Welcome back to the Healing Pain Podcast with Natalie Dattilo, PhD

I had the opportunity to speak on a panel for the development of a new chronic pain app. There were three of us that were practitioners on that panel. It was myself, a social psychologist and our guest, Dr.Natalie Dattilo. We were fielding questions both from people living with pain as well as practitioners. I had the opportunity to get to know Natalie and I wanted to share her with you and introduce you to her because I found her approach to be very refreshing. For me, it was refreshing even though we know that mental health is finally getting the attention it deserves both in pain care and other aspects of illness.

What I like about her approach is that she focuses on well-being and resilience. Instead of focusing on what’s wrong, she’s focusing on what can we improve and how can we improve someone’s resiliency so that they can cope and overcome whatever physical or mental health challenge that they’re facing.

She is a licensed Clinical and Health Psychologist who specializes in the treatment of depression, anxiety, stress as well as insomnia. She provides psychological evaluation and treatment at Brigham Women’s Hospital and is an Instructor of Psychiatry at Harvard Medical School. In this episode, we discuss the intersection between self-care and resiliency, when it comes to living with chronic pain or another challenging health condition.

We discuss why self-care is important and how self-care is related to resiliency, how to build resiliency, as well as the barriers that might show up as you start to engage in a self-care routine. The rates of depression, anxiety as well as chronic pain skyrocketed during the COVID-19 pandemic. This is an important episode to share with your friends, family as well as the patients that you treat. There’s no time like a depressant to take stock of how you’re doing mentally, physically as well as emotionally and to develop a self-care routine that will contribute to resiliency. Without further ado, let’s begin and meet Dr. Natalie Dattilo.

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Strategies For Self-Care & Resilience With Natalie Dattilo, PhD

I had the opportunity to speak on a panel for the development of a new chronic pain app. There were three of us that were practitioners on that panel. It was myself, a social psychologist and our guest, Dr.Natalie Dattilo. We were fielding questions both from people living with pain as well as practitioners. I had the opportunity to get to know Natalie and I wanted to share her with you and introduce you to her because I found her approach to be very refreshing. For me, it was refreshing even though we know that mental health is finally getting the attention it deserves both in pain care and other aspects of illness.

What I like about her approach is that she focuses on well-being and resilience. Instead of focusing on what’s wrong, she’s focusing on what can we improve and how can we improve someone’s resiliency so that they can cope and overcome whatever physical or mental health challenge that they’re facing.

She is a licensed Clinical and Health Psychologist who specializes in the treatment of depression, anxiety, stress as well as insomnia. She provides psychological evaluation and treatment at Brigham Women’s Hospital and is an Instructor of Psychiatry at Harvard Medical School. In this episode, we discuss the intersection between self-care and resiliency, when it comes to living with chronic pain or another challenging health condition.

We discuss why self-care is important and how self-care is related to resiliency, how to build resiliency, as well as the barriers that might show up as you start to engage in a self-care routine. The rates of depression, anxiety as well as chronic pain skyrocketed during the COVID-19 pandemic. This is an important episode to share with your friends, family as well as the patients that you treat. There’s no time like a depressant to take stock of how you’re doing mentally, physically as well as emotionally and to develop a self-care routine that will contribute to resiliency. Without further ado, let’s begin and meet Dr. Natalie Dattilo.

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Natalie, thanks for joining me on the show.

Joe, it’s nice to be here.

It’s nice to meet with you again. We met before and did a little webinar together. Me, you and a social psychologist talking about chronic pain. I love some of the things that you were saying. We were talking mostly to people with chronic pain but also some practitioners. It was great to connect with you, hear a different perspective and learn about your work both your clinical background and some of the things that you’re involved in.

One of your platforms or things that you’re passionate about is self-care. For people with chronic pain or health conditions, when they enter into the healthcare system, self-care is not something that is necessarily talked about right away. It’s not necessarily on their mind. I’m wondering how did you become so interested in self-care? We should probably define self-care so people understand what it means.

I’m interested in self-care as a practitioner and clinical psychologist. I’m working with people who are struggling with things like depression and anxiety, alongside some co-occurring medical conditions and relying on them to practice good self-care. There’s only so much that we can do together. I can bring my tools. We can work on treatments and prevention but self-care is such a big part of that. Self-care is also about self-empowerment, self-advocacy and feeling empowered to take the best care of yourself that you can. That’s one of the ways that I define it.

Self-care is the intentional steps that we take to tend to our needs too. This is also important for people who tend to take care of others and making sure that you’re also filling your cup, making sure that you’re taking care of yourself so you can be available and show up as your best self for the other people that you’re taking care of.

Self-care is about empowerment.

Empowerment and prevention. Thinking about self-care is important, preventative care or self-maintenance as opposed to something that you get or a reward, luxury, privilege and all of those things. Sometimes people think about self-care a little backward but it’s something that you get to indulge in. It’s critical and required to stay healthy.

I want to give an example of that. When you say reward, we can talk about them on the behavior level and a little bit on the neuropsychological level. If I had a stressful work week and I say, “My week was stressful. I’ve worked really hard and I had a lot of things going on. I’m going to reward myself with a massage.” Does that fit into self-care, the way that you’re contextualizing it for us?

Yes. I wouldn’t rule out massage as a very effective form of self-care. It can work. There’s a continuum perhaps if we think about the practices of self-care and, which ones we know are effective. Rewarding yourself with a massage or an opportunity to unwind at the end of the day or take a long hot bath. If that’s the form of self-care that you need then that’s the most important part of the equation and asking yourself, “How am I doing and what do I need?”

That’s going to change. Sometimes you’re going to need a little more, a little less something that feels more pampering and more active. Maybe it’s practicing assertiveness or checking things off a task list that you’ve been putting off with the goal of being productive but also making sure that you’re attending to your needs and those might also include feeling happy, joy, delight, fun and pleasure.

When I go back and I think about reading other physical therapists’ daily notes and evaluations when I used to do supervision in the hospital, in the private practice or back to when I worked in the interdisciplinary program, I don’t believe I saw self-care as a goal in a lot of healthcare practitioners’ intakes and their goal setting. It’s interesting to think about where that fits in because so often as professionals we’re thinking, “We have to treat this.” People coming to us thinking, “There’s potentially something wrong with me.” I can’t figure out how self-care fits into that picture.

I do a self-care assessment with the patients that I see. I ask them, “What are you doing for self-care? What are your self-care plan and practice?” Some people will tell me that they have one and that this is what they tend to do on a regular basis or as often as possible. Some people will look at me like, “I don’t even know what that would entail.” Bringing a framework into that conversation to help people make a plan or pick and choose the activities that might be most effective and available for them.

You’ve studied ACT. In ACT we talk a lot about avoidance. ACT is Acceptance and Commitment Therapy for those who don’t know. Avoidance is a common term used throughout many different professions. Is there a covert form of self-care that acts as a form of avoidance? People don’t realize and they think they’re caring for themselves and it’s a version of self-care but it becomes aversive for them in some way.

Avoidance is something that shows up cross diagnostically. We see it in almost every clinical presentation in some form or another. We develop what I would call anti-avoidance strategies. How do you know when you are using something as a form of distraction that’s healthy and when are you using something as a form of avoidance, which we would consider unhealthy.

Avoidance can show up as experiential avoidance as an internal avoidance and try not to feel things internally or it could be behavioral. You’re avoiding people, places and things because they cause you to have some form of distress. I get this question a lot. “How do I know when I’m avoiding and when I’m using a healthy form of coping like a distraction?” This can be a very effective form of coping if you’re dealing with something that’s upsetting to you and you don’t have a ready solution to that problem. Sometimes you need to do something else, take your mind off of it for a bit and revisit it later.

The question that I would ask people is, “Who’s in charge of the behavior? What’s in charge of the behavior? What’s driving the bus? Are you making a conscious choice to step away from the distress that you’re experiencing or the problem and doing something with the goal of feeling better and coming back to it later and be productive? Is the thing that you’re anxious about or avoiding calling the shots here? Even if you know you’re avoiding something, as long as you’re choosing that as the strategy, “I’m choosing to avoid this right now because I don’t want to deal with it,” as soon as you make that a conscious choice, it’s no longer avoidance. Avoidance tends to happen outside of our awareness of it.

Let’s give an example. Someone who has chronic pain and they’ve done too much. Past that Boom-Bust Cycle and pain flares. They can’t deal with it and decide in the middle of the day to take a nap. Healthy, non-healthy, self-care and not self-care, where does that fit?

It might depend on the consequences as well. You’ve maybe pushed yourself too hard. Maybe the best thing for you to do at that point is to rest, take a nap and lie down. Maybe that is attending to your needs and I might consider that self-care. The mindset that you bring to the activity or the action is important and it’s what determines whether this is self-care, healthy, unhealthy or avoidance. It’s, “I’m choosing to do this because I believe this is the best thing for me.”

If that choice has consequences like you’re missing your meeting and picking your kids up from school, there are going to be negative or aversive consequences to that decision. That’s when it gets a little bit tricky because you don’t want to not be tending to the important things in your life as well. That’s when it begins to look a little bit more like avoidance and something that’s not healthy or productive.

If I’m fully aware that I did too much activity and I chose to take a ten-minute power nap. I set a timer on my phone for a limited amount of time. I realized that helps me in some way to self-regulate, whether it regulates pain or my emotional distress then that could be a healthy version of self-care that we’re talking about.

I would call that self-care.

If I did too much and I don’t realize I did too much, I’m not mindful of that and I take a nap, I don’t set a timer on the phone, I sleep and it disrupts my sleep cycle for the next day, it’s probably not the best version of self-care in that sense.

One also feels more self-compassionate like I’m tending, taking care of myself and I’m giving myself the rest of my body and the break that my brain might need. The other is it feels a little bit more destructive or critical. I’m even mad at myself or punishing myself for having done too much as opposed to taking care of myself in a healthy and compassionate way.

I like the word tending that you used. That’s a good word. It almost reminds me of the relationships we have like the mother and child, when they’re younger. There’s attending. There’s a need to tend to someone’s needs. We can do that for our loved ones but we can do that for ourselves as well.

I also think about self-care as self-nurturing, attending to those needs. There’s a warmth and comfort in that. That feels softer and not forced necessarily.

I want to start to move this a little bit because the idea of self-care obviously can help people with symptom reduction and that’s important for a period of time. Then there’s also a resilience-building factor to all of this. What’s the fine line between resiliency and self-care? There’s been some information in the literature about it and some of it is things that we talk about as far as professionals.

Resilience is a hot topic for so many reasons. Self-care is a critical component of resilience and resilience is adaptive coping. We talk about it as the ability to bounce back from adversity and self-care is right up there on the list of things that we should and could be doing to help build resilience or cope adaptively in the face of adversity, setback or challenges. This can show up as a physical pain and emotional condition or a stressful situation.

We’ve been experiencing a prolonged stressful situation for the past year and a half and our resilience has been put to the test. People had to get creative in their self-care because options that might’ve been available to them prior, either weren’t available or things have changed so significantly for them in their lifestyle. We’ve had to get creative in terms of things that people had never tried before and things that you could do at home.

You talk about areas of life that affect resiliency. You mentioned stressful events like the pandemic we’ve been through. Where does it start there? Our resiliency factors are biological and we’re born with them. Are they things that we can develop throughout life?

That’s such an interesting question because it’s both. We know that there are elements of both at this point and the idea of thinking about resilience from a biopsychosocial perspective is new. It’s mostly fallen into the category of psychological or emotional resilience but what we know now from studies is that there might be biological differences in an individual’s ability to be resilient.

That’s interesting and important because it opens up other opportunities for intervention and prevention. The studies that look at resilience, the clinical and scientific studies examine trauma and folks that go on to develop PTSD and those that don’t as a way to operationalize and define resilience. We are talking about pretty significant forms of adversity that not everybody may experience but the idea that there are biological predictors of folks who might go on to develop something like PTSD versus those that don’t is interesting. I look forward to learning more about that.

As a psychologist, you’re talking about biology, which is interesting.

It’s thinking about the anatomical structures in the brain, the neurochemicals that are involved in learning, neuroplasticity and that there are critical time periods in our life like across the lifespan at which we might be more susceptible to the fallout from stress, adversity and trauma at other times. The other interesting aspect of looking at resilience over the lifespan is that we are exposed to different risk factors at different points in time in our development.

Things that are stressful for children aren’t as stressful for adults and vice versa. The other thing that’s interesting about resilience research is that there’s an optimal amount of adversity for humans to experience. Not having any isn’t good for us. Having too much isn’t good for us but that there is a sweet spot so to speak. As a parent, it is okay to let your kids struggle a little. You don’t want them to suffer but not letting them struggle, deprives them of an opportunity to build resilience and this we can see in their brains. These are clinical.

Not allowing a struggle to happen. It doesn’t turn genes on that could help promote that resilience.

It’s called stress inoculation and in the clinical studies that you might look at, you can give people a little bit of stress and watch what happens in their brain and behavior and you can train people to be better at experiencing stress, adversity and even trauma.

I would think as professionals, that’s what we do with things like graded exposure, exercise and activity, where we realize that someone’s coming to us for some change. They’re not happy with their life, health and where they are. We’re helping facilitate that change. At times once we’ve given them the skills, do we also give them a little bit of a nudge to experiment and try things out?

Exactly. We are challenging them and this is part of growth and healing. We’re intentionally putting people in uncomfortable situations that they can handle so that they can also learn that they can handle them, get stronger, grow stronger and get better.

One of the things that I’m very interested in is the social context of chronic pain and chronic disease in general. More from a cultural perspective and movement that I believe that we need in our society probably globally in healthcare. When you’re talking about resiliency and the biological factors, it makes me think of transgenerational trauma.

These are people who have entire histories of trauma that go way back in their family and it does affect genes and they’re passed down. We’re seeing them in clinical practice and sometimes we have tremendous success and then sometimes I have had moments where I’ve said to myself, “I’ve had twelve visits with this person. They themselves have a whole history of pain and trauma and their family has a history of pain and trauma.” Twelve visits are not a lot for that patient and not a lot for me. We need a lot of advocacies on the healthcare side but also looking at it from a societal perspective as well, to try to remedy some of these challenges.

It’s such a good point, especially when we’re thinking about resiliency and resilience from a biopsychosocial perspective so social resilience. How do we build resilience in a community or within a family? Family organizational and systemic resilience. I love the idea of talking about community resilience and how we can support and lean on one another and learn from our individual models of resilience and extend those out on a more collective and widespread scale.

There’s a lot of value in there and I’d like to see us do a little bit more work in that area. It might seem contradictory to the concept of self-care with this overemphasis on self. It’s right in the title but I do think there’s a bidirectional relationship between self-care and community care and that all are required.

I can only see it as a circle, self-care, resiliency and community care and all connects. These are the things that people bring into community centers, churches and schools and we can affect larger groups of people that way.

We take care of each other and ourselves. I also see self-care a little bit differently than others as a form of social responsibility. When we are able to take care or better care of ourselves or tend to our needs in a way that keeps us healthy and out of the healthcare system, to the extent that we are able and have those resources that are scarce, especially in mental health, it’s available to those who need it the most when they need them most. I not only see self-care as not selfish. I see it as a social responsibility.

When we look at this self-care resiliency continuum, we have decreased in the impact of trauma and PTSD, if you’re exposed to that. Not everyone is adversely affected by that. Some people have the ability to cope with things and need some more skills. Reducing early exposure in life because that’s when our nervous system is growing and is primed, the neuroplasticity is happening. What if I or a patient asks you, “What else could I do to promote resiliency in my life so I can become a more resilient human or person?” What are some skills and tactics they can use?

Studies would show that if you want to know what it is, it cannot overstate the value of positive reappraisal. From a psychological resilience standpoint, the value of positive reappraisal, which is not putting a positive spin on a negative situation, although it might sound like that. Reappraisal is the process of meaning-making or better understanding and approaching adversity from the perspective of learning growth. It can sometimes look like a silver lining and look like, “What’s the upside here? What is this teaching me?” The ability to do that is so important for adaptive coping and resilience.

Can you give us an example of maybe a patient you were working with? We’re in a clinical example of what reappraisal might look like for someone struggling with a chronic health condition. Let’s say they’re having problems with mobility. That’s a big one for many people.

It’s not easy to do but we can get better at it. It requires thinking about your situation and examining some of the assumptions that you’re making about yourself or the situation that you’re in. How long do you expect it to last or how many areas of your life do you expect it to affect? Can you think about that situation with more accuracy or in a way that’s going to be more helpful to you so that you stay motivated, inspired, don’t get depressed and don’t backslide in your progress?

Thinking about mobility is important and a lack of mobility might be seen as only bad. Nothing’s ever only anything. There might be aspects of that situation that may be beneficial that might go too far but is there something about the situation that you find yourself in now that’s important? Is it teaching you something important about you and your ability to persevere, withstand pain and difficulties? What is it teaching you about your ability to reach out for help or rely on somebody else for that? What is it teaching you about patience? These are important coping skills that you are building on the spot when you’re dealing with things that you would rather not be dealing with.

Those are nice open-ended questions. People can use with their patients and receive what comes up for them.

What is this teaching you? It must be teaching you something.

It’s interesting that you mentioned cognitive reappraisal. This is a little technical but I know you can roll with this. In the ACT, they don’t talk about reappraisal. They talk about cognitive diffusion. They’re similar but different. Do you feel like it can be as effective versus reappraisal or is that we need to learn to cultivate both of them?

My approach is both. There is room for both of those that they don’t have to work in opposition with one another. In some situations and circumstances lend themselves better to each other. It’s knowing which tool to use for the job but the diffusion strategies are helpful in separating you from what’s on your mind from the things that you’re thinking about, which you also need to do in order to be appraised.

You have to take that step back and think about what you’re thinking about and metacognitive so that you can decide. Is this a situation that is susceptible to reappraisal? Do I need another approach, which is being very curious about what it is that I’m thinking, my experience and observing what it is that I’m thinking about without necessarily trying to change it?

I have to be able to notice or observe my thoughts first and that’s part of the reappraisal process.

That’s so important.

You get to be in a position to decide what to do with those thoughts. You get to decide, whether this is a helpful thought for me. “Does this making me feel better, worse, more encouraged and discouraged? What is the value of the purpose of that thought? If I can change it, I’ll change it and if not, can I change the way that I relate to it?”

A patient asked me because we were talking about some of her thoughts related to pain and how it impacts our function. She said, “I understand all this. Can I be with this thought for a couple of days then come back and work with it?” It was such a curious comment that she made and it wasn’t the worst thought. I wasn’t concerned that she was going to harm herself, have a plan to harm herself or anything. I said, “Observing that thought and seeing what happens with it. If it changes or if it morphs, it becomes more positive or stays exactly the way it is. Maybe it becomes more intense in your body or it doesn’t. Within about a week’s time, she came back and she said, “Me staying with it caused it to go away.” That’s always so interesting.

I love the idea of making room for thought. Even I have people put it in their imaginary backpack and carry it around with them. It doesn’t have to do or mean anything, it’s just there and you can decide later what it is that you want to do with it. Being observant of that and taking a more neutral stance around that are skills that you can teach people and get better at over time.

Curiosity is also important. Cultivating curiosity, I say curiosity is the great neutral and it requires being observant. It requires stepping away from the things that you’re thinking about and or whatever it is that you’re experiencing internally. It’s getting interested in it like, “That’s interesting, weird or why is that happening?” Being curious about your own experience takes you automatically into a more neutral space and it’s very rewarding to the brain. It’s inherently rewarding to the brain to be curious about something so you feel better.

I want to drop down into the body because we’ve been talking a lot about thoughts and the mind with regard to resiliency. The bottom-up mechanisms, as we say, exercise, physical activity, movement, working with the somatic body and working with the autonomic nervous system, which is typically below the neck. Where do movement and physical activity fit into not only self-care but resiliency is even more important to discuss.

Exercise physical movement, physical activity is at the top of my list. Whenever I’m working with someone, I want to check in about what exercise they’re doing, what physical activity they’re able to do. It’s right at the top of my list when it comes to self-care and for all sorts of reasons. The ability is important. It’s for managing stress, anxiety and mood. Using the body to activate the brain, body and biology, get everything circulating in the right way. you feel better.

Exercise, we know it strengthens the part of the brain that’s sensitive to pleasure. When you exercise, it makes everything you do more pleasurable, enjoying and enjoyable. That’s important. It also sends an important message back to us about how we’re doing. There’s this behavioral biofeedback mechanism where when you’re active, you see yourself being active and you tell yourself important things about how you’re doing and what you’re capable of. As you’re being active, as you see yourself as somebody that moves their body on a regular basis, that does a lot for our confidence and motivation. There are so many levels and layers to that one thing that it’s critically important.

One of the things that concerned me during the pandemic was homeschooling, which we had to do for a period of time. I was concerned about adolescents with regards to physical activity but more so very young children because we know that cognitive development oftentimes tracks with motor development and vice versa. I don’t think we make that connection in the early years. We think, “Kids have to go to school. They have to learn, sit down and read, write and do Math,” but motor learning, being physically active boosts a lot of that process and not development.

Such a good point and we’ve lost some of that. We were losing that battle maybe a little bit before with devices and being inside. We do need to encourage our kids to move more for exactly that reason. Those parts of the brain need to connect with the learning centers and emotional regulation centers of the brain and a well-connected brain as a healthy brain.

The more you’re engaging the motor cortex and linking that up with executive functioning, critical thinking, creativity and all of those things are important. As adults, if we’re doing intentional and planned exercise and activity, we move. We probably don’t move enough but what we don’t do enough is play. I consider that an important part of self-care too.

We’re looking for neuroplasticity in play. If someone’s reading, they’re sitting down if you’re at home, you can take out a pen and paper or maybe your journal and start to write some of these ideas down. Maybe set up a plan for yourself. It’s typical that people would maybe set some goals for themselves. Exercise twice a week for twenty minutes, maybe develop a meditation practice and crossword puzzles. All these things are good for resiliency. Should we change up our routine and is that beneficial for our self-care routine and for resiliency?

It might be worth taking a look at what you’re doing during the week and do you have time, space and energy to add items? Some people do and if it’s important then you prioritize self-care. It might be worth having plans for self-care activities, at least if not daily, weekly. I do encourage people to be very intentional and planning their self-care but sometimes we’re busy and the idea of doing something else or adding another thing to the to-do list. There isn’t the time or room for that.

I encourage people to make the things that they’re already doing every day, a form of self-care or an act of self-care. If it’s a cup of coffee that you’re going to have anyway, maybe take a little bit of time with that. Slow down, drink that and savor that instead of running out the door with it or meals. Meals are a great time to practice self-care and engage the senses and pay attention to what you’re doing or practice gratitude before a meal and those things. It doesn’t take a lot more effort or time. It takes more intention.

Talking about this is important. I started my day with, “I don’t have time to do my run,” and I was going to put it off. I’m thinking to myself, “I have time I can fit that in and I can work this in somehow.” Talking about this brings things to the surface and you realize, “This is important to me.” This is something that is valuable for my brain and my body and I have a friend that I run with sometimes. There’s a social component there. Talking about this is so valuable for people.

There are a few non-negotiables that I have to get done and that I also enjoy doing. It’s not a have to, it’s also want to but when those things start to go, I’m in trouble.

It’s been great speaking with you, Natalie, about stress, resiliency, self-care and all really important topics. Tell our audience how they can learn more about you.

I’m on Instagram. I’m @DrNatalieChristine on Instagram. That’s my handle. I’m also on Twitter and that’s@Natalie_Dattilo and I have a website DrNatalieChristine.com where I have a blog and I post about topics related to mindset, motivation and self-care.

You can check out her website. It’s DrNatalieChristine.com. Pretty easy. You can tweet her. What I would love for you to do is take a screenshot with your phone, share that on Instagram and tag both Natalie and myself. It’s @DrNatalieChristine and @DrJoeTatta so you can tag both of us and let us know how you liked this episode. There are lots of valuable nuggets here and both the science part of it as well as a take-home piece that you can do.

At the end of every show, I may ask you to share this with your friends and family on Facebook, LinkedIn, Twitter, Instagram and anywhere people are talking about self-care and resilience to help them. I want to thank Natalie for joining me. We’ll see you next episode. Take care.

Important Links:

• Natalie Dattilo
• @Natalie_Dattilo – Twitter
• @DrNatalieChristine – Instagram
• @DrJoeTatta – Instagram
• Blog – Dr. Natalie Christine

About Natalie Dattilo, PhD