Instant Genius - How to cope with whatever life throws at you

Episode Date: February 16, 2024

We all have a breaking point. But how close we come to it – and how we cope – comes down to our unique blend of genetics and life experiences. In this episode, we speak to health psychologist Prof Vincent Deary about how we’re adapted to get through with tough times, the physiological processes at work when we’re struggling, and how to build yourself back and recover from fatigue. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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So you can experience exceptional sound at home. Music just as the artist intended. Visit name audio.com to learn more. This is Instant Genius, a bite-sized masterclass in podcast form. I'm Noah Leach, news editor at BBC Science Focus. Health psychologist Professor Vincent Deary says we're all just a few life events away from being pushed to our limit. In other words, having a breakdown. But how close we come to breaking and how we cope comes down to our unique blend of genetics and life experiences.

He says in his new. new book, How We Break. In this episode, Vincent tells us about how we're adapted to cope with tough times, the physiological processes at work when we're struggling, and how to build yourself back and recover from fatigue. So, Vincent, your book is all about breaking. It's called How We Break navigating the wear and tear of living. So I just wanted to start with asking what counts as breaking for you. Is it the same as a breakdown? And is it something that happens to everyone or just a few people. I think we're all vulnerable once we get pushed to our limits. So to give you a slightly long answer, over the last 10 years I've been working in a transdiagnostic fatigue clinic.

And what transdiagnostic means is whatever your primary diagnosis like autoimmune condition or liver disease or cancer, if you're exhausted, you can come to our clinic for help. And at the same time, I've been doing research into people with an autoimmune condition called Children's Disease. I've also been working with fear of falling in older adults. And in all these various different conditions, one of the things that has really struck me is no two cases are the same. You see people reach their limits. Some people get worn out and exhausted. Some people get anxious.

Some people get depressed. Some people get addicted. There's loads of different ways we respond. but my observation is that we're all just, I don't know, two or three life events away from coming up against the limits of ourselves. And one of the focuses of the book is almost taking this out of the clinic because it's not only in research and in the clinic I've seen this, it's in myself, it's in my friends, my colleagues, my family. When the pressure gets too much, we all do start to what I call in the book, Tremble. We begin to notice we're reaching the limits of our capacity. we begin to get exhausted, anxious, preoccupied, our mood goes down. And you don't necessarily need

to cross the clinical line for that to become an issue. So that's a slightly long answer. I do think we all have a natural limit. And I think given enough life events or just difficult or trying circumstances, we will all get to that limit. Sometimes it feels that we're not as well adapted to a situation like that as we think we might be being such an old species by now. on the planet and obviously well adapted in many other ways. So we're really struggling and then our bodies just throw it back in our faces and make us sick as well as if it already wasn't enough. So why is that? Why do our bodies and sometimes our minds too, which will probably come on to, not always support us during this time? It's interesting because one of the things I think

is happening, particularly when people become exhausted and worn out, it almost is adaptive. It is the body saying you need to switch off. Now you need to switch into recuperation and recovery. So some of the researchers in this field, they hypothesise that in the same way that we've got a flight or fight drive, we've also got a rest and recovery drive that switches us off, makes us a bit fatigued, makes us inclined to withdraw. And this recuperative drive is as adaptive as the flighter fight.

It's our body's way of saying slow down. But what I observe in, again, a lot of people including myself, is that the kind of work systems and the kind of society that we're caught up in, we're often getting to being worn out before we actually stop. So we're pushed right to the edge of ourselves when often if we had stopped before that, we might not have got so worn out. So I think it is an adaptive drive, but I think our society is kind of geared up just to keep us on the goal all the time. And one of the things I've really learned over the last 10 years of thinking about this in our clinical work and research is it's that balance between on and off that is really key. We're very good at being on, but I think we're less good at being off. And sometimes to paraphrase and mango Emily Dickinson, because we wouldn't stop for life, life stopped for us, i just made us stop, forced us through exhaustion. You spoke already about this, what you call trembling, kind of being prepared ready for a breakdown in a way, but some people might kind of tremble more than others.

You talk in the book a bit about neuroticism. So I was hoping that you could talk a bit about this. What are some of the characteristics that a neurotic person might have? Yeah, I think we need to be careful of turning it into a category because if we look at both the genotype and the phenotype, if we look at kind of what seems to underlie it in terms of genetic, and also in terms of how it looks in terms of presentation, it seems to be that classic bell curve. So neuroticism is a general tendency to some of the more difficult states that human beings can experience. So exhaustion, worry, anxiety, hostility, low mood, all the kind of negative states. They tend to cluster. Some people have a lot of that. Some people have a little, and most of us are somewhere in between. We're all born with our sort of fair share of fear and

trembling. And it kind of makes sense from an evolutionary point of view. To be completely without worry or anxiety would mean you're going to miss a bunch of threats. To be completely overwhelmed by worry and anxiety means that you're going to get worn out really quickly. So it makes sense as a kind of spread of these, you know, its excess and its lack are in some way both adaptive and difficult. So that's neuroticism as a trait. It's kind of spread in the population. And some of us are just born with more of it than others. I use myself as a case example in that. And I score fairly highly in neuroticism, which is quite annoying as an individual because you have to learn to manage yourself. You have to learn to manage your difficult emotions. And some of us are also,

not so much born that way, but our bodies become tuned that way. So there's some evidence that if your mother has been through a particularly difficult third trimester, if there's a lot of external stress, those threat mechanisms that seem to underlie some of that neuroticism, they get tuned up a bit, which again sort of makes sense because if your mother is in a difficult, stressful environment, chances are that you're going to be in one, two, once you're born. So it may make sense to be born, a bit more hypervigilant, a bit more threat sensitive. So that's really what I mean by born trembling. It's just some of us are by virtue of our genetics a bit more prone to it. And some of us are also born in situations that amplify that. Absolutely. So let's move straight

on to that. That's genetics as the one half and life experience, the other. And your book places quite a heavy emphasis on how all of our individual situations are totally unique to us based on that unique blend of all of the elements within those two categories. So could you delve into that a bit more? How can these two things working together affect our ability to cope and our likelihood to be put into, or not put into, but find ourselves within situations that are hard to cope with? There is a philosopher, I think it's Thomas Nagel. I might have got this wrong, but there's a philosopher who says basically luck swallows everything. There is the genetic lottery. I just happen to be the output of half my mum's genes, half my dad's. And we can see in our family, there is a whole

kind of vein of neuroticism running through my extended family. We're all a bit prone to different forms of anxiety and depressive disorders. But at the same time, there's then where you land in the world. There's the culture that you're born into, the peer group that you're born into. So again, I use both myself and my mum as an example of this. She was born with an awful lot of abilities and talents, but into a very oppressive working class, mid-20th century Scottish environment where she didn't really have a chance to flourish. Whereas I was born into a similar environment, a visibly different kid. And again, I was a very poor fit for my environment. And one of the things I really wanted to bring to light about being a poor fit is you're sort of given back to yourself as

work. So you have to encounter more difficult emotions. You have to plan more, you have to think more, you're going to be more physiologically activated, if you like. You're going to have to go in almost battle ready into the situations, whereas if you're a good fit with your environment, you don't need to do any of that work. So it's that combination that I was interested in in terms of why some of us tremble and break a bit more easily than others. It's that combination of not just the genetics, but where the luck of the dice throw you in terms of where you're born into the world, because I was lucky enough, in part thanks to my mum's frustrated ambitions playing out in her kids, to go to university and then to see the culture change.

So I can now admit openly to being a queer kid, whereas, you know, it would have been criminal to admit that in the 60s or early 70s. So, yeah, the games that were in change, and I wanted to capture the real specific, of that particular combination of genetics meeting that particular environment. Do you think that it's important for us to understand our own, what you call algebra? I really like that phrase, that formula that's brought us to where we are now. I mean, for some people, it might not be so reassuring to think that your situation is so unique that it might feel like it's therefore harder to find help, or is knowing that we have a

unique bend of circumstances? Is that helpful? So I think it's a bit of both. So I use myself and I touch upon my daughter's social anxiety. So I use as two examples of social anxiety. We would both fit the label in that certain situations make us anxious about being in front of other people. But if you actually look under that diagnostic hood, you'll see that it manifests quite differently. You know, I've just come from London where I was doing a talk in front of 30 or 40 people. It makes me a little anxious, but it doesn't get in the way of me doing.

it, whereas if you put me in a small dinner party, that's where my social anxiety really shows up, whereas my daughter's anxiety shows up totally differently. So we both fulfilled the label, but if we were going to get any kind of therapeutic intervention, it would need to say, okay, what's difficult for you? How does this show up for you? And it will show up slightly differently for each of us. Similarly, in the work that we did around fear of falling in older adults. We were coming up with a cognitive behavioral therapy intervention to help people get back out into the world because when you're fearful of falling, tend to become quite isolated, stay at home, very self-protective. And I think in the clinical trial we did, we treated about 400 people,

and again, no two single cases were the same. They all would fall under that diagnostic label, but the treatment would have to acknowledge, okay, for you, this is difficult, whereas for someone else, that bit is easy. These are your strengths here. Someone else has got different strengths that you can draw on. So it's that balance, I think, that I'm trying to capture in the book between the individual case and some of the general principles that we can use to treat each of those individual cases. Ambition comes in all shapes and sizes. At First Citizens Bank, we roll with your goals because we're built for what you're building. Fit for your ambition for Citizens Bank. It's peak pollination season, and my business is scaling fast.

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You've touched on a fair amount so far about luck in this conversation and also in the book and how little control we have over who we are now at this very moment. And this is a bit of a tricky question, I think. But how much do you think outlook plays a part? How much comes down to whether you are just a glass half full, glass half empty kind of person? I think it's worth emphasising that particularly if you're doing research or clinical work or you're working on yourself, you're always looking for the wiggle room,

is the way I would put it. You know, you are given a hand, but there's also how you play the hand. And so that's the bit where I'm always looking for what's the leverage. And I think one of the key bits there that you see, for instance, in the way that acceptance and commitment therapy works. So acceptance and commitment therapy

is one of the newer evolutions of cognitive behavioral therapy. And it seems to be particularly, useful for people who say are struggling with long-term conditions, like long-term physical health conditions. So that's where the acceptance bit comes in. But the commitment bit is going, okay, given that I've got this, what matters to me and how can I do what matters to me, given these constraints? And so they talk a lot in acceptance and commitment therapy, often called act, for short, about values and identifying what your values are. And I think that's where the outlook bit comes in. So one of the examples I use in the book is someone very close to me whose name I've

changed, who is a zero-hours contract worker, going through very difficult trying circumstances, an awful lot to cope with. But in the book, we see him continue to keep going because he has a very clear value. He knows where he wants to go, so that helps him steer through the turbulence. So I don't think it's so much about being either optimistic or pessimistic as having a that idea of where you want to go, I think that can really help because I think what it can allow you to do is accept that you're going to have to put up with some difficult stuff along the way, but that it's worth enduring because that's where you want to go. What about when those two situations don't align, so something that's preventing where you

want to go, situations that are out of your control? So in the book we talk a bit about goal persistence. So we generally see goal persistence is a good thing. If you've got a goal in mind and you come up against some difficulty, then it's a really good idea, generally, to keep going. And that does seem to be related to optimism. People who have got goal persistence tend to be a bit more optimistic. But there's a flip side of that. And we use my mum's late life depression to illustrate that in the book is sometimes actually the sensible thing to do is to give up on the goal, particularly if it's become unrealistic and unachievable. So we see in a book that my mom had this vision of how her life should have been, and she kind of got stuck in that,

rather than going, okay, this is what I've got, how can I make the best of this? It was no, I wanted that and I couldn't have that. So actually, sometimes we do need to stop and pause. And yeah, I saw that a lot working with people with long-term physical conditions. Often that adjustment and that goal giving up was part of the key work they had to do, but it's a really difficult bit of work to do. It involves grief, recalibrating what matches to you. That is often what I was helping people do in the clinic. But yeah, sometimes giving up is really important. You spoke before about blame and the kind of society that we live in that makes you feel like you need to keep going even when you probably should stop, but also a society that means it feels

like it's our fault when we do eventually break and reach the end of our tetheres. Can you tell us a bit more about what we can do to resist this and whose fault it is when we break. And if that's even a helpful way to look at it at all, I mean, should we be apportioning blame or should we just be giving up on that as a kind of end goal as well? I think understanding the factors involved in pushing us to the edge, I think we can do that without the framework of blame. But I think you're absolutely right. As a culture, we're often judging ourselves and we're valued in terms of the systems we're embedded in, we're valued in terms of our productivity, our ability to keep going, our outputs, our busyness. So I don't know about you, but everyone that I know, if you ask how they are at

work, everybody goes, oh, I'm just really busy. So we really advertise busyness and productivity. And I understand that. And of course, it's partly why I'm relatively successful, because I've bought into that culture. But I think the flip side of that is when we can no longer be productive or life is getting difficult, we start to devalue ourselves. So I think it can be really a very crucial move is to uncouple our sense of our self-worth from our productivity. And to start from a place of saying, actually, I'm okay as I am. I don't need to prove myself by my productivity.

And I think that's quite a countercultural thing to do, is to value ourselves just as we are. So from your experiences in the fatigue clinic, do you feel like, we're all getting enough help and support when it comes to fatigue. We're looking after ourselves and we're taking a note of it. I somehow feel like I already know the answer before. Well, let's try and make the answer a bit more nuanced. I think there's a bunch of stuff that we all know and that loads of us try and do. So we know about exercise, we know about sleep, we know about food, and we know we should be doing all of that to kind of recharge our batteries. I think a bit that is less focused on and it's a bit more not taboo culturally, but we just talk a bit less about, is genuinely switching off, genuinely going into deep rest, recovery, recuperation, revitalisation, because I think we often see that as trivial.

So it's the stuff that brings us joy or happiness or just a sense of ease, a genuine relaxation being able to let your dart down. And I don't know about you, but that's something I struggle with, and it's something I see a lot of people around me struggle with. We're very good at gearing up, but we're less good at gearing down. And so a lot of the solutions that we have for recovery are all about doing more or doing yoga, doing mindfulness, doing this, doing that, as opposed to what would it be like to genuinely do nothing? What would it be like just to be okay as you are? So I think that is something that I see as worth working on in our lives and paying a bit more attention to that. I think the headline for that would be rest is a skill that I think we don't practice enough. Yeah, I'd really like to come on to your tips for coping in the moment and before and after a bad situation.

But before that, I wanted to just touch on some of the science within us and understanding a bit more about what's happening in our bodies. biologically and psychologically speaking when we're going through a really tough time. What are you seeing in our anatomy and in our minds? I think the fact that you said anatomy and minds is really key because distress is not only in our feelings and our thoughts, it's also in our bodies. And a concept from health psychology that I found really useful is alistasis and alistatic load. So to try and put that simply, alistasis is the work of adjusting. If you've got a challenge at work, you will gear up mentally.

You'll be slightly more anxious because you want to get it right. And you will also deploy more energy. It will be a campaign, if you like. You will need to release more of your body's resources as well. And that's great. We're designed to do that. We're designed to physically, mentally and emotionally gear up. That's Alistasis.

The problem is when we get stuck in systems that don't then allow us to switch off or where the challenges keep coming. So if you think of people in difficult social circumstances, or in war zones, or in really difficult work climates, or in very difficult relationships, those situations where there is no chance to recover from that expenditure, that is when we begin to get this thing called allostatic load. And that is the costs of being geared up all the time without chance for recovery. So that's not only mental and emotional, it's also physical. So you're going to get more inflammation. Your immune system is going to begin to be affected.

You're going to become more vulnerable to getting it ill. You're probably going to take longer to recover from it when you do. So I found that notion really useful of allostasis and allostatic load to think about the biology as well as the psychology of what happens to us when things are too much for too long. Some of those anticipatory feelings leading up to something that you know is going to be a tricky situation, whether it's at work or in your personal life or in your health or someone else's health, those feelings that help to prepare you can be deeply unpleasant themselves. So that trembling, that turbulence, as you describe it in the book or what some might be more familiar with as kind of dread basically or terror even. How can we basically make those more pleasant? I feel like that's, I'm asking you for. a magic solution there. But I mean, it's that they obviously are helpful to some extent because we've developed them and they're preparing us for something. But those feelings themselves can almost be as bad as an event. So do you find that with your patients that you've seen and other coping mechanisms you can advise for listeners? Yeah, it's a really lovely insight, that anticipatory anxiety

that can often, like you say, actually be worse than the actual thing in itself. So I get anxious before, say, doing a podcast or before doing public speaking. And I've learned to manage that. And I've learned to manage that through using some techniques, again, from acceptance of commitment therapy. And I think the key thing there is not to get locked in a battle with the anxiety. So if you start telling yourself, I shouldn't be having this feeling that I'm having now. You're suddenly not only dreading the thing that you're doing, but you're also starting,

in a battle in the present with the anxiety about the thing that you're dreading. So what I now do with my anticipatory social anxieties kind of go, okay, you can come along for the ride. You're kind of my constant companion. And there's a very simple, deceptively simple technique from acceptance and commitment therapy where you verbally reframe that. So I would really like to go to the dinner party, but I'm socially anxious, because I'd really like to go to the dinner party and I'm socially anxious. And suddenly they're no longer framed in opposition. It's like, okay, the anxiety can come along for the ride. I might even talk about it to someone at the dinner party and actually it might be a bit of an icebreaker. And they might even like me a bit more

because I'm admitting to some vulnerability. So I think that reframing can really help of actually stopping telling ourselves we shouldn't be having the feelings and going, okay, these are part of the ride for me. How can I kind of accept that? But still do. the thing that I want to do. And I think that's the other key there is don't let the feeling stop you doing the thing that you want to do. And you touched on this before about the kind of art of recovering really, but I'd like to come on to that because it's obviously a really important part of struggling is what happens when it's finished, which is really nice points to kind of look forward to for people who are struggling, but one that often gets forgotten in that

moment. But when it does come to healing and kind of building yourself back, you in the book talk about what you call the lost art of convalescence. So could you explain what you mean by this and how you think it could help? There are four clinicians in the fatigue clinic consultant, occupational therapist, physiotherapist and myself. And we all came to the same realization at various different points, seeing patients who had got worn out by life, by labour, by illness, is that if some of them had been given proper time to recover and not being forced back into quite punitive work or life rhythms. They may have not ended up in the clinic in the first place. Again, seeing it in myself and people around me who didn't necessarily cross the clinical line is we all expect ourselves

after big life events or after a real time of trial and difficulty to kind of, you know, just get back to normal within a couple of weeks. It's kind of how work culture is set up that you'll, you'll be back at work in two weeks time, just take a couple of weeks off. And it's not kind of how we work I do think that acknowledging what we've been through, even if it's good stuff, even if it's the completion of a major task. So I see it all the time in people going through exams, everybody crashes afterwards and they often take quite a long time to come out of that crash because your system has been geared up. So key message, be gentle with yourself. And if it takes a bit longer to recover than you think it should go with that. You know, pace yourself. Don't force yourself back

into a relentless rhythm, kind of gradually ease yourself back in. Quite a lot of the work that we did in the clinic was doing that negotiation with employers for clients to say, actually, can they have a slightly longer phased return to work? Because they're going to be much more likely to sustain it than going back to full on within a couple of weeks. So Vincent, what are your top three tips for getting through and recovering from a really difficult time? I think the first one would be slow down. Because I think often when we're in high gear and there is that sense of urgency, we just keep pushing. It's almost like, this is work before I'll just keep pushing harder. And I think when we feel we're reaching our limits, we sometimes just need to stop and take a

breath. And I think the next step after that is something along the lines of befriending yourself. So one of the things I've seen in clinic and seen in almost everyone I know is we're much kinder to other people who are struggling than we are to ourselves. We call it the best friend technique in cognitive behavioural therapy. What would you say to your best friend? And it would generally be, you need to take the weekend off. You need to put a cap on how much they work is getting to you. So treating yourself as your best friend with kindness. I think that's the key word, is befriend and be kind to yourself. And I think the third thing related to that is when our resources are low, we tend to give what we've left to the stuff that we feel we have to do. And so life just becomes duty and

recovery, which can be really wearing. We need to lean into the joy. We need to lean into the stuff that actually put some energy back in the tank. So although it feels you haven't got much left to give, give it if you can to the stuff that gives you something back. Lean into the stuff that aids you to recover, to rejuvenate, to sort of revitalise and refresh yourself. So yeah, those would be the top three. be kind to yourself and lean into the joy. That was Professor Vincent Deary on his new book How We Break, navigating the wear and tear of living, which is out now. Thank you for listening to this episode of Instant Genius,

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