Hitting the Pandemic Wall

By Farah Dharamshi, MSEd., JM

Hitting the wall…

I get it. It has been a year since the WHO declared COVID-19 a pandemic. A year since your classes went online. A year since your classroom or office became your bedroom, kitchen, closet. A year since you left the house without your mask and hand sanitizer.

What a year it’s been.

You haven’t “seen” or hugged your parents, you lost your uncle, your neighbor’s wife passed away, your friends have been reduced to squares of pixels on your display.

So you’ve turned to something, to do- anything to fill the creeping expanse of a seemingly endless year (decade? Who even knows anymore?).

You have attempted bread baking and quilting, you have tried to compete in virtual races, you have watched every Netflix, HBO Max, Amazon series/movie (and found out that some things just should not be made), started reading five books each month (but never actually finished one), reorganized every drawer in your home while writing hundreds of Vote Now postcards, and rallying against social injustice, and now…

You are done.

You are depleted.

You have APEs to secure, midterms to study for, jobs to apply to, a thesis to complete, grants to write and you are too exhausted to move. Perhaps you are also struggling with feeling bad for – feeling bad. Rationally, you’re upset with yourself. You are scientists. You know the value of social distancing, and the importance of all the mitigation procedures in place.

But knowing why we need to remain as Zoom-connected islands doesn’t make it any easier. So many of us feel immobilized and stuck in a never-ending downward spiral.

When I have found myself struggling this past year, I have delved into the science of motivation. According to Brad Stulberg, a performance coach, there are two types of fatigue. The first in which your body and mind are genuinely exhausted (“real fatigue”), and the second in where your body has tricked yourself into feeling drained because you have been in the same old routine for the past twelve months (“fake fatigue”).

Dealing with this fatigue requires two diametrically opposed responses: stopping or moving.

The first type is easy to spot – your body is achy and sore, your mind feels psychologically fried. You need to stop, rest, prioritize sleep hygiene, and disconnect (spending time in nature always helps). While the second type is easier to discern physically, it feels the same mentally; the psychological inertia: sluggishness, apathy. The longer you wait for the drive and motivation that got you to Rollins to appear, the more weighted down you feel. A core tenet of behavioral activation  is that mood follows action. According to Brad Stulberg, “you don’t need to feel good to get going, you need to get going to give yourself a chance to feel good.”

Clinical psychologist, Thea Gallagher offers some helpful suggestions to push through the wall:

• Give yourself credit for all that you are doing and write it down at the end of the day.
• Find joy in the little things where you can.
• Get outside for some mood-boosting fresh air.
• Don’t beat yourself up. Treat yourself with the compassion that you would treat someone you love.
• Engage with what you can control (regular meals, sleep hygiene, exercise).
• Don’t be afraid to reach out for help. Your mental health is as important as your physical health.

For me, the daily practice of running served as the one thing I was able to maintain control over. When the world stopped, I could still put on my shoes every morning and go somewhere (even if they were endless loops around the school track). While I cringed almost every time the alarm rang, I knew it was the only semblance of my life pre-COVID that I could retain. That agency has powered me through.

We are in the home stretch. There is a visible light just around the corner. Plants are budding and spring is in the air. The time change “forward” is more meaningful this year than ever before. I know it’s hard, but after a brief respite get up again. The world needs you.

You’ve got this.

Farah Dharamshi, MSEd., JM,  is an Associate Director of Academic Programs (ADAP) in the Department of Epidemiology at the Rollins School of Public Health.

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References 

1. https://www.therapistaid.com/therapy-guide/behavioral-activation-guide
2. https://www.scientificamerican.com/article/on-the-other-side-of-that-pandemic-wall/
3. https://www-scientificamerican-com.proxy.library.emory.edu/article/how-we-can-deal-with-pandemic-fatigue/

Lessons in Resilience – Be like the weeble

“Do not judge me by my success, judge me by how many times I fell down and got back up again.” 

― Nelson Mandela 

After a recent meeting, a debriefing conversation sidelined to discussing the general sense of angst we were all (students, staff, faculty, children..) experiencing, and the phrase “lessons in resilience” was spoken*..  which got me wondering – what is resilience? why is it so important? can it be learned at any time?

There is no denying that we are all feeling burned out, with no end in sight. How many times have you caught yourself questioning the actual date/day/time? It can be numbing how everything has blurred together, while being barraged with one crisis after another.

Along with COVID, we are experiencing a grief pandemic, “We’re dealing with disparities in health and socioeconomics, and we have blurred boundaries between our work and personal life. A new daily stressor happens before we learned to deal with the last one.” (Debra Kawhara)

“Note to self: every time you were convinced you couldn’t go on, you did.”

― Unknown

How can we grow and become stronger, and resilient through all of this?

Seeking Help

First, what are some myths regarding resilience? It is NOT in fact a badge of honor to be struggling. It is okay to feel overwhelmed, despondent, numb – in these situations, please ask for help. Being able to reach out for support is critical. Rely on your social networks, and/or resources for assistance. “Resilience is when you have the ability to break and get back together.” Caveat here – you will not be bouncing back, but rather bouncing forward. Each time you work through any adversities you build new skills and incorporate new ways of coping and are better able to deal with future challenges.

Leaning In

Resilience CAN be learned. My favorite quote on this comes from Josh Altman, “There is already a seed of resilience inside everyone,” he says. “Learning to lean into rather than avoiding difficult situations makes us stronger.”

This article by Paula Davis-Laack on her work with soldiers provides a helpful framework on cultivating resilience:

1. Practice the skills associated with resilience to cultivate crucial faculties: self-awareness, nimble thinking, high-quality relationships, stress awareness. “Resilience isn’t about toughening up people – it’s about empowering them.”
   
   
2. It’s okay to feel positive during a crisis: I have had numerous conversations with students, colleagues, and friends/family about this. Don’t feel guilty for laughing, enjoying yourself, finding joy and humor in the midst of the crisis we all find ourselves. It is what will get you through this time, and future challenges in your life.
   
   
3. Relationships matter: Perhaps one of the greatest lessons we have all learned during social distancing and quarantining is how much we value and need social interactions. Who are you counting on, who counts on you? Cultivate, build and strengthen your relationships. They give life meaning, and make you stronger.
   
   
4. It’s okay to be vulnerable: Brené Brown’s work in this area has been groundbreaking, “Vulnerability is not winning or losing; it’s having the courage to show up and be seen when we have no control over the outcome. Vulnerability is not weakness; it’s our greatest measure of courage.” We grow from struggle and adversity.

Try doing this self-assessment: The Resilience Advantage Questionnaire, and then access the toolkit.

Good Enough is Good Enough

Finally, if you can find 16 minutes, watch this TED talk, Sh*t happens: 8 Lessons in resilience. Spoiler alert: here are the major takeaways: no person is an island (reach out for social support), mentalizing (thinking about thinking, taking time to process your emotions), practice, practice, practice on where to focus your attention, be like the weeble – “weebles wobble but they won’t fall down,” name the thing that we are most challenged by to avoid the risk of the “nameless dread” coined by psychoanalyst Bion, and the best –  good enough is good enough.

“Wobbling” is essential for those times when we can’t function at our best, and nor should we expect ourselves to. We cannot be 100% all the time, there are challenges that are often out of our control, this is when we must be compassionate with ourselves.

“I can be changed by what happens to me. But I refuse to be reduced by it.”

― Maya Angelou

References:

1. https://www.winona.edu/resilience/common-myths.asp
2. https://www.fastcompany.com/90547087/these-5-myths-about-resilience-might-be-hurting-your-ability-to-cope

“Hope is not a strategy”

Do you like rollercoasters? My first five years of life were the epitome of privilege and comfort in Uganda, and then within days my parents and I were on a plane to Montreal as refugees. The ensuing years were tumultuous. I remember living in attics, visiting the Salvation Army for clothes, and drinking the mini half and half singles for breakfast. We eventually settled in a small northern city, and my parents re-invented themselves several times over. During the summers, my parents would pack us up and we would drive across  Canada and the US – always stopping to visit the most extreme theme parks. My dad loved to take us on all the craziest roller coasters. Something my father said has resonated often during these past few months … “just enjoy the ride.”

The past few months have certainly felt like a rollercoaster to me: overwhelmed health care systems, cities and nations on lock-down, collapsing stock markets, unprecedented capriciousness and pandemonium from our political leaders. VUCA. First coined in 1987 by the US Army War College¹ to describe the post-Cold-War world, and based on the leadership theories of Warren Bennis and Burt Nanus,² this acronym is applicable now more than ever.^3,4 

Volatile, Uncertain, Complex, and Ambiguous.

Volatility: the accelerating rate of change, uncertainty: the lack of predictability, complexity: the interconnectedness, of cause-and-effect forces, and ambiguity: the strong potential for misreads. These four terms are interrelated; it is harder to predict a health outcome, the more volatile, uncertain, vague and complex the event. Case in point: SARS CoV-2.

“I would not give a fig for the simplicity this side of complexity, but I would give my life for the simplicity on the other side of complexity.”

– Oliver Wendell Holmes

The antidote to this is…

…VUCA: Vision, Understanding, Clarity, and Agility. This week’s PROspective article by Jake Wood, CEO and Co-founder of Team Rubicon, illustrates the two faces of VUCA, specific to the COVID-19 pandemic.

For public health professionals, consider this an opportunity to cultivate a growth mindset which will be translatable across multiple scenarios and situations in your professional and personal life. Take some time to hone (or develop) your personal guideposts which will provide the vision and strategy to ground you when the next VUCA situation takes place.⁵ You would fare exceptionally well by starting with the core tenets of our Epidemiology department: integrity, rigor, ambition, and collegiality. Cultivate how to be responsive and not reactive to the next crisis that you will inevitably be faced with.

“Hope is not a strategy”

– Jake Wood

How will you identify and reduce the impact of volatility, uncertainty, complexity and ambiguity when faced with challenges?

Here are some suggestions from an article in NEJM Catalyst, on “Responding to Covid-19: Lessons from Management Research”:

1) Put people first

2) Manage operations creatively

3) Attend to teamwork and communication

4) Create outside partnerships

5) Embrace clear and humble leadership

As an aside, these have all been very much in practice at RSPH during the past few months.

So, are you enjoying this ride? You don’t have any choice but to be right where you are, in the middle of a pandemic so you might as well just surrender to the ride. The lows will amplify the highs and the turns will be confusing, but they will all provide opportunities to learn and grow.

References:

1. U.S. Army Heritage and Education Center (February 16, 2018). “Who first originated the term VUCA (Volatility, Uncertainty, Complexity and Ambiguity)?”. USAHEC Ask Us a Question. The United States Army War College. Retrieved July 10, 2018.
2. Bennis, Warren; Nanus, Burt (1985). Leaders: Strategies for Taking Charge.
3. https://www.forbes.com/sites/davidmichels/2020/05/10/for-leaders-the-lessons-of-covid-19-go-beyond-crisis-management/#23050c927e9b
4. https://chiefexecutive.net/understanding-vuca-environment/
5. https://www.ckju.net/en/blog/strategic-management-how-and-why-redefine-organizational-strategy-todays-vuca-world/58699

Juggling 101

Juggle: to throw several objects up into the air, and then catch and throw them up repeatedly so that one or more stays in the air, usually in order to entertain people¹ 

Sound familiar? 

Just when you think you have it under control, another assignment /project /responsibility gets added to your list. How do you find an APE while keeping up with your readings and assignments, preparing for midterms, fulfilling your REAL responsibilities, navigating your roommate issues, while eating healthy, and trying to get to the gym… Oh – and keeping in touch with your friends across the country, calling your parents… keeping up with the latest episode of…

Or, are you are trying to circumnavigate the pressures of applying for grant funding, preparing course/lecture material, writing articles, dealing with administrative deadlines while balancing the demands of parenting and relationship responsibilities, when your HVAC has to be replaced, and your car transmission is on the fritz…

How are you doing it all?

You multi-task of course. You try to accomplish as much as you can, when you can, all at the same time.

Now, while doing things simultaneously may seem like the height of efficiency, in actuality, it reduces work quality and wastes the precious time you are trying to save, resulting in the need to multitask more to complete your duties/responsibilities. All counterintuitive.

Multitasking forces your brain to switch back and forth very quickly from one task to the next. Interruptions as brief as two to three seconds can be enough to double the number of errors on a task.² Numerous studies confirm that task-switching results in loss of productivity, accuracy, and efficiency, it also reduces the ability of the brain to learn new skills.

While the obvious effects of this are lackluster results in your endeavors, according to Dr. David Meyer from the University of Michigan, the more serious consequences are the adverse effects on your health, because of the constantly elevated stress levels.³ “Multitasking is especially stressful when the tasks are important, as they often are on the job. … The brain responds to impossible demands by pumping out adrenaline and other stress hormones that put a person ‘on edge.'”

Dr. Sandra Chapman from the Center for Brain Health at the University of Texas, has found that “multitasking is a brain drain, that exhausts the mind, zaps cognitive resources, and if left unchecked, condemns us to early mental decline and decreased sharpness.” Numerous studies indicate that chronic multitaskers have increased levels of cortisol, shown to damage the memory region of the brain.⁴

Researchers Ophir, Nass and Wagner at Stanford studying (student) media multitaskers, found that high multitasker students were always drawing from all the information in front of them, and were not able to keep things separate in their minds. “When they’re in situations where [there] are multiple sources of information coming from the external world or emerging out of memory, they’re not able to filter out what’s not relevant to their current goal.”

Doing more things does not determine better results. Doing better things determines better results. Doing one thing to the best of your ability brings about optimal results.

There is time enough for everything, in the course of the day, if you do but one thing at once; but there is not time enough in the year, if you will do two things at a time.

– Phillip Stanhope

Single tasking

Single tasking, as the term implies, is doing one task at a time with as few distractions/interruptions as possible. And yes, it is easier said than done.

Start here:

Do one thing at a time, but do it well.

• The single browser tab habit: limit yourself to having one tab open at any given time to prioritize the task you are trying to complete. And for more motivation, you may be inspired to try a “single-tabbing” challenge like James Hamblin. 
• The evening planning routine: set 10 minutes aside nightly to plan the next day’s tasks –Identify your two-three priorities, and tackle them first.
• Minimize distractions/focus deeply: keep your smartphone in your drawer, turn off your email to focus on one task at a time. This is harder than it seems, so start with 15-minute intervals, and increase to longer time periods of intense focus.
• Get rid of clutter: keep your workspace as minimal as possible
• Use breaks effectively: stand up, drink a glass of cold water, walk around the office perimeter. You will be more effective, if several times during the day you step away from mentally challenging tasks for 3-5 minutes.

For an excellent, more detailed training-plan for single-tasking and focus, take a deep, undistracted dive into this how-to guide from ZenHabits.net. 

Our days are filled with a constant barrage of distractions, unexpected challenges and increasing responsibilities. But, the science and experience are clear – by doing less all at once, you will likely be able to accomplish more much more.

New Year’s Resolutions

A new decade. A new year. A new you. 

This year, countless people will set their resolutions for the year.^1,2 Motivated and fueled with the energy a new year brings, they will rely on their willpower and determination to actualize these goals. Yet, the majority of these best intentions will have flickered by February.³

So how can this year be different for you?

The refrain of countless self-help professionals has been that it takes “21 days to make a change.” By this, they mean that by following a given practice for 21 days, say to set the alarm every morning for a two-mile morning run, that by day 22 you will automatically wake up in the morning ready to run. This prescription for a new you, however, has been widely misinterpreted.⁴

In the 1950s, the surgeon Maxwell Maltz observed it would take a minimum of 21 days for his patients to mentally accept their new appendage, that is, to form and accept a new mental image of themselves. In his book, Psycho-Cybernetics, he delved deeper into his own period of adjustment to new behaviors and concluded that it took a minimum of 21 days before he would adapt to change. However, the “minimum” that Dr. Maltz recorded was lost as pundits hung on to the “21-day change” mantra. 

Now, just how long does it actually take for a new habit to form?

It turns out, it takes an average of 66 days⁵ for new habits to become automatic.

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

– Will Durant

You are your habits. Habits are cognitive associations that are formed when we repeat an action in a given scenario and are then rewarded for having done so.⁶ According to researchers at Duke, habits account for about 40% of our behaviors on any given day.⁷

Knowing this, how do we make this year be the one that allows us to make habits not daily decisions?

1) See yourself the way you want to be:

Maltz also observed that change begins within. The most powerful tool you can employ is your own imagination. Picture yourself the way you want to be and change your mental picture. See yourself as the researcher, community activist, fitness buff, you aspire to be. The internal picture you carry of yourself is a powerful tool. Use it. Your current behavior is a reflection of your current identity. Change your identity and begin the change process in yourself.

2) Form Associations:

Add the new behavior to a habit you have already established. Brushing your teeth is a no brainer… so add 10 pushups, a 30 second plank, or drink a glass of water, each time you brush to create association, and link the behaviors. Determine a specific time and space for your desired behavior to live in your world.^8,9

3) Use Physics:

Reduce the amount of friction to achieve the habit and set yourself up for success. Make the action as effortless as possible – sleep in your running gear, or have it laid out by your bed, surround yourself with healthy foods, block out time to write every morning before the day gets away from you. Eliminate as much of the decision making as possible, to make the behavior automatic.

Add friction to dismantle the behavior. According to Wendy Wood, “if you add thought to the behavior, you make people attend to it, and more likely stop”. Place the bowl of fruit on your desk and put the bag of chips on the top shelf of the pantry. Find ways to add friction to the behaviors you no longer want to engage in.

4) Rebound:

You are going to miss a day, skip a run, not follow-through – the key here is to get back on track as quickly as possible. Do not fall for an all or nothing mindset. Put your scientific training to work and treat your “failures” as data points; opportunities to learn what works and how to change your course to achieve your goals.

5) Be patient:

Remember the tortoise and hare fable? This is a key step in the process. “Slow and steady wins the race.” Remain steadfast in your resolve and pacing. Change is difficult. Some behaviors will take longer than others to become habits, but if you are persistent (and are kind with yourself) – you can manifest your inner vision of yourself.¹⁰

So, set your intent. Decide on the person you want to be, and the characteristics you aspire to embody.

Happy New Year!

1. https://www.sciencedirect.com/science/article/pii/S0899328988800166?via%3Dihub

2. https://health.usnews.com/health-news/blogs/eat-run/articles/2015-12-29/why-80-percent-of-new-years-resolutions-fail

3. https://www.businessinsider.com/new-years-resolutions-courses-2016-12

4. https://www.forbes.com/sites/jasonselk/2013/04/15/habit-formation-the-21-day-myth/#e37c81ddebc4

5. https://onlinelibrary.wiley.com/doi/abs/10.1002/ejsp.674

6. https://www.ncbi.nlm.nih.gov/pubmed/26361052/

7.  Neal, T. D., Wood, W., Quinn M. J. (2006). Habits- A Repeat Performance. Association for Psychological Science, 15, 198-202

8. Milne, S., Orbell, S., Paschal Sheeran, P., (2002). Combining Motivational and Volitional Interventions to Promote Exercise Participation: Protection Motivation Theory and Implementation Intentions, British Journal of Health Psychology, 7 163–184.

9. Gollwitzer, P., Sheeran, P., (2006). Implementation Intentions and Goal Achievement: A Meta‐Analysis of Effects and Processes, Advances in Experimental Social Psychology ,38, 69–119

10. Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology, 92, 1087-1101.