Ep 19: Grief & Executive Function: How to Rebuild Your Life After Loss

On this episode, I’m taking a look at how grief and emotional trauma impact our Executive Functioning. Grief and emotional trauma are really hard to talk about. Even though grief and emotional trauma are part of being human, they're both really hard to talk about as we all have experienced or will experience some form of each within our lives. However, not only is everyone’s reaction to grief different, but everyone’s reaction to other people’s grief is different, too. I thought that maybe by learning more about it, we can find it a little easier to talk about. Most of all, hopefully finding some answers to why we react the ways we do when we experience loss can help us discover strategies that work to orient ourselves to this new normal. After all, things won’t be the same after loss, so how can we navigate that?

I reached out to Dr. Lisa Shulman who is a neurologist and a professor of Neurology at University of Maryland in Baltimore. Lisa is also a published author and wrote a book called Before and After Loss: A Neurologist's Perspective on Loss, Grief, and Our Brain. Her focus on the brain’s reaction to grief and, as you’ll hear her explain, emotional trauma, was exactly what I needed to answer the many questions I had. Lisa’s personal experience with grief and her professional experience led her to research the topic. Her extensive knowledge of the brain helped me understand it all so much more and her calming presence somehow made it easier to talk about. I hope you enjoy and learn from this conversation as much as I did and that this episode helps you in your life before or after you experience loss.

Show Notes

Learn more about Dr. Lisa Shulman

Read Lisa’s book Before and After Loss: A Neurologist's Perspective on Loss, Grief, and our Brain

Learn More about Jody LaVoie

Watch Hannah’s conversation with Jody on our YouTube Channel

Resources on Grief, Loss, and Emotions

Grief Board of Directors Template by Jody LaVoie

How to Feel Your Feelings by @emilyonlife (on Instagram)

Contact us!

Reach out to us at podcast@beyondbooksmart.com

IG/FB/TikTok @beyondbooksmartcoaching

Transcript from Hannah's Conversation with Jody LaVoie (continue scrolling to find the transcript of Hannah's conversation with Dr. Lisa Shulman)

Hannah Choi 00:00

So hi, Jody, thank you so much for joining me on my podcast today.

Jody LaVoie 00:27

Hi Hannah, thanks for having me. I love talking about this with you.

Hannah Choi 00:31

Great. So I spoke with Dr. Lisa Shulman earlier in the at the end of last year, and she and I had a great conversation about grief and emotional trauma and how that impacts executive functioning. And I wanted to talk with you because I know that you work with widows who are getting back to...Or maybe you can explain it to me, why don't you explain to me who you work with and how you support them?

Jody LaVoie 01:04

Yes, no, absolutely. So I am a grief and loss expert. I'm also a widow, myself. I'm a mom, and I've run a business. And I help widows learn to fall in love with their life again. And you brought up an excellent point, Hannah about when when would somebody kind of start being able to feel like they're ready to figure out how to fall in their love with their life again, and it's generally when kind of that overwhelm of grief happens, and you're just trying to check off tasks. And you wake up one day, and you're like, you know, there's got to be more I'm doing it. I'm doing the day to day stuff I'm functioning, but I'm just functioning, how can I find more?

Hannah Choi 01:54

So at what point would someone reach out for someone, for some support with someone like you?

Jody LaVoie 02:28

You know, Hannah, it's different for everyone. And I'll give a couple of examples. So when someone receives a terminal diagnosis for their spouse, they start grieving right away, even though they're hopeful. And they're working hard with experimental treatments to, you know, try to not have this person pass away, their grief starts then. So they could come work with me, you know, right. When their spouse dies, I worked with a client even before her spouse had passed away, because she had started grieving a year and a half prior. So for other widows that lose their spouse, suddenly, that's they're in shock. And it takes a little bit of time for them to get to that place of okay, I'm functioning. But I know there's gotta be more.

Hannah Choi 03:22

Yeah. And after talking with, with Lisa Schulman and learning about how, how loss and emotional trauma impacts our executive functioning, it, it completely makes sense that someone would have might have to wait and not be able to just start to tackle life again, when it has been what has been traumatic and sudden, imagine it. Yes. Do you have to wait? So what are some, what do you recommend to your to the people that you work with? What are some strategies that people can try?

Jody LaVoie 04:00

You know, and I know we're keeping to executive functioning strategies, which is so important, because obviously, we all need to be able to function our day to day lives and thrive in our day to day lives. And how can we do that better? So the really, the first and foremost thing that we work on is our thoughts, and working on where those thoughts come from. And that doesn't mean that we're ignoring grief. We're pushing the pain away. We're not feeling it just means our thoughts trigger our behaviors, which trigger emotions and it's this endless cycle. And so if you can, there's a couple strategies with your thoughts. One, one, that thought happens if you can pause, just take a breath and actually try to think about, okay, what is this thought really, and where is it coming from and what, what is my action that I'm taking guessing, based on this thought, and what should I be doing differently? So that's one way to do it. And the second thing, there's a series of four questions that I love, there is a coach, an author named Byron Katie, and she helps people really with self-inquiry. And she believes that if you ask yourself these four questions, it, it really promotes thinking and changing. And the first one is ask yourself, if that thought is really true. Is it really true? Second, Can you absolutely know, it's true? Is the second question. Third question. How do you react? And what happens when you believe that thought? And fourth question is, who would you be with out that thought, and that's really releasing and breathing. And, and you as, as the widow and as any person, or now take, taking control of your thought process. And that takes a while. And it takes practice. But just that act of recognizing, so important?

Hannah Choi 06:12

Yeah, I love that. I remember, one strategy that I learned for grief, that that that I that really helped me was to recognize that you're feeling it and then label the feelings that you're having or label what is happening. Instead of instead of just feeling it also just sort of identify what you're going through, and then and let it happen. And then acknowledge that it happened and sounds like a similar process.

Jody LaVoie 06:47

Very, very much so and it is so important to label your feelings, feel your feelings. But it's also important to put some parameters around that too, if you are able, I mean, not everybody is able. Everybody is in a different stage. But if you are in the process of okay, feeling sad, it is okay to acknowledge that I'm feeling sad, and I'm missing my person. But I'm going to sit in it for five minutes, 10 minutes, and then I'm going to get off the couch or out of my bed and go do something to move to a different place. So that's, that's, that's helpful as well.

Hannah Choi 07:28

Yeah. And setting parameters. And that, that requires a lot of a lot of perseverance and, and discipline, but but also, then, I imagine opens up a lot of opportunities for you once you're able to set those parameters.

Jody LaVoie 07:45

Absolutely. Yeah.

Hannah Choi 07:47

What's something else that you recommend for your?

Jody LaVoie 07:51

Well as a widow, and I know with Dr. Shulman, you talked a lot about that early stage grief, it's hard to just get stuff done. And all of a sudden, you've have an overwhelming amount of tasks that were just dumped on your plate, not only going through, you know all the paperwork and all of the different things that one must do after you lose a spouse, but that spouse helped around the house help do the errands, help take care of the kids, you now are doing that all on your own. So pick one thing and create a SMART goal around it. Because it's one thing to say, Okay, I am going to get to the gym five days this week. Great. Did you put it on the calendar? Do you know exactly what you're going to do with your what is your outcome you want to have until you actually take action? And put it on your calendar? Like we're not going to happen?

Hannah Choi 08:48

Yeah, yeah, we love those smart goals at Beyond BookSmart. And we use, we use them a lot. And I know that they really help make those goals more meaningful. So it makes sense that that that would be a really useful, useful strategy to use. Yeah. That's great. Glad to hear you use those as well.

Jody LaVoie 09:07

Absolutely.

Hannah Choi 09:08

Yeah. Do you have any other tips?

Jody LaVoie 09:12

You know, I do. And I love this one. And this helped me a lot. It's creating, I call it your Widow Board of Directors. And I was running a business. So therefore this board of directors concept really, really resonates with me, but these are your people that have your back. These are your people that are going to help you. This is your best friend who's going to run cover for you. If you're if you're like going out today's not a great day. And I need help getting my kids to soccer. You can reach out to this one person and have them get it done. You can have another person that's helping you with your business decisions or your career decisions or just work decisions in general because I As a grieving person, we're not firing on all cylinders, we've got a lot in our brain, and that can cause distractions. But yet, we still want to exceed at our jobs, we still want to get those things done, but have your person that you can call on to help with with that. So designate people to be active in various aspects of your life and, and tell them, here's what I need from you, I need you to check in on me weekly, or I NEED you, but be specific about their role, and the action they need to take.

Hannah Choi 10:36

And I imagine that can be a difficult thing for people to do. I know, I know, a lot of the clients that I work with, and just people that I've talked to in my life have do have a hard time asking for help. And that's a time when you really need to be able to do that. Do you have any ideas for people who struggle asking for help?

Jody LaVoie 10:54

You know, I think it's about giving yourself permission. So many of us are perfectionist out there. And you know, prior to losing our spouses, we can keep it all together, and then it all falls apart. And then one can feel embarrassed, shame. Why can't I do all of this? No, no, no, no, no, I'm giving you permission to not be perfect. And to ask for help you need it. And people want to genuinely help you and do things for you.

Hannah Choi 11:29

Yeah, I love that. And but without asking, they might be afraid. They might not know how to help. So if you're able to ask, then you're gonna, then they're gonna be so happy to help.

Jody LaVoie 11:39

It's so true. And I coach people that are trying to support grieving people. Just that, be specific, in your ask, because it's a people come to Grievers and say, How can I help and, you know, I, the needs are vast. But to be very specific of, I'd like to bring you dinner this week is Wednesday, or Thursday better. But just be specific, it's helpful.

Hannah Choi 12:06

And I love that. That's great. What else you got?

Jody LaVoie 12:11

You know, it's very easy to forget about yourself, especially as women, we take care of everyone else first. And when we're grieving, our kids are grieving. The other people, relatives, family members are grieving. It's okay to take care of yourself. And you need to because you can't support other people, if you're not putting your oxygen mask on first. And so step one with that is just move your body, whatever that looks like for you. If you can get outside and take a walk, great. Even if you live someplace cold bundle up, just seeing sunlight and breathing in fresh air. So important starts about five minutes, just walk around the block.

Hannah Choi 13:03

I love that. That's great.

Jody LaVoie 13:07

Yeah, and one more thing that I do, Hannah. And I know Dr. Shulman talked about this a lot about journaling. And the importance of journaling, which I do what I've also tied into my journaling, gratitude. And so every day, when I get up, my very first thing after I brush my teeth is I, I journal for the day. And I probably spend 5 - 10 minutes, really just writing my thoughts. But at the end of that day's entry, I do two things. One, I write something that I'm really proud of that I did the day before, because celebrating your wins, even the small wins, yeah, are so important. It's so easy. And our brains automatically go to the negative. And there's data that that shows this, Hannah, we have about 60,000 thoughts a day. 80% of them are negative eight, zero. That's crazy. So celebrating a win is important. And then the other thing I put on my journal are three things that I'm grateful for, and getting yourself back to gratitude. Especially when you're you're sad, and you're grieving and you're, you have all of this emotion, but to focus on what is good. And it really helps your brain move to a different space.

Hannah Choi 14:35

I do the same thing, although I don't do what I'm proud of. And I love that I think we're gonna add that into my journaling. But I do gratitude and I actually just finished up I do it in a line a day journal, one of those like small just has a small entry for every day. And I just finished my fifth year of doing it. Thanks. And I was looking back over I was just reading out loud, my sister and brother in law were over recently and I was reading through it just to see what, you know, what I've been thankful for over the years. And during the pandemic, I noticed that I was many, many days, I was just thankful for sunshine. And, and, and I just looking back on that, I think wow, like, even in those dark days of so challenging for everybody, I was still forced myself to find something that I was thankful for. And some days it was just sunshine. But it's, it's it is possible to find something to be grateful for every day. So true.

Jody LaVoie 15:35

And I live in gloomy Chicago, and it's winter and the sun is out today. And yeah, just like brought a smile to my face. And that is certainly picked up my spirits.

Hannah Choi 15:48

Yeah, good. Great. Do you have anything else you'd like to add before we finish?

Jody LaVoie 15:52

You know, those are going to be my top five. I don't want to give people too many to, you know, chunk off. So if you can tackle those five listeners out there, you will be well on your way to success.

Hannah Choi 16:05

Yeah, that's great. And where can people find you if they're interested in learning more?

Jody LaVoie 16:10

Yeah, so I am very active on LinkedIn, under my business Widows in the Workplace. I have an Instagram Widows in the Workplace. And I certainly have a website widows in the workplace.com.

Hannah Choi 16:26

That's great. I love it. All right. Well, thank you so much, Jodi, it's been really interesting talking with you and I really appreciate everything you shared.

Jody LaVoie 16:35

Thanks, Hannah. I've I've enjoyed our time together as well.

Transcript of Hannah's conversation with Dr. Lisa Shulman

Hannah Choi 00:04

Hi everyone and welcome to Focus Forward, an executive function Podcast where we explore the challenges and celebrate the wins you'll experience as you change your life by working on improving your executive function skills. I'm your host, Hannah Choi.

Hannah Choi 00:19

Today I'm taking a look at how grief and emotional trauma impact our executive functioning. I really struggled to write the intro for this episode, I kept finding myself putting it off. And if you've listened to my procrastination episode, you'll know that the same thing happened with that one. So I did some reflection to figure out why. And I realized it's because of the same reason. I'm afraid I won't get it right. Grief and emotional trauma are really hard to talk about. And even though they're part of being human, we have all experienced or will experience some form of it in our lives. And everyone experiences it differently. Everyone's reaction to grief is different. Everyone's reaction to other people's grief is different. It's a big part of these beautiful and difficult lives we're living, and yet it is still so hard to talk about. I thought that maybe by learning more about it, we can find it a little easier to talk about, and maybe finding answers to why we react the ways we do when we experience loss can help us discover strategies that work to orient ourselves to this new normal. Things won't be the same after loss. So how can we navigate that?

Hannah Choi 01:37

I reached out to Dr. Lisa Schulman who is a neurologist and a Professor of Neurology at University of Maryland in Baltimore. Lisa is also a published author and wrote a book called before and after loss, a neurologist perspective on loss, grief and our brain. Her focus on the brain's reaction to grief, and as you'll hear her explain, emotional trauma was exactly what I needed to answer the many questions I had. Lisa's personal experience with grief and her professional experience led her to research the topic, her extensive knowledge of the brain helped me understand it all so much more. And her calming presence somehow made it easier to talk about. I hope you enjoy and learn from this conversation as much as I did, and that this episode helps you in your life before or after you experience loss. When you're done listening, please check out the show notes for more resources, including a link to Dr. Shulman's book, which I highly recommend reading and a conversation I had with Jody LaVoie, a grief coach who supports widows who are returning to work after loss. Okay, let's dive in and learn about grief, emotional trauma and the brain.

Hannah Choi 02:56

Hi, Lisa, thank you for joining me, could you introduce yourself to our listeners for anyone who doesn't know who you are?

Dr. Lisa Shulman 03:02

Yeah, it's a pleasure to be here, Hannah, thank you for inviting me. I'm a neurologist and author. I'm a Professor of Neurology at the University of Maryland School of Medicine. And I got involved in the area of emotional trauma, traumatic loss and grief through my own personal experiences. And it really has ended up being something very important to me, close to my heart. And I really looking forward to discussing it with you today.

Hannah Choi 03:42

Are you comfortable sharing your personal experience and telling your story about how you got to where you are today?

Dr. Lisa Shulman 03:50

Yeah, certainly. You know, I, I mean, I really, I think the place to start is that, you know, I I'm a sub specialist in neurology, I'm what's known as a movement disorder specialist. And most of the patients that I see have Parkinson's disease or Parkinson's related disorders, various forms of what we call neuro degenerative disorders. And I've been doing this for about 30 years now. And so, you know, I have followed many, many, many people through serious illness, you know, to points where they are quite disabled and of life. And, you know, and for those reasons, you know, I thought to myself when I confronted serious illness in my life when my husband was diagnosed with cancer, I thought that I was more prepared than the average person as somebody who counseled others going through hard times. I should vivid, my husband Bill is a neurologist too, and we work closely together. And I think that in over the experience of his illness and his decline and ultimately, his death, you know, I was taken aback or unprepared for the fact that I, you know, like so many things in life that you don't know really know what it is until you're in somebody's shoes. And, and the fact of the matter was that when he was seemingly suddenly gone, I was ill prepared, and was had a really tough time of it. As for a while I floundered, you know, because I hadn't expected to feel the way I felt all of the new precautions. And at some point, many months, many months later, well, actually, I started spontaneously to write a journal and just to get my feelings on a paper piece of paper, although I'd never done anything like that before. And then many months later, I made the connection, which wasn't as obvious as it seems to me now, between my own experience, and a personal experience I was having of loss, and my professional world, of understanding how the brain works, and the brain responds. Which really, you know, it's like one of these things where you think afterwards, you know, I, you know, because I, in my, I'm a researcher, I not only see patients, but I do research, and I write, manuscripts, and a lot of the papers I've published are about the behavioral responses, adjustment, quality of life, managing difficulty in one's life. And yeah, it took me months to, you know, Link, obvious similarities between what I was going through in my professional life. And that ultimately led me to quite a bit of research into brain function, about how the brain responds to emotional trauma and loss. And ultimately, I began to find that is a path forward for me. And then I wrote the book based on that information.

Hannah Choi 07:46

Yeah, I really, I really, really, really enjoyed your book, I, I be what you said just a little bit ago about you feeling like you were prepared. My personal interest in learning about grief and, and emotional trauma, and the impact on the brain comes from experience that I had in my family, and with some friends, I had a period of five years in a row, where we had some pretty traumatic and unexpected losses. And, and I now looking back on it, I feel like when that happens, again, because it is a part of life, I want to be more prepared. And that is my that's, that's kind of like the motivator for me. And but it's interesting what you said, like you don't, when it's yourself, and it's you feeling it, it's, I imagine it is harder to make that connection and realize, like, oh, wait a second.

Dr. Lisa Shulman 08:50

Like one of the one of the things that I often start off with when I'm giving a talk on this topic, is how Psychiatry and Neurology are the same thing. And even though as a neurologist, I will understand the brain function that governs our behavior, our mental health, our personality. But when even even though I understand that, I can't wrap my arms around it to be honest, it's like something I have to sort of intellectualize because you the texture of our lives, our experiences are so rich, and so compelling, that to think that this is related to neurotransmitters and neurons, nerve cells, you know, it boggles the mind. Yeah, even for a neurologist who studies it.

Hannah Choi 09:55

Yeah, and I am, I am far from that and but the little that I do know about the brain, it both helps to understand, okay, this is my brain, but then the same time, like what? It doesn't feel like it's just my brain? Yeah. So when we first when we first communicated, we and you mentioned it a little bit, just just a bit ago, I had asked to talk with you about grief and the connection between the brain and executive function skills. And you suggested that we also include emotional trauma. And I was just wondering if you could explain that in diseases? Are they different from each other? Are they the same? Does the brain react differently?

Dr. Lisa Shulman 10:45

Yeah, you know, I'm gonna challenge you even in the way you asked that question us, from the conventional physician, that grief has this special position and emotional trauma is different, and that I'm trying to push them together. But I would push back and say that, that is a notion about grief, having a unique position in the spectrum of emotional trauma, but that the more you understand about the way the brain behaves, what parts of the brain respond to serious traumatic loss of all types. The more you see that grief is just in the spectrum of emotional trauma, right. And that, you know, we have one of the most intriguing parts and these things will be eternally intriguing to me, is that how different we all are, in terms of the impact of different events in our lives, and you cannot pinpoint or a map, you can't predict what for one person will be emotionally traumatic, and what will not. We certainly all know people who have had significant, say, losses of loved ones in their life, but they don't go through a terrible period, not everybody does. And by the same token, we see people who suffer other losses in their life, it may be a loss of a job, it could be a breakup with some relationship, it could be the loss of a pet, it could be a, you know, a physical assault, you could go on and on. Certainly COVID, the pandemic has been a source of trauma, emotional trauma and loss in our lives. So you can't pinpoint it. And so I would just say that for every individual, imagine a spectrum or range where you have a unique range of for you what is most would be the greatest and most of your causes of emotional trauma. And that is, I think, the, for me, it's the most appropriate and accurate way to think about it. You know, I think the most important thing is to think of this is a very important point I'd like to leave with your listeners, which is that the brain is agnostic to the type of trauma, the isn't there isn't any unique area of the brain to respond to one of those forms of emotional trauma that I mentioned or another. You know, it might be that you're planning on going to graduate school, and you really, like totally crash when you're taking a test, you need it to ace and that for you is you walk out in a state of utter shock, how it's going to affect your life that you know for you is triggering the same responses as the person in fact, who might find themselves sadly, losing a loved one, it's just a matter of severity for each individual. So it's not the cause it's not the triggering event or the type of event. It's the individual personal meaning of the event that ends up triggering the same cascade of responses.

Hannah Choi 14:39

And, and that the actual response within the brain. It's like not necess not necessarily there, like how it looks, how it looks externally but what's going on inside of their brain. Is that right?

Dr. Lisa Shulman 14:52

Right. Right. Exactly. So you know all the consequences, the symptoms, the consequences, this equality It all would be the same based on the severity of the loss.

Hannah Choi 15:05

Yeah, you know, I was I lost my dog about four years ago. And, and that hit me harder way harder than I ever thought it would. And I found myself sometimes thinking, Oh, this is horrible, just like judging myself, like, you shouldn't, you know, she was just a dog. You know, it's but, but what you're seeing now is making me feel a lot better. I mean, and I caught myself when I said that I, you know, I said, No, she wasn't the, because if experience for me if that loss was so great, so it must have been more than she was just a dog. So it's good to hear that, that, that,

Dr. Lisa Shulman 15:47

You know, I would I thought a lot and done, you know, reading about why certain things are so personally, individually emotionally traumatic, and that one cannot predict that necessarily, you know, I, I believe that there is it relates to the topic of identity and the story that we have constructed for ourselves about our lives about where we fit in the world. What makes sense to us, the infrastructure of how we get up every day interact with people do our jobs are potentially a partner or parent, all the roles we take, we have a conception, the conceptual framework, and that is related to our identity. And when some piece of that is lost, or injured or at risk, that is jumping to the idea of brain function here perceived by the brain, as an actual assault on or threat to our survival. And this is another very key concept here. And it's a matter of it may sound jarring, and I think the first time I saw that, in the literature, I I thought, wow, you know, could that possibly be? But you have to think of this from an evolutionary standpoint. And from an evolutionary standpoint, I mean, this is how our brain ended up being wired, based on evolution. And our and our brains are all incredibly similar to each other, actually, we think of ourselves as individuals, but who we have the same hardwiring. So the fact is that over evolution, we all know that we were being changed by what would allow enable us to survive. And those who were poorly prepared and unable to move to vulnerable would not have survived with evolutionarily. So we the most hardwired, the most high priority, from the perspective of your brain, not your mind your brand, yes, is keeping us alive, keeping us functional, right. And that is what ends up ruling the day in terms of this of the brain to be triggered by some loss. If it's perceived as something that could be a threat to our function to our survival, then, you know, potentially even all hell could break loose as the brain kicks in with all sorts of reflexes to help us go through bad times.

Hannah Choi 19:17

Yeah, that's so interesting. So, I was just thinking, Oh, maybe I come from a long line of the first people who domesticated dogs. That's why I felt it so strongly. So how, how, how does the brain react to emotional trauma. What's going on in there? And, and then I don't know if you can bring anything in about executive function since that's my particular interest. But I mean, executive functioning affects all areas of our lives. So it's kind of in just naturally part of that I'm, I'm sure.

19:59

Yeah, well, I can certainly bring that in. So I think that when we think about how the brain reacts to emotional trauma, it's helpful to organize it from the standpoint of acute responses and chronic responses. And how acute our responses are the immediate short term responses to things in our lives in our environment to triggers. And the there are chronic effects of these acute accumulation of acute responses over and over. You know, from the standpoint of the acute responses, it's easy, because everybody understands, I think, the basic concept of fight or flight. And, you know, if we are in the crosshairs of a bear, a gun, a car, you know, the same response again, you know, there isn't a different response for a bear or the car, it is the same response, which is a survival response of fight or flight. And it is a massive brain and systemic response. That immediately jolts our mind to be vigilant and alert, as alert as we possibly can be blocks out anything extraneous, gets our heart, our lungs, our muscles, prepared to run, to fight to breathe hard, and so forth, we are totally focused on you know, somehow surviving. So that is the acute response. And the fact is that after, we want to talk about grief itself, after the loss of a loved one, our world is filled with daily triggers, that each time we are exposed to these things, sometimes it's somewhat anticipated, but sometimes it is absolutely not. We find ourselves going through that over and over and over. Now, the chronic effects of it are very interesting because it's related to something called neuroplasticity, which is not as complicated as it may sound. Because neuroplasticity is simply that the brain is continually rewiring itself, based on our experiences. You know, right at this moment, we've met each other, we're chatting together, we're going to remember this, and our brain is establishing new, great connections for us to go back to in the future. And that's neuroplasticity. So, but the neuroplastic changes that occur, based on what I just talked about the continual or petitive triggering of the alarm of trouble for the fight or flight mechanism results in the part of the brain that colloquially is called the fear center, but from a neurologic standpoint is called the amygdala, which is part of the limbic system. So the fear center is constantly being strengthened while the cortical functions which are like all of our thinking, our memory, our executive functions, our judgment, all that is being weakened. And it's very important because actually, there are scientific many, many studies, this is not speculation, it shows that the brain pathways that connect the fear center to the our intellect, are being weakened. Because the fear center is being strengthened, the effects of the judgment are being weakened, we can also see that the volume of the different parts of the brain are being altered, in that the fear center is being gets larger, literally. While the the parts of the brain we need to calm ourselves that down and why some compose ourselves are being getting smaller. And this also affects on the brain activity between the two, which is very unhealthy. Everything we do in life is some interaction between the emotional side of the brain which is very primitive, right, you know, and the cerebral cortex, which is our advanced friend, so you know, like, I don't know about you, but I'm not too crazy about roaches or spiders. You know, I like I can if I see a bad spider or roach, I could get triggered. I don't want you eat us Oh, but you know, but then like, you know, your seat of wisdom, like kicks in and goes, you know, I'm living alone now. And I don't have anybody to go. And then I just say, you know, I calm down if you're just gonna have to deal with this, because not gonna get into bed with a spider in my room, you know? So, you know, you can see that interplay between the fear center and the intellect. Yeah, it has to be a healthy balance, right. And unfortunately, based on the set of circumstances, I've described, it imbalance occurs, and you end up being, you know, like, this raw, primitive brain that's autonomously setting off the alarm. And then you know, and then what do we see amongst the people who are going through emotional trauma and or having difficulties? You know, we hear them describe feelings of anxiety, difficulty with their sleep. Flashbacks. And from your perspective, the issues of executive function are being weakened, because they're the the fear center, the primitive responses of fear are predominating.

Hannah Choi 26:35

Yeah, and I was I was, I remembered, in part of your book, you said that one of the strongest predictors for I'm not sure how to describe it, but for feeling, for lack of better words, feeling like, Okay, after emotional trauma is the idea of self-efficacy. And, and I imagine that feeling that cognitive self efficacy comes a lot from being able to access your executive function, and being able to use that that part of your brain.

27:15

Yeah, I think I'm really glad you brought that up. Because a lot of my love of my research and work has focused on self-efficacy for managing chronic illness. And, you know, in my own crazy journey, figuring out things at some point, it was another kind of like epiphany, where I went, Oh, wow, that's another? Why didn't I ever think about that, you know, this, that grief, or emotional trauma can be seen as a chronic condition? Yeah, a chronic condition, just like the chronic medical conditions I had, you know, been studying for a long time. And so from that standpoint, you're right, what we're seeking is to develop self efficacy to manage this condition, emotional trauma, traumatic loss or grief. And self-efficacy, that phrase may not be common, commonly known to some people, it simply means that you have a level of confidence, or belief in yourself that you can manage your situation. And importantly, I think of it as that you are developing a sense of control over your life. We all you know, we all seek in our daily life, a sense of control, when you don't when you're not feeling a sense of control. It's very distressing. Yeah, very.

Hannah Choi 28:48

So, so many of the clients and pretty much all of the clients I've ever worked with, and all of my colleagues to it comes up that that after after figuring out what strategies and tools work best for them to support the areas of executive function that challenge them, once they figure that out, and they're able to have some control over that area. They all say they feel more confident. And and that is that self efficacy right there.

Dr. Lisa Shulman 29:15

Right, you know, the, the kind of the pathway is that one needs to develop basic font of knowledge about your situation, and then develop skills of self management, which it sounds like you're counseling people about, and then by practicing those new skills, that every time you do it, that you start to have increasing confidence and increasing sense of control. So you sort of build on it until you reverse the cycle of feeling helpless.

Hannah Choi 29:58

So if you have an end unbalance in the fear center like the limbic system is kind of taking over and inhibiting the part of the brain that we're using for executive functions. What are some things that people can do to write that balance? And, and I'm sure, like right after this, that whatever traumatic incident happens, it's really difficult to get out of that. What are some things that people can can try?

30:24

You know, I think that that was one of the most encouraging parts of what I learned over time, because I realized that it certainly is calming and reassuring to understand the way in which the brain is responding and how it explains your experience that in and of itself is comforting to know that, you know, you're not as many people say, going crazy, that you're not having this, you know, breakdown, so to speak, but that this is a common, we're all in it together. We're all going through it together. And I think that's very reassuring. But the epiphany was when I realized that it leads to obvious interventions, I thought this is this is exciting. You know, it actually I want to start go back for a moment to what I referred to before about neuroplasticity. So what I was describing before, is a spiraling down into bad neuroplasticity, the brain has been rewired in this unhealthy Well, way. And the important part of understanding neuroplastic changes is that we can thoughtfully and deliberately rewire and create connections, brain connections, neuro connections, but those that are healthier to move the needle in reverse good neuroplasticity, you know, neurologists have a cool phrase that we use, that when things fire together, they wire together. I've heard that, yeah, great. And that is actually a great description of neuroplasticity. That, you know, it's nothing more complicated than practice makes perfect. You know, if you, if you sit down to learn a musical instrument, you can can't do a thing if you get on a bicycle for the first time. Forget it, you know, but, you know, you keep on doing it. And you know, Eureka, suddenly you're have a new skill, and oftentimes you never lose it. So what is that, it's things that fire together, wire together. And so we can use that understanding and knowledge to think about how what steps we can take to reverse the process, which is causing everything I said before the fear center to be this crazy alarm in our head. That is domineering our life over time for some of us. So what what can we do? Well, you know, actually, in my book, I just want to mention that, you know, I actually wrote my book with people, for people who are going through very difficult times, and I will never forget how disorganized my thoughts were, during that period of time. So I wrote in the book, what I called three steps, which were to organize a strategy because I felt that I needed it. I personally needed things, you know, spoon fed and so forth at the time. And so I thought, I don't want people to feel overwhelmed by what I'm saying here, and that they have to figure it out. So the three steps that I described in the book was the first one was, and I'll describe the three in a moment. The first one I called subconscious, conscious integration. And the second one is immersion and distraction. The third one is gradually opening the mind to new possibilities. So I'll briefly describe each. Subconscious conscious integration is one way to describe that what I described before that there has been a disconnect between the emotional parts of the brain and the cognitive parts of the brain. And from that standpoint, a lot of the disturbing emotions and memories from a time of trauma It ended up being suppressed in our subconscious. They're not accessible to us. Part of the reason they're not, the main reason they're not accessible to us is because it sets an alarm off every time we even go in that direction. Right? So but it's a big part, it is key to healing, to reconnect with that, because when you have a lot of disturbing stuff in your subconscious, this results in flashbacks, nightmares, or panic attacks. Well, that. So that's what that first step is, we'll talk come back and talk about how to accomplish it in a moment to is immersion and distraction. And what that refers to is that, you know, one can't do go through the angst of what some people might call grief work constantly, you have to be very aware that you need to give your mind and yourself and your brain space to chill out and have some enjoyable times. So that's what immersion and distraction means. Sometimes you're going to have to do the hard work of immersing immersing immersing immersing yourself in these difficult memories, which for me was when I was doing the journaling. But that I would plan in my day, also other times where I was going to distract myself from it. And the third ends up being after you've gone through those two steps I just mentioned, the third step is that of time will come when there's enough healing, well, you can begin to open yourself up to new possibilities, because, you know, life will not return to what it was before, after many serious losses. And so, you know, we do have to find a way to make a pivot and start to think of well, how are we going to build this new life, which, you know, take some time.

Hannah Choi 37:15

So, if someone has a set a sudden traumatic loss, and they haven't read your book, and they have and they, and they, you know, don't you know, know, these steps, or they don't know even where to start, where is a good place to start for people.

37:32

You know, in the book, I do have a chapter or more where I talk about the nuts and bolts of what you can do. And I think you know, it's really important to know that there isn't one shoe that fits everybody here, we are all very different. And we are looking for some vehicle that allows us to relax enough to get back in touch with disturbing thoughts and emotions, disturbing emotions and memories. Now, you know, for me, it was journaling and journaling. Writing is uniquely well suited to this. But there is mentioned in a moment, many other options. The reason why journaling and writing is uniquely suited is because you are, it's very personal. You can write in a more raw way, when you're writing, knowing nobody else will see this. Because in the end, I wrote a book and put it all in there. That wasn't what I was thinking when I was writing. So they never still doesn't make me comfortable. But you know, when you are writing that you're writing only for yourself and think about it. You can go to a counselor or therapist, you can speak to a dear friend, you can speak to an important clergyman in your church or synagogue or mosque you can you can do all those things. But in every one of those cases, you are sharing something deeply personal with others. And you know what? We all censor ourselves. Yeah, it's only natural and we not you know, who would lay it all out there for somebody to hear we are all censor ourselves. So when you write, you can write just for yourself. You can. It's very difficult to be honest with yourself that you can try your best to be honest with yourself that you can get it on paper, as imperfect as it is. And again, another unique part of writing is that you couldn't go back a week later a day You later a year later and read what you wrote, and annotated and continue to improve it, you know, I find that most people find you go back and read your own words and go, you know, I was, that's only part of the story. And because it teases out more Yeah. And then you can annotate now more. So that's why I think writing is really super. But there are many, many others, you know, there are so many creative outlook outlets. And I think we can think about those creative outlets that people have, whether it's music, or art, dance, all of these outlets are ways that people are expressing themselves and could find it. And it's a way it's kind of a portal into your deepest thoughts. So, all of that, and of course, faith based practices, meditation and other contemplative practices. It goes on and on. Another important source that we shouldn't overlook is getting out in the natural environment. You know, we tend to understate that, but we can all I think, relate to time how often you find yourself if you take a simple walk, or you know, you're you're seeing some beautiful mountains, you're sitting by a lake, you're at the beach, and how it how transforming it is to your thoughts. Yeah. And when you're going through a terrible time, after emotional trauma, that's a ripe moment for you to not only feel like you can exhale, but that you can relax enough to connect with thoughts that otherwise would be inaccessible. The hardest part really is looking in the mirror and understanding ourselves enough to know how to proceed. You know, I'd be the first one to tell you that when I was going through a terrible time, I was not resourceful. Again, getting back to executive function. Now. I was not resourceful. You know, it was like, years later, when I wrote the book, and people are then contacting me from different organizations and podcasts and web, web websites, and so forth. And I went, Oh, my God, there's like an endless array of resources. And I felt totally isolated. And you know, here I am a researcher, I have no difficulty looking things up. But at the time, it was not accessible to me. And I know that's true of others, because everyone has told me.

Hannah Choi 42:59

Yeah, yeah. I heard I heard, I listened to a podcast that you were on. With a woman who has a podcast about grief, and my working memory is my biggest executive function challenge. So I can't remember the name of it. But anyway, on that you were talking about how how the brain can actually make it so that you don't see objects that are maybe related to the to the person that you lost, or the trauma that you went through. And I thought that was so fascinating, and how that real fat right there for me really shows you that it is your brain. Your your brain. Oh, Dear Life, maybe? Sorry, just came to me, then. Yeah.

Dr. Lisa Shulman 43:50

Yeah, yeah, I think we should review some of the specific cognitive responses, or effects on cognition. And one of them is what you're talking about, you know, the, you can picture the we're talking before about how the brain is perceiving. This is a threat to our survival. So there are a vast number of protective reflexes and responses that are being activated. And we talked I talked already about many of the physical ones. But from a psychological or emotional standpoint, the brain is in an emotional, protective crouch all the time, which is going to serve to shield us from disturbing triggers disturbing things in our environment. And we have a whole host of psychological defense mechanisms that we all learn long ago, like dissociation, repression, denial and so forth, that are kicked into high gear. It's a subconscious reef. So we're not, we're not deciding we're going to behave that way we don't know that those reflexes are in, I've been kicked off. And this can, as you say, result in literal holes in your perspective or your your vision. And the one that you described to occurred in my life, which was that something as, obviously concrete, as my husband's cell phone, his iPhone, was sitting on our desk. And I mean, not just months, it could have been years, a long time went by, where I just didn't even know, I never saw it. Or I didn't. There was a proper word, I didn't allow myself to see it. You know, but someone actually, in the house, saw it and pointed it out. I had, like, I was shocking to me, it was shocking. I thought, My gosh, it's specific all along. And I chose to ignore it, such that it was a literal hole in my visual field. Yeah. That was just your how, how incredibly strong and powerful these things are, you know, somebody who originally described a dissociation dissociate, described dissociation is fundamental to emotional trauma. And so dissociation is a really important part of this. And my book goes into this in some depth. Resulting in that when you are confronting disturbing stressors in your environment, that your mind has this incredible protective response of just kind of turning off, or shielding you from recognizing what you saw just getting, you know, it might put you in a place for a few seconds or moments where you are, you're basically detached from your environment. Or it might be more mild than that. There can be these interruptions of awareness, it fragments, your memory, because you're having periods of the day where this is occurring, it's causing flashbacks, you can become increasingly emotionally numb, because you're not being open to everything that's really in your environment all the time. So it's a very big part of why many of us feel like something has changed fundamentally, after loss.

Hannah Choi 47:53

Yeah. It's, and and it's interesting that how you said it, it really just comes back to survival and protecting ourselves.

48:05

Right! I mean, it's a, it's actually we have to think about it as a very effective strategy that the brain is employing. In other words, if, when, when we have, if we have, you know, horribly, a terrible tragedy or catastrophe occur, we remain able to function and survive. Yeah, it would be possible that we were wired in such a way that we were not able to survive, that, you know, we that you could not function, you could not make a meal, you could not dress yourself, you could not you'd be in such a way, but he said no, the truth is, and I really want to get to this, which is that we're talking about executive function and cognition after trauma. And number one, you can remain extremely high functioning in the face of cognitive change, we are not talking about somebody developing the dementia and being unable to perform their daily activities. Speaking for myself, even in the worst of this, I was seeing patients, writing papers, writing grants, doing everything Yeah. So it just shows you how these things can be quite segregated. Another important point is that the cognitive changes are not across all domains and not across all parts of executive function that you know, as well as I that executive function has many different components. You know, what I'd like to really point to that I think is not discussed enough. And I'm really interested in your thoughts on this, Hannah. You I believe that something that's overlooked a lot is cognitive flexibility.

Hannah Choi 50:08

I am right there with you.

Dr. Lisa Shulman 50:12

So, you know, I think that during, after trauma, trauma after emotional trauma, cognitive flexibility takes a big hit for a long time, I imagine. And I just wonder, you know, how do you come across that in your own work?

Hannah Choi 50:29

I mean, I, I think I really believe that cognitive flexibility is that and metacognition, just understanding how we think and why we think and why we do what we do, and don't do what we don't do, I think those two together are, for me, what I see in my clients and in myself and in others are the most of the two most important, because without that cognitive flexibility, especially I imagine with when you when your life experiences such a great shift, and such a great change. And like you said before, life is not going to go back to how it was before, that cognitive flexibility is probably going to be the answer to finding new ways of doing your life now. And finding happiness and success. I mean, I can't think of another executive function that is going to be more helpful than that.

51:31

And really, at the heart of, you know, being able to be successful, because, you know, it runs from the sublime to the ridiculous, you know, if somebody does, for example, reach out for or tries, I was talking before about all the kinds of methods that one strategies one could try, if someone does begin on say, Okay, I'm going to do this, I'm going to go to find a counselor, I'm going to go to a support group. And, and that doesn't have the proper chemistry, or it just doesn't feel like it's being helpful to you for some reason, you know, if you don't have cognitive flexibility and resourcefulness, you know, that it's pretty much a dead end for somebody, rather than saying, Oh, well, you know, there's 10 other ways to do this. The so I mean, that's the sublime, the ridiculous part of it can be that you can literally find yourself doing things in incredibly robotic ways. When you are in a going through a period of terrible emotional trauma, where things are being done the way they were always done very automatically, and you get kind of fixed in the spot. And then when hopefully, you do become more healed and have more insight and cognitive flexibility, you know, like, it's like, one day you think, we're gonna say, you know, I'm doing these three steps, and there's a way to do this one step, why don't I see that all? You know, and, you know, I mean, for those who have experienced the loss of a loved one, I mean, there are some of these things that are so common. The simple example I've spoken to many people, is, if you if it's somebody that you know, a partner, that you find yourself going to the supermarket and buying all the same foods, even though that person is no longer home, you are in thinking I want to buy this in honor of the memory of the lost loved one, you just automatically are buying in and you're stocking your pantry and the things that you don't ordinarily use takes actually a fair amount of time to you wake up to the fact that you're doing that. Another one I talked about on a BBC broadcast is that people oftentimes describe preparing foods that their loved ones preferred, not what they prefer, they prefer it right, right. Again, it's not something that you plan out, you're just automatically doing it. And it takes it sometimes you then in a robotic, you're doing it and you're doing it and you're doing it and you don't have the cognitive flexibility to go this is what's happening and maybe I don't need, you know, five boxes of that.

Hannah Choi 54:33

Yeah. And it just it really shows you that we are our habits. We are the that like you said, you know, like that, that our brains have been wired that way. So we think that way,

54:45

You know, one of the things I'll I'll pointed to other examples in the cognitive sphere or to other issues. One is the inattention And we talked about the dissociation and how we results in this loss of awareness and so forth. And, you know, people who have suffered serious emotional trauma are have been found to be quite vulnerable to accidents. And this is a very, it's a significant problem, you know, more falling, more car accidents, just accidents. And, you know, I read about that, but you know, I will just say, again, from pointing to my personal experience, you know, in the year following my husband's death, I fell and broke my ankle. And I was in three car accidents, fortunately, fender benders. And then since then none of that this is almost the 10th year anniversary of his death. I mean, it shows you that there is some cognitive change that you are not as alert to your environment.

Hannah Choi 56:07

Yeah, yeah, well, it makes sense. And I just did an episode on ADHD. And in my research, I found that people with ADHD, who struggle with attention are also more prone to accidents, car accidents and injuries.

Dr. Lisa Shulman 56:23

So that also also totally makes sense. Yeah. And like, the final point I don't want to overlook is the impact of our bio rhythms. And, you know, many of us know that we are either you know, morning larks or night owls. And that's just a very fixed part of our genetics. That's not something you can change. And so when you are, you know, you don't you have minimal or no reserve after emotional trauma. So therefore, from the standpoint of cognition, think about if you are, are you a morning Lark or a night owl?

Hannah Choi 57:05

Well, I am a night owl, I am fighting fighting that right now. I'm trying really hard to become a morning Lark. I'm a little better, but I'm trying to fake it till I make it but it's not happening.

57:21

So, you know, if you have are in a bad way, with minimal to no cognitive reserve, and you're you should just be aware, well, you know, if you are that morning for you, Hannah, is not going to be the optimum time for you to try to do a serious cognitive task. Right, right. Because you have to two things that are going on. And so why you why even fight it.

Hannah Choi 57:53

And that's so much of what what I do in my coaching is help helping people figure out when is the best time of day for you to do different things. And you know, when when are you going to be most successful, when is not a great time to try something new or even to try something challenging? Yeah, just becoming aware, learning that learning about ourselves and, and knowing that,

58:16

I mean, I think it has a lot to do with something important that my husband taught me, which is about being forgiving to yourself. And, you know, I think that all of us, and maybe women even more than men, you know, are, you know, filled with angst and second thoughts and remorse, recrimination, and you know, like, especially for people who are going through terrible times, after traumatic losses, it's very important to know, go gentle with yourself and think, you know, I'm doing my best. And I'm I going to keep on working on this. And sometimes, I'm going to have a longing to regress, sometimes I'm going to really handle something poorly, I'm going to make a poor decision. And that we should go well, I'm going to be forgiving to myself, because I'm going through a hard time and I'm going to learn from this and try again. I think that that's a very important part of it. And on the small side of it in terms of what you were just saying the day to day side of it. You know, you might sit down and think okay, I've set aside this time to do what I called before the subconscious conscious integration, the grief work, the inner work, and you might sit down and it might be very unsuccessful. You just simply can't find you can't find your rhythm like you had on another day? Well, I mean, it's good to acknowledge that it just go well, no, for some reason. For whatever reason, this is not the right time for me. Yeah, I'm gonna do something else. And tomorrow's another day.

Hannah Choi 1:00:15

yeah. We always talk about how you can't listen to those shoulds. You have to, you know, be gentle with yourself and, and do what's right in the moment. Is there anything else that you can think of? Did you want to go back to your three steps? Was there anything that you wanted to expand on there?

Dr. Lisa Shulman 1:00:32

You know, I think that, you know, one thing that I would say that can be quite confusing, is when we talk about this idea of subconscious conscious integration, the work to integrate, and reconnect the emotional response to the cognitive functions. And then we refer to that second step of immersion and distraction, I think one of the things that can be confusing, and is to me about exactly how to talk about it, is that the balance between the kinds of things that calm us down, and will be a source of distraction. And the kinds of things that will calm us down and enable us to do the hard work of Yeah, of reconnection of subconscious conscious integration. And that I think, can be a source of confusion. And we sort of all have to find our own balance there. And maybe identify times that are ripe, to even even if it's for a short moment, you know, say for example, in the ways we were talking before, that you might be out in a natural environment, and you feel a sense of relief, and you feel like you can think more clearly. And in that moment, a memory might drift back to you. That is maybe a sad, a sad memory. It's a sad memory. But you see, it just became accessible to you, because you had relaxed enough for that purpose. Yeah. And now, you know, one doesn't have to feel compelled to do some work around that, because you've already accomplished something, like doing that, or feeling feeling sad about it isn't necessarily enough to feel like that's a regression. It's instead, as you go through that, and you in the way we talked about self efficacy, developing confidence in yourself, that you go through, you have that moment, and you might reflect and feel sorrow. And then you go back to maybe what you were doing, and you have just had an experience where you succeeded in the face of you didn't have, you know, a break and emotional breakdown, you didn't weren't triggered, the fight or flight mechanism wasn't triggered to its nth degree, you instead had a moment of sorrow and you went through it, which is different than what would have happened before. That's, that's a success.

Hannah Choi 1:03:43

Yeah. And that that makes me think back to when you were talking about journaling and how, how when you when you like say, you wrote that down that you find that you this used to happen before and now this now this happens. You can look and see that that evidence that evidence of growth and progress and how that must be really empowering and and give you and bolster that self efficacy that is so helpful in getting through.

Dr. Lisa Shulman 1:04:14

Yes, and you know, that you're able to acknowledge is that it's a healthy mind to be able to acknowledge that that was a beautiful important part of me. It's not here anymore, you're honoring it. I mean, you you'd give anything to go back and have that person back or undo that traumatic event. But this really refers to the important field of post traumatic growth and how you achieve that. There you with time, you know, we have well, another favorite phrase is