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There is power in having a positive mindset, even if you have a negative perspective right now.
No, I’m not talking about toxic positivity, which encourages people to always look on the bright side (often ignoring or glossing over loss, pain, grief, etc.).
I’m talking about practical optimism, a concept I learned about from the book Practical Optimism by Dr. Sue Varma.
Practical optimism is a way to change your mindset that holds space for negative feelings and experiences, while equipping you with skills to deal with what you are facing and even possibly turn your challenges into opportunities.
This may seem impossible, especially if you are dealing with mental health challenges as a result of debilitating chronic skin rashes. But I encourage you to give this episode a listen with an open mind!
Joining me to discuss this concept and how to develop a positive mindset is Dr. Sue Varma who is a distinguished psychiatrist and cognitive behavioral therapist based in New York City. With over two decades of private practice experience, she has made significant contributions to the field of mental health, including serving as the pioneering Medical Director and Psychiatrist for the esteemed 9/11 mental health program at NYU for which she was awarded the Mayoral Proclamation. She’s also the author of the book Practical Optimism: The Art, Science, and Practice of Exceptional Well-Being.
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In This Episode:
- The devastating situation where Dr. Varma discovered optimism
- Are optimism and a positive mindset genetic?
- Toxic positivity practical optimism
- Pessimism vs skepticism: what's the difference?
- Which personality type are you?
- The eight pillars of practical optimism
- How to change your mindset even if you feel like you are “broken”
- How to know if you're emotionally dysregulated
- Benefits of committing to therapy
Quotes
“A lot of times people dismiss optimism as a variety of things. It's woo-woo thinking, it's pollyannaish, it's very naive, it's toxic positivity, or it's something you're either born with or not. So why do we bother studying it? And what I found instead was that optimism, yes, there is a genetic component, but the reality is that only 25% of it is genetic. Seventy-five percent of it is learned.”
“Practical optimism…says, ‘I invite space for your loss and your grief, but I'm also going to equip you with skills that will help you deal with what you're facing right now, but also in the future, and help you prevent some of the bad things that might be coming your way.’”
Links
Find Dr. Varma online | Instagram
Get Dr. Varma’s book Practical Optimism HERE!
Healthy Skin Show ep. 131: Mindset: What To Do When Nothing Seems To Help Your Rashes
368: How To Create A Positive Mindset (Even If You Have A Negative Outlook Right Now) w/ Dr. Sue Varma {FULL TRANSCRIPT}
Jennifer Fugo (00:14)
Dr. Sue, thank you so much for being here on the show today to talk about having a positive mindset and being optimistic.
Dr. Sue Varma (00:18)
Thank you. Thank you for having me, Jennifer. I'm excited.
Jennifer Fugo (00:21)
So I wanna say, first and foremost, that as a fan of your book, Practical Optimism, I feel like I'm a practical optimist, to be honest with you guys, so I got the book to learn more about having a positive mindset and how to change your mindset. I really, really loved it. I wanted to talk today about a lot of the concepts in the book because I feel like they're extremely relevant to what people are going through, I think in general, but also for my community. And I wanted to talk a little bit first, to kind of set the stage of this conversation, about what brought you to this concept, because we had this, I didn't know until I started reading the book, that we have this shared commonality of we were both in New York when 9/11 happened. And it sounds like that was one of the roots, or one of the key points, for you in your journey. So could you share a little bit about that experience and how that helped to feed and inform where you are now?
Dr. Sue Varma (01:26)
Yes. So, you know, I found optimism in one of the most unlikeliest of places, in the rubble after 9/11. And during 9/11, I was a medical student and we were in training at the time in a New York City hospital and all of us were told to start discharging patients because we were going to have a lot of people who were wounded and injured coming into the hospital. And we discharged patients and we waited and waited and waited. And what that meant was, when no one was coming into the hospital, it meant that we lost a lot more lives than initially anticipated that day. And it was truly one of the most devastating acts of terrorism, mass violence, on US soil. And I don't think anyone, I don't care how well-trained you are in trauma therapy, you are not prepared to handle the grief and devastation that you saw that day.
And years later after finishing medical school and finishing training in psychiatry, I was recruited for this job to be medical director of a 9/11 mental health program. And all of us were really focused on the idea of resilience at the time, but no one thought about optimism. And what I would later learn through my own research was that optimism is a key feature of resilience. But resilience is talking about bouncing back from adversity. But optimism really helps you flourish in the face of it. And that is when I became a believer in optimism to say, you know what, is there more to this? Because a lot of times people dismiss optimism as a variety of things. It's woo-woo thinking, it's pollyannaish, it's very naive, it's toxic positivity, or it's something you're either born with or not. So why do we bother studying it?
And what I found instead was that optimism, yes, there is a genetic component, but the reality is that only 25% of it is genetic. 75% of it is learned. And then I realized that I am already doing a lot of the work that is involved in learning optimism: skills about emotional regulation, problem-solving, interpersonal skills with other people, being able to plan properly, being able to have healthy habits. And the reason I got so invested was I found that optimism leads to not just a longer life, but a healthier life. Optimists live on average 10 to 15% longer. This is what's called exceptional longevity. People living into their 80s, you make it to 85, the likelihood of you being an optimist is extremely high, because you're taking care of yourself better, you're doing certain key things better. So it was really random, Jennifer, how I landed upon optimism, and it was through trauma and a highly unlikely place.
Jennifer Fugo (04:07)
I have to, it was funny as you were going through this list, I'm thinking to myself, oh gosh, there's that whole toxic positivity thing, like just fake it until you make it, just keep being optimistic. Can you speak a little bit to what the difference is between what you're talking about in having a positive mindset and learning how to change your mindset, versus that? Because I think a lot of people get caught up in the toxic positivity type of space.
Dr. Sue Varma (04:28)
Yes, and you know, look, the people who might be giving off the toxic positivity vibes, they're not ill-intentioned, they want you to be happy and they're telling you “just look on the bright side.” And some of them are saying this because they care, right? It's well-intentioned, but what they don't realize is that when you tell someone to just get over something or look on the bright side, you're dismissing the pain, the grief, the loss, the challenge that they have been through. And instead, what practical optimism is, it says, I invite space for your loss and your grief, but I'm also going to equip you with skills that will help you deal with what you're facing right now, but also in the future, and help you prevent some of the bad things that might be coming your way.
People don't realize that optimists face the same number of negative life challenges as the pessimists do, except that their mindset helps them overcome them faster, quicker, and actually turn that obstacle into an opportunity. And there's a great, great quote that I love that Winston Churchill had said, is that optimists look for the opportunity in every problem, but the pessimist looks for the problem in every opportunity. So it really is, we are gonna be all facing the same number of life challenges, but how do you choose to wanna look at it? And there is some truth that extreme optimism, what we call blind optimism, or the ostrich effect, where you're burying your head in the sand and you expect that things will just turn out fine, extreme optimists are also dangerous because they don't do the work. So if your doctor says your blood pressure is high, your cholesterol is high, we need to do something about it, a blind optimist will dismiss it and they'll be like, nah, doc, you're worrying too much. Everything will take care of itself.
On the other hand, we see the same thing happening with pessimism, but for different reasons. A pessimist might go to their doctor or, get this, they may not even go to their doctor. They may say to themselves, I'm too scared to find out the truth. So both extremes don't end up seeking medical care or following through with it for different reasons. The pessimist becomes paralyzed by negativity and the toxic optimist just doesn't believe that negativity can exist. And really what you want is to be able to marry these two, because there is something beautiful about pessimism. People don't realize that a pinch of pessimism, just like a pinch of salt, goes a long way. Pessimists are actually more realistic, more accurate in their assessment of problems.
And so if you want to be that pessimist when you're doing your homework, great. But do not be a pessimist when it comes to decision-making, right? Because pessimists become paralyzed. They do not make decisions. They perseverate. And we were talking about this, about decision-making style. I can get more into that, but pessimists become paralyzed and don't make decisions. And toxic positive optimists don't make decisions because they just put blinders on and they're like, everything will work out fine.
And we know that, you know, there's a lot to be said about wealth. That extreme optimists are losing money because they're just like everything will work out and they're not really cautious in terms of how they spend their money or how they invest their money. But slight optimists are richer than pessimists because they invest money early on, they believe in their future, they get advice from people that they trust, financial advice, and save more than pessimists. So optimism not only leads to better health and longevity, less heart attacks, less strokes, but it also affects your bank account, believe it or not.
Jennifer Fugo (07:53)
So you bring up an interesting perspective and as I'm listening to you talk about pessimism, is that the same, like the pinch of pessimism, is it the same as being skeptical, or is that kind of different?
Dr. Sue Varma (08:08)
You know the saying trust but verify? That's what practical optimists do. They trust. So trust is key. So if you're plain skeptical, where you just knock down what anyone has to say to you, and I think it's really important, and this is relevant in where we are in terms of politics and fake news. So, you know, look at your sources and be willing to get opinions from people that disagree with you. Smart people, accomplished people, look at the scientific research. Is it a peer-reviewed journal when we're talking about health? Is it a placebo-controlled, randomized, prospective study? So do your homework. Don't just live in an echo chamber. Get opinions from at least three different people, but different people that you trust, that trust you, that have your back, that have your best interests at heart, but are also experienced and knowledgeable in something.
So I hesitate to say 100% like, yes, that the idea of a pinch of pessimism is a pinch of skepticism, but that's it. And then it moves very quickly to decision-making. In the information gathering stage, be skeptical, but gather the information. And a lot of times pessimists don't even gather the information. They literally are just like, this is overwhelming, does not compute, too much info, or I'm just too scared of hearing this, I don't want to hear things. I have patients that have very extreme health anxiety. They don't want to go to annual screenings for mammograms or colonoscopies because they A, maximize or magnify the problem. Oh my God, it's going to be worse, I'm going to get a cancer diagnosis. Meanwhile, there's no cancer in their family. Their screenings have come back negative every year, but they're afraid that this next time, that's it, it's going to be stage four, in the absence of any information.
So magnifying a problem and undermining or minimizing your own ability to deal with the problem. It's that combination that makes the pessimist very dangerous because then, I say, okay, as your therapist, then what? If you did get that, God forbid, hopefully it's not gonna be that case, because we don't have any evidence to suggest it, but God forbid, what would you do? And they're like, I would just die. I'm like, when? They're like, just hearing the news, I would faint in the office, I couldn't handle it. And I was like, all right, let's go through that. And then when you talk about the steps, what would you do, they are able to verbalize. No, actually, I would call a friend to come join me or I would call my partner. I would get information, I would read, I would talk to the doctor, I would go to specialists. So that's what cognitive behavioral therapy is all about, is challenging those negative thoughts and really recognizing and taking back your agency and saying, you know what? I really don't want to know bad information, but if I do, I can actually do something about it.
Jennifer Fugo (10:49)
You had mentioned before, and we were talking about this before we started, about problem-solving, and that's part of this, problem-solving, decision-making, and that there's essentially two different types of individuals. I'm sure there's some gray in between. But can you talk about those two different types and how, just so that someone could very clearly go, oh, I see where I kind of fall on this. Because it can be, I mean, I know plenty of individuals who are like, need more information, more information, more information.
Dr. Sue Varma (11:31)
Yes, totally.
Jennifer Fugo (11:50)
It's like they put off making a decision endlessly and then feel so overwhelmed by the amount of information that they just can't even decide and become so paralyzed. And then you have other individuals who sometimes will leap before they look. They won't ask the right questions and then end up, especially, I will say, in the more integrative functional space, there's some really amazing practitioners, there’s some individuals who probably may not have as much experience and you end up spending a lot of money on things that were not really warranted and weren't appropriate. But if you had taken more time, you might have gone, oh, you know what, this probably wasn't the right way forward. So what are those two types of individuals that tend to, I guess, what are the two extremes that you talked about in your book?
Dr. Sue Varma (12:08)
So in my book, I talk about satisficers who are like, all right, this is good enough for me. And good enough, you know, there's that saying that perfect is the enemy of the good. So the maximizers are people who collect a lot of information, and no amount of information is ever good enough. Or at least, they get mired in all of the details. I'll give you an example. I remember shopping for a car with my parents many years ago. And my dad is a satisficer where he's like, this checks off these three boxes that I'm looking for, whether it's price, or horsepower, or safety, or mileage for the gas. My mom, on the other hand, is a maximizer and she would be like, is there a moon roof? Is there this? Is there that? And we're like, moon roof? When did you need that? She's like, I don't, but like, you know, we might as well make sure that it has everything if this is what we're paying. And I was like, oh my God.
Or I'll give you an example of a patient who had broken a phone and needed to get a new cell phone, but was overwhelmed by all the options that were out there and was like, just, I'm walking around with my broken phone and I need a new one. Or a camera, or a TV, or any kind of technology purchase, this patient would get stuck because they're like, I need to do my homework and I can't buy a new one unless I've done all my homework. So I'm just going to walk around with a broken thing. So this need then trumps this need for perfection. Having the perfect decision, trumps anything else.
And the problem is that you end up delaying, avoiding, procrastinating. And a lot of times we see maximizers have something called buyer's remorse, where it's this idea of I bought something and oh my God, or sometimes a buyer's remorse is with a partner. They're like, oh my God, this is my boyfriend, or this is my husband or wife, and like now what, is there something better? And I feel like when, totally different topic, but if we're gonna talk about dating apps, I think this is why for a lot of people they're really struggling, because they feel like other people are looking for the next best thing. And that idea that maximizers always believe that there's something better out there and they're afraid they're not gonna make the right decision, so they don't make any decision at all. And they end up becoming pessimists, or lonely, or depressed, rather than having something that's good enough.
So I'm not saying that satisficers are always doing things the right way, but they ask themselves, what is relevant, what information is relevant for me right now. So I always say pick three people, like limit it, rather than trying to listen to the opinion of 20 people. Let me limit the number of people that are giving me input. And there's two different types of thinking, divergent thinking versus convergent. And in one of them, you end up thinking first broadly when you're brainstorming, that's fine. Get all the options, get seven to ten, but then limit your number of choices. Limit the number of people, input, opinion, choices. And then give yourself a deadline to say, all right, five days, seven days, I'm going to act forward. And you know what? Let me look at the refund policy. So that's something I do. Sometimes I find myself, you know, skewing towards the maximizer and I say, you know what? I'm gonna book a hotel because I need to, I'm going to a conference, I'm speaking, I need to book a hotel now, because I wanna lock in a good rate, but I'm gonna pay a little bit more so that I can refund the ticket, or refund the hotel if I need to, or if I find a better option.
So give yourself a little breathing room. And I know some people are like, I'm fine with being a satisficer. And that's great because they don't have buyer's remorse. They're not looking back and having some regrets. So I'm just trying to help people have a little bit of flexibility in the way that they're making decisions, so that they don't feel like this is the be-all and end-all. Because a lot of times maximizers start to anticipate buyer's remorse. So it's not even as if they bought the TV and now they're stuck with it. They're afraid of what might happen if they might make the wrong decision and then are stuck with it. And it's like what we call anticipatory anxiety, anxiety about anxiety.
Jennifer Fugo (16:08)
Yeah, and that can be really, really hard when people feel stuck. Like you're saying there's this perfectionist piece where we become trapped in this idea that it has to be this perfect ideal, and then the grass is greener someplace else.
Dr. Sue Varma (16:24)
Yes, yes.
Jennifer Fugo (16:53)
And constantly going, this isn't good enough, let me go here. And I think sometimes we start to see that when individuals are just bouncing from one doctor to another, one type of protocol, or one type of, could even be a practice for their mental or emotional health, one thing to the other. Just like, no, no, no, this is the next thing. It's a little bit of shiny object syndrome too. Like just can't commit and stick with things, it can be really, really challenging.
So I wanted to ask you, you have, so this concept of practical optimism and having a positive mindset, you have eight pillars. Do you wanna quickly share what those are just so that way listeners can get a sense of what is, I think, critical? What are the big topics that this really encompasses?
Dr. Sue Varma (16:58)
Yes, so you know I have these pillars, while they don't have to be practiced or learned in any particular order, they string together in my mind very nicely, because the first pillar is having a purpose. And that purpose could be purpose in life or it could be purpose simply in an activity. What is my purpose today? What is my purpose for this conference I'm going to? Who am I going to meet? This networking event? This party? So just being intentional and being mindful about your next steps in your day or in your life.
And I talk about how to find your purpose if you feel like you’ve lost it. And I say if you can't find it, it's your job to create it, and I give people steps of how to put the cart before the horse, so to speak. And it's a tip called behavioral activation that says how to sort of reignite that sense of purpose. Sometimes people are like, I'm in a job that I've been in a long time, I don't feel like I'm doing good for anybody, I'm just making the company money. And I say how to do something that's called role remake, or job crafting, so that instead of you trying to fit to your job, you make your job fit to you. And say, all right, I'm a social person, I'm gonna start doing company, you know, happy hour, non-alcoholic happy hours, or I'm gonna do, you know, a marathon, or I'm gonna do a book club, or a wellness club, or something that aligns whatever your personal hobbies and passions are into your job, integrating them.
Because a lot of times people feel like it's one or the other. Like I either have to go off and create my own business and be an entrepreneur, or I stay at this job and be miserable. And I'm like, no, there's a way to do a little bit of both, or even have a side hustle or a hobby or something. And it doesn't have to always be monetized. So there's a lot about finding joy in the pillar of purpose. And I talk about how purpose must also be matched with pleasure. Because sometimes purpose for a lot of people can be raising a family or doing things for other people, which I talk about the importance of how we live longer when we're volunteering, altruism really leads to more added years and quality to your life. At the same time, too much purpose, if it's for other people and you don't have enough pleasure, I call it the drudgery drawer. You got to add some joy and how to infuse joy into your life.
So one of the big things of practical optimism is that it's a practice. It has to be practiced, a skill, like a language, a musical instrument, learning a new sport. And I give very concrete, actionable tips in every single pillar. So purpose is having vision, but also how to increase the joy in your life. And then it moves to all the different ways that you're going to carry out the final plan, your final goal, which is practicing healthy habits. But you could replace habits with any new goal. I want to start a business. I want to improve the quality of my relationship.
That's the eighth pillar. It's the execution. It's the final step of bringing into life, actualizing your goals, your vision. And how you do that is by processing negative emotions that come along the way, which is one of the pillars. There are steps, it's called name it, claim it, tame it, and reframe it, which is acknowledging the pain in your life. So naming it, where's it coming from? Even something happened today, you got yelled at by your boss or by your spouse. So that acknowledging, naming it.
Claiming it, where in the body are you feeling? Claim it, is it a jaw clenched, is it a shoulder that you're holding the tension? Taming it is the deep breathing or an exercise that you can do with journaling, lot of science behind journaling, and then reframing it. How can I put a positive spin? If there is one, if there's not, then let it go. And I say, ask yourself when you're really struggling with something, is this a problem to be solved or a truth to be accepted? Because not everything is meant to be solved.
And then you move through problem-solving, which is one of the pillars. What are the obstacles in the way? How to work around them. Developing self-compassion is a really key one. 10-minute self-compassion exercise helps you get out of whatever it is. Like if there's an embarrassment, or a rejection, or a failure, you accept it, you don't beat yourself up, and then you create an action plan going forward. The pillar on present is about reclaiming your attention in a digital age and your relationships, being mindful, how to add opportunities for mindfulness.
And then the pillar on people is my favorite. Acknowledging that there are going to be different relationships in your life, different levels of depth. And I see a lot of times we're going sort of vertically where we're creating a lot of relationships with people, sorry, we're creating a lot of horizontal relationships where we know a lot of people, but we're not going deep on them. So I would say go deeper with the connections that you have, even if it's one or two people. And how to do that, how to show up for people, how to maintain reciprocal, two-way relationships where you're also equally fed. And to never minimize the role of micro-connections, a sort of social snacking, like talking to the barista, the dog walker, the person at the grocery store. We had a lovely chat before recording this, right? So creating time and space to connect with people throughout the day and not always thinking of it as a transactional means to an end. Because I know we're busy, but it's really important to schedule that time in.
And then the practicing of the healthy habits, all of the ways. I always say that good mental health is made of good choices. But excellent mental health, exceptional mental wellness, is about stripping and removing choices altogether. And you might say, like, I'm an adult, I work really hard to get to where I am so that I can have choices. And I'm all about that, right? Like we know, according to the self-determination theory, that people want agency. It's one of the three basic things, agency, belonging, and community or connection. So we don't want to strip anyone away of their agency and take choice all out. But what I'm saying is, turn choices into habits so that things are automated, and how to lower the entry barrier.
So there's tons of ways on how to make habits easier, how to make them stick. And then also I share my four favorite mental health habits that are both a habit onto themselves, but then they're a habit that lead to more productivity. They're the four M's of mental health, mastery, movement, meaningful connection, and mindfulness.
Jennifer Fugo (23:13)
I actually really loved, one thing I loved about your book is that it's not some prescriptive one-size-fits-all to developing practical optimism and a positive mindset. It allowed me to take stock of where I am to really, like you do a good job, and that was the one thing that I actually appreciated. I didn't feel like I had to do these things in order to attain XYZ. It was a really wonderful insight in how to ask insightful questions about the way that I respond to certain things and think about how I could shift that to something else. I really loved, actually, you had almost like a script of how you would talk to a patient. And I was like, wow, this is actually really helpful. It provides something that, you could like apply that to many situations.
And obviously, the book is no replacement for actual therapy and a therapist to help you work through this, but it is nice to see something that's not just like, I was like, my gosh, there's no diet in this book. This is wonderful. I love that. I love that we're actually just sitting with the action steps, with the way that we're showing up in life, where we're struggling and not, like you said, not demeaning it, not putting it down, not trying to shove it aside and that we're able to hold space for it.
And at the same time, that there are ways to work through it so that you can actually, I would say, and I've been working on this myself the past couple of years, of changing those patterns, changing the way that you respond so that everything isn't always, I don't know, maybe it’s like, if I'm a more pessimistic, negative, like I'm the victim, this was done to me vs having a positive mindset. There was a lot of really great examples that helped me even see where I was in the past and how far I've come, and some things that I could even continue to work on. Even though I have been working through with a trauma therapist for the last two years. So it's really an insightful book.
And one thing that I found really beautiful, you talked about, and I'm going to quote you from the book, you said there's this idea of putting something fractured back together, and in the process, of restoring it to something beyond its original glory. And that statement just jumped off the page, I read it five times. And I oftentimes think back and I felt broken at the time, when I started to realize that I needed to begin this process of addressing different issues and traumas under the surface. And I think many in my community and many of my listeners can relate to feeling broken. Their bodies feel broken, they're not working with them, their health is not what they wanted or imagined it to be, wherever they are in life. Can you speak a little bit to that statement and that concept to help listeners understand it more?
Dr. Sue Varma (26:39)
So first of all, thank you so much. It means so much to hear from you how helpful and useful many of these concepts are, and how sort of inviting, non-judgmental, and that makes me really happy to hear. When we talk about brokenness, I think that one of, there are many feelings and emotions that come with that, and one of that I think is a sense of helplessness, and hopelessness eventually. That the idea of I'm broken, number one, it assumes that there's a right way to be and that if I'm not that way, some standard, then I'm broken. And so it helps, at least for me, it helped me challenge that assumption that there is one way, a right way, a standard way, which there really isn't.
And then it says that it's binary. You're either broken, or you're not broken. And the kintsugi, this art of repairing, using a golden lacquer to put back, and what they say is that in this Japanese art form of broken ceramics, the original ceramic actually is not as valuable as the broken, rejoined, through the golden lacquer, that ceramic. And you can visibly see, it's not as if you're joining something back to make it look the same as what it used to look like. You are seeing the brokenness, you see the veining, the gold veining. So it at no point ever tries to hide the fractures, it highlights the fractures and it puts gold.
And so to me, when I became a psychiatrist, so much of our training was about how to repair dysfunction. And it was taking somebody from dysfunction to functional. But I wanted to focus the rest of my life and my career from functional to optimal. And that's, to me, what kintsugi represents, is beauty, flourishing in the face of adversity. Because none of us will get to leave this world unbroken. Something will break our spirit, or try at least, or many things will try, to break us. And this says, I'm up for it, bring it to me, and here I've got my gold, my practical optimism practice ready. You know, I got the glue ready, bring it on, bring it on, I'm ready for the challenge. And this is meant to be a practice that you maintain, a philosophy, a way of life, a way of thinking that you retain for life.
And when you were talking about that you feel as if practical optimism is something that, even though you've been working for two years in trauma therapy, you still could use it. Jennifer, I feel like I could still use it. There are days that I have to go back, you know, and I may flip through and say, I need the inspiration. Because so much of this wisdom came either through, you know, sort of on the shoulders of other giants, other researchers who may have offered, you know, something here and something there, and then kind of creating my own life experience, 20 years of clinical practice, speaking to the public. So this worldview and vision is something that I need to tap into when I'm feeling broken, because inevitably there are going to be days, even if it's small.
And I think of trauma, there's big T, you know, with those life-threatening and horrific events, hopefully once in a lifetime. But 80% of us will experience a life-threatening event at some point in our life. But who ends up having post-traumatic stress disorder, that really depends on a variety of things. You know, like they say, while 80% of us will experience, at least more than half, will experience a life-threatening event, only a very small subset of people end up getting what's called post-traumatic stress disorder. And so there's a lot of things that we can do to prevent it. And to me, practical optimism is equal parts preventative as it is treatment. It cannot replace individualized therapy, but in conjunction, as an adjunct. People should share it with the therapist. Give a copy to your therapist and say, listen, I want to work with you here, but when I'm gone, you know.
I wrote the book first and foremost, I wrote the book that I needed personally when I was going through the darkest times in my life. But then I wrote the book that my patients needed, because they would always say, in between sessions, what work can I do? And I was always trying to give them books, and there are a lot of great books out there, but A, they may not be written by medical practitioners. They're not written by people who are in clinical practice as well, or in terms of the number of years of experience, or they were great theoretical books, but they didn't tell you how to. And then they weren't written in the tone of, I'm no different, you know, I'm just like you, I have also lived experience. And let me start out the first chapter by telling you how broken I am or was, and what I went through. So I feel like it's a combination of these things. But thank you for appreciating that part, because we all have a brokenness and it's something that should be celebrated and not hidden.
Jennifer Fugo (31:41)
I think one of the other interesting things about the book that I really, really liked was about cognitive distortions and emotional regulation, and being able to cognitively restructure things. So can you, gosh, in this day and age where people are so fast to react, to get angry, to get sad, I feel like maybe we live in a bit of an epidemic right now of emotional dysregulation. And that's just my opinion, I have no factual information to back that up. But can you speak to what emotional regulation and possibly dysregulation is, and what are some of the ways that that can show up? And is that like a cognitive dysfunction, or are there pieces of that that are associated with it?
Dr. Sue Varma (32:36)
Yes, and I do agree with you that we are, I would say, more on edge and definitely there is a lot more dysregulation, in part because we're not living in communities the way we used to. And other people are our stress buffers. And on a daily basis, when we're experiencing whatever it is, stressors, challenges, they are that much more magnified when we don't have loving, supportive people in our lives in close proximity to us who can give us hugs. I'm a big believer in hugs. They increase oxytocin, which is really a buffer for cortisol in the body. So when you are feeling alone, it puts your threat level, this hypervigilance, this state of fight or flight is always on and it's always ready to react. And so something that might have been minor that you would have let go all of a sudden becomes that much more magnified. Plus there's cyber bullying and there's a lot of hate online, and it's easy to do that anonymously nowadays. So loneliness and anonymity in being a mean person, I think that these things highlight the dysregulation.
And the cognitive distortions result when you're assuming that the worst thing is true. So catastrophizing, fortune telling, mind reading, assuming you know what other people are thinking, discounting the positives, negative filtering, focusing on the one negative thing and not recognizing all the positive things that you've done or another person has done. So there's like 18 or 20 key cognitive distortions and I found them really valuable. When I went reluctantly, hesitantly, eventually to cognitive behavioral therapy, therapy is expensive. We were encouraged to go, but I was working, when I was training, 100 hours a week and I was like, who has time, who has money, you know? Our program wasn't paying for it and it was very expensive in New York City, to live, to have loans, to pay for therapy. So it took me a while to go, but also because I didn't realize that there is a type of therapy, this cognitive behavior therapy, that is action-oriented, solution-focused, time-limited, problem-solving, and I'm like, this is great.
The only problem is that therapy waits for the other shoe to drop, and that's where practical optimism comes in, because most people won't go to therapy until things are really, really bad. I know that's changing, especially in younger generations, but I remember speaking to a mentor 20 years ago and I was like, we need to engage in mental health prevention. Everyone should be required or encouraged, and insurance should pay for it. People should have access to affordable, good treatment for mental health, which is not available, and there should be a preventative setting. And I remember the mentor, great, loves me as a person, but laughed at the idea, was like, ha ha ha, who goes to that? And now we are seeing more prevention built into primary care offices, so you have questions on screening depression and anxiety. But we are still not having, I mean, that's a 10-minute visit with your primary care doctor who's checking blood pressure, cholesterol, diabetes, annual screenings. They don't really have the time. They may care, but they don't have the time to sit there and have a 45-minute session with you about your mental health.
So that's where practical optimism comes in, is that it recognizes that not everyone will go to therapy. We know that 40% of people who have diagnosable mental health treatment will never get the treatment. And we're not even talking about the millions of people who have symptoms, but are never gonna get diagnosed. So there are gonna be so many people who need the help, but will never be able to access it, afford it, or have the insight to realize that they need it. So this is where the preventative part comes in.
Jennifer Fugo (36:15)
So I have a question for you, earlier I was talking to my husband and he was telling me something about someone he knows and he said, well, this is how he is. And sometimes my husband will say that to me, well this is how I am. And there's plenty of people, I'm not calling my husband out, there's plenty of times where I in the past have probably said that myself about me. And I'm now in this phase where I'm like, well, is that true? Like I'm very curious and it took a while for me to get to that point where I was like, well, is that true? Is that statement true that I think about myself?
So what do you say to someone who says, but this is how I am? Are there some things that we're just, that's how we are? Or is it possible that we say that to almost deflect from maybe issues, or ways that we interact or address things, that maybe aren't the most balanced and healthy?
Dr. Sue Varma (37:22)
Such a great question. I think it's so hard, when you love someone, I mean, there's so many different layers to this. One is, how does that behavior, when someone says, this is just how I am, how does it actually impact you? How does that translate? Because if it's something that somebody, let's say they chew their food in a very annoying way, okay, it irritates you, right? Or they wear their pants way too high, or there's something ridiculous about a quirky idiosyncratic habit, but it actually has no bearing or impact on your life otherwise. All right, that might be something that you accept. But if somebody, you're in a relationship with someone, who flies off the handle within 30 seconds and starts yelling and becomes insulting or borderline abusive, then that's not something, or even any mild version of that. Where someone is not supportive, your partner's not supportive of your career or decisions that you're making.
There's this African proverb that I love. It says, before you get married, keep two eyes open, once you get married, keep one eye closed. And it's this idea of, when you're picking partners or picking key people in your life, be very methodical about who you're choosing so you can try to keep out negative, toxic people and energy. But then when you have chosen this as a person to be with, are there forms of acceptance that you can engage in that don't diminish you as a person, or disrespect you as a person? So I feel like it's a very tricky question. There's no one blanket answer, it really depends on what it is and how it impacts you.
Jennifer Fugo (38:57)
Like I said, I have found this the last two-year journey of mine, and you had mentioned a lot of people come to therapy because they hit maybe rock bottom, things get really bad. For me, many of my audience know I had really severely debilitating back pain that I did originally have physical proof that it was due to this terrible herniation, and I probably maybe would have qualified for surgery had I gone in the beginning when I could barely walk without a cane. So there's that, but then after a certain point, two years in, there's no more proof that there's a physical problem. The MRIs are clear. The doctor can't explain why I'm in so much pain. And it took me two years of living in debilitating pain to finally go, “well, I guess I've eliminated everything else, I'll finally make an appointment.” It stinks that it took me that long, but I am deeply grateful.
I will not say that it has been an easy process, it's certainly not been comfortable. But it has been life-changing. And I'm not fixed. I think that's an important thing to say, I'm not fixed. But like I said, I think to go back to that phrase that you used in the beginning of the book, I feel like there was this fracture of who I thought I was. And it's being pieced back together in time, restoring it to something that is stronger than I was then. And there's I think there's a deep-seated belief in me that we all have this capacity to pull so much wisdom out of our suffering and to transmute it into something so much greater. But if we're not if we're not told that that's even possible, you just think that suffering is all there is.
Dr. Sue Varma (40:55)
Yes, and also it requires a certain amount of curiosity, belief, faith, hope, optimism to seek treatment, right? Because then the assumption is that things can be better for me at one point. And it also takes humility, because it says I don't have all the answers. And I think that a lot of times people have a perfectionistic standard. And when they go to therapy, they're looking to be the person they were before the pain, the injury, the loss, the grieving. And I always say, you're never going to be that person, right? Like, really accept and acknowledge that if you have been through something that's a life-changing experience, maybe it's negatively life-changing, you have changed. You are not the same person you were before this, and it's an unrealistic expectation. But then also, do you really want to be that person that brought you into treatment ,in the first place? There was a reason that brought you in, right?
And so you want to be able to examine that reason and everything else around it because a lot of times people may come in for one problem, they're like, I have a problem in my job. But then when they start talking, you recognize that they've been putting so much effort in their job that everything else in their life has been neglected and put on the back burner, their exercise, their physical health, their personal relationships. And even though they're not coming in, when they're coming in to talk to me, about their personal problems, they're like, no, no, no, I wanna just focus on the work, I want to take a 360 holistic analysis of every aspect of their life and want to make those things better. And I say that you're not gonna go back to where you came from, and do you even really want to? Because where you came from is what got you here in the first place, right? So you may wanna go back to a baseline, but what if your baseline was flawed and complicated and not a strong foundation?
So therapy really does help a lot of people flourish to a person and a version of themselves that was even better than their best days. And they don't recognize that. They're so afraid that I'm going to go in, and you're going to make me talk about my childhood and relive all these painful memories that I have worked my entire life to bury, and I'm going to have to confront demons, and I'm not here for that. But what they don't realize is they're going to be leaving with an even stronger foundation built. It's like building back better, times 10.
Jennifer Fugo (43:20)
Well, I think that is the best way to leave this conversation today. I feel like we could have had a three-hour conversation on this. So we'll have to have you come back so we can dive deeper into this. But I wanna make sure that everybody knows A, how to find you and connect with you and B, again, I really highly recommend this book, Practical Optimism. It is available on Amazon, and if you want to check out a free first chapter, we'll put the links into the show notes for you guys. Dr. Sue is on Instagram, so you can find a ton of content there from her, and she also has a really great newsletter that you can subscribe to on her website. So we'll put all of the links into the show notes. Dr. Sue, thank you so much for being here today. I really appreciate you.
Dr. Sue Varma (44:09)
Thank you. It was such a pleasure talking to you. Thank you so much for having me.
