All right, well, welcome. I guess there are a lot of people out there somewhere. So the topic today is best communication practices for promoting a culture of health. So I'm David Francis. I'm a clinical psychologist, but I work for an occupational health company. For 32 years, I owned an EAP company, so that's where I come from. You know, I'm a psychologist, but I've spent my entire career in the world of work. Okay, so here's the agenda today. We're going to talk about communication deficiencies that get in the way of promoting a culture of health. You know, what are the bad practices? And in contrast, what are the best communication practices? So we'll talk about those. And I want to spend about the last half of the program talking about best communication practices regarding evidence-based mental health concepts, because they exist. And I think that most people are unaware of the evidence-based mental health concepts that are out there. And I think occupational physicians, preventive docs can do a lot to spread evidence-based knowledge regarding mental health, because, you know, seriously, we need help. Okay, so what are the communication deficiencies that get in the way? There are two categories of deficiencies. One is what people are told, and the second one is how people are treated. So what people are told are things like inaccurate information, ambiguous messaging, and recently, outright lies all over the place. But you know, so we have truth working for us, but of course the way that truth is delivered is often just as important as the truth. And so how people are treated, deficiencies that can get in the way include communication delivered disrespectfully, people are not heard or not listened to on purpose. And so let's just take a look at what some of these practices look like. Here's one vision of not caring facial expression, which says, I don't need to listen. People like this, or who look like this, is of course is an exaggerated version, tend to interrupt people or talk over people. Why? Because they're more important than you are. The smirk, usually it's not this exaggerated, but indeed I have worked, I've done executive coaching with many people who have a lesser smirk of superiority. And certainly a patronizing tone is part of it. Now there are other things that project to people, I don't care about you. For example, a posture, a condescending posture, or accompanying that, maybe a superior facial expression, which says, I'm better than you. So all of these things really get in the way, clearly, of effective communication. With these kinds of people, arrogant, abrasive, overbearing, non-listening people, what they all have in common is they don't listen. And so with the people that I coach, if they learn how to listen, they get one of these rocks. Vladimir did not get one. All right, so I'm going to talk about five techniques here, five practices, that I believe define effective communication. The first one is active listening. Now probably everybody here would agree that it's important to hear, to listen to folks, but I'm not sure everybody knows how to do it. So let's just talk about the actual behaviors associated with good listening. First of all, good eye contact. I'm not talking about staring the person down. I'm talking about maintaining eye contact, like doing public speaking, for example. Second element of effective listening is little head nods. Little head nods that look like this. Very good. Way to go, Brad. That's important. You know, big head nods is agreement. I'm not agreeing with you, I'm just hearing you. Receptive posture. That's an open posture. It counts. You know, by the way, these slides are in the handouts, so there are handouts that you can access, and the more database ones, including these, are in the handouts, so you don't have to take a picture of the slides. Okay, receptive posture. So this is, here's classic non-receptive posture. Hey, I really care. You can tell me. Of course, it's strictly confidential. All right, so open posture. And finally, reflective or acknowledging statements. So these are overt verbalizations to the speaker which says, okay, speaker, I heard you. And so they will usually take a form like this. See, here are the most common ones. You know, shrink-like statements. So what you're saying is, sounds like, you seem, and so forth. So you see, it's none of your content. It's all of their content. Yes. They're asking you to remind the speaker we can't see his gestures. Bummer. Yeah, is there not video? We have a comment on the chat which says they can't see my gestures. So there's no video. Yeah. So is there indeed no video? Is that why they can't see it? Okay, that's why they can't see it. Yes. Sorry, virtual people. Excuse me. All right. Yeah, it's too bad you're missing out. But anyway, all right. So another thing that you can do, clearly, to acknowledge the speaker is simply to paraphrase. It's just to repeat back to them what they've told you. This is what good customer service people do. And what does it look like? It looks like, looks like this. So here's Bacall saying, I don't like your manners. And here's Bogie saying, I don't mind if you don't like my manners. I don't like them myself. So this is a wonderful demonstration of active listening and of acknowledging and reflective statements. So here Bogart is just reflecting, it is paraphrasing what Bacall is telling them. So here are some examples, active listening. Sounds like you're mainly concerned about side effects. So you believe that vaccines are harmful. Seems like you think that daily exercise is going to take up too much time. So these are just examples of reflective or acknowledging statements that a good listener would do. All right, the next thing I'm going to talk about is talking up to people rather than talking down. You never want to talk down to people. Look like Andy Samberg or Vlad. Instead, you always want to talk up to people. And the reason why you want to do that is if you really want to promote a health culture or if you want to promote anything, you want to be genuine. You want to be real. The phonier you are, the less likely you are to achieve the goal of promoting a health culture or anything else. So if we're talking about a health culture, you really have to buy into it, live it, breathe it. So that's number one, being genuine. Second thing I like a lot is the use of first-person statements. If you're representing a group or a department or a field, you talk about we, what we believe or how we feel. But anyway, so these are keys to being genuine. I especially like I feel statements. I feel statements are powerful and especially in our culture, we're not very good at it. But I think when you look at really great communicators, these are people who are able to talk about their emotions in a genuine way. And typically that means first-person statements. So I statements are powerful, important technique for promoting anything, and especially difficult conversations. You know, when I'm talking with people about doing performance reviews, especially critical performance reviews, I always recommend starting out with an I feel statement, especially if you've got to criticize somebody. You know, Laura, I'm very concerned about your performance. You know, that would be a way to start. It's genuine, it's real, it gets into it, you know, and especially if you're concerned. Makes sense. The basic I feel statement is a three-word statement. I feel followed by an emotion word, or I am followed by an emotion word. Do we have any comments? Okay, all right. So people have difficulty with this. I used to do a lot of marriage counseling, so to me the archetypal example of inability to express feelings comes from this example. Here's wife, here's husband. How do you feel, wife? Wife says, I'm depressed and miserable. Okay, I understand. Depressed. Sorry about that. How do you feel, husband? Well, it's been tough. Yeah, I know it's been tough, but how do you feel? Well, you bust your butt, you never get on top of things, you know? Yeah, I understand, but that's philosophy. That's really not, that's not an emotion. So she's depressed. How do you feel? I feel that things will never improve. That is how I feel, to be honest. Yes, I understand you're being honest, but that's a prediction. That is not an emotion. So honestly, I'm looking for an emotion. What do you got? I feel like hell, all right? Is that what you want me to say? No, no. You see, that's a place, that is not a feeling. So that really doesn't count. Okay, what do you want me to say? What is this, some kind of shrink talk? Yes, yes it is. Okay, so typically, I'll give them a list of feeling words, a list of feeling words, and they'll choose a word. Now, what do you suppose is the most commonly accepted feeling word in that circumstance off of the list? I'll give you a hint. It's a word that can be used that represents sadness, or disappointment, or anger, or frustration. That's a good one. Usually, it's not uncomfortable, but usually it's upset. Usually, it's upset. Upset is a good one. It counts, and you know, all right, I'm upset, darn it. Yeah, okay, that's good, yeah. Now, in the workplace, of course, as you all know, you got to be very careful about emotional expression in the workplace. So, you know, in my role as a coach and as a consultant, I recommend that only about eight negative, critical feeling words should ever be used in the workplace. I have seven of them here, but here's the eighth one. Concerned, because that's most frequently used, and here's an example. All right, so here's Dr. Fauci saying, I'm very concerned about what's going on right now, and you, we've all heard him say this many times, and he does it well. Okay, so I feel statements. Here's some examples. I'm frustrated at the lack of compliance. I was disappointed that we couldn't discuss the matter. I'm upset with how all this was handled. So, you know, this all counts. This is genuine. This is real. This is no BS. You're allowed. Now, you can always express positive feelings in the workplace. That's allowed, and, of course, you have to, you have to feel positive to be able to say these things, but, you know, that's why I love this picture, because she looks so terrific, and she looks so happy. So, anyway, so you can always use positive feeling words in the workplace. Negative feeling words, be careful with, but concerned is okay. So here's some examples that she might use. I'm confident that injuries and illnesses will hit all-time lows this year. I'm proud of management's health initiative. We're excited by our new fitness offerings. These are just examples. All right, so the next thing I want to highlight is descriptive language. Again, I'm talking about best communication practices, so I'm differentiating descriptive language from judgmental language. In your head, especially recently, you're thinking all kinds of things about the stuff that you hear. So, you know, there are judgments, and there are descriptions. So, you know, the judgments are going to include some of these things, you know, or more extreme. Boy, that was dumb. Do you really believe that stuff? You're going to watch that channel. That's what they're selling, you know. So you can think all of these snarky kind of thoughts, but clearly you can't say them. So you have to ask yourself, why do I think this is bad for them? Why do I think this is dumb behavior? And you have to translate that out into the behavior. You have to describe what you're observing, so that, for example, something is bad for you. Why? Because it increases health risks. Okay. It's good for you. Well, why is that? Because it's going to make you live longer when you give up smoking. And so you're thinking, boy, that is ignorant and dumb, but, you know, here are the facts, and of course you have to focus on the facts, which you do. Same thing here. Instead, you're thinking selfish, but really mask-wearing impacts others. That's uninformed, and he has doubts. And so here is an example of, say, addressing a doubter. Here's a doubter. So that's a really nice doubting picture. And here's a way of confronting it. I can see that you have doubts about mask requirements. I'd appreciate if you'd be specific about them. See, I mean, it's very descriptive based upon your observation of this person's face. All right. The fourth thing I want to talk about here is impact statements. That's typically, they're in the form of if-then, but it can be, you know, these other formats. It's really talking about the consequences. These are all ways of talking to people, talking about events, talking about behaviors that is less likely to provoke people, that is less likely to inflame people, that is more likely to persuade people. If-then statements. That's what I'm talking about. So here are some examples. When these new initiatives are implemented, you're going to feel healthier. If you just start a little at a time, you'll be amazed at how easy it becomes. When doctors are ignored in favor of talk show hosts, people will die. All true, you know. It's much better than saying, boy, you listen to that guy, you know, which is what you're thinking. The last thing I want to talk about before we get into mental health is something that I call the say-ask technique, and the say-ask technique is really, it's a smart way of asking a potentially provocative question. So if you have to ask a question of someone and you suspect this person is going to be very defensive, is going to fight you on it, one way to defuse the question is to make a statement that precedes it, and that way it makes it harder for the listener, the person on the other end of the conversation, to jump to conclusions about your motives. So you're saying first where you're coming from, and then you ask the question. Say-ask. Okay, so let's look at an example. This is a doubtful person, and so, you know, you might address this person by saying, looks like you seriously disagree with the policy. What exactly is your point? So it's a great gift. Okay, so anybody here not know who this is? Okay, this is Peyton Manning. Okay, moving right along, here's another example. Again, for sports fans, Stephen A. Smith. All right, so here's Stephen A., and you say, I can tell that you don't believe the recent data, why not? Okay, say-ask. Are you going to get anywhere with him? Probably not, but still, it's the right approach. Now, I also added this additional slide because I saw an article in Bloomberg Business Week a couple of weeks ago about hybrid meetings, and I thought that would be appropriate to interject here, and here's what they recommend for hybrid meetings. This is actually from Microsoft, but it was reported in Business Week. So keep the digital chat open because you want to prevent or make it difficult to have a parallel conversation going on. So you want to keep the digital chat open. Cameras should only focus on faces to reduce distractions. Same way with the virtual backgrounds, and there's also the advice to talk directly into the camera. So this is from Business Week a couple of weeks ago, but it was all about a Microsoft team, you know, that came up with these ideas, which I thought was pretty good. All right, so let me just summarize what I've been talking about here for the last 15 minutes. Active listening, including the body language, which, but the point is, I care. So I'm going to listen to you. I'm not going to do what these bad listeners do. You know, I'm going to care about you, and you demonstrate your respectfulness by talking up to people using first-person statements whenever you can. I feel statements to start difficult conversations and to create passion behind an idea, and descriptive rather than judgmental language, if then statements. Okay. Now, I want to spend the rest of the program talking about mental health because it's really important, and it's a serious problem, as you all know. And I would say that, in general, we're pretty deficient regarding mental health communication. And, sir? Yes. You bet. Okay. Oh, yeah. Yeah, no, that's okay. Thank you. All right. Yeah, go ahead. Is it on? All right. Sorry, virtual participants. Having a technical glitch here. All right, thank you know, now a lot of meetings and interaction with employees and colleagues is virtually, with what you're demonstrating or providing to us now, we apply all the same principles in Skype meetings, in virtual meetings, I mean, should we have video versus not, when would it be to have a good video versus not, we have tremendous latitude now in terms of how we communicate with our employees, with our colleagues, with health messages, with meetings, can you just, you may or may not have thought about it, but if you can provide just a minute or two and talk about that in the context of what you just provided to us of when not to, I would appreciate it. Yeah, it's, just turn it off, turn off the switch, yeah, yeah, that's a good question and you're right, I haven't thought about it much, because to me it's, I would recommend doing all these things on video with people, you want to capture the human experience and the human connection as much as possible, especially if you can do eye contact, and you can do eye contact, I mean, it's doable, is everybody a great communicator, no, but you know, the best communicators get it, you know, nowadays there aren't, you don't observe that many great communicators out there in the world, you know, most of the politicians are sad, sad cases, don't do it right, you know, and you don't believe them anyway, but you know, the really good ones will maintain the eye contact, stuff you can do virtually with video, so yes, I recommend video whenever you can. To the camera? Yeah. Or do you just, because like your audience could be there? To the camera, sure, oh yeah. To the green light. To the green light, yeah, anyway, thanks for the question, yes, we have another question, hold on just a second, okay. But in the same sort of context, you said not to use backgrounds, and with WebEx and Skype, you know, oftentimes there's sensitive, you know, there could be sensitive information behind you, and sort of encourage us to either like blur it out, is it just that it's distracting? Okay, again, the question, I think there's a switch there, but it's okay, so the question is sometimes there are distractions already, I mean, if you're working at home, and there's a cat running around behind you, or you know, something like that, it makes sense to have a background, and I say yes, yes, of course, I agree with you. What I was reporting here was just reported in Business Week, it was, you know, that was just Microsoft, they got a task force together, and they recommended that, but I'm sure, huh? Yeah, well, sure, right, if your house looks like a crack house, yes, I think you should have a virtual background, yes, good idea, okay, well done, all right, let's move on to mental health, so here's the sad fact, and I believe this is underreported, one in five American adults experiences a mental health issue, yeah, underreported, in my opinion, depressed opinions, depressed employees incur the highest healthcare costs, well, you know that, up to a third of physicians report that their own mental health issues are problematic, according to the Lancet, which should come as no surprise, frankly, because if you think about it, the same drive, the same compulsiveness that allows you to be a great student and get into medical school and to get the best residency also enable you to be a relentless self-critic, all of you, and you all know what I'm talking about, and so honestly, that's at the root of all depression, really, we've all read cases involving Olympic champions, wonderful students, terrific people who commit suicide, good grief, and you ask yourself what could possibly be going on, and I'll tell you what's possibly going on, I'm a failure, I'm not as perfect as I should be, I mean, is that rational, no, no, that is not rational, however it exists, anyway, I just want to throw that out there, so I mean, this is pretty depressing, up to a third of physicians report their own mental health issues are a problem, but even more depressing, up to 400 docs commit suicide every year, good grief, give me a break, fortunately, I'm guessing that doesn't happen to OCDocs, because we're not in the emergency rooms, you know, so, way to go, you chose the right specialty. Finally, this we know, the predominant mental health issues among the working world, which is our population, the people who are employed, the predominant issues are depression and anxiety, so we really should know about that stuff, more than what we know now, so I want to introduce some ideas to you. Let's start out in our mental health discussion with the DSM-5 definition of a mental disorder, and here's what they say in the DSM-5, a mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning. That's a mouthful, holy cow, so that's hard to digest, now the reason why it's hard to digest is partially because there is a lot of redundancy there, notice a disorder is also a syndrome and a disturbance and a dysfunction, this is a little bit like saying an automobile is a car, in logic this is referred to as a tautology, this is using a lot of different words, or at least different words to say the same thing, that's what this is, so that's part of why it's confusing. Now it turns out you can simplify this definition further with some careful editing, you can reduce this 33 word statement down to seven words. Mental disorder is really disturbance in cognition, emotion regulation, or behavior, oh alright, that I can get my hand around that, that's comprehensible, so it's cognition, it's what you're thinking, it's your emotions, and your behavior, that's really what a disorder involves. So a simple model is this one, where they all interact with one another, your thoughts determine how you feel, how you feel determines what you think, how you feel influences your behavior, your behavior influences your thoughts, and so forth, but what's the master control here? Most of the time the master control is cognition, it's what you're thinking, most of the time. Now sometimes when you respond to split second, you know, somebody throws a baseball at your head, you react, okay, you know, it's just split second reaction, which is remarkable that we can do that, isn't that remarkable? The electricity that flows through our bodies literally, I mean, you know, that's not even a metaphor, we've got electrons coursing through our body, making things happen at the speed of light, I used to be a biology teacher, anyway, alright, so we're talking about the evidence-based mental health perspective. The evidence-based mental health perspective is the cognitive behavioral perspective, wherein good mental health is defined as mental health that's characterized by rationality. I mean, after all, what differentiates a mentally healthy person from someone who isn't? So problematic mental health means that there's a high frequency of irrational thinking. Dave, you're oversimplifying. Well, yeah, but it's true, it is true, for every mental health condition involves a dysfunction in thought. The cognitive behavioral perspective of treatment focuses on problem solving, not on obtaining insight. So from the evidence-based perspective, asking why questions is interesting, I mean, it's interesting to know why you're so screwed up. It's interesting to know why you're unhappy. You can talk about your history, you can talk about your upbringing, you can talk about mom and dad, talk about the trauma you experienced. So I mean, it is interesting, but you can know all of that stuff and still be unhappy and miserable, and still have the problem, and you know what I'm talking about, a lot of you know very personally what I'm talking about. A lot of you, this is a very smart group, have plenty of insight, and still have some symptoms. So from the evidence-based perspective, the right questions to ask are, what am I doing now, what am I doing that contributes to the problem? Because my history is my history, it already happened. It only lives on in one place, my head. All that awful stuff that happened to me, all the trials and tribulations, here's where it is now. So yeah, you can fuss about it forever, what are you going to do about it? Let's take a look at what's there now, that resides there now. So evidence-based perspective is asking the question, what am I doing now that contributes to my problem, and how can I fix it? And thank goodness there is a technology by which to do that, by which to begin approaching it. There is lots and lots of research on this, lots, over 60 years worth of research. Don't bother to take a picture, this is all in the handouts. So this is pretty dense. I have two pages of references that are in the handouts. This is the first page. Now I just want to draw your attention, and these are very significant studies. The first one from NIH, Why Cognitive Behavioral Therapy is the Current Goal Standard of Psychotherapy, and then another publication from Hopkins. But I just want to talk about the third one, which is a study, a meta-review of other meta-reviews conducted at Cambridge University. And this is very comprehensive, very, very dense, hard reading, but I've made it easy for you. I just went to the last page and extracted this. And it's funny, because you all know, we all read these academic articles, and it's very interesting. And psychologists are really good at this, with the chi-squares and all the statistical tests and all that. And you're going, oh, that's very nice, you did all that stuff. And what did you actually find? All right, so here's what it says. It says that cognitive behavioral therapy works. That's what it says. And there's lots of research that supports this. This meta-review suggests CBT works and improves the quality of life for people living with many different mental and physical conditions. There is now a literature regarding cognitive behavioral therapy for borderline personality disorder, for a variety of psychotic conditions. I mean, it's really remarkable. It really is what they have come up with. Anyway, you guys need to know about this. This should come as no surprise, because when you think about it, these familiar practices, meditation and mindfulness, also involve thought control, right? You know, meditation is, don't be thinking about all those disturbing thoughts. Instead, focus your mind on one symbol or process or some neutral sound. You know, you can have a white noise generator. But that's what you should focus on. Otherwise, you're thinking about how awful you are or what terrible things are going to happen. Anyway, now, there was a wonderful article in today's New York Times, today's New York Times, about mindfulness meditation, where they have five different audio-guided meditations, if you're interested. Today's New York Times. What is today? May 2nd. All right. So, but I want to emphasize that being, you know, because what I anticipate is a lot of people, especially people who have been trained in traditional methods, will say, well, Dave, you know, this just sounds so simple, sounds so simplistic. Aren't you missing stuff? Well, I don't really think so, because being aware of your characteristic thinking habits does not minimize suffering. I mean, when you get a psychological problem, you can be hurting big time. So I'm not minimizing that. Being aware of your characteristic thinking habits doesn't provide a simple fix. You know, you can identify the problem, all right, and say, darn, that's what I'm doing. I better work on that. Good, you're right. Now, go see somebody who knows what they're doing to help you out, or get a good book, you know. So I'll talk about that, too. Being aware of your characteristic thinking habits doesn't diminish the value of certain meds. You know, sometimes that really makes sense in conjunction with good talk therapy. Similarly, being aware of your characteristic thinking habits provides a rationale for evidence-based treatment. What I like best is that it circumvents the black box of the mind. In my opinion, mental health shouldn't even be called mental health. I really think that's where a lot of the stigma comes from, because when you think about it, the mind is not definable. The mind has been out there for centuries, been the subject of speculation and superstition and nonsense for centuries. Of course there's stigma. But you can't really investigate it scientifically. You know, there are no mind measurements. I mean, you can measure, you know, the electrical outputs that happen in your head. Fortunately, you can measure what the mind does. The main thing that the mind does is it thinks. How about that? So that's the whole business of evidence-based mental health treatment, is you're keying in on something that turns out to be observable internally. I'll elaborate on that. So I like getting away from the mind. I like going back to cognitive. So this enables actionable self-help ideas, if you tune into your own thinking habits. And it reduces stigma, because bottom line, what would you rather have, a mental problem or a cognitive problem? Really, bottom line? What to me is so disturbing is if you go on the NIH website, the only references you're going to see to cognitive relate to dementia, where they talk about cognitive deterioration with dementia, which of course is true. But they really seem to be behind the times, especially when compared with the medical establishment in the UK and in Australia. Anyway. So communication regarding evidence-based mental health, what should you be doing as OCDocs? Somebody comes to you and they're depressed. They may tell you they're depressed, or just as likely they won't tell you, but you look at them and you go, yeah, they look pretty depressed. So of course, what you want to do is you want to empathize. You want to listen to them. You want to help them to talk. A lot of times they don't want to, but you don't want to be too pushy. But you want to be empathic, of course. I think one of the best things you can do as a preventive physician or as an OCDoc is to help patients understand that mental health can be understood as cognitive health. I think it would be beneficial to the world if that generic term mental health was converted to cognitive health. I just don't think mental serves any good purpose anymore. It's like horseless carriage. It's an obsolete term. But again, as a consultant to employees, you want to provide an easily understood alternative to the inscrutability of mentalness, of anything mental. And basically, the hope for people is, it turns out your problem is largely attributable to self-defeating thinking habits that you have acquired. And guess what? They can be heard. They can be identified. They can be labeled. They can even be disputed and challenged, and in many cases, minimized or eliminated. That's the promise of evidence-based mental health treatment. You need to know about that. And your patients need to know about that. So I'm not talking about occupational physicians doing therapy. I'm not talking about that. What I am talking about is trying to inculcate in your clients cognitive awareness, conceptualizing mental health as a function of characteristic thinking habits, which, by the way, in the literature, they usually refer to these as automatic thoughts. They're just automatic, sometimes barely conscious. And in fact, when you ask people, well, I'm ahead of myself. I'll show you the next slide. A lot of times, people can't identify the actual thought. So I have a nice device for that. So what kind of—what am I talking about? What are you talking about, Dave? I'm glad you asked me that. All right. So what are some anxiety-generating thoughts? Well, they're going to be worries, and it turns out that anxiety is directly proportional to the frequency of worries. Are you telling me that the more you worry all day, the more anxious you're going to be? Yes. That's exactly what I'm saying. What is a worry? A worry is a prediction of a negative outcome, often catastrophic. You know, there was one famous psychologist, Albert Ellis, and he invented the terms awfulizing and catastrophizing. I think that really says it, you know? I mean, the people with the most anxiety, chronic anxiety, do that frequently. Now, I also want to draw your attention to this last bullet, which is open-ended rhetorical questions, because often, worriers worry in the format of a rhetorical question, especially what if. What's so bad about that, Dave? Well, I'll tell you what's so bad about it. You can't argue with a rhetorical question. You can argue with a statement, where the statement says, I'm an utter failure. Why do you say that? Well, because I bombed during this last presentation. But how does that make you an utter failure? Well, you know, I never bomb, and I should do better. But what is your definition of utter failure? Does that mean that you're, you know, you bomb once, and that means you're an utter failure? Well, no, not exactly. See, there's some wiggle room there. You can argue with that. You can't argue with a what if. What if just implies stuff. What if I fail? Well, you know, what if this? What if that? You know what I mean? So to me, part of unraveling that is to turn the rhetorical questions into a statement. What is the open-ended question implying? It's implying there's going to be disaster at the end of the road. That's what it's implying. Well, how likely is that? Well, I don't know. Feels pretty likely. Yeah, but what's the proof? Well, I just feel that way. Yeah, I know you feel that way, but you know, what's the evidence? Well, I don't have any exactly. Well, okay. Let's examine that in depth. See what I mean? You pick it apart. Anyway, that's what a cognitive behavior therapist would do, but in a more serious way than what I'm doing. But I do think humor is important in therapy. I do. It's just that most of the shrinks I know aren't that funny. Okay, so what are some depression-generating thoughts? So I think this graphic is really very descriptive. And you know, even Sigmund Freud said that depression was anger turned inward. What does that mean in terms of thoughts? It means these kinds of thoughts, nasty labels. So what are the most common depression-generating thoughts? And these categories I obtained from David Burns's book, Feeling Good. It's on a subsequent slide, so you don't have to, you know, that's really the Bible of this stuff, and he has a more recent one. But you know, one category of depression-generating thoughts is all or nothing. Either I'm a great success or else I'm awful. That's common. This is what perfectionists do. Fortune-telling. No one will ever love me. Well, how do you know that? Well, I just feel that way. Well, what proof do you have? Well, I'm pretty awful. Yes, you are pretty awful. It's true. But isn't it possible that you might run into somebody equally as awful? Well, you know, I suppose it's possible. You should never say never. Yeah, I know people say that, but I don't really believe it. Let's discuss further. Name-calling. I'm such an idiot. I'm such a moron. You know, but really that's what this graphic shows, all the nasty things you can say to yourself about yourself that nobody else says about you. You know, you're sitting there being your good self, thinking, oh god, I'm such a loser. They're all looking at you going, you know, you've been so successful. You're so smart. You have a great family. Yeah, but you don't really know me. Come on. You know, you can make fun of this, but you know that it's real. Okay, so personalizing. It's all my fault. You take responsibility for stuff that it's not your responsibility. This is really typical of depressed people's thinking. The final one I'm going to list here is emotional reasoning. I feel so terrible. Therefore, things must be terrible. Well, I know you feel terrible, but how is that evidence that everything is terrible? Well, I wouldn't feel terrible if things were better. Yeah, I know, but that, you know, that's, let's discuss further. Okay, emotional reasoning. Got it. So these are typical kinds of self-defeating, irrational, automatic thoughts that people do. People with mental health issues. But you see, they're cognitive issues. These are cognitive issues. Mental health translates out to that. You need to know that, docs. Now, you can use medical language along with plain language. So you can say to somebody, okay, major depressive disorder or generalized anxiety disorder, but you can also say, you know, by the way, you're depressed. It almost always involves a lot of self put-downs. I wonder how many times a day do you put yourself down? Are you kidding? No, I'm not kidding. I'm serious. How many times a day? You just ponder that for a moment. How many times a day do you put yourself down? Well, I don't know, five, six. All right, well, we ought to count them. We really should count them. I'll get to that slide in a minute. Same with anxiety. This one I've had a lot of success with. How many times a day do you worry? You know what chronic worriers almost always say? When you talk to them, you say, well, how many times? You know what chronic worriers say? Chronic worriers will almost always say, well, I worry all day. That's what they'll say, I worry all day. And I will say, well, let's find out. You know, let's count them, you know. Now you can gather personal data regarding self-defeating thoughts. First of all, you have to hear them. Now, a lot of times people don't exactly hear them as a discrete sentence. They might see a picture or they might, you know, get some kind of an image. So I always say to them, picture a thought bubble over your head, like in this picture, and what were you probably thinking when you were in the depths? When you were feeling the worst, what were you probably thinking? Now, it could be an open-ended question or it could be, and you try to keep it brief. I don't want a whole, you know, a whole paragraph here. Try to keep it brief, you know. What were you thinking when you were in the depths of depression? You want me to be honest? Yeah. Okay. I was thinking, you suck. Okay, fine. Does that occur frequently? Yes, it does. Okay, well, let's start tracking it. You know, once you become aware of your characteristic negative thinking habits, you can count them. Literally, you can count them. And so all you need is pencil and paper. I mean, really, you hear the negative thoughts, you keep a daily tally, you total it at the end of the day. That is absolutely doable. If you're all out of pencils, there are plenty of free apps. So, there are apps on your phone that make it real easy to count stuff. So, you can do that. Now, I'm guessing that some people will suppose that this is just, it's just too simplistic. You're wrong. I'm sorry. And, you know, and the reason why I say this is I've seen it in many people. Once they become aware of the targeted, identified, personal, self-defeating thoughts that they do over and over again automatically on a daily basis, it sets up a feedback loop you didn't have before. So, now you're thinking about your thoughts. And guess what? You start depressing them. When you get people to count stuff. Did I finish the story about the worry? Where they say, it's usually, did I say 40 a day? I didn't. All right, let me, let me back up a notch. People say I worry all day. The punch line to this, and this is true, it never, in my experience as a clinician, it has never exceeded 40. You know, I don't, I don't know why, but it's interesting. Once you get people to set up that feedback loop, and now you're hearing the inner voice, it's not all day like they thought. And now they're thinking about it. And now when you tally it at the end of the day, you got a 40 a day, guess what? The next day you want to reduce the total. You're trying to beat the total. Why? Because you're really smart. And you're compulsive that way. And you're focused. And you go, I'm gonna shoot for 35 today. Yeah, you know, but you become very preoccupied with that. Okay, are you cured? Probably not. Can you, by doing this, diminish your anxiety? Yes. Can you diminish your depression this way? Yes. Yes, you can. Again, I'm not saying, you don't have to recommend this to people. I mean, this is background for you. I want you to just be aware of the cognitive perspective. What I'm trying to promote here is cognitive awareness. That's, that's where the evidence lies in mental health. It's not, it's not in mental. It's in cognitive. So there are plenty of resources to unlearn self-defeating thinking habits. Well, first of all, your company's EAP should know, but a lot of times they don't know. And as the physician, as the most educated person there, I think it's your responsibility to make sure that your EAP is up-to-date, that understands what evidence-based treatment is, that they have a network of people who know what they're doing, because often that is not the case. All right, so your company's EAP, and I recommend this book, Feeling Good, by David Burns. His most recent update of his book, which has sold millions of copies, is called Feeling Great. Why not? There are also lots of other resources. There are plenty of phone apps that I like. And again, this is all in your handouts. What's Up, Mind Tools, CBT Thought, Record Diary. You know, again, it's pushing you. Part of this whole business is to get it out of your head and onto paper. I mean, think about it. As long as these thoughts are in your head, they're bouncing around like an echo inside of a cave, magnifying. So, part of the whole approach is, what am I thinking that's problematic, get it out of my head and onto paper. Let me take a look at it, and I'm a smart person, and I should be able to jibe this with reality. Am I thinking rationally? But it's hard to do this as long as it remains in your head. So, you got to identify, get it out of your head. All right. Anyway, these are very good phone apps. I like Moodkit, Sanvello. I mean, that's, you know, nine dollars a month. I would try these other ones first, but these are all very good. There are lots of them, but, you know, these I'd recommend. Now, the best website, in my opinion, comes from Australia. It's called Mood Gym, ANU, Australian National University. You know, they're way ahead of us. They're way ahead of us. This is comprehensive. This is great, you know, I think, in my opinion. All right, so 27 bucks a year. They have a free version called eCouch. Don't really like the name, but I like that it's free. Also from Australia. Feeling Good, this is David Burns's website. He's got all kinds of goodies. This one is from the UK. This is also very good, getselfhelp.co.uk, and then finally psychologytools.com. That's pretty good. So let me just summarize what I've been talking about here. What is this cognitive behavioral approach about? How do you unlearn self-defeating thinking habits, either by yourself or with professional help? How do you do that? Well, the steps are, first of all, you hear the thoughts, and sometimes it's hard to do alone. You know, when you got a coach to guide you and push you, make you do this, hear the inner voice. What are you saying to yourself when you're feeling most miserable? Record these thoughts, and again, try to keep it simple. One or two or three key thoughts. Classify them. Now, remember that slide I had? It had five categories, you know, personalizing, name calling, you know, all or nothing. That's what I'm talking about. So you would classify, well, what exactly am I doing? Again, when you classify them, this gives you more power over them. First, you hear them. Now, they're doing their nasty work all along. They've been doing it all these years. You got this far in life, and they're in there doing all their stuff. So now you're hearing them, you're identifying them, you're taking it out of your head, you're putting it on paper, and what exactly am I doing? Which category? Oh, it's this category. All right, and then you dispute them because typically they're not rational. Typically, they're exaggerated. Typically, they're self-defeating. Every psychological disorder involves this type of thinking. All mental health problems are cognitive health problems. All right, so let me just review what we've been talking about here. Communication deficiencies, we talked about this up front. I was just talking about communication technique, talked about the rotten things to do, primarily not listening to people, being insincere, talking down to people, conveying the message, I don't care about you. We talked about best communication practices, which included active listening, descriptive language, I statements, if-then statements, and say-ask statements, you know, for defusing provocative questions. And then finally, we talked about best communication practices regarding evidence-based mental health concepts, and really what I'm trying to convey to you guys in the front lines, talking with employees, is really to provide another option for folks. You know, they're suffering with mental health issues, and sometimes they really seem intractable, and maybe their life is really tough, and I mean, you can identify, man, it's tough. But to what extent are they contributing to it? Inadvertently, unknowingly, because they've had a rough childhood, you know? That programming is still there, you know? So you can begin to unravel it by trying to introduce cognitive awareness, and that's, so that's basically it. All right, so that's the end of my program, and so if you have any questions, do we have any questions? Another question, yes, okay. Thank you, Kairou. Yeah? Do you recommend, in terms of these engagement tools, if we are in occupational health within our organizations, how about active engagement, in terms of, like, there's these new initiatives or ventures of chatting with a therapist for cognitive behavioral therapy, versus these tools that are put out? Yeah, I mean, it's just the concept, what I'm talking about is demystifying mental health. That's really what it is. You take away the mystery of the mind, and you substitute it with, it's what the mind does. It's what you're doing now in the present. So, you know, probably the most effective treatment for you, an employee, tune into what you're thinking. Yeah, I mean, and a lot of times it's hard to do it. You can do it online, virtually, it's okay. I mean, there are services that will do this. Yeah. So, yeah. But I'm just looking at the evidence. Well, it's really a conceptual approach. Okay. You know, it's really saying, forget about the couch, you know? Forget about bald guys with beards. Okay. You know? Yeah, they're nice, but, you know, I mean, you know, that's an old-fashioned insight-oriented Freudian perspective. And, you know, you can be stuck, you know, gaining insight for the next 20 years, right? So I like the online chat, if it's productive. Thank you. Sure. Anybody else? Yes. Can you give an example of how you'd use this for, like, chronic pain? Because that seems to be more of what we see in Acmed, and trying to give people, you know, the tools to work through, kind of, the chronic pain issues. Yeah. So, what I recommend is, there's an organization in Philadelphia called the Beck Institute. And, because the father of cognitive therapy was Aaron Beck, who just died this last year at age of a hundred. And, you know, they're associated with UP Medical School. And that's who you should really consult. There are specialists who actually specialize in cognitive therapy for pain. That's not, I've never done that, personally. But a literature exists. There are specialists who exist. The way to find them is through the Beck Institute in Philadelphia. It's a good question. Yes. I just want to make folks aware, and to support some of the things that you've said here today, ACOM develops clinical practice guidelines. And in 21, we released a guideline on depression followed by anxiety. The two best treatments that we found in researching the literature was CBT and exercise. In the chronic pain guideline that we also publish, CBT is also in there as, you know, a great option for helping those folks. And they're free access for everyone that's an ACOM member or a resident. Mm-hmm. Okay. Well, that's good to know. You know, to me, I'm always amazed at what comes out of the Beck Institute. You know, they've been at it for a long time. So I was really surprised when I read about cognitive therapy for, you know, multiple personalities, you know, dissociative reaction, multiple personalities, you know, variety of psychotic things. Or schizophrenia. You know, there's actually now cognitive behavioral therapy for schizophrenia, which is, I don't know how they do it, to be honest. But there's a literature, you know, people from Beck Institute have written books about it. So, you know, I believe them. But, you know, if you work with people that have that diagnosis, man, it's tough. Impenetrable. But they've learned how to penetrate. Okay. Other questions? Yes. Kaoru. Hi. I'm Kaoru, Dr. Ichikawa. So I'm from Japan. So the problem of employees in Japan, number one, we have a national survey every year. So the number one stress in the workplace for Japanese employees is interpersonal relationship with co-workers. And there's so many, I guess you will call passive-aggressive behavior. So instead of talking down or talking up, no talk and get, like, really frustrated. Do you have any recommendation how to solve those? To address passive-aggressive behavior? Yeah, they stressed out with interpersonal relationship with the co-workers and they cannot speak up. Okay. All right. So, yeah, there are things you could do other than punching people out. My own personal approach, I don't know what's in the literature, but I know what I've done in the past is I've done coaching with video feedback. So I get, I get people to, I used to do marriage counseling like this as well. You know, I would, I would tape people in simulated discussions and and then play it back to them. By the way, you could try this. You know, it's not I'm self-taught on this, but it was effective. I did it for a lot of years. And so you only need about two minutes worth of simulated discussion. So you would have a target situation. You can do this in group settings too. You can, you know, you can have group trainings on this, but I used to do it one-on-one. And so then you do about two minutes of a simulation. Now you play it back and you can see things. You can see, you know, so if it's passive-aggressive behavior, you can see facial expressions or you can see, you know, they're expressing anger in an indirect way. And now you can address that. It's amazing. It's a terrific perspective. People, we don't see ourselves. And so through the miracle of video, you can see yourself, you know. So I, that's, I like that. And you, so I'm talking about very direct coaching. And now have them repeat the situation or let's talk about an alternative to the passive-aggressive behavior. How would you do it more directly? And typically it's I feel statements. I am concerned when you do such-and-such. I feel hurt when you behave this way towards me, so forth. Good. Yeah, thank you. Sure. All right. Anybody else? No. All right. Thanks a lot. See ya.

communication practices

culture of health

mental health

communication deficiencies

active listening

descriptive language

cognitive health

cognitive behavioral therapy

self-defeating thinking habits

mental well-being