Dr. Joe Arpaia MD discusses his recent article in Today’s Veterinary Business on why we shouldn’t always do our best. Dr. Arpaia talks about the 5 components of stress, the difference in stress vs strain, and the importance of separating unease from difficulty.
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LINKS
Stop Doing Your Best (Article): todaysveterinarybusiness.com/stop-your-…st-effort/
Ibernetics.com – Cognitive Training to Better Manage Stress:
www.ibernetics.com/
Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688
Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Joseph Arpaia is the husband of Oregon veterinarian Mary Arpaia, DVM. He has been interested in mind-body interactions since he was a child and began meditating over 40 years ago. He received his B.S in Chemistry from the California Institute of Technology and his medical degree from the University of California, Irvine. His medical specialty is psychiatry and he has maintained a solo private practice for over 20 years in Eugene, OR, focusing on treating stress-related conditions.
Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram
SHOW TRANSCRIPT
Dr. Andy Roark:
Welcome, welcome, welcome to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys I am here today with Dr. Joe Arpaia. Dr. Arpaia is a psychiatrist. He’s an MD. He is married to a veterinarian. I picked up on his article, I put a link in the show notes, it is called Stop Doing Your Best. And I thought, “What is this?” And Dr. Arpaia makes a stress related recommendation about maybe why it’s not best to always do our best. And he breaks that down and talk about what that means and how do you balance that and the physiological impacts of stress and how stress and strain work on our bodies and kind of how we can maybe get around that a bit. I thought it was a really useful conversation. It made me think a bit about how I structure my day and what I do with my time. Guys, I hope you’ll enjoy it. Let’s get into this episode.
Dr. Andy Roark:
Welcome, welcome to the show Dr. Joe Arpaia. Thanks for being here.
Dr. Joe Arpaia:
Oh, you’re welcome. Thanks for having me on.
Dr. Andy Roark:
Oh, it’s my pleasure. You are a psychiatrist and your wife is a veterinarian, and I sort of came across your work in Today’s Veterinary Business magazine, where you had written a column just just a month or so ago, well, actually not, this is back earlier in 2021 called Stop Doing Your Best. And I want to get into that in a minute, but your main area of interest is in treating stress and stress related conditions, correct?
Dr. Joe Arpaia:
Yes.
Dr. Andy Roark:
Can we go ahead and start this discussion by talking about stress and how we perceive stress and I guess the interface in stressful jobs and how we respond to them?
Dr. Joe Arpaia:
Sure, sure. That’s a great place to start. So when we think about stress, let’s say I have a stressful job. So I go in and I say, “I’m under a lot of stress.” That’s one way we use the word stress. Then in the moment we might say, “I’m feeling stressed.” And then later on in the day, when we’re exhausted, we might say, “I’m stressed out.” And we’re using the same word stress, but these are subjectively quite different experiences. When we say, “I’m under a lot of stress,” we’re referring to generally the tasks that we have to do or the demands we’re facing compared to the resources we have to deal with them. So if in the morning I go into the office or if the veterinarian goes into the clinic and a couple of staff have called in sick, that’s more stressful in the sense that now there’s all the demands of the day, but the resources are less. So I call that difficulty. You can roughly think of it as the ratio of demands over resources. So when you have fewer resources, then it’s more difficult. And if you have more resources, the difficulty goes down, as long as the demands stay the same, or if demands go up, of course, difficulty goes up unless resources go up to compensate.
Dr. Joe Arpaia:
The other component of stress, when we say “I’m feeling stressed,” usually we’re referring to something different than just the tasks or the demands or the lack of resources. It has to do with our desire to achieve something or our aversion to a particular outcome. We’re trying to avoid something. You might think of desire as wanting something we don’t have. And aversion is something we don’t want. And the combination of those, I call it unease because it’s not an emotion. It’s something even more primal. If I’m just, “Eh, I don’t like this,” that’s aversion and it makes us uneasy and we want to try to fix it. We want to try to make the aversion go away. Or, “Hmm, I’d really like that.” There’s this desire to get whatever that is and until we get it, we’re uneasy. And when we get it, the unease goes down.
Dr. Joe Arpaia:
Now, as we go through the day and we’re dealing with difficulty, dealing with unease, it affects our energy level. So these are all phenomenological. This is phenomenological approach. I’m not saying it’s energy as this neurotransmitter or this chemical in the body. Just how we fee.
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
And so we feel more and more drained. So we go through the day, the first hour, we’re good. The second hour, we’re okay. As time goes on, our reserves go down. So we have these energy reserves and they’re going down. And that’s when we start saying, “I’m stressed out. I’m depleted. My reserves are down.” Between the experience of difficulty and unease and those energy reserves, we’ve got two processes, which I actually think there’s a lot of brain stem activity here. One I’ll call activation, and it’s largely sympathetic activation, but there’s like our body’s hitting the gas. It’s pushing a gas pedal to get energy out of the reserve so we can meet the demands and we can reduce the unease.
Dr. Joe Arpaia:
So we have this stress, which is a combination of demands and difficulty and unease, and we act activate in order to pull energy out of our reserves and we’re able to meet those demands, reduce our unease. And the problem with activation is it drains reserves. So we have this other system, what I call modulation, which is largely parasympathetic activity, which helps us restore our reserves. So we get to rest. And as we rest, our sympathetic activation comes down and we recharge our reserves and we’re back and ready for the next day. And this goes on and on and on, and that’s, you might say, is life. We handle difficulty. We reduce unease. We use energy to do that. And then when we need to rest, we reduce our activation, increase this modulation or parasympathetic system. And we recharge.
Dr. Andy Roark:
Yeah. So it seems like sort of a stress cycle, if you will.
Dr. Joe Arpaia:
Right. And we might say the stress response system. And that’s very effective. I mean, I sometimes joke and say, “It’s worked really well.”
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
When our species started out, we were facing ice sheets a mile thick, there were tigers running around the size of small elephants, and wolves that stood six feet at the shoulder, and all we had were pointed sticks and torches, and we made it. So clearly this system has some benefits to it.
Dr. Andy Roark:
Yeah. So I like that. The unease part, when you sort of mentioned that, it reminds me of sort of this Buddhist concept of thirst, which is kind of our innate wanting, either wanting to fix something or wanting to have something, and it sort of keeps us in a state of discomfort, but it makes a lot of evolutionary sense,. It’s a driver for us to push onward, essentially it’s a driver against complacency, right?
Dr. Joe Arpaia:
Yes, exactly. In fact, i use desire and aversion come from in some mindfulness systems, there’s a level of awareness which you’re paying attention to literally that, your desire or aversion. It’s translated as feeling but the instructions really say it’s not an emotion. It’s the raw, “I want to get.” They sometimes call it grasping, clinging, and the sort of wanting to push away. And it’s a visceral thing, that unease, really, it activates visceral processes. I sometimes joke, and if you have your hand outstretched, and especially if you like cats, and someone puts a little kitten in your hand, there’s this, “Ah.” You want to pet the kitten, there’s this feeling of the body going toward it. And if someone puts let’s say a banana slug in your hand, there’s this, blegh. I mean, it’s not dangerous. We’re not fearful of that banana slug, I mean, most people would want to pull their hand back a bit. That’s aversion and it comes in all sorts of intensities, and the stronger it, the more it motivates us.
Dr. Joe Arpaia:
And you’re exactly right, without desire and aversion, we’d still be sitting in caves. So we need this. And the fact that our brain enjoys doing things that reduce and it tends to learn what reduces desire and what reduces aversion, tends to, “Hey, do that more.” That’s a very powerful learning. That’s how we learn to walk, for instance. Babies don’t think about walking. They start to balance and they get uneasy as they get off balance and their brain does something with their muscles that brings them back on balance. And the unease goes down, the brain goes, “Okay, that worked. Keep doing that.”
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
And we learn to walk, we learn to talk, we learn to ride bicycles, and all sorts of things because whatever reduces unease, the brain tends to learn more of and says, “Do that. That was good.” We get into trouble though, because in a system that’s more complex than learning how to walk, difficulty and unease may not track very well. So when the baby’s learning to walk, or I’m learning to ride a bicycle, the demand is stay balanced. My difficulty is I don’t have the resources to balance yet. So the difficulty’s high. And whenever I do balance, and demands go down, difficulty goes down, and unease goes down at the exact same time, so this learning process works.
Dr. Joe Arpaia:
But let’s say I’ve developed this idea that I need to do a 100% on every task.
Dr. Andy Roark:
Okay.
Dr. Joe Arpaia:
Well, now the difficulty may be, I’ll give you an example. I have patients where, they’re in college and they’re pushing themselves, “I need to get a perfect, I need to get an A.” And I’ll ask them, Well, what are you taking the course for?” “Well, I’m just taking it because I need to graduate.” “Okay, so the grade is really not going to have any effect on your future career. This is just something you’re taking to grad. In fact, you’re taking it past fail?” “Right?” “So all you need to do, the real demand is just get a P, a pass.”
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
But so clearly this desire to get 100 on every single test is overdoing it. You just told me what your difficulty is. Your demand is the demand is get the pass. You don’t need a 100. So there’s clearly this feeling, this desire, to get a 100 or an aversion to not getting a 100. And now this aversion to not getting 100 in this pass-fail course is causing problems in other courses, because there’s too much time being spent on the pass-fail course. And not enough time on the course that is actually important for their career. When the problem is that when they study hard on this pass-fail course, their unease goes down, and their brain goes, “Do more of that. Keep doing that. That’s that’s what you need to do, keep doing it because it feels good.”
Dr. Joe Arpaia:
So even though, you might say, my guess is their prefrontal cortex can say, “Yes, I agree. This is not helpful.” Their mid brain is going, “Yes, it is. This is the survival learning that has brought us through thousands and thousands of years of adversity and keep doing it.”
Dr. Andy Roark:
This feels like the mental wiring for anxiety, of “I’m going to stress out about the future because that will motivate me to do everything that I can to control it.” You know what I mean?
Dr. Joe Arpaia:
Right.
Dr. Andy Roark:
And in some way, I’m going to get rewarded for this anxiety that I feel, and so we train ourself to be anxious. Do you think that that’s similar to how some of us approach doing our best and approaching academics and things like that?
Dr. Joe Arpaia:
The world is somewhat uncertain. And so uncertainty raises our unease, and it’s not clear exactly what the demands are. So there’s this motivation. “Well, if I just do everything, then I’m going to get everything covered. I’ll reduce my unease by doing everything I possibly can.” And the problem is we’ve lost sight of the fact that our reserves are finite. We have to have time to recharge, that some of these demands we’re trying to meet are not really demands in the sense that not meeting them won’t have any real effect on our life. And the anxiety is this feedback loop between the unease and then it affects our perception of what the demands really are so we lose perspective and we over activate, so we’re constantly on edge, we’re constantly pushing ourselves. We can’t unhook from the unease and the activation and allow that modulation to take effect. So the person’s off. They go home from the clinic and they’re still, “Oh, yeah. What about this client? Oh, what are they going to post? What if I get a bad review?”
Dr. Andy Roark:
The behaviors that I tend to see are people staying forever at the vet clinic, not going home because not every single I is dotted and every T is crossed and there’s maybe something else that I could do, or I could follow up with this, or I could make more detailed notes of this conversation that I had. And then when they do go home, there’s that, to your point, there’s the rumination on cases, there’s the fear of negative reviews, or something coming in when they’re not there. And I guess my question for you, it sounds like those sort of match this sort of stress type behavior. Is this purely habitual, in your opinion, or is this a genetic component for some of us? How do those things sort out, as far as causation?
Dr. Joe Arpaia:
There certainly seems to be a family tendency. So I take a family history of someone who has this kind of this pattern, which I’ll call an anxiety pattern, there tend to be anxious, but it’s hard to say whether that’s actually in their genes or was imprinted, because if the parents imprint, the parents are modeling this kind of behavior, this kind of approach to the world, this way of relating, we’re mimics. Children pick up on that very quickly. So to me what’s important is that actually the person can un-train themselves. So there’s a lot of, whether it’s genetic or early childhood learning or just practice, the fact is, is that it can be unpracticed, so we can unlearn it.
Dr. Joe Arpaia:
And to do that, what we have to do, the first step is to start really being able to separate unease from difficulty. And that’s one of the things I teach my patients early on is, “Okay, is this about how you feel, or is this about what’s going to happen in the world?” Sometimes the example is, “Okay, is this going to matter in three days and three years and 10 years? What are your real values? What do you want to make important? Not just what feels important in the moment.”
Dr. Joe Arpaia:
So they start to separate, “Okay, I’m uneasy about this. At the same time if I really sit down and think about it, this is not important, or it’s not as important as other things, because other things have a higher priority.”
Dr. Andy Roark:
Yeah. Or you say other things are more important because they’re more actual, they’re more real. A lot of times we wrestle with the fear of the pet owner writing a negative review and they never actually write it and they never had an intention to write it. It’s 100% fictional. Right?
Dr. Joe Arpaia:
Right. Right. Or the person’s, they’re missing out on their family. One of the assignments I’ve done, it’s pretty harsh when someone’s really not distinguishing. I’m like, “So you’ve got kids, so, okay, let’s fast forward for 50 years. At some point you’re going to be dead and your kids are going to be standing around your grave or your headstone or something. What do you want them to be saying?”
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
Do you want them to be saying, “Mom was just such an awesome vet. She never came home. And she spent all her time with her.”
Dr. Andy Roark:
That’s brutal. It’s useful, but, man, that that’s brutal.
Dr. Joe Arpaia:
But I mean, it’s worked for some people when they kept going to this, “Well, no, it’s just, I can’t let go of that.” I mean, in fact, that’s not a Buddhist string, you contemplate your death.
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
And It starts to make you realize, “Wait a minute.” Or some of my patients who had cancer and they come in. One patient, I remember her telling me, she goes, “There was BC and AC, before cancer and after cancer,” because she beat the diagnosis. I would say she was cured. But she said, “My priority list was before I got cancer. Now I know what really matters. And I put my time into what really matters and I’m not getting distracted like I was.”
Dr. Andy Roark:
Yeah. I think that’s a really important life lesson. I can tell you, that’s something I’ve struggled with in my life. And I think I’m probably not alone. For a sort of a perfectionist type personality, sort of a high achieving, goal-oriented person, man, that shift from deciding that hanging out and playing board games with my kids matters in a way that anything I do in the vet clinic doesn’t. That was nonsense to me for a long time. And it’s still hard for me, honestly, when I just look at it, to get my head around that idea of what really matters. I feel like we’re so habituated that academics matter, job performance matters, and like those things are just so reinforced than say going the park with your kids or taking your spouse on a date. That seems like that should be the topping. That should be the last thing that we get to do. We should do that when we’ve done everything else. And it feels like a bassackwards way to live. But man, it’s hammered into me pretty well.
Dr. Joe Arpaia:
Oh, I think people are very well meaning when they do that, parents and teachers and they saying, “Just do your best, do your best, do your best.” I remember a conversation with somebody where she was stressing about this English paper she needed and I’m like, “How are you doing in your English class?” She’d say, “Oh, I’m doing really well.” “This is eighth grade. It’s not going to matter. Why don’t you just put your name on the paper and turn it in.” And she burst into tears and I’m like, “Well, what’s going on.” She says, My parents, everyone, tells me, ‘Do your best.’ My parents tell me ‘Do your best.’ Teachers tell me ‘Do your best.’ And you’re telling me, ‘Don’t do your best.'” And this is really distressing her.
Dr. Joe Arpaia:
And so I pointed out, I said, “If you’re running a 10 mile race, let’s say you’re running a 10K. You’re going to run every kilometer at your best time? You run that first kilometer at your absolutely best one kilometer time and you’ll maybe make it through the second kilometer and then you’re going to be needing a cardiac rehab unit.”
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
“You pace yourself and pacing yourself, when we say pace yourself, it means you’re not doing your best. You’re doing good enough. And the reason you pace yourself is that you have energy to do what’s really important. I mean, if this English paper is really, really something you’re passionate about, yes, do your best on it. If it’s not, do good enough, and then you’ll have the energy to do what you’re really passionate about.”
Dr. Andy Roark:
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Dr. Andy Roark:
Over on the Uncharted Veterinary Podcast this week, Stephanie Goss and I are talking about what do you do when the whole team’s acting badly? What do you do when everybody’s got kind of a crappy attitude and everybody’s just sort of feeling down and nobody’s really being nice to each other, including you? You’re kind of part of the team. How do we turn this thing around? Guys, that’s what we’re talking about. You can get it wherever you get your podcast. I’ll put a link in the show notes to this week’s episode. Check it out. It’s a good one. It’s a super fun one.
Dr. Andy Roark:
Also, if you just can’t even get enough of my co-host Stephanie Goss on the podcast, she’s amazing. She’s fantastic. She is doing a communication foundation workshop on November the 7th from 4:00 to 6:00 PM Eastern time, 1:00 to 3:00 PM Pacific time. It’s a two hour workshop. It is all about taking stress and anxiety out of hard conversations and learning eight key elements that you can take back to your practice to build a team that’s filled with strong, effective communicators. That’s it, that’s the workshop. Two hours, eight keys, hard conversations made a whole lot easier. Do not miss it. This is free to Uncharted members. If you’ve been on the fence and you’re like, “Maybe I should join Uncharted?” Spoiler alert. You should totally join Uncharted. But if you’re not ready to make that jump, it is $99 for the public. So you can absolutely jump in. Just check out the two hours, see what we’re about, see if you like it. I hope that you will. I think you will. It’s pretty good stuff. That is, again, on November the 7th
Dr. Andy Roark:
Guys, that’s enough. Let’s get back into this episode.
Dr. Andy Roark:
The do your best mantra. First of all, I feel like is strongly, positively reinforced early in our lives. Do you agree with that?
Dr. Joe Arpaia:
Yes. Oh yes. That’s why we learn it so thoroughly.
Dr. Andy Roark:
I mean, oh yeah. And especially the valedictorian, coming out of college and heading to vet school. This is someone who has ascribed completely to this mindset and mentality and been rewarded for it again and again. I feel like to some degree, those are often the people who struggle the most when you get into vet medicine where the best outcome is often not the one that you get and it’s not going to be the one that you get. The best outcome involves specialty care and thousands of dollars of treatment and that’s just not going to happen. And what we have always gone to, of do the best, be the best, get the best, I feel like that does us a disservice.
Dr. Joe Arpaia:
And also I think sometimes the outcome is largely, not maybe largely, but to some degree it’s outside of our control. I mean, sometimes I tell people, “Mother Nature’s playing the cards. We’re just trying to load the deck here, but she’s in control of what cards you’re going to get.”
Dr. Andy Roark:
Well, if people buy into this, and I feel like your rationale is pretty strong of we’ve only got so much that we can control, we’ve only got so much energy and time in a day. We need to think about the things that are actually important and you can’t make everybody happy and we can’t do everything to the ultimate perfectionist level. How do you help people start to accept that? If this has been our construct that we’ve lived in our whole lives, and we’ve always said, “I do all the things. I get A’s in everything that I do.” And now this person is looking around and realizing that that’s not happening and they are dropping balls. And I think I’m sure you’ve seen those people, I know I’ve seen those people, who are having that realization, in their 30s and they’re just juggling so many things and they’re really struggling. How do you help people change that world view when it’s so ingrained?
Dr. Joe Arpaia:
Right. So I said the first step is to be able to get them to objectively be able to look at what they’re doing and realizing, “No, I’m managing my unease, but my I’m not managing my demands for the difficulty. I’m spending way too much energy reducing unease and the important tasks and things like that, some of them are not getting done.” The problem that they face though, is that unease tends to hook our attention. And let me give a simple example, I mean, this is a simple example, but I think it captures it. Let’s say there’s a board on the ground. It’s 50 feet long. It’s about two feet wide. It’s nice and thick and your task is walk from one end of the board to the other.
Dr. Andy Roark:
Okay.
Dr. Joe Arpaia:
That’s a very easy task. Now I’m going to take that exact same board, two feet wide, 50 feet long, eight inches thick. It’s a real solid board. I’m going to put it up between two skyscrapers. It’s the same task. It’s a two foot wide board. That’s a very easy task for every average adult. The problem is is when it’s between two skyscrapers, we have this extreme aversion to being in that situation. We might fall. And our attention gets hooked by unease. We look down.
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
And when you look down your body changes. That activation goes up through the roof, your heart’s pounding, and when your activation’s that high, it actually can impair your balance. So now you feel wobbly, you feel lightheaded, and now it’s actually a high difficulty task.
Dr. Andy Roark:
Yeah. I worked commercial construction back in between, right in between high school and college. And I really liked it, but we were building this industrial building and so we did the footers and the concrete work and then scaffolding. And so we’d put up the scaffolding. And I remember being up on the second story of this building and they just had the big steel girders and these guys I worked with would just walk along these girders. And I had myself all looped in and roped in and everything. And I distinctly remember saying to one of those guys, “How do you do this?” And he says, “You just do it.” And I said, “Don’t you worry about falling off of this thing?” And he said, “Look at this beam. I don’t fall off it when it’s on the ground.” And that’s what he said to me. And so when you’re saying this, it’s the exact analogy of the board, because you’re right, this beam is 12 inches wide, it’s a big surface.
Dr. Joe Arpaia:
Right.
Dr. Andy Roark:
To me I can’t get over the, the fact that this is two stories in the air.
Dr. Joe Arpaia:
Right.
Dr. Andy Roark:
But he was like, “I’ve seen you walk on these things on the ground and it’s not a problem.” I think that that’s a great analogy of how our mind makes a situation very different.
Dr. Joe Arpaia:
Yes, yes. And so we have to respect that physiology. That physiology that grabs our attention and draws it in causes us, we may intellectually know, “Oh yes, it’s fine. I mean, I can walk on this,” or, “I should really go home. My kids need me,” but our attention is grabbed by the unease. And there’s actually a physiologic trick to help us unhook.
Dr. Andy Roark:
Okay.
Dr. Joe Arpaia:
And in fact, in the law enforcement work I do, we call this a reset. And I actually learned it in my martial arts training because my instructor, we’d meet over his house and we’d go into the backyard, and we generally worked out at night, so we’d go in the backyard or go over to a park. And then it was heavy contact, no glove sparring. And you’d get very uneasy because you’re going to get-
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
Beat up.
Dr. Andy Roark:
Yeah. Just to restate, you would go to someone’s house at night and fight them in the backyard. And that caused you unease. I get that.
Dr. Joe Arpaia:
Right.
Dr. Andy Roark:
I get that.
Dr. Joe Arpaia:
Especially because he was very, very skilled.
Dr. Andy Roark:
Yeah, he’s a martial arts instructor. That makes it worse.
Dr. Joe Arpaia:
And so what we learned to do is first of all, people do this, they actually do it intuitively, they sigh, they do a long exhale. When we’re tense and we want to, there’s this physiologic release, we’ll do it. We take a breath in, we sigh, and there’s actually research on this. It tends to activate the vagal system. And when someone does it, you often see a bit of a drop in their heart rate for a couple of seconds and we would do this breathing and then we’d ground. Instead of when feeling stressed, you’re feeling uneasy, you feel like a soap bubble. You’re up, your shoulders come up, you feel like you’re up in your head and you’re not really grounded or not connected to the earth. And so we would just make sure our attention was grounded. It’s like, where are you supported? You’re not floating. You’re on your feet or you’re sitting down and you’re seated on the chair. The earth has got you. So you have this long exhale and you ground.
Dr. Joe Arpaia:
And what it does is it helps your attention unhook from what’s grabbing it. So you have this couple of seconds to unhook from the unease and focus on the difficulty. “Wait, what is really going? What’s really important here? And what are the resources I have to deal with this?” Instead of, “I just have to handle this perfectly.” And you reset and then you reorient or refocus and then you choose a response.
Dr. Joe Arpaia:
And what’s nice about the reset is you can do it every few seconds if you have to. I mean, there are times when I’ve got a patient on my mind, someone who’s not doing well, someone I’m worried about, are they going to try to kill themselves? And I’m at home and trying to interact with my family, and my attention, I’ll feel it it’ll go. And I’ll just reset. No, back to the family.
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
I’ve done what I can. The person said they’ve contracted to call me. They said they would be at the next appointment. I can’t do anything more. That’s good enough. Those are my limitations. Back to the family. And then 30 seconds later, I might reset back to the family. Long exhale, ground. “Where am I? What’s going, okay, I’m here. This is where I need to be. This is where my attention is going to be.”
Dr. Joe Arpaia:
And what’s nice is after a few resets, generally my mind says, Okay, okay, okay. I get it. Spend time with family.”
Dr. Andy Roark:
Does it get easier over time? I mean, I go through those processes as well of trying to set these things down and reset. Can this become a learned habit of making it easier to sort of set this unease down? Or is it always a struggle?
Dr. Joe Arpaia:
Well, it seems to be, first of all, my patients tell me that when they’ve practiced, they get better. And so the first step, again, being able to separate difficulty, unease, and really get skill at that, be able to, “No, no, no, wait a minute. I’m just getting caught up in. What feels good? What feels important? What are my priorities? What are my values? What’s going on in the big picture? Okay.” So their mind gets better at doing that. And at first it’s interesting. I’ll ask people, “Okay, is that difficulty or is that unease?” And they’ll go, “Well, that’s difficulty.” And like, “Wait, it’s really more about how you feel, isn’t it?”
Dr. Andy Roark:
Yeah.
Dr. Joe Arpaia:
“Oh. Oh. Okay.” So that’s a mental skill. And that has to become more and more reflexive. If we have to sit down and do a cognitive exercise on a piece of paper, it’s not a reflex. So we have to make the ability to distinguish difficulty and unease more automatic. The reset has to become automatic too. It’s like balancing. If you’re on a bicycle at first you get off balance and you reset, you rebalance. And you don’t notice you’re getting off balance until you’re pretty far off balance and then you have to work really hard to get back over your balance point and sometimes you over correct and go to the other way and then you’re wobbling.
Dr. Joe Arpaia:
When you’re skilled on a bicycle, your brain notices that you’re getting off balance without you even knowing it’s doing that. Your brain says, “I’m getting off balance,” and it re-corrects. So you’re never balanced perfectly over your two tires when you’re riding, you’re always wobbling, but your brain’s gotten so skilled at noticing when it’s off and re-correcting that it looks like you’re just perfectly balanced on the bicycle.
Dr. Joe Arpaia:
So this reset, you have to start getting a sense of, “Okay, what’s my attention on? Oh, I’m getting pulled in.” You do a reset, and the reset, it’s very unobtrusive. It doesn’t have to be this long. It’s just, “Hmm. Okay.” It’s this sense of the exhales a bit longer. I’m grounded. There’s actually a sense of space around me. The world’s not crowding in, client’s not right in my face, the situation I’m dealing with is not right crowding. It’s like, “Oh, I got some space around me and I’ve probably got some time too.” And so make a habit of balancing and resetting, resetting, resetting.
Dr. Joe Arpaia:
There’s actually, we have this heart rate tracing. So the law enforcement work I do, we train first responders, medical first responders, law enforcement first responders, to avoid making mistakes under pressure. And one of the things we teach, the central thing we teach them, we call it reset, refocus, respond. And what’s interesting, I was demoing this and one of the police officers, he was our use of force instructor. And he was pretending to be a psychotic patient and having a psychotic break. And I was going to walk up to him and try to help and then he was going to attack me. And I’m wearing a heart rate monitor, and we can see my heart rate on the screen as I’m walking toward him. And my pulse is starting to go up, it’s shooting up over a 100 because I know it’s going down.
Dr. Joe Arpaia:
And all of a sudden you can see it drops. It drops by 20, 30, beats per minute. And the graph is beat to beat heart rate. So the heart rate’s going up beat by beat up over a 100, 110, 120, and then it suddenly drops, four or five heartbeats it’s dropped, and then it comes up again and then it drops, and then it comes up again and then it drops. and I’m walking toward him and engaging and I’m doing this reset without even knowing I’m doing it. I’m just resetting as I’m walking into the scene. And then he attacks me and my heart rate shoots up to 160, and then we disengage, and then it comes down. And that’s something we see in some of this research we’re doing, they don’t get relaxed, their heart rate doesn’t go from 120 and then go down to 80 or 70 and just stay there, because you need to be activated. You need to have this activation so you can draw energy. You’re awake, you’re alert, you’re tracking things. But you’re also modulating that activation so that you’re able to keep track of what’s important, not to just focused on what’s making you uneasy and then misperceive things and see things that are a threat when they’re not really a threat.
Dr. Joe Arpaia:
I mean, in law enforcement, that’s obvious why you don’t want to do that. But in vet meds too, the client comes in, and they’re uneasy, because maybe they’re nervous about their animal. Maybe they’re nervous about how much it’s going to cost. Maybe they’re nervous because they’re taking time off from work or they have to get to daycare. There’s all sorts of reasons why they could be uneasy. And if we go in and we think they’re uneasy because they’re upset with us, now we’ve misperseen the situation. Now, instead of going, “Whoa, wait a minute, let me check. What’s the client really nervous about or really uneasy about? Or are they that uneasy at all? Maybe they’re just rushed, or maybe they’re tired.”
Dr. Joe Arpaia:
So that ability to reset and then start checking things out. What’s really going on? What’s the real difficulty? Not just, “Oh, I’m nervous about this,” and my brain starts creating a mirage that I then believe and get all involved in and go wrong with not so good results.
Dr. Andy Roark:
That’s really helpful. I think this has been fantastic. I think we’ll leave it here. Let me just ask you, Dr. Joe Arpaia, where can people read your work? Where can they learn more?
Dr. Joe Arpaia:
Well, I have a very disorganized blog at fullcapacityliving.com and I’ve got some people helping me create a more organized site at ibernetics.com, and it’s I-B-E-R-N-E-T-I-C-S, ibernetics. And that’s actually a play on cybernetics. So cybernetics is the communication and control protocols in machines and ibernetics is the communication and control protocols within ourselves. So it’s just a nerdy.
Dr. Andy Roark:
I love it. Awesome. Well, thank you so much. Thanks for being here.
Dr. Joe Arpaia:
Oh, you’re very welcome. Thank you. And keep up your work. It’s really great. And I was looking at some of your other podcasts before this and the stuff you’re doing is so good and so important. Thank you.
Dr. Andy Roark:
Thanks a lot. I really appreciate it.
Dr. Andy Roark:
And that is our episode. That’s what we got for you. I hope you guys enjoy it. I hope you got something out of it. As always the nicest thing you can do is if you did get something out of it, leave us an honest review on iTunes or wherever you get your podcast. It really does mean a lot. We really do appreciate it. Guys, take care of yourselves, be well, talk to you next week. Bye.
