort of treated a little bit differently than the medicine residents who are there and this is their turf and their domain. And they’re so inspiring, and they work so hard and a lot of them are my dear friends. And they’re running around and they were joking this morning that no one has had any time to work out, but yet, we’re running around the hospital. And I said, Well, if you really know what the research says, you’ve just got to give yourself credit for the laps you’re doing and all the staircases you’re running through while you’re on shift. Because really look at your Apple Watch, you are working out. And if [Aaliyah Crumb? 17:11] research teaches us anything is that we have to give ourselves credit for the things that we’re doing, because our physiology will respond.

So I sort of go around even just informally preaching all of the placebo research, because we need to harness it not just for, if we know it, that’s fantastic for us as clinicians, and then we need to tell our patients because this is powerful stuff.

Chris Kresser: It’s super powerful. I mean, I’ll tell, you probably have some of your own favorite anecdotes. But some of my favorite are the placebo surgery stuff, work that was done in Washington where they would prepare the area, they would even do an incision, and then they would just close it back up and not even perform the surgery. And then those people would have as good or better results than people that actually had the true knee surgery. And then the one study out of Japan of people with poison ivy allergy, where they told them that they were rubbing poison ivy on one arm, and then like it’s just a benign tree, like a maple leaf or something on the other arm. But what they did was actually the opposite of that.

Jordyn Feingold: Oh I don’t know this one.

Chris Kresser: Oh this one? Yeah. And people, a large percentage of people broke out in a rash on the arm that was with the maple or the benign leaf and didn’t break out in a rash on the arm that they actually rubbed the sumac, the poison ivy on. And there’s so many similar stories. We know that the color of the pill, for example, has an impact on its efficacy. And they figured this out, like in a, I think there was a sleep medication in Italy where the pill was blue. I could be getting the colors wrong, and it wasn’t working well. And then they figured out that the color of the national soccer team uniforms is blue, and that was sort of like a stimulating, exciting color. And they changed. It’s just bizarre. It’s so clear that we’re missing an entire element of the equation. And as long as we continue to sort of look at this as something that needs to be overcome in order to sell more drugs, I don’t think we’re going to make progress that we need to make.

Jordyn Feingold: Totally. And back to relationships and placebo, there was a recent study a couple years ago, were similar with giving, they were giving sham antihistamines after inducing an allergic response in patients’ arms and they just gave like unscented lotion, it wasn’t actually an antihistamine. And they recorded the amount of time that it took for people to recover. And those who had doctors who were scripted to be kind and compassionate versus the cold doctor actually recovered more quickly with sham antihistamine from the allergen.

Chris Kresser: Yeah.

Jordyn Feingold: So, this is, it’s hard to do and I can’t say I always do it. But when I’m with my patients, especially in the hospital, when they are seeing so many different people and people are in and out of the rooms, they’re getting woken up at 5am to be stuck for bloodwork. Which I tell my patients I’m like, if you refuse in the morning, we can come back later and get your blood.

Chris Kresser: Right.

Jordyn Feingold: Like we don’t have to wake you up first thing at 5am. But when I go into my patients’ rooms, really just trying to get to know them beyond the slew of complex conditions that they have and asking them, what’s something that your healthcare team doesn’t know about you that you want us to know, that no one has the time to ask. Because, when we read about our patients, and going through rounds, it’s like the 53-year-old with diabetes, hypertension, COPD, asthma, we’re really defining our patients and therefore seeing them as the compilation of their illness, as opposed to and really at the expense of the human being who’s sitting in the bed and the family that they come from, and the strengths that they have.

And one of my just like lofty goals that should not be like such a hard lift would be to really include patient’s signature strengths, even just one strength in their one liners. So that when we’re talking about them, Mrs. Johnson is a 72-year-old who is very high in her ability to love and be loved who has XYZ, so that we can just humanize the patients, and not just talk about what’s wrong with them. But begin to think a little bit about what’s right with them. And through those things, I actually think we can get to more productive ways of healing.

Chris Kresser: I love that. I think it’s, I’ve seen some of those same placebo relationship studies where they randomize people to a caring affect, and lots of questions and listening and then the other, in the other group that the physician would just come in, say a couple words and leave the room, and it makes an enormous difference in the outcome of the treatment. So what about E, engage? How does that show up in the model?

Jordyn Feingold: Sure. In engagement, I think it’s sort of like threefold. And then I actually want to go back and say something about, let me go back for a second and say, before we move on, I also think that with relationships, I always talk about with medical personnel, the relationship that we have with ourselves and the importance of self-compassion. Because we don’t often think about our relationship with ourselves as a relationship. But it’s so important when we’re in such a high speed, high stakes environment as clinicians and our mistakes can really actually be lethal to people that we really learn how to cultivate our own internal dialogue. And I really love Kristin Neff’s work on self-compassion. And so before moving on, I think it’s really important that we just pause and conceptualize that we need to tend to that relationship, just as we tend to the relationships with our patients and our colleagues.

Chris Kresser: I agree, 100 percent. And that would even take it a step, or at least build on that and say, I don’t think compassion for others and empathy for others, and as Kristin would attest, is really even possible without self-compassion and self-empathy.

Jordyn Feingold: Yeah, and I just put myself on mute for a second because I live right near the hospital with constant sirens around so, I apologize.

Chris Kresser: Well, keeping it real.

Jordyn Feingold: Oh yeah. Oh yeah. And it’s so much what I, what Kristin would also say is that it’s so much easier to hold compassion for other people naturally. That we’re, the advice we would give a friend we would seldom default to ourselves unless we’ve really practiced it and stretched the self-compassion muscle. And yet, it’s the self-compassion that helps us sustain our compassion for others, that we can’t sustain it until we know how to care for ourselves and talk to ourselves that way.

Chris Kresser: One of my Zen teachers, Sherri Huber who’s actually really, she combined Western, some Western psychological concepts with Zen practice, and wrote a book about compassion actually. And one of her favorite sayings, which has always stayed with me was, “If we had a friend that treated us the way we treat ourselves, we would have gotten rid of that friend a long time ago” which is, yeah, very true, I think for most of us. And it’s sometimes hard for us to monitor that kind of self-talk. And if we, she actually did these retreats where you would write down the things that you catch yourself saying to yourself or about yourself, and then there was a little bit of like drama therapy, and you would hand those parts to other people and other people would speak those parts. And it was so much easier in that context to get angry and say, “Wait a second, that’s not true.” But when it’s just the tape that’s running in our own heads all the time, it’s a lot more difficult to catch that stuff.

So yeah, I think, I love Kristin’s work as well and there’s so many others out there that have really emphasized this, but it’s I think just, there’s something about human maybe human nature certainly or the way we relate to ourselves in Western world that is, makes this a pretty common experience and challenge that we face.

Jordyn Feingold: Totally, totally.

Chris Kresser: All right, so engagement.
The Importance of Engaging in the Flow of Life and Within Ourselves
Jordyn Feingold: Engagement. So I think of engagement as this like threefold construct. So the first that comes to mind is flow, really get this psychological experience where we are at one with what we are doing. Where there is no, there’s no time, there’s no ability to self-scrutinize, or even be dispassionate to ourselves because we were so invested in the task at hand. Our actions and awareness are merged. And this comes from Mihaly Csikszentmihalyi which, who I actually found out passed away very recently. And he’s the father, one of the fathers of positive psychology and this concept of flow, and wrote the [crosstalk 27:12] book on the topic in 1990, I believe.

So flow is the ultimate state of engagement. And we talk to medical students and practitioners about how we can get into more flow in our work day. So much of it is the way we focus our attention and design our work day to do tasks in specific ways and not keep the phone buzzing in our pocket, even if it’s related to patient care, which is actually something that I’ve been really struggling with. Because so much in this modern day, where I’m just on epic chat all day, in touch with social workers and in touch with all of the members of the care team being pinged nonstop, and as now I’m going through my training, I’m realizing just all of the barriers that there are to flow in the inpatient setting, and how I can, we have to design our way out of that. So flow is one facet of how I think about engagement.

The next one I mentioned briefly, is character strengths, how do we use the best parts of ourselves in our work and actually bring that to the forefront? And I also think it’s really an antidote to the negative internal dialogue, is how do we lead with our strengths rather than focusing on our weaknesses? And then the third is mindfulness practice. Not necessarily meditating, although I think if all of our doctors meditated, we’d have a healthier health care system. But really, how do we be with our experience when things are challenging and difficult, rather than so in the experience? So it’s an interesting, I think about this as an interesting counterpart to flow. Sometimes it’s really about being with, we can’t be in it because it’s either too painful, or we need some outside perspective and learning how to really be with ourselves.

Chris Kresser: Yeah it’s really interesting to hear your internal perspective on how the structure of inpatient care is at odds with engagement in certain ways. And I would say, also, just the way that screens have invaded our lives in general are at odds with that, especially if you don’t take any steps to rearrange those default settings on the phone, for example. Every app you install is trying to notify you no matter how inane or irrelevant that notification might be. Like, oh, a new app was just uploaded to the App Store. Do you really need to be notified about that like while you’re on a hike or out to dinner with your partner or something? It’s just kind of absurd in some way to me that the assumptions that we’ve made about our time and how we want to spend our time and then, the almost complete lack of boundaries or sense of protectiveness around that time. Where there’s kind of an implicit assumption that I’m willing to be interrupted at any time for any reason.

And often, reasons that are not at all my reasons, that are really about somebody else’s priorities and goals and not mine. And I think it’s, with inpatient care, the stakes are higher, and there are other variables at play there. So, it’s interesting to think about, like, what is essential, real time communication? What are things that need to be communicated immediately and need a response immediately? And then what are things that could actually just be asynchronous in the sense that they don’t require immediate response? It’s something you could respond to later that day or even the next day. But we’re just using the synchronous tool, because that’s what’s available and we’ve just fallen into that habit.

Jordyn Feingold: Exactly, I think about that so much. I’m like, this is a brand new technology, this didn’t exist and I wasn’t part of the system when it didn’t exist. So I don’t, I can’t even imagine. I mean, [inaudible 31:38]. There was just one chart, and it [inaudible 31:41] the patient’s room rather than 17 different doctors inputting things to our electronic health record, which is an incredible tool. But like anything that is really innovative, there’s always a dark side to it. And, the dark side is that we’re constantly in it. I spend more time in my patient’s charts than I do with my patients.

Chris Kresser: Yeah.

Jordyn Feingold: And so, having had the luxury of studying positive psychology and learning so many of these things before my medical training, I feel like I’m almost like uniquely equipped to be with the experience as I’m going through it, rather than getting so bogged down by it. I’m almost able to bring this mindset of curiosity and saying isn’t this interesting how this is how it is so that I’m not, it’s really that mindfulness piece. It’s like I’m trying to figure out, it’s such a gift to be able to go through it this way and say, “What about the system would I love to change?” Sort of knowing that I have to learn it from the inside, in order to change it. It’s kind of this like mental gymnastics that I’m doing in order to keep myself sane as I go through it. And not just sane, but like, really happy and able to like have levity and joke, and do my jumping jacks in the call room and give myself credit for exercise that day. But it just makes me wish that all clinicians, physicians, nurses, functional medicine doctors, all of our health coaches, had this knowledge going in of how the system is so dysfunctional and needs to be changed, so that we can go through and say, sort of identify the pieces without just being bogged down and overwhelmed by all of the change that needs to be made.

Chris Kresser: Yeah, I think that’s important and it’s important to go back to first principles, like, what is the point of this technology? And then what are we trying to achieve? What’s the outcome we’re trying to achieve? And is this technology even the best way to achieve it? That’s a whole other conversation. And I think of Slack in our experience with my company, is like, it’s a synchronous chat tool and there are certain types of communication that really require that. But there’s not a lot of them. We’re not like an emergency services provider. And but it becomes the default in a lot of organizations. It’s like, even if something doesn’t require an immediate response, it’s just throw it in Slack, it’s the easy thing to do. And then what that translates into is just a near constant stream of interruptions throughout the entire day. So that it’s almost impossible to do any deep focused work.

I talked about this with Cal Newport when he was on the show. And it’s just, I think it’s a real problem not just in medicine, of course, but in all of work life and just life in general at this point is we’ve let some of these technologies dictate the way we work instead of figuring out how we want to work and then making technology serve that. So it’s something we definitely struggle with, even in the functional medicine clinical setting, like how to best use these tools to serve patients and serve the clinicians.

Jordyn Feingold: Right.

Chris Kresser: All right [crosstalk 35:16].

Jordyn Feingold: Yeah, we could go on. Yeah.

Chris Kresser: Yes, I want to get to the, I want to get through the acronym. So we’re on V.
Using Sustainable Habit Change to Increase Vitality
Jordyn Feingold: So vitality is all about what makes us feel alive and really able to do what we need to do on a daily basis with vigor. So it’s amazing how many clinicians are really poor sleepers, poor eaters, they don’t do any physical activity. And what the research shows is when we don’t do these things, when we are drinking a ton of alcohol, or smoking cigarettes, like we don’t counsel our patients on these behaviors because we don’t want to feel like hypocrites. And there’s a huge cognitive dissonance in telling someone to do something that we are not doing ourselves. So it’s really helping us find sustainable behaviors. And using things like motivational interviewing for clinicians to, and SMART goal setting to figure out what are small changes that we can make, so that we can be doing, so we can live more in line with what we need to help our patients do. So it’s really like the basic stuff.

And in the vitality module that I always teach, I talk about, this is where I talked about placebo, and the connection between the mind and the body, the mind and the gut. And all of these reciprocal interactions that, thanks to the legacy of Descartes in the 17th century, we’ve separated the mind and the body. But really, we need to reintegrate them because they are so inextricably linked, and we really can’t move one without moving the other.

Chris Kresser: Great. And I just want to remind everyone who’s listening, we have of course, a lot of clinicians and practitioners, and health professionals in the audience, but this acronym and the principles apply to everybody. Relationships, engagement, vitality, all critical ingredients to health and well-being. So what is A?
Reducing Burnout by Reframing Accomplishments
Jordyn Feingold: A is accomplishment. So it’s the sense that we are working toward our goals, and we are efficacious and have an internal [inaudible 37:31] of control. What we do actually matters. And at the core of burnout is this low sense of personal accomplishment. We just lose sight of what we’ve been doing. We adapt to our own success, and it just doesn’t even feel like anything anymore. And accomplishment in the REVAMP model just helps us reorient to this. So I think there’s this tension that in order to like, success feels like a zero sum game. Like in order for me to further my own success, someone else has to lose, and that gets reinforced in our society in lots of different arenas.

And especially for people in Western medicine who have gone through, for doctors who have gone through medical school and pre-med, and have had residency and like, you’ve always had to sort of put yourself above someone else. And it fosters this crazy mindset that like, I’m going into this helping profession to help other people, and yet I have to, like put myself above my colleagues. And it’s really, it’s actually just totally bogus. Because what we know is that, our personal goals and pro-social goals don’t need to be zero sum. That we do best when we’re working on teams and helping each other succeed. So the accomplishment is really it’s like two main contexts that I love. It’s grit, which is passion and perseverance for our long-term goals, which is Angela Duckworth, and many other people study this. And otherishness, which I first read about from Adam Grant and one of his colleagues and my colleague, Reb Rebele who talked about this idea of helping ourselves help others and helping others in ways that are sustainable to us.

So I merged these concepts and I call it gritty otherishness. And, it’s important for us all, people in the health professions and just all human beings to realize that we don’t need to stake ourselves against others in order to achieve our goals.

Chris Kresser: Yeah, I think, going back to like the focus in medicine on a quantitative approach and hard science, I think a lot of people who would otherwise be attracted to medicine as a career have not chosen to take that path for that reason, and also the reason that you’re talking about now. Like they’re not, when I was a student at UC Berkeley, there was kind of a running joke that if the libraries would close at 2am and they’d have to like physically remove the pre-med majors. Because, if they didn’t, they would just stay there all night. I mean, actually, I think the library was open 24 hours when I first went there, and then they changed the rule, because the pre-med students were staying in the frickin library all night long.

And so I think a lot of people who otherwise would make excellent physicians or healthcare practitioners, nurse, nurse practitioners, nurses, whatever, what have you are not pursuing medicine for this reason. And that’s a shame because we lose a lot of potentially amazing clinicians that way.

Jordyn Feingold: And it’s really a shame when folks even get there and then they are like, this is just not me. Like, I’ve had to change myself and had to like bend my values to be, to get here. Now I’m in debt because I chose to go to medical school, and I don’t even want to do this anymore. This just doesn’t even feel authentic. And one of my, like, a big focus of my work is like helping people not get to that point, like helping people connect with their purpose, and their, and that leads us to meaning like, their reason for being, their reason for going into this work in the first place. Because it’s just so easy through the process to get bogged down by the competition and the cutthroat-ness and people really, we can really lose ourselves in service of achieving our own goals.

Chris Kresser: Yeah, absolutely. All right, so we are at M.
Finding Meaning and Purpose in Life
Jordyn Feingold: Yeah, so meaning and purpose, which is probably just like the biggest, most broad topic. And it’s really about just connecting with our why. Throughout our training and in the day-to-day slog of what we do as doctors, as humans in any job, it can be really easy to lose sight of the why we’re there in the first place, and how the day-to-day tasks really connect with our overarching values and our reason for being. And I love the Japanese concept of Ikigai that comes from I believe it’s central in Okinawa, Japan, which is one of the Blue Zones that has been studied where human beings live the longest and are the most well on the planet. And it’s this idea that, it’s the Ikigai, the reason you wake up in the morning, your reason for being. And it’s this nexus of what we like to do, what we like and what we love, what we’re good at, what the world needs, and what we can be paid for. And it’s, if you think of like a four-way Venn diagram, the Ikigai, our reason for being is at the center of that. And we recognize it. It’s an evolving concept for us over the course of our life.

But with your Ikigai you never want to retire. So I read that in Okinawa, Japan, and I’ve never actually been there. I’ve been to Japan, but not to Okinawa, that retirement isn’t even in the paradigm. Like there’s, we, people are so active and engaged in their Ikigai, whether it’s fishing or teaching, or karate and martial arts, that people are doing these things literally until they can’t move anymore, until they can no longer because it is their reason for being rather than going through your career and just saying, “Oh, I can’t wait, one more year until retirement.” And of course, our Ikigai doesn’t have to be our profession or our job. We do just spend so many waking hours doing our jobs, that it would be really great if we could connect with one part of our Ikigai in what we’re doing. And I do think for me, positive medicine and psychiatry is totally a part of my Ikigai and it’s about helping people make decisions, helping our trainees and clinicians make decisions in their lives that put their values and their Ikigai at the center of how they spend their days.

Chris Kresser: Yeah, I think that’s so important. I mean for, retirement is such a bizarre concept. I think it only really fits in a society where people are doing work that’s not meaningful to them. Certainly I can imagine a financial independence as a concept where you no longer have to work for money and you just get to choose the kind of work you want to do, independent of that consideration. But like the idea of just the last 30,10, 20, 30 years of your life on a lounge chair, or sitting and watching TV or whatever retirement looks like for people has always been kind of nonsensical to me and actually a sign of the profound kind of sense of disconnection and disengagement that a lot of us suffer from.

Jordyn Feingold: Absolutely. And retirement is one of the scariest words for physicians, because it does mean you’re losing your salary, but you’re also losing the livelihood, the day-to-day life, the practice, the meaning that you built for so many years. And of course, we can’t necessarily, do surgery when we’re 90 years old, but I will say, I’ve been so inspired in grand rounds, when I see all of these older, mostly gentlemen, because by the folks who are 80 and 90 years old now, there were not many women in medicine then. But who come to grand rounds, and who volunteer as voluntary faculty to teach and to bestow knowledge and wisdom on medical students and junior faculty. I think, there’s so much opportunity to keep our older, more senior generation of clinicians around to just bestow wisdom, and even if they’re not operating anymore, or not seeing patients anymore.

The way we treat our elderly and aging older adults in this country is just really, it’s really inhuman, and we should be helping folks stay connected to their passions and their, what they did in their livelihoods, rather than making that, forcing them out. And so, yeah, I think connecting with that, and just knowing why we’re doing what we’re doing. Thinking about what our values are and really asking ourselves, like, what do I care about most in this world? And how does that actually show up in my life? Like, literally in the things that I’m doing, the people I’m surrounded by.

Chris Kresser: Yeah, yeah, I agree. All right. Last one.
Learning How to Prolong and Deepen Positive Emotions
Jordyn Feingold: Yeah. So positive emotions. Such an interesting note to end on, because I know you had SBK on the show. He talked about transcendence as this emergent phenomenon that happens when we are integrated with our like more basic needs of security and growth. And I extend that idea of an emergent phenomenon to positive emotions to some degree, because when we’re living a life filled with meaning, and we’re living a life in relationship with people we love, positive emotions are a natural, they result from those things. So we, that’s where we experience love and that’s where we experience joy. And when we’re in flow, that’s where we experience interest and humor. So I think that positive emotions are both something that emerge, and we can learn how to prolong and deepen them through the process of savoring, through practicing gratitude, and really learning how to notice and enhance them.

Because, as you well know, we evolved as a species that overvalued, we needed to focus on the negative in order to survive and, through the harsh conditions of our ancestors. And that left us with this vestigial negativity bias, where it’s so much more salient when negative stuff happens and when things go wrong. So we really have to learn how to identify the positive things that happen, and call them out and let them sort of permeate our being. And ironically, when we chase them, sometimes it can push them away. So when we just say, like, “Oh, I just want to be happy.” And we just try to live a life of pleasure, because we misunderstand what actually contributes to sustainable well-being, which is not just buying a new car and taking it for a spin around the block and, having sex with random people because it feels pleasurable.

So when we misunderstand what happiness is as pleasure, pleasure is not a bad thing. It’s a beautiful thing. But if it’s the only thing that we’re chasing, it can really mislead us in our pursuit of happiness. So, I like to think that happiness really happens when we live a life of meaning and a life of relationship and engagement and vitality. And then we also have to learn how to really prolong and deepen the other positive emotions that come up when they come up naturally in our lives.
The Importance of Post-Traumatic Growth
Chris Kresser: Nice, I love that. So I want to, we only have a couple minutes left here, but I want to at least touch on this because it’s one of my favorite frames and parts of Scott’s book and Tedeschi’s work which is post-traumatic growth. So we’ve all heard of PTSD, post-traumatic stress disorder. And it’s real. It’s been well studied and I just want to be clear that when we talk about post-traumatic growth, we’re not diminishing the reality of post-traumatic stress and the need to understand that and respond to that. And I think it is very helpful and empowering for people to be aware that growth is another potential outcome and result of trauma, not just distress, and not just things getting and staying bad over time. But that there’s actually an opportunity with the right kind of attention and support for growth to be a result, or an outcome of trauma. Can you talk a little bit about that?

Jordyn Feingold: Yeah, and I want to emphasize what you’re saying and say that post-traumatic stress disorder is also not even the opposite of post-traumatic growth.

Chris Kresser: No.

Jordyn Feingold: Because in my own research that I’ve been doing at my institution on how frontline health care workers are faring in the wake of the pandemic, we’ve been studying post-traumatic growth using the short-form post-traumatic growth inventory. And what we found is that one of the greatest predictors of post-traumatic growth was the presence of symptoms of post-traumatic stress disorder at the pandemic peak. So we essentially looked at post-traumatic growth. So the presence of spiritual growth and belief in new possibilities for one’s life, that people developed more positive interpersonal relationships, that they were able to better use their character strengths, that they discovered new possibilities for their lives, that that was one of the best predictors of all of those things.

Especially spiritual growth and relationship development, was the presence of some pretty distressing thoughts seven months earlier. And this idea that this automatic rumination of PTSD that the beginning or acute stress, we should say that when something bad happens and it starts to really, enter our consciousness unwittingly that we are thinking about it, that we’re ruminating about it, that when we begin to more deliberately think about those things and talk about them and digest them and process the trauma in a more deliberate rather than an automatic way, which is more associated with PTSD, that that is one of the greatest predictors of growth after traumatic events. And I think the concept of post-traumatic growth is incredibly reassuring for people who suffer from trauma-related experiences and who endure traumatic events, because I do think it is a real phenomenon, and we can enhance it, and we can foster it in people and really good psychotherapy and people just processing what has happened to them. And sort of like avoid, one of the greatest predictors of adverse reactions to trauma is avoidance. And because when we avoid the things that make us anxious, it reinforces the fear and the trauma. So when we can safely re-explore some of the drivers of our stress, we can learn how to process and overcome them.

What’s super interesting, and it’s like, like, I didn’t think post-traumatic growth would be controversial, but me and Scott have been talking about this a lot, that there are a lot of critics of post-traumatic growth now who say it’s maybe not a real thing and growth doesn’t require suffering. And of course, growth doesn’t require suffering. We can grow from the positive things that happen to us. The birth of our children and marriage and incredible phenomena. And we can’t change the fact that bad stuff happens and traumatic events happen. So, right?

Chris Kresser: I’m just kind of floored by that opposition. It doesn’t, it’s nonsensical to me and like, it’s arguing against life, the experience of life. And anyone who is living life and paying attention, and has experienced any kind of setback or challenge and has grown as a result of that will know just from their own experience without any kind of academic argument, that that is a valid frame and an important one.

And this has also been a big, a part of many spiritual traditions and teachers in those traditions, Jon Kabat Zinn, for example, his book Full Catastrophe Living is all about that. When bad things happen, which they tend to and sometimes really bad things happen, how you cope with that and not just cope but actually how can you, as you are able to navigate the pain and the even trauma, the deep sadness and difficulty, distress and everything that comes with that, how do you find the bright spots? How do you find the opportunities? How do you use those as the seeds for change and evolution? Pema Chodron, When Things Fall Apart is a another book along the same lines. And so I can’t think of a more important frame for all of us in this day and age that we’re living in now, right? Because COVID has been a traumatic experience for nearly everybody in some way or another, certainly for some much more than others. But few of us have been untouched. And so we have a choice, are we going to simply stay in the distress? Or are we going to attend to that with compassion and understanding? And not, like you said, not avoid it.

So, I think some people tend to get confused about this discussion and assume that we’re just talk, we’re saying we should just like put a happy smile on our face and pretend that nothing happened. No, that’s not at all, what we’re talking about here, quite the opposite, actually. Because to really be able to grow from a difficult experience, you have to fully let it in and accept it and not submit to it, but accept it and accept that it happened, and that it is still happening and respond from that place. So I just, I think that’s such an important frame for people, especially in this pandemic era that we live in. And for me, it’s been a major ingredient in my own health and well-being having struggled through a very difficult, serious and complex chronic illness earlier in my life, and then using that as an opportunity and even as a springboard to do the work that I’m doing now. So it’s something that’s pretty close to my heart and I’m glad to hear you talk about it.

Jordyn Feingold: Closing the path of growth. And you couldn’t have done a better setup for the book that Scott and I are writing on post-traumatic growth. And it really is a choice. And we have to choose. What other choice do we have? And our goal through this book that is forthcoming is to help people figure out what that means for them and get on the path of growth, no matter, through the pandemic, no matter how it’s affected us. You’re right, no one has been unscathed from this. So yeah.

Chris Kresser: So yeah, tell us a little about the, or can you tell us about the book at this point? And then also a little about Thrive RX for the clinicians in the audience.

Jordyn Feingold: Absolutely. So I’ll start, just a teaser about the book. It’s a workbook. So it is an opportunity to learn and to learn about yourself and engage with your own internal dialogue and learn how to modify it. And we bring up a lot of the concepts that we’ve talked about today on the podcast, mindfulness, self-compassion, and character strains, a lot of the tenets of positive psychology and bring them in a really humanistic way, not to suppress. I love that you had Robert Biswas-Diener, not to suppress the dark side, but learn how to let it in and engage it and then tame it a little bit, too.

So it’s, we’re in the process of writing and it’s been a really fun journey. And that’s all I’ll say for now on the book. And I don’t know when it’s coming out, but sometime in 2022 hopefully.

Chris Kresser: Yeah.

Jordyn Feingold: And it’s been a joy to work on it with Scott, because he’s amazing. And then Thrive RX. So for any clinicians listening on the line, so old school, any clinicians listening, tuning in, it is asynchronous, so you can watch these videos on your own. It’s all online. Course for clinicians to learn about positive psychology as well as principles of leadership and how to engage with folks who are in different disciplines than us and as well as financial training and financial independence. And it’s really, I collaborate with three other physicians, and it’s really geared for I would say physicians, but truly anyone who is a human being who helps another person, whether you’re a health coach or a RN, or just a caregiver to someone else in your life, this course is I think it’s been really fun to work on and to meet all of our students. So I can put, I’ll send you the link, Chris, so that maybe we could put it in the show notes or something like that.

Chris Kresser: Absolutely. Yeah, we can do that. We’ve got a transcript and everything. So we can put that along with everything that we list with the show on the website.

Jordyn Feingold: Perfect. Perfect.

Chris Kresser: Well, Jordyn, thank you so much, I really enjoyed this conversation. I love the work you’re doing. Looking forward to the book. And, yeah, I think it’s so crucial to get this work out into the healthcare community. Like you said, it’s really a disconnect when clinicians are suffering so much themselves to expect them to be able to support patients in the way that patients need to be supported. And so I think it’s really important work and I can, your passion for it and engagement really come across. And so I applaud what you’re doing, and look forward to hearing more about it in the future.

Jordyn Feingold: Thank you so much, Chris. And maybe in the future, we can make sure that all medical students and residents have health coaches.

Chris Kresser: Absolutely. We’re working on it. Yeah, it’s yeah, and it’s, because all of this shouldn’t fall to the physician, the clinician. It’s an unrealistic expectation, and so, there is a role for, a big role for health coaches to play in providing that kind of support to patients. So because we, reality is we do need physicians to focus on the stuff that they’re uniquely trained to do. And that doesn’t mean that there isn’t a place for them to also relate well to their patients and interact with them in a, with more of that qualitative focus. But it’s true that that’s, there will always be to some degree, a level of, that’s never likely to be the full extent of what they do in a clinical interaction, right? They still need to do lab testing and procedures and all of that stuff. So yeah, that is the role for coaches.

Jordyn Feingold: I think we need you personally. Every physician, every trainee, we need you to help us so that we can do the jobs that we signed up for too.

Chris Kresser: Yes, yes, exactly.

Jordyn Feingold: [Inaudible 1:02:43] professionally and personally I think you [crosstalk 1:02:45].

Chris Kresser: Yeah. I like it. All of the above, for sure. And probably all of the administrators in the hospital and staff in the hospital, and everybody else, right?

Jordyn Feingold: In the hospital, yes.

Chris Kresser: Yeah, yeah. All right. Well, thanks again, Jordyn, and thanks everyone for listening. Please keep sending your questions in to ChrisKresser.com/podcastquestion and we’ll talk to you next time.

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