- Everyone faces challenges in life.

But when those difficulties are born of trauma, the challenge to persevere becomes more daunting.

Today's guest walks us through the science of resilience and how we can all thrive in the wake of adversity.

He's Dr. Jonathan M. DePierro, this week on "Story in the Public Square."

(gentle music) (gentle music continues) (gentle music continues) Hello and welcome to a "Story in the Public Square" where storytelling meets public affairs.

I'm Jim Ludes from the Pell Center at Salve Regina University.

- And I'm G. Wayne Miller, also with Salve Pell Center.

- Our guest this week is Dr. Jonathan M. DePierro, associate director of the Mount Sinai Center for Stress, Resilience and Personal Growth.

He's one of the co-authors of "Resilience: the Science of Mastering Life's Greatest Challenges," which is out now in its third edition, I should note.

He's joining us from New York.

Jonathan, thank you so much for being with us.

- Thank you for having me.

- You know, we wanna note that your other co-author, Dennis Charney wasn't, Dr. Dennis Charney wasn't able to be with us today.

And we note with some sadness, the passing of your other co-author Dr. Steven Southwick.

But we're grateful for you for being with us today.

You know, resilience is a word that, yeah, I think, I knew as a high school student long time ago, but it seems like it is much more prevalent in popular culture and the way schools talk about educating students and just in life in general.

What is resilience?

What are we talking about and why is it so popular today?

- Yeah, so resilience has a lot of definitions, which has been kind of a problem for scientists, figuring out what it is, how to measure it, and then also how to promote it.

The way we think about resilience in our work at Mount Sinai and in the book is the ability to adapt to, recover from, and grow after life's challenges, big and small.

- So, you know, so that, it seems simple.

I'm imagining that it's a lot harder in practice.

- Right and especially if you've been through a really traumatic event, the recovery process can take weeks, days, months, and can be prolonged, but can be helped along by a variety of different things, including the support network that you have socially.

- So all three editions include some writing about the trauma that many people, I would argue probably most people in America experienced in the wake of the terrorist attacks of 9/11.

Is that what A, inspired your research?

And B, is that what inspired on some level or at some point this book and its three editions?

- I would say in part, but at really the onset of this research was with Dr. Charney and Dr. Southwick working at the VA and seeing patients with PTSD, seeing veterans with PTSD, and really wanting to learn more about how they can recover best, how they can heal best from the trauma.

And so what they did is they actually interviewed Vietnam War POWs.

They had many of them come into the VA, sit for recorded interviews, and that formed the basis of decades of research and understanding human resilience.

Personally, my interest in resilience did start with 9/11 responders because I started my work as a clinician, as a psychologist working with first responders who went down to Ground Zero, participated in the rescue and recovery effort, and many of whom developed PTSD, depression, anxiety as a result because they saw really intense human suffering.

And we're actually very lucky that there's a federally funded program under the Zadroga bill to provide medical and behavioral healthcare to these responders.

And I was one of the, was former to this, prior to the center starting, one of the clinicians that was providing that care.

- Were you in New York when 9/11 took place?

- Yes, I was, I was actually, dating myself, I was a high school student, I was a sophomore in high school.

I was at Xavier High School on 16th Street.

So not too far off from Ground Zero, far enough away for it to be safe, but not so far off that you couldn't see the dust and the impact of that.

And a number of my classmates lost family members.

- So were you personally traumatized from that, would you say, or?

- Yeah, so, you know, trauma is one of those tricky words.

I think for me as a 15 or 16-year-old kid, it did affect my sense of how safe the world is, right?

I actually, I was just thinking back, I had been in the World Trade Center towers sometime earlier that same year.

- Wow.

- Meeting with family, like family members for lunch.

And it did sort of puncture the veneer of safety.

But I didn't develop what we would consider to be post-traumatic stress symptoms afterwards, in part because our school really came together, was very supportive.

I had friends, I had family, and I wasn't as directly affected as other folks.

I did not personally lose people in the attacks.

My dad lost business colleagues.

- Wow.

So the third edition has been updated to reflect life in a post-COVID world.

And we're going to get into the book in depth momentarily.

But can you draw any parallel between 9/11 and COVID, the trauma that so many people experienced?

- Right, in some ways there are similarities and in some ways there are very clear differences.

In terms of the similarities, it was a trauma, these two were traumas on a large scale that affected a good number of people.

COVID by making it different is that it affected people all around the globe, somewhat at different times, but all around the globe.

9/11, the epicenter of the impact was in New York City and in Pennsylvania, and at the Pentagon.

And it reverberated out from there, but it was somewhat circumscribed in terms of the number of people that were killed, the number of people that were injured, the number of families affected as directly.

But COVID the scope of that had been, you know, just many times order of magnitude bigger than that.

So the reach of COVID was certainly higher.

And, you know, arguably in the United States, there was a coming together of neighbor and neighbor supporting each other after 9/11 that we didn't see for a variety of reasons after COVID, which I think complicated people's emotional recovery, if there was mistrust of doctors, there was vaccine skepticism, there was anxiety around every corner that wasn't going away, that was being fueled in part by some news stories.

- You know, Wayne's right, we wanna make sure that we get to the book.

But I wanna linger a little bit more sort of in this table setting as it were.

I don't know that you can answer this question with a simple explanation, but I'm curious about a definition of trauma.

And there are all different kinds of traumas, and I suppose that it's probably unique to each individual case.

But what does trauma do to an individual?

- Right, so there are a couple of different definitions.

There's the psychiatric definition, and I would say there's a broader definition that a number of other experiences would fall under.

So a broad definition is that trauma is an experience that overwhelms the body's ability to cope, that is in excess of what you can actually deal with, and, you know, leaves a mark, in terms of its emotional impact.

Psychiatrically, a trauma, a traumatic event, if we look at our diagnostic manual, is a life-threatening situation where you, yourself, were seriously injured, where you saw someone being killed, you heard about a loved one being seriously injured, or killed, or through your work, say as a 9-1-1 dispatcher you learned about the details of horrific events over and over again.

So there is a life threatening injury component to that in our psychiatric understanding.

But one thing I wanna point out is that, that does not include experiences of racism, and discrimination, and emotional abuse that many people would consider to be traumatic.

I, myself, as a clinical psychologist, would consider in many cases to be traumatic and leave an emotional impact.

- Jonathan, is it fair to say that most, if not all, people will experience at least one traumatic event in their life?

- That's absolutely fair.

That's actually what our research studies show.

Somewhere between 65 and 95% of adults will experience at least one life-threatening event over the course of their lives.

Now, what we also know is that trauma does not equal post-traumatic stress disorder.

Most people who experience a life-threatening event do not develop post-traumatic stress disorder, the vast majority of folks.

In fact, it's really only around 10 or 11% of folks who experience a life-threatening event that go on to develop PTSD.

It's like resilience.

It's one of those terms that's thrown around in social media in articles, but it means a very specific thing, and it's actually not, certainly not as common as trauma exposure in itself.

- Well, so let's start, let's talk about, the book lays out a number of strategies that people can use to be more resilient.

The first is confronting their fears.

Let's talk about what that really means and why it's so critical.

- Right, so through facing your fears, you can challenge yourself to learn new things.

Let me give you an example.

One of the most common fears before COVID was public speaking.

And one of the ways to challenge that fear is to gradually expose yourself to tiny doses of public speaking.

That might mean speaking in front of the mirror, speaking in front of two people, and then speaking in front of a room.

If you need to, for your job, or for your academics, to public speak, that's the way to go about it.

You will not just by thinking about it, talk your way out of that fear.

You really have to confront the fear piecemeal with support in order to address it.

The more you avoid something that you fear, the bigger the fear looms in your mind.

So I have, I know people who are afraid of flying and would not get on an airplane for decades and conjure elaborate stories about all the bad things that can happen.

But it's really only by stepping foot on that airplane do they realize, "Hey, that bad stuff didn't happen.

I got to my destination."

They can learn that the world is actually safer than they make it out to be.

- So in addition to exposure, would therapy be helpful in this regard?

- Right, so some people, they can face their fears on their own with a little nudge from a friend, or a colleague, or a spiritual guide, or maybe just themselves.

But for some people that fear is so significant that they do need the help of a therapist.

And there are exposure activities that a therapist could guide them through where they make a pyramid of different parts of the feared situation, the thing, and they start with the thing that's easiest to do related to it, and they get up to the big thing.

So, as an example, when I worked with 9/11 responders, many of the responders had a goal of eventually visiting the 9/11 Museum in New York City in lower Manhattan.

They knew it was going to be very, very upsetting for them to confront reminders of the trauma at the 9/11 Museum.

But their first stop wasn't getting to the 9/11 Museum, the first stop was going into Manhattan in general because they had been avoiding Manhattan.

So just that was a success.

And then we built upon it.

And then maybe it was watching, doing a virtual tour on the museum website, so they could see, you know, in the safety of their own homes or the therapy room, what they might be exposed to there.

And it builds up to it.

And that's something that, it was a big part of a lot of the work that I did, where you sort of chip away at the fear step-by-step.

And this happens after traumas where people don't wanna feel bad after trauma, so they avoid things that remind them of the trauma.

But in doing that they don't get the feedback that the world is actually safe.

If you're in a car accident and you avoid driving in a car, you never get that feedback to your brain that you're not gonna be like, you're not likely to be in another car accident.

- So I think it's important to note at this point that obviously the book is informed by a lot of very important research, but it's also informed by a lot of interviews that were done, stories from real people.

Why was that important to bring, you know, real-life accounts?

And we read many of them in the book.

Why was that important?

And that I think would separate this book from others that would be more quote, unquote, "purely clinical."

- Right, I think it gives it life.

It gives you examples.

These are not superhuman individuals.

They've been through difficult situations, but they're not different than you and me in any real meaningful way.

They exemplify some of the things that our research studies show.

They exemplify some of the things that our brain imaging studies show, and they give life to it.

It could be kind of dry and boring for the average person to take a book off the shelf and just read 10 chapters of pure science.

This gives it life and also personalizes it.

And we hope that people see themselves in the stories of these individuals.

- So the next strategy is maintaining an optimistic, but realistic attitude.

How do you do that?

- Right, so we're not talking about toxic positivity or Pollyannish optimism.

What we're really talking about is acknowledging the challenges that you face and focusing on what's within your control.

People who are pessimistic tend to get bogged down in lots of things that are outside their control, and they also tend to see the challenges that they face as lasting forever and pervasively impacting lots of parts of their life.

But people who are optimistic can put really good mental boundaries around the challenges that they face, that I know it's gonna last for just a short time.

I don't know when it's gonna end, but it's gonna end.

And there are things that I can do that are within my scope of control to make my day better.

- You know, Jonathan, I had some friends who've come back from war and suffered with PTSD.

I can think of trauma in various loved one's lives that is profound.

How do you approach this not sounding like you have to draw on some, that you're somehow flawed if you're not resilient, if you're suffering from PTSD, or if you have some sort of, you've experienced some sort of trauma, how do you make sure that you're not re-victimizing those people in approaching resilience from, you know, be optimistic, confront your fears?

It seems to put the burden on the victim in some respects.

- Right, and this is why we have a broad definition of resilience.

We see resilience and the processes of recovery in individuals who are suffering from, suffering with PTSD symptoms and depression.

It is not enough to say that resilience is simply that you didn't get PTSD after a trauma, or that there's something wrong with you because you did.

Those same skills that might've prevented someone from developing PTSD in the first place, are the same skills that can be used to help someone with the diagnosis recover.

And actually, what we know, to skip four or five chapters ahead, is that there is actually tremendous growth that can occur in the midst of suffering.

We call this post-traumatic growth.

- [Jim] Yeah.

- And what we knew from our healthcare workers is that 80% of our healthcare workers who were taking care of patients at the height of COVID at our hospital in Mount Sinai, said that they changed in a positive way as a result of the work that they did.

That they had a new sense of their own abilities, stronger relationships.

They had a new sense of priorities in their life.

And at the same time, what we also know is that those healthcare workers with PTSD symptoms endorsed the most growth.

So that distress and those symptoms actually, you know, fueled them to look at themselves and look at their lives and reevaluate where they are now in relation to where they were before.

- [Jim] That's a remarkable- - That the distress can actually be, could be alleviated, sort of leveraged for change.

- Yeah, you know, and that's a statistic I think that's often left out of news accounts of people who worked in healthcare and what their outcomes were and.

So social support you write is also vital.

Why is it vital and what are we talking about when we say social support?

- Yeah, so that's an excellent question.

It is probably one of the most reliable resilience factors.

In studies that we've looked at before, during, and after trauma exposure, social support is the biggest protective factor.

And when we talk about social support, I'm talking about two or three different things.

I'm talking about emotional support, that is to say someone to validate your emotions.

Someone you can talk to when you go through a difficult situation.

Somebody who's in your corner and backs you up, and validates you 100%.

That could be a friend, family member, or so on.

But there's also tangible support.

Someone to take you to the doctor if you're sick.

Somebody to watch your kids if you have something to do, if you're going through something and need some time away.

That's called tangible support.

And we also saw during the pandemic, especially, with our healthcare workers, that leadership support was an additional form of social support.

That they had a manager or director who is right there with them, giving clear directives, supporting them, validating their distress, and being there.

And I'll just add one more thing, which is exceptionally important.

Giving support is as important as getting support.

Getting support has a lot of literature behind it, but giving support to other people, being altruistic, giving of your time, giving of your energy to people actually blows back on you in a positive way.

So it's not just about the support that you receive, but it's about the support that you give, even in the midst of going through something difficult yourself.

- I think that's very important to hear.

What if I'm watching this show and I live alone, I'm isolated for whatever reason, how would I go about finding social support?

- Yeah, so I think it's just really, starts with finding one or two people.

And I'll give you an example.

During the pandemic when people were having to isolate and shelter in place, there was a huge explosion in online communities, people turning to social media and Twitter in a positive way.

There's bad examples (laughter drowns out speaker) but in a positive way for support.

But one of the things that I would encourage people to do is like, go through your phone.

Think about somebody you haven't talked to in a while, and send them a message that says, "Hey, what's up?"

It takes all of two seconds.

And what actually we know from the literature is that, that person getting the "Hey, what's up?"

message feels good, getting that message, knowing that somebody's reaching out and caring for them.

So there's a huge benefit to just checking in with people, checking with people that you've had some relationship with to, you know, reestablishing, reinvesting in relationships, even remotely, you know, in person, you know, has its benefits.

But even remotely there could be a lot gained from building relationships.

I'll give a very brief example from my life.

I did my psychology residency at Bellevue Hospital, which is probably one of the most interesting and challenging places to train in New York City.

- Yeah.

- And my 13 co-interns that I trained with, we still talk to each other on social media.

We have a running WhatsApp group.

And it's been active throughout the pandemic.

Every week there's activity on it.

We stay in contact, we are our support network.

- You know, yeah, Jonathan, I am, you know, this book offers so many great strategies.

I'm wondering when, do you have any thoughts, advice for somebody who's watching this at home, maybe has some trauma in their history, has worked to try to, you know, get through it on their own to develop some resilience on their own.

Is there a point though, where you need additional help, you need professional help, you need help from a therapist or a psychiatrist?

Is there a threshold?

- Yeah, there's many ways to think about that.

But one way is to think about if the symptoms that you're experiencing, if the, for example, mistrust, or irritability, or sleep problems, or negative views of yourself, if that's not changing, despite a lot of efforts on your part, that doesn't mean you're failing.

That might mean that you need additional support if the symptoms are impacting your life in meaningful ways, impacting your ability to have relationships, or function at work, or function in other parts of your life, that's an indication that it's time to reach out for support.

And I'll say one or two things about support.

You know, psychotherapy and medications have come a long way in the past 100 years, and there are extremely effective treatments for depression, anxiety, and PTSD, many of which were actually developed at Mount Sinai.

There's innovation all the time.

But good treatments are out there.

And people can educate themselves by going to NAMI website or National Center for PTSD to get information about what resources are out there and what to ask their therapist for when they're seeking care.

- So not surprisingly, religion and spiritual practices, you write is very important.

Can you break that down for us?

- Right, so I'm gonna make a distinction.

Lots of people say that they're spiritual without saying also that they're religious.

And so one way to think about it is that spirituality is a sense of connection to something greater than yourself.

And people can have that spiritual sense of awe hiking in the wilderness.

They can have the spiritual sense of awe looking at a beautiful building, or looking at a piece of art, or doing yoga, or meditation.

Religion is people connecting to that sense of something greater through a formal practice, through an organized set of practices and principles, usually with a group of people in a church, or mosque, or temple, or other kind of place of worship.

Both of those things have independent benefits for your own psychological and physical wellbeing.

Now, you can imagine, for example, someone who has a practice of going to a house of worship.

What is involved in that?

Well, you have to get up out of your bed, get dressed, you know, shower, get dressed, go to the place.

You meet people who look forward to seeing you.

You look forward to seeing them.

You're helping them, they're helping you.

And you have a set of, you know, a set of values that you aspire to, meaning and purpose.

So there are many fringe, there are many additional benefits, other than just having the belief to these practices because they give your life a set of, like, it gives your life texture and it fills in some of the time that could otherwise be spent, you know, sitting on your couch.

- You know, so sitting down on the couch is a challenge for a lot of us, right?

Is there a link between physical health and the kind of resilience that you're talking about?

- Absolutely.

We know that people who have good physical health, there tend to be positive consequences, positive impact on their emotional wellbeing.

So things like physical exercise can actually, and many studies have shown that physical exercise can improve people's depressive symptoms, can speed recovery from depression, and can prevent people from developing depression in the first place, as one example.

But there are many common mechanisms.

And, you know, I think there is a increasingly false dichotomy between mental health and physical health.

Mental health can really be thought of as an aspect of physical health.

We're talking about the body, and the brain, and subjective experience, that's physical.

- Curiosity is also important.

And we've only got about a minute left here, but very briefly, why is curiosity important?

- [Jim] Maybe like 30 seconds, Jonathan?

- Yeah, curiosity is important because it challenges you, challenges your brain to learn new things.

The more you're using your brain, the more you're engaged in life, the more benefits you can get from relationships, from challenging your brain to learn a crossword puzzle, or to learn a new language, or to learn a new hobby.

And that can really fuel you in terms of, you know, helping you get through challenging times.

- Jonathan DePierro, the book is "Resilience."

Thank you so much for being with us today.

That is all the time we have this week.

But if you wanna know more about "Story in the Public Square," you can find us on social media or visit pellcenter.org.

We can always catch up on previous episodes.

- For G. Wayne Miller, I'm Jim Ludes asking you to join us again next time for more "Story in the Public Square."

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