Healing and the Science of Resilience Colleen Kraft

Healing and the Science of Resilience Colleen Kraft, MD, MBA, FAAP

Faculty Disclosure Information: In the past 12 months, I have relevant financial relationships with: Cognoa, Inc. Dot. Com Therapy Happiest Baby SOBI I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

Healing, Service, Self-Care Recognize the role of resilience in building your capacity to care for others; Identify the neuroscience of trauma and resilience, and how this can inform your practice; Commit to resilience development as a restorative practice

RESILIENCE The Ability to Positively Respond to Adversity

Resilience vs. Wellness

Resilience / Performanc e Matrix • Avoid burnout, being comfortable, or distress • High resilience allows you to sustain high performance © 2019 Hello Driven Pty Ltd

Stress and performance

How resilience helps performance

Defining Adversity or Stress How do you define/measure adversity? Huge individual variability Perception of adversity or stress (subjective) Reaction to adversity or stress (objective)

Defining Adversity or Stress Hypothalamic-Pituitary Axis Reactivity Levels of Cortisol Epinephrine/Norepinephrine Inflammatory markers National Scientific Council on the Developing Child (Dr. Jack Shonkoff and colleagues) Positive Stress Tolerable Stress Toxic Stress Based on the REACTION (objective physiologic responses)

Defining Adversity or Stress Positive Stress Brief, infrequent, mild to moderate intensity Most normative childhood stress Inability of the 15 month old to express their desires The 2 year old who stumbles while running Beginning school or daycare The big project in middle school Social-emotional buffers allow a return to baseline (responding to non-verbal clues, consolation, reassurance, assistance in planning) Builds motivation and resiliency Positive Stress is NOT the ABSENCE of stress

Defining Adversity or Stress Toxic Stress Long lasting, frequent, or strong intensity More extreme precipitants of childhood stress (ACEs) ACEs Physical, sexual, emotional abuse Physical, emotional neglect Household dysfunction Insufficient social-emotional buffering (Deficient levels of emotion coaching, re-processing, reassurance and support) Potentially permanent changes and long-term effects the mediators of stress impact upon the mechanisms of brain development / connectivity)

Brain Structure (and Function) - The Brake – PFC (with some hippocampal help) Frontal lobes: Abstract thought, reasoning, judgment, planning, impulse and affect regulation, consequences Parietal Lobe: Integration of sensory data and movement Temporal lobe (outside): Processing sound and language Occipital Lobe: Visual processing Cerebellum: Smooth movements Coordination Limbic System (inside): Emotions and impulsivity + The Gas Pedal + Amygdala Brain Stem & Cranial Nerves: Vital functions Swallowing

Vision Resilience and Executive Function Composure Reasoning Health Tenacity Collaboration

The Prescription we need to fill…. Self Care

One Minute Close your eyes Stretch out, get comfortable Focus on breathing Senses Smell Touch Taste

Self Care in Clinic One little interaction that brings joy!

Ten Minutes Listen to a favorite song Tea or coffee Warmth of the cup Smell and taste Walk around the block Outside if your can Feel the sun or rain

30 minutes Take a walk Read something enjoyable Clean to music! Call a friend Cloud watching

Resilience and Executive Function Vision Composure Reasoning Health Tenacity Collaboration

Vision About purpose and meaning Working towards clear goals Ability to prioritise effectively between competing goals Being committed & decisive Vision motivates to action

Composure About regulating emotions Effectively managing stress Recognising the signs of stress Increasing emotional granularity Having strategies to regain composure when stressed or anxious

Composure Interpretation bias Awareness of own biases Being open to challenge Reappraisal Learning how to reinterpret physical signals (anxiety » excitement) Use proactively and retroactively

Reasoning About problem solving & critical thinking Ability to think clearly when facing stress Being resourceful Seeing opportunity in change Ability to challenge own beliefs

Reasoning Anticipate and prevent Visualize scenarios & plan for adverse outcomes Take action to mitigate future problems Reasoning bias Recognize thinking style Manage blind spots

Tenacity About perseverance Bouncing back from setbacks Learn from own successes and experience Perseverance is more important than intelligence in achieving success

Tenacity Realistic optimism Avoid being overly optimistic (impacts motivation) Avoid pessimism (also impacts motivation) Realistic sense of hope Managing mistakes Accurately analyzing mistakes Avoid self-judgement and focus on learning

Collaboration Investing in relationships Building support networks Mutually valuable relationships Mentor relationships Social context Recognizing behavior for context Using humor appropriately

Health Nutrition Sleep Lack of sleep releases cortisol, leads to being impulsive Quality is more important than quantity

Resilience Exercises Storytelling Reframing Strengths and gifts analysis Acts and Gifts, Mentoring, Volunteering

Resilience Exercises Gratitude Three Good Things Humor Silver Lining Mindfulness—body scan, deep breathing