In this episode, Physical Therapist and Owner of Healthy Phit Therapy & Wellness Consultants, Dr. Lisa Folden, talks about diet culture.

Today, Lisa talks about the pervasive nature of diet culture, how to reconcile diet culture with physical therapy recommendations, and how to support patients who are on their weight loss journey. What is diet culture?

Hear about weight biases and phobias and how to deal with them, the Health At Every Size movement, and get Lisa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaway

• “Diet culture is this pervasive thought process that we’re born into, that fosters the belief that we’re never enough – we’re never thin enough, we’re never healthy enough, we never got it right.”
• “Diet culture is the constant reminder that something’s wrong - you need to fix it all the time.”
• “Even if weight is causing some of the issue, the reality is, the research shows that weight loss doesn’t really work for most people. 95% of people who lose weight gain it all, plus more, back.”
• “Weight loss is a by-product that some people will experience, and other people will not.”
• “We think in our society that no one should be fat, and if they are fat, it’s because of poor health choices.”
• How to challenge the weight bias:

1. Unlearn the idea that people in larger bodies are inherently unhealthy. It’s not going to help you make them feel better, and it’s not true for many people.
2. Think about accessibility. Considerations are made for people with various degrees of mobility, so ensuring that there’s appropriate furniture is a consideration for those with larger bodies.
3. Reassure patients. Especially when dealing with patients who have dealt with the weight stigma, it’s important to reassure patients that size variation isn’t a problem.

• “I assume that their condition is caused by something other than their weight, and I treat them based on that.”
• “We’re supposed to be different sizes, and we don’t have to lose weight to be healthy. You can be healthy at any size.”
• “Stop telling your patients to lose weight, offer people in larger bodies the same treatment options you offer people in smaller bodies, and don’t shy away from manually and physically examining them because of their body weight.”
• “It’s going to be okay.”

More about Lisa Folden

Dr. Lisa N. Folden is a licensed physical therapist, mom-focused lifestyle coach, and the owner of Healthy Phit Physical Therapy & Wellness Consultants in Charlotte, NC.

As a body positive women’s health expert and health at every size (HAES) ambassador, Dr. Folden assists women seeking a healthier lifestyle by guiding their wellness choices through organization, planning strategies, and holistic goal setting. Dr. Folden is a mom of three, published author, and speaker who understands the complex needs of the modern busy woman. Therefore, she considers helping busy moms find their ‘healthy’ as one of her of top priorities.

Dr. Lisa is a regular contributor to articles on topics related to physical therapy, health, wellness, self-care, motherhood, body positivity, and pregnancy, and has had the distinct honor of being featured in Oprah Magazine, Shape Magazine, Livestrong, Bustle, and several other local & national publications. Additionally, she is a member of the National Association of Black Physical Therapists, the Association of Size Diversity & Health, The Know Women, Alpha Kappa Alpha Sorority, Inc., and serves as an expert panelist for H.E.R. Health Collective (2021).

Suggested Keywords

Diet Culture, Weight Loss, Body Positivity, Acceptance, Stigma, Body Size, Fitness, PT, Physiotherapy, Symptoms, Healthy, Wealthy, Smart

Resources:

Health At Every Size Community

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Read the full Transcript Here: 

00:02

Hey, Lisa, welcome to the podcast. I'm happy to have you on today.

00:07

Thank you so much for having me. I'm so excited to be here.

00:11

Yeah. And today we're going to be talking about diet culture, in health care, and specifically in physical therapy, which is not something that I've ever spoken about on this podcast. And so I'm really happy to have you on to talk about this. And I remember speaking with Dr. Lisa van who's, and we were talking about biases in health care. And she said, one of the more accepted biases in health care is against overweight people. Yes. And so I'm happy to have you on and dive into that a little bit deeper. And so let's, let's talk about first diet, diet culture, you know, its impact on our not just our physical health, but also our mental health as well. So why don't we first start with what do you feel diet culture is? Let's define that.

01:13

Sure. So it's nuanced, of course, but essentially, diet culture is it's this pervasive thought process that we're kind of born into, that fosters the belief that we're never like enough, we're never thin enough, we're never healthy enough, you know, we've never gotten it right. And so it feeds into, you know, this multibillion dollar industry that says, you know, buy this tea, by this waist trainer, by this weight loss program by this because you always need to be getting smaller, shrinking yourself, doing something to change yourself, because, you know, you couldn't be healthy, you know, there's no way you're healthy, especially if you happen to be someone who was born into or developed into a larger body, there's no way you're healthy. So diet culture is sort of the constant reminder to you that something's wrong. You need to fix it all the time. And it's a deep part of our healthcare system. It's a deep part of, you know, like Hollywood and television, things we watch every day. So it's it seeps in without anybody really knowing that it's happening. And it's so common and so accepted, that we just look at it as you know, health, like a lot of things that are really diet culture, a lot of us would just look at as Oh, that's health, that's fitness. And it's and it's not, because it's actually corruptive. And it, it breaks us down. And it's not good for our mental health or for our physical health. It results in a lot of weight cycling and bingeing and restrictive in disordered eating. And so, you know, it's really bad. I mean, that I don't call a whole lot of things good or bad, but diet culture is one that I kind of just categorize is bad and unnecessary,

02:53

really. And so looking at that through the lens of a physical therapist, how do you reconcile that culture with what we do as physical therapists, because so often, if someone is, let's say, an example, someone is coming to us with osteoarthritis hips, knees, one of the recommendations is weight, weight loss of whatever that weight loss is, I don't think the recommendation is to be a size zero or two. But that recommendation is weight loss. So how do you? How do you kind of blend these two this diet culture, which knows very bad, but yet, in certain populations, it can be helpful to take off some weight to unload those joints. So how do you reconcile with that as a PT?

03:40

Yeah, that's a great question. And it's obviously something I've had to kind of deal with head on as a physical therapist still treating in the clinic. You know, like I said, in the standard outpatient practice. So here's the thing, there's physics, right? physics exists, when there's more pressure, you know, from gravity and weight, you can feel more pain. Like that's, that's a fact. But there's also, you know, this idea that we all have different sort of thresholds for our pain. And, you know, you know, like, I know, you can look at someone's, you know, x rays to people, and they can have identical things happening there, you know, at the structural level, and have completely opposite symptoms, one with severe symptoms and one with none. So, when I address the issues of pain that could be could be contributed to from weight, I just, I approach my patients from the lens that even if weight is causing some of the issue, the reality is the research shows that what weight loss doesn't really work for most people. 95% of people who lose weight, gained it all plus more back within one to two to three years, and they don't really have research beyond the five year point because nobody typically makes retains it. So the reality is, even if if you know if that is the suggestion, that's kind of what we've been taught as physical therapists, I know that it doesn't work. So I'm not helping my patients by saying, hey, you really should lose some weight. So I approach it from the lens of I'm going to treat them as if this osteoarthritis, this this issue, whatever they're dealing with, has nothing to do with their weight, and everything to do with all of the other possibilities in my toolbox as a physical therapist. So are we dealing with, you know, restricted, you know, soft tissue, tight muscles, you know, imbalances, muscle imbalances, are we dealing with, you know, just lack of flexibility and other things, can I do some manual therapy that can help, like, what other things can I do, because even if weight is a contributing factor, me telling them to lose weight is in the long run, not going to help them because for like I said, most people aren't going to maintain that weight loss any way, or if they ever achieve it in the first place. And it can be so daunting, when people in larger bodies go to health care professionals, and no matter what is going on with them, if they are in a larger body. The suggestion is weight loss literally across the board, not just you know, in our profession with, you know, things regarding the joints and osteoarthritis, you know, other things like that. It's literally everything, I'm having stomach pain, lose weight, I'm, you know, they literally here for everything. And so I just don't want to be a part of that. And I don't think I don't think that it helps our clients to get better in the long run.

06:28

Yeah, and it, might it add one more thing to this person's plate, so to speak to maybe, then they will say, Well, I'm not even gonna go back to this PT. Yeah, is there a way to meet people where they're at, and through exercise and other modalities, if they were to lose some weight great, not make that the singular focus?

06:54

Absolutely. And that and that's just what it is. Because, you know, adopting new health behaviors is good for everybody, whether you lose weight or not. And you know, just just just increasing the synovial fluid in the joint from, you know, more activity can be great, you know, so weight loss really is a byproduct that some people will experience and other people will not. And, and coming to terms with that has been a journey for me as a professional, and then in my own personal life and my own, you know, struggles from the past with weight loss and diet culture, but it's really freeing, and it helps people eat, I can just this year alone, I've had at least four clients, all of them were women, but they all had the same story, like severe trauma, from interacting with other healthcare professionals, like figuring out something's going on with them, and then being told, like, Oh, yeah, you just got to get that weight off, you just got to keep that weight up, and just kind of hearing it over and over again. And so coming to me was like a, sort of a breath of fresh air for them. It's like, you're the first person, it's like, not telling me I need to lose weight. And it's like cash. Like, I couldn't imagine that being the discussion. Every time I go to the doctor, every time something's bothering me, you know, as if to say, thin people, and people in larger bodies don't experience some of the exact same diagnoses and issues, you know, if weight were the problem, then that would be the situation then people and, and fat people would not have the same diagnosis. And we know that's not true. So yeah, you're right, it adds a whole nother layer of trauma that they have to deal with.

08:28

Yeah. And, and sticking with that theme, let's go into some of the the biases. So the weight bias, fat phobia and healthcare, we could talk about PT in general, like I said, and speaking with Dr. van Who's she sort of said, Hey, listen, this is apparently one of the accepted biases that you can have, you know, so let's talk more about that. Go ahead. I'll give the mic over to you and just kind of what's the situation on the ground here?

08:58

Yeah. And, and she's, she's right with that. It's like, it's like the legal bias. It's like it's okay. And, and even people, what's disheartening to me is interacting with people in larger bodies, they often will just accept it, because it is the norm. And they begin to believe that inherently something is wrong with them. They haven't figured out the magic formula, they're not doing something right. And so there's something wrong with their body. And they're almost Okay, in a sense being discriminated against or dealing with the biases because it's just so much a part of what we do. So it you know, it shows up in everything, like literally from the time you're born. You know, I had a great discussion on my Instagram with some people we were talking about, I did a summer body challenge. So I had everyone like, put on a sports bra and black bottoms and just show it and be proud of your body and we said it was the Being confident and proud of my body this summer and always, you know, not feeling like I gotta lose weight, two summers coming, you know, warmer weather doesn't mean I have to get to the gym and lose some weight or cut back on my calories. And a recurring theme in those conversations was just this idea that like, it starts at home, like my mom, you know, said, Oh, you're putting on a little weight, or you're getting a little chubby, or it's, it's this pass down fat phobia, it's like, do whatever you do, don't get fat. And it's like, oh, my gosh, we, we think we literally think in our society that no one should be fat. And if they are fat, it is because of poor health choices. So we create this hierarchy, where I'm better than you, I must make better health choices in you, because I am thinner, and you are fatter. And it just couldn't be farther from the truth. Because, you know, we, a lot of us like to believe we have a whole lot of control over the size, shape and weight of our bodies. But so much of that is genetic, you know, so much of that has a genetic component, we only have so much control. And even within the window of our control, without going into disordered eating patterns, it's still a very small, you know, amount of change that you can expect to see. So, you know, we hear it from our parents, we hear it at home, we see it on television, you know, when you get on a plane, and the seats are barely big enough for an average adult, you know what I mean? Like, barely, like we're squeezed in there. So imagine that humiliation, you know, as someone in a larger body having to either buy two seats or figure out how to squeeze into that seat. You see it in doctors offices, there's small seats and doctor's offices, even though we treat a huge variation of people in their body sizes, the lobby looks like everybody should be the same, you know. And so those are, you know, things that I want to see changed and considerations I want to see being made, especially in healthcare, because, you know, we we have the privilege of working with people, you know, from largely diverse communities, especially as it relates to their size. So, at the very least, that should be a comfortable experience, you know, you're going to your doctor should be a comfortable experience, you're going to your physical therapist, it should be a comfortable experience. So yeah, there's more I could say, but

12:36

I have a question for you that. So as a physical therapist, so let's say you're talking to you're talking to a group of pts about this, what advice do you have, that they can put into action to challenge these biases, and to make their spaces more inclusive?

12:55

Yes, that's a great question. So the first thing is to start within, and just avoid all of those assumptions that we like to make. So just you know, unlearning, that's where it starts like unlearning this idea that people in larger bodies are inherently unhealthy, or have inherently made bad decisions. Because one, it's not going to help you get them better, or make them feel better. And to it's not true for a lot of people. So getting rid of those, those preconceived notions about what someone in a larger body, you know, has going on, or what kind of health status they have. Also, if you're in a setting, where you have the privilege of sort of, you know, making decisions about the clinic setup, you know, thinking about the furniture, thinking about, you know, having things that are accessible, we think about this, and we're talking about people, you know, with varying levels of ability, if they're in a wheelchair or on crutches, you know, we think about making sure the doorways are wide and this and that, and height, adjustable seating and things of that nature, we should do the same thing for people in larger bodies, people come in different shapes and sizes, and we should do as much as we can within our power, you know, to accommodate them. The other thing is, especially when we're dealing with people who have dealt with the weight, stigma and all that trauma, we need to reassure them, we need to let them know like my patients are literally floored when I tell them like there's nothing wrong with you. You know what I mean? Like we have to abandon this thin ideal, like everybody is not gonna be thin, no matter how hard we work, no matter how hard they work, no matter how many calories we cut, everyone in the world will never be thin, nor do we need to be. It's okay to have variations in size. I truly believe in the concept of Health at Every Size, which is an excellent book by Dr. Linda bacon. But you know those things so I'm learning, reassuring your clients, you know, avoiding the assumptions. You know, there are people in large bodies that can do just as much as you can do or more, you know, but then when you do encounter someone in a larger body that is having trouble because of You know, their mobility issues or their body size, you need to be quick with the modifications, you know, we're good at that, like that. That's what pts do. So you know, give them the opportunity to try it full out. And if they can't, or you see them struggling, jump right in with a modification and you reassure them and you let them know there's nothing wrong with this, like exercise movement is for every body. And if you can't do it this way, well, guess what? I got another way you can do it, oh, that didn't work, I got another way you can do it. Or let's try this one. instead. It's, it's okay. And people need that reassurance. Because in the healthcare setting, especially if they've had that trauma, they're so nervous and so uncomfortable. And again, they feel like there's something wrong, you know, with them. And so, you know, we learn this in PT school, we treat the whole person, you know, we don't see a person and this is a knee, no, we're treating the entire person and all of that all of their preconceived notions, all of their trauma, all of their hardships that comes with them into the clinic. And so we have to figure out a way to work with them, ease their you know, their minds and give them the tools that they need to get better. And so I typically, I take weight out of the equation, I just, I assume that their condition is being caused by something other than their weight, and I treat them based on that

16:14

period. Now, here's the question, how about if you have a patient or client coming to you, who they want to lose weight, or they're in the middle of this weight loss journey, and they're committed to it, because they want to feel better? for themselves? Not for anything else. But you know, we're coming off of a really difficult year where a lot of people might have gained weight over COVID. And so how do you or how would you suggest PT support the patients that are coming to you, they're saying, Hey, listen, I, I'm on this journey, this is what I'm doing. I'm moving, I'm exercising, I'm eating better? How can you give them a little extra support? With out perhaps leading them into an extreme version of that?

17:04

Yeah, what I find in those cases, your role is more of a, I don't want to say a silent partner, but you're there for the supporting piece of it. But the goal is to not. Okay, I'll say it this way, I respect body autonomy. So essentially, I know the research, I don't think that, you know, chasing weight loss is a great idea, really, for anyone, despite COVID I know, people are like I gave the quarantine 15. I'm like, Listen, you're alive. That is such a blessing with the year we've had, you know, the year plus we've had at this point, so but I respect body autonomy. So if you believe like, this is not a weight I'm comfortable with I'm not, I don't feel good, I don't think I look good, I want to do something different, then by all means, go about, you know, the process that you feel comfortable doing, I am going to be here to support you by way of giving you evidence based solutions. So if you tell me, Hey, I'm doing this, you know, 30 day detox, I'm only going to be drinking lemon water. And shakes, I'm going to tell you, I don't think that's a great idea. And here's why. But ultimately, you are an adult. So you get to make all of these choices for yourself. Before I became you know, haze or Health at Every Size aligned and anti diet, I did, I did all kinds of things. And I would not have taken kindly to someone telling me, oh, you're wrong, you need to stop it. So people need to have the freedom to do what they want. And I just as a therapist, I just want to be there. And in my role as a health coach, I want to be there to support them, but provide them with the evidence that's out there. And then, you know, as they go through their process, I'm happy to fine tune, I love to give people workouts, you know, that's, that's what we do is PT. So yeah, I can give you some workouts. If you talk to me about like, I feel really weak in my glutes, I want to be able to do this or I want to be able to benchpress or daily, oh, I've got you, I can give you a great program, you can work on it, you know, we can follow up with me. But whenever you're talking about extreme dieting, and crazy restrictions and weighing yourself incessantly and you know, tracking your movement on your Fitbit all day, I'm gonna kind of bow out and give you the, you know, the freedom to do what you choose. But just let you know that I don't think that's going to really support your goals

19:26

overall. Yeah, and, you know, it's the same as as if we would talk about a return to sport after an injury. So we can help guide the patient through their rehab process. And when we get to that decision making point, it's a shared decision making point where it's you, the client, maybe it's a spouse, a child, a partner, the doctor, whomever might also be within that decision making framework, and exactly what you just said, You're giving the best evidence based information. You can to that patient, and then that patient can make an informed decision on what they can do next, or what feels good, what is the best decision for them? So I just want the PTS out there listening to understand that this is not unlike any other shared decision making that we would do. And it's not a you do what I tell you to do. Because we're biased against people who are fat. Yeah. Because you're overweight, you clearly can't make a good decision. Right? which is not the case. And it's maybe they need information to make a better informed decision, just like someone coming in after an ankle sprain or an injury or low back pain.

20:43

Yeah. And you know, and that that's a great point that you bring up because you're right, it comes up with injuries, people will Google it. And listen, I love Google, no disrespect to Google, I google things all the time. Know when somebody is coming in, and they're dealing with some type of injury or medical condition. And they're going solely based off Google. It's like, Yes, we have a responsibility as a trained professional to say, Hey, here's what I think you should really know. But ultimately, you're right, they they're going to have to make the call. You can't you know, get someone better in physical therapy, just you know, when they come to you, it has to be their follow through at home and their decision making. So that you're absolutely right. That's a great analogy, for sure.

21:27

Yeah. And now, you said this a couple times. But I just want you to talk a little bit more about the Health at Every Size movement. You mentioned it a few times tell the listeners exactly what that is, and what its significance is to diet culture.

21:43

So the health and every size movement is it was sort of tagged by Dr. Linda bacon. I don't really know the lifespan, how long it's been around, I don't think it's been before, like the 90s. But it's essentially a movement that believes in body respect, and body positivity or best body neutrality, and respecting and understanding that we're supposed to be different sizes. And we don't have to lose weight to be healthy, you can literally be healthy at any size. So it's it's really the antithesis to diet culture. It's everything that diet culture is not it's not a movement that is rooted in, you know, being sedentary and eating McDonald's every day. But it is a movement that's rooted in people making their own individual health choices, and and creating health habits that improve their health without any focus on weight loss. So the Health at Every Size movement sort of omits the idea of like, let me check my way, let me weigh in this week. Let me let me measure this week, let me see where I am. It's it kind of throws all of that out of the window. And so the book is actually Health at Every Size by Dr. Linda bacon, that was sort of my introduction to it. And it's been life changing for me again, personally and professionally. So I recommend it to essentially everyone.

23:03

Nice. And because I think oftentimes when people look at someone who's overweight, they think, oh, they must have heart disease. They must be a diabetic, they must have this, but you can have normal labs and be overweight. Yeah, yeah. So and I think that is one of the biggest biases not just in healthcare, but in society in general.

23:27

It is it is. And that is the premise behind Health at Every Size is recognizing that you can't look at someone's physical body and know what their health status is. And we're just so used to making those assumptions and it's so counterproductive to true health and it's so damaging, you know, to people, you know, I personally know people and my own personal story. I'm only 411 I know we've never met in person, but I'm very short.

23:55

A short and you come across way taller.

24:02

It's the hair.

24:04

The hair gives you an added oranges.

24:07

I am short. I've always been short. But genetically, my family my mom's side of the family, they're more like apples shape. So they carry weight in the stomach. They're usually just you know, they got big solid legs. My dad's family was a little bit more Hourglass OR pear shaped so very lower, larger lower bodies. And so literally my entire life here and I have never, ever, ever ever not been overweight. Ever according to BMI which is a whole nother topic but I believe it's trash. So I have always my entire life they considered in an overweight category. I have never had high blood pressure, high cholesterol. AB issues doing any physical activity I used to run once upon a time I ran 25 K's I've never had an actual health issue, but I have always been considered over weight, and that stigma because that you know, value was created by a mathematician, you know, that really even said that it wasn't supposed to be used to like actually measure health into BMI, the BMI. But because of that, being sort of what our healthcare system is run on in our insurance markets, kind of, you know, utilize for everything. I have never, for my whole life, I felt like something was wrong. It's like, I'm not running enough, I must be eating too much. Let me stop having carbs. Let me switch to this diet. Let me and that is it. You know, it's not just my story. That's a lot of people's stories, especially here in this country. And it's like, if we could just stop for one minute, and ignore the weight and ignore the BMI, and just focus on health activities, health behaviors that make you feel good. If it's walking for you, if it's running, if it's skating, if it's dancing, if it's height, whatever it is, for you know, joyful movement, that's kind of you know, that's a part of the Health at Every Size, mantra, it's like joyful movement. Eating when you're full stop eating when you're hungry, stopping when you're full, trying different foods and just living a life and, and managing the other aspects of your health, like your mental health, your emotional health, your spiritual health, if we could just focus on that, instead of the scale, or the measuring tape, BMI, we will be so much healthier. So so so much healthier. So yeah, I, like I said, I could talk about BMI forever, but I just I really, I love what health and every size stands for because it, it's really about valuing body diversity, that's what it is. Because the bottom line is, we're not all going to be the same size, we're not all going to be thin, we're all going to have different dimensions, and our bodies will change over the course of our lives, age, stress, hormonal things, pregnancy, you know, all kinds of stuff. And so we have to get more comfortable with that fact. And not try to create this, you know, there's the whole snap back movement with pregnancy, like, have a baby lose the weight. It's like, wait a minute, let's just be you know, let's adjust to motherhood and whatnot. Um, so yeah,

27:08

yeah, it's it. I can't even get into the BMI. Because I cringe when I when people start talking about their BMI is and what it should be. I mean, for my height for BMI. I am right now, like a tick away from being overweight. And I would if you saw me, you wouldn't think oh, she's overweight. But according to the BMI, I'm like, a tick away. And for me to be in that sweet spot. I would look emaciated. Yeah, exactly. You know, so, like, 100 pounds. Let's like, stop with the BMI stuff. You know, and, and I just had all my labs and I could not be healthier. Absolutely. So there you go. But yeah, I'm with you on the BMI. We could talk. We can go on about that for a while, but we won't. So let's talk about, you know, we talked a little bit about what, what can physical therapists do to look at their own bias and fat phobia in health care? Is there any Do you have any other tips for health care providers out there, when it comes to their bias and phobias?

28:30

Yeah, I would say, you know, in addition to what we talked about earlier, and then on learning practice, you know, we have to just stop telling people to lose weight, it's counterproductive, it's not effective. And again, most people aren't able to even do that consistently and maintain it. And then we have to offer the same treatment options we would offer offer someone who was thin, like it, you know, we just have to treat them with some, you know, equality or you know, equitably, and giving them the same options. And then I know in physical therapy, this has come up before and that's one of the sort of issues that the fat acceptance community has expressed in dealing with with healthcare professionals, is they are less likely to be examined to be physically examined, because of their body fat. And I get that, you know, when you go to physical therapy school, and we learn all these manual techniques, oh, it's much harder to try to palpate things, you know, when there's more adipose tissue, of course, but that doesn't mean you don't do it. You know, so my advice is to do it, it might be uncomfortable, it might be awkward, it might be challenging, but guess what, you grow as a professional and then you at the very least give that patient the the decency and the respect of trying what you know best to do, you know, in that you know, situation. So, um, you know, just being being supportive and not being demeaning that playing into the weight biases. And first really acknowledging that you have them that that's that's the first part because a lot of people don't think that they have until they're put in a situation where they have to face them head on. So recognize them. And then stop telling your patients to lose weight offer people in larger bodies, the same treatment options. You offer people in smaller bodies, and then don't shy away from manually and physically examining them because of their body weight.

30:19

Yeah, great advice. And hopefully people listening to this podcast will take that advice to heart. Now, where can people find you on social media websites? All the good stuff? If they want to reach out to you they want to work with you. Where can they find you?

30:37

Yes, well, my favorite social media is Instagram. I'm pretty much on everything. But if you really want to reach me, you can find me on Instagram and I'm at healthy fit. And that's h EA l th y pH it. I'm also again on YouTube and everything else. But I live there. I'm on the peanut app, which is kind of new. If you're a mom, and you want to have talks about body positivity and changes to your body through motherhood. I'm on that app. You can find me there Dr. Lisa folden. And then my website is www dot healthy fit that calm.

31:10

Awesome. What is this the peanut app? Yeah, this

31:15

is really cool. It's like club friends, but it's for moms. And so they have tons of discussions on there. But um, I was requested by the I think the creators to serve as like a professional and do talks on things in the health realm. So yeah, so I go on there every, every other Friday, and I host talks on things related to body positivity, Fitness, Health, Exercise, things like that.

31:38

Fabulous. Congratulations. It's awesome. Thank you. Now last question. It's out when I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? Maybe like fresh out of PT school?

31:53

Oh, yes. Oh, fresh out of PT school that changes things, let's see, or high school or undergrad or whatever you want somewhere in there. I think you know what I think the best advice I would give to myself is it's going to be okay. That's really it. Because I was one of those like type A planners, like let me figure everything out. And I just remember being stressed all the time, like wanting my life to work out a certain way. And so it would have been nice. If you know, my older self this Lisa could reach back to that Lisa and just pat her on the back and say it's gonna be okay, honey, you're going to be fine. You can calm down. I just Yeah, that would that probably would have helped me relax a bit more during that process, you know, going through PT school and like, I felt, I just felt this heavy, you know, weight on my shoulders to like, get through and pull through and be great. And so if I could say anything to myself, it would be to just you know, relax. It's going to be okay. Enjoy the ride. You know, for sure.

32:51

Yeah. It's a very common piece of advice from a lot of people on this podcast. Obviously not hard to believe. Right. Right. Right. Lisa, thank you so much for coming on the podcast. It was a great discussion. And, you know, my hope is that people will take away from this all of the great tips to really examine your biases, and just start treating everybody like the people they are. Absolutely. Thank

33:18

you so much for having me.

33:20

Anytime. Anytime. You want to come back. You are welcome. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, CEO of CS Thrive, Kirsten Franklin, talks about mindset.

Today, Kirsten talks about what mindset is, why we should care about it, and how it affects our outcomes, results, and everyday life. How can we leverage mindset to change the results of things we don’t like in our lives? How can we change our core beliefs?

Hear about Kirsten’s four questions, her stopwatch strategy, and get her advice on how to manifest as a conduit, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• “What you deeply believe will always play itself out for you.”
• “Sometimes just the awareness of the thing makes the thing go away.”
• “When you’re really in the moment, just throw a big red stop sign in your head. What you’re doing is actually stopping the subconscious chatter. That alone can elevate you.”
• “If you’re still trying to get to that next level, then you have to pay attention to what you’re saying to yourself at this level. You have to hear what you’re saying, because it’s dictating your reality.”
• “It’s the ‘taking action’ that’s the hard part.”
• “None of it is a big deal. Relax.”
• “There’s two ways to manifest. There’s the manifest by force versus when you open up and let the universe and all of its power flow through you.”

More about Kirsten Franklin

Kirsten is a world-class rapid transformation coach who has helped change the lives of over 1000 individuals. She is the brains behind the unique MVP method that is responsible for helping her clients rapidly transform their Mindset, raise their Vibrations, and modify their Processes, so they can achieve their dream lives.

She helps people overcome fears, adversities and traumas while improving their clarity, focus, performance, communication, relationships and thinking, so they can fulfill their ambitions. Many of her clients are seen as being highly successful and seek her out to help them define and achieve their next-level.

She has spent over sixteen years studying mindset, positive psychology, behavioral science and neuroscience and she is a master of techniques such as Neuro-Linguistic Programming (NLP), Strategic Intervention (SI), Cognitive Behavioral Therapy Coaching (CBT), Timeline Therapy, Mindset, Mindfulness, Meditation and more.

Kirsten received her Juris Doctorate from St. John’s University School of Law in 2001. Now retired, she owns multiple companies and is the CEO of CS Thrive, a coaching and consulting company that helps executives, founders, small business owners and athletes become unfu*kwithable in their business and lives. In free time, she is the host of the podcast Girl on Fire; writes for “Mind-Flux,” a publication she created on Medium.com; writes fiction and non-fiction books, and hosts live events. She has been featured in Thrive Global, NBC, CBS, and Fox.

Suggested Keywords

Mindset, Mindfulness, Fears, Psychology, Behaviour, Therapy, Awareness, Manifest, Conduit, Abundance, Action, Reality, Subconscious, Liberty, Results, Outcomes, Positivity,

To learn more, follow Kirsten at:

Website:          https://www.kirstenfranklin.com

                        https://www.csthrive.com

Podcast:          https://bleav.com/podcast-show/bleav-in-girl-on-fire

Facebook:       Kirsten Franklin

Instagram:       @kirsten_franklin

Twitter:            @CSThrive

LinkedIn:         Kirsten Franklin

Clubhouse:     @kirstenfranklin

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

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Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart

iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

Read the Full Transcript: 

Speaker 1 (00:01):

Hey, Kiersten. Welcome to the podcast. I'm so excited to have you on. So thanks for joining me today. Thanks Karen. It's great to be here. It's nice to see you again. I know, just so everyone knows I was on Kirsten's podcast a couple of weeks ago, and we will talk all about that podcast and where people can find it a little bit later, so you have to wait to get the good stuff. But in the meantime today, we are going to talk about mindset. So I feel like mindset can mean a lot of things. So what is it really? Yeah, so that's a great question because it's one of those words like coach or like this, or like that, that we hear all over the place and for me in the way that I use it. So it was actually originally coined by Carol Dweck and she was talking about eight thought process, like being fixed or growth mindset, meaning you believe that you were given a certain sort of limitation and that's the highest you can go and that's fixed.

Speaker 1 (01:04):

Right? And that no matter what you do, you'll never going to go and surpass that level of ability. And growth is one where you feel as though, you know, you have the ability to change it, right? You can, you can go beyond the quote limitations. There are no limitations. And the way that it's sort of been more used frequently is in discussing the subconscious mind. And that's something she references back to because that's actually where all the magic happens. And you know, the way I use it is really talking about that subconscious language. It's about the core beliefs that you hold about yourself. It's almost like the rule of law that you have decided is true for you and you're going to live by it no matter what, Hey, even though you don't really know, you kind of created those laws. So it gets a little tricky in that people understand the difference between conscious and subconscious, but as you talk to them, they really believe many times that they know what they're thinking.

Speaker 1 (02:02):

And the funny thing is is you don't until you catch it and you really kind of latch on and you're like, oh, why did I say that that way? Right? And, and you kind of have to dig into it, but you can, you can understand your deepest core beliefs by the language. And actually just take a look around you. Is there something in your life that you don't like, or maybe you're kind of feeling attracted towards or repelling against, then there's something out of alignment in those core beliefs, because whatever you believe is what you're going to see in your reality. And so when we use the term mindset, is that dependent upon our core beliefs? You know, or is this, I mean, obviously mindset is something we can change, but if people say, oh, well I have these core beliefs and they're not going to change.

Speaker 1 (02:51):

So then how can the mindset change? Does that make sense? Yes. And actually there's a perfect example. So a lot of times I like to ask for questions when somebody is in a certain emotional pattern, right? Let's say, oh my God, I have anxiety. I can't drive over bridges. Right? Like, or, or whatever it is. So I'll ask four questions and I ask the first question, like, could you let that feeling in like, are you willing to just feel it? Because if you're not willing to let it in and you're constantly pushing it away, well, you can't get rid of it because you're, you're, you're not willing to work with it. Right. The second question I'll ask is, do you believe it's even humanly possible for you to eliminate the feeling of anxiety? Could it ever just go away? Right. And these are just yes or no questions.

Speaker 1 (03:35):

And if the answer, yeah, I think I could get rid of it. Like that's totally possible for me. Right. The next question I would ask is, would you let it go? Are you willing to let it go? Okay. And again, it's a yes or no. The reason I ask these questions is a yes or no fashion is at any point when you say no, no, I'm not willing to let it in. Then you can't let it go. No, I don't believe, I don't believe it's possible that I could just eliminate it then. Guess what? You will not eliminate it. Right? No, I don't. I, you know, I'm not really willing to let it go. Okay. Well then, you know, you're going to keep it for some reason, right. Or if you say yes, all the men in the last one says, okay, well, when, when are you going to let it go tomorrow?

Speaker 1 (04:15):

Okay. There's a reason why you're not today. Right? So, so the thing about what you had just said is that whatever you believe is going to be true. So if you believe it's not possible, it's not going to, it's not going to, it's not going to be possible for you. Right. And so, so it's a, it's a, it's a tricky little thing, you know? And so how can we, how can we change our beliefs? How does that work? That's a, that's a long process and a short one. So you can actually just change them. That's the fastest way to change them is to literally just change them. What is it that you wish you believe? What is it that you hoped you live? How is it that you would hope things would be, and then just believe them? And it's actually that simple. Now I know a lot of us thinking like, yeah.

Speaker 1 (05:06):

Okay. You're funny. I, I that's. I'm like, yeah. Okay. Yeah. Right. But I want you to think of the moment. There has to be a moment in your life where you're so off. So fed up, so done with something that it was done. You're never going to take that, do that, see that, feel that again, and you walked out on it. Like it typically happens in relationships. I'm never going to have that. You don't, you're done, never happened again. Right. Because you're done because whoever you were that got yourself into that situation, you were done with it and you were not willing to accept it and you won't ever accept it again. Right. Whether it's like somebody who speaks to you in a certain way or does something or whatever, or even the way the grocery bag of groceries, you know, bags of groceries.

Speaker 1 (05:47):

You're like, yo, you like it. You know, it's just done. That's the same thing in our head. Sometimes we can just be so over something that we're done with it. And it changes right there in an instant. Right. and then more typically it's we think a lot about how we wish it could be how we wish it should be, should be as a, as a dangerous one for me, because it's a comparative thing. Oh, I should be here, but I'm not, oh, like, I shouldn't be married, but I'm not, oh, this should be this way. And that starts a spiral of depression because your life doesn't look the way you want it to, then it's no good and it's all wrong. And then it comes down. And as you know, when we have these stressors and emotional things, they come out physically. Now you have neck pain.

Speaker 1 (06:33):

Now you, now you get headaches. Now, all of a sudden, your knees hurt. Right. If it's not a physiological difference, then it's typically coming from an emotional space it's coming from inside. Right. So how do we change them? I mean, look, I'm going to be totally honest. You can like, go, am I allowed to swear? I'm going to try not to sweat. You could like Google this stuff. Okay. Like there are affirmations, there's hypnosis. There's, self-hypnosis, there's positive cycles. There are a million different ways. And I don't believe in one size fits. All right. So I could lay down some techniques right now. And you know, a third of y'all will get it, do it, try it. It'll work. A third of you will be like, yeah, I'm not even bothering. And a third of you will try it and it's not going to work.

Speaker 1 (07:13):

Right. But even that is in your head. So if you are someone who doesn't believe that talking things out helps anything. Then if my method is talking things out, then it's not going to work for you. So that's the power of our brain. Let me tell you how powerful our brain is. I was just having this conversation. So, you know, I was talking to somebody and there's a blind spot. So meaning your eye, witness identification, all stuff, all bad. Why? Because we interpret things so differently and we can create blind spots. So you ever had that moment where you're like, oh, can you get me that book on the shelf? Right. And the person's like, I don't feel like getting you up, but you're standing right next to the shelf. Just grab it to me and give it to me. Okay, fine. What's the book it's not here.

Speaker 1 (07:55):

Right. And all the fighting goes back and forth. You finally get up from your seat. You walk over to the shelf right in front of the space is the book he or she literally couldn't see it because somewhere the command was given no book. You don't have to get it. You don't want to get it. It's not there. This is stupid stuff. Right. And so it literally happened. And so it's kind of crazy. Like, I can't tell you all the science behind it because we're studying it every day. In fact, you and I, before this, this packets were just talking about how they figured out. They think the, the place in your brain that lights up when you're deciding whether something is going to get stored in your subconscious mind. Now that's a really interesting place to play because I mean the magic that we can make happen right there, who knows.

Speaker 1 (08:40):

Right. But you know, it's, it's many different techniques to change it. You know affirmation again, you can Google that, you know, but it's really important because what you deeply believe will always play itself out for you. So I always tell people, take a look around your life. If there are areas or places that you are just simply unhappy, you really need to dig into your beliefs about yourself, the way it's supposed to look how it's supposed to be, and you'll see how that's playing out. Yeah. So I, it sounds to me that you're saying not, there's no one size fits all for this. And I think that's the realest answer. You know, like you said, I can tell you this or this, and it might work for some and not others. And so it sounds like you need to figure out what is going to work best for you and then seek that out.

Speaker 1 (09:42):

Yeah. And it's a testing thing, right? I mean, you really do have to go through things. Like I have a mindfulness email that I send to everyone it's 52 weeks. And why, because it's literally 52 different ways to practice the same thing. Right. Mindfulness. Right. But the goal is, is that okay? You try it one week. Some people get bored with stuff really easy. Right now it's a new thing they could do every week. Right. But the goal is that at the end of it, it doesn't matter whether you picked up or found your thing, you just did it for an entire year, 52 different ways, but you did it. So at the end of the year, you still have the result, even though you didn't realize you were kind of doing that, you know, here I'll, I'll tell the audience one thing that they can do that works for everyone period.

Speaker 1 (10:23):

And it's only if you do it. So just remember you have to do it, actually do it. And it's something I do with all my clients. And it's called no negative and try it for a week. Try for a few days, it's really about awareness. And what I started them off doing is I literally have them take their phone, their stopwatch feature on their phone. When they wake up, they started the very first instance where they feel, say, or do something in the quote negative. They have to hit the stopwatch button, record the time, write down kind of what it is. They were doing, what it is, they're feeling what it is or how I was saying. So you wake up, you hit this, do you start the thing? Like, oh crap. I got to go to work. Gosh, 12 seconds, 12 seconds elapsed. All right.

Speaker 1 (11:06):

Oh crap. I have to go to work. All right. Start the button again. Okay. Brushing my teeth, got to pick out clothes. I got dressed. All right. Hit the button. Right. And, but that's it because you'll see, even by the end of the first day, people are shocked at how many, how many, but also how often and frequent things come because you live your life on autopilot all day. You don't realize that you're living sometimes in this hugely negative space. You think you're fine and you can't figure out why you're grumpy by the end of the day. Well, if you're telling yourself, oh, every five seconds, this isn't good. That's bad. Oh no. We've got to think about this. Yo of course, you're going to bring your vibration down. And your day is going to suck by the end of the day, every day. You know what I mean? It just is. So, so that's a technique I like to do. And that's only part of the technique, but that, that, that level of awareness, just as eye-opening most of the time. So that's a fun one to do. Oh, that's great. I'm going to try that. Oh gosh. Look, I'm already negative. No, no, no, no.

Speaker 1 (12:08):

Yes. All my new Yorkers let's do it. We all know how we are. We think we're funny. We're really like sarcastic and negative. Yeah, exactly. Oh my gosh. Yeah. I'll try that tomorrow. And we'll see what happens. I will report back to you. So, so obviously we know mindset is something that can be altered. Can't be changed. It can be positive. It can be negative. So how does that affect our outcomes and in how we live our life every day? Yeah. So, so let me give you an example. I call it the kindergarten story because I think it's kind of common for a lot of us. So I want you to imagine that you're in kindergarten. If you're listening to this outside of the country, it's a one year about four or five years old. It's the first level of school you go to here in the United States.

Speaker 1 (12:58):

And we have this thing called Valentine's day. And at the kid level, we just, you know, get a bunch of candidates together, throw a bunch of cards and give one out to each member of the class. But sometimes there's that special Valentine. Right? So, so let's say little care. It's kindergarten. And she's all excited. Turned her mom made all the little Ballantine things she's handing out. But Joey, her best friend, well he's has the special Valentine. And she's going to ask him to be his, be her beer Valentine. Right? So Karen goes up to Joey, we made a special bone. That'd be, will you be my Valentine? Joey loves comedy. He says, oh my God, Kimmy just asked me. And she's super cute. I'm going to totally be here Valentine. Now little Karen's like, wow. Now little Karen's had picked up this message, but it wasn't said, but this is what you heard.

Speaker 1 (13:46):

You're ugly. You can't get the guy. Oh, and Kimmy with brown hair and purple eyes. She's that's that's that's the ultimate cuteness. Like that's that's it. Now she's four. She goes home cries. Mom, mom fixes it. Everybody has dinner next day. You're for you, Joey and Camy. By the way, you're all besties. You're hanging out. Like nothing happened. You, you feel like you don't feel it. It was a split-second. It was a moment it's gone. It's not really gone because let me tell you what happens now. She matriculates she's in middle school and Karen has to ask a boy to a dance. It's one of those Sadie Hawkins thing. So the girls have to ask the guys. And so her and her bestie and most people at this age have faced some kind of rejection, whether it's in the girlfriend, boyfriend, lover section or, or any other part, like not getting the baseball, you know, position, whatever it is.

Speaker 1 (14:34):

So we understand rejection. So we're fearing a little bit and we're nervous. So it's natural. Right. And everybody will tell you that. Oh yeah. It's natural. Don't worry. Just go ask anyway. So you and your Bessie, of course, it's Kimmy go. And you're like, okay, all right, we're going to ask our guys. So Kimmy goes first. Can we ask the boy? And he's like, yeah, sure. What out? Right. So Carrie was like, yeah, I'm going to ask Tony. She goes up to Tony. She asks him. Tony was like, man, I wish I could go. But I can't. Now what Karen doesn't know is that Tony is a son of the local preacher and he's not even allowed to go to school dances. Tony is secretly actually in love with her. But he has to say no anyway, but all Karen hears, not consciously, but subconsciously because she doesn't remember five years ago, she all she hears subconsciously is yo dumb.

Speaker 1 (15:19):

Don't you know, you're ugly. Why you try to do this? That making a fool of yourself. You know, you can't get the guy just stop. You are not pretty. You are not enough. You can't get him just up. Okay. Underlying, underlying thought the overlying crunch thought, oh man, I can't believe it. I'm so to the point and maybe he doesn't like me, right? Like, why is it so easy for Kimmy? Why isn't it the same for me? Like, it becomes that now you can't leave Karen out. Karen's like, all right, she's going to high school. She's like, you know what? I don't even care anymore. I'm bringing to the new high school, new me, everything. She goes out, she becomes a head cheerleader. Everybody loves her. She's popular. She's gorgeous. She's smart. She's funny. She's nice to everyone. And so she's, she's the girl, there goes Joey from kindergarten.

Speaker 1 (16:08):

He's the captain of the football team. And you guys are of course still talking. So Hey, what up? You start dating on the outside. It it's like the ultimate thing. Like, you know, you've made it right. You've arrived. Like this is it. Like, this is everything that everybody dreams of. Right? Prom, king prom queen. We're going to do it. You know, Joey's all happy. But Karen Karen's like, dude, Tom feels weird. Why doesn't it feel right when you think he's cheating on me? Like you think like, what's going on? Like, like I know we, we look so good together. It looks, it looks like it should be perfect. This is actually everything I ever wanted since kindergarten. But I dunno. I think, I think, I think he talks about, look at, look at him, smile. Look at him, smile at that girl that just walked by.

Speaker 1 (16:51):

Look at him, say hi to everybody. Right? She starts going, yo crazy lady. I take taken his phone, looking at his text messages. Eventually poor Joey. Now she's creating damage and Joey, but you always like, all right, forget it. I can't, I'm done. Right. And then Karen thinks, oh yeah. That's because you're right. Your cheater, you're doing something right. And she has to solidify in her mind. What's going on? So now Karen gets smart in college. She's a psych major. She's not going to play this game. She thinks she's good. She finds herself a man, they get married. They have kids. But again, something's not right. Like it feels wrong. Like it doesn't feel good. It's supposed to feel amazing. Right. But, and then she starts picking on things like, why can't you take the garbage out? Why can't you take it on time? Why can't you put it in the bin?

Speaker 1 (17:36):

Right. Right. And all this weird things has nothing to do with the garbage in the bin. And it has to do with this internal, emotional strife that she can't release because she's not quite sure why she doesn't feel right. But the truth is it's because she's too ugly to get the man, this man she doesn't deserve. It's not right. He couldn't possibly be there for the right reasons because she's not good enough like that. And it plays out in this way. That's why it's important. Because every day when you wake up and you have those negative thoughts and you enter these scenarios and things come crashing into your universe, it's usually in your head, that's created it at some point or is receiving it in some way. Right. And you're being reactive, like a five-year-old to it. And you don't even know you're doing it.

Speaker 1 (18:18):

So if you want to have a nice, happy, easy, joyful life and wake up bounding out of bed, like if a kid on Christmas, this is the head game you got to play with yourself. It takes work. Right? No. Yeah, yeah. Yeah. I mean, you know, just like anything else, it does take, it takes consistent effort in, in getting it done. And actually to be honest, sometimes it doesn't sometimes just the awareness of the thing makes the thing go away. But you have to remember, you have been imprinted every second of every day, since before you were even born in utero with an impression and emotion, something okay. To date. So if your brain decided to take all those impressions and make a big deal out of them, well, you're going to be undoing a lot of stuff. And that's why it's layers. That's why it's kind of like, you know, when I'm working with CEOs that are, you know, in multimillion dollar companies, and now they're about to go into something and like close to a billion and they have all this stuff going on.

Speaker 1 (19:13):

Or, you know, I was just talking to an athlete who started a business and he was like, I should have been so much further. And you know, and you know, we broke it down that the work that he did to become an athlete, to become an MMA fighter is not the same level of work he's doing in his business. Right. He, he, he practiced every day. He, you know, ran, kicks every day. He had people watching him, critiquing him, helping him, mold him. He spends like three hours a day in his business, but he wants it to be a superstar rocket, you know? And it's like, well, you didn't get into the octagon and fight and win your first fight by, you know, being around for three months. You've been in this business three months. But you think you should be like a millionaire, like where is that coming from?

Speaker 1 (19:54):

Right. So it's, it's, it's all it's, it's it's in your head. Yes. I, I understand. I get it. I get it. I do. Now let's talk about, if you have something let's say in your life that is not going maybe the way we want it to, which let's be honest. I think that happens too. Can we say everyone at some point? Oh, of course. How can we leverage our mindset to change this so we can change our results? Okay. So I'm gonna, I'm gonna, I'm going to go a little woo on you here. So it's a combination of your thoughts and your energy, right? And so you know, just to, to focus on the mindset aspect of this, you can really dig into, you know, how would I deal? You have behaved, have responded, have done something. And how did you, you do it.

Speaker 1 (20:55):

What's kind of the difference. And how do you step into ideal you? How do you make decisions from that higher place? Right. just taking business, you know, let's say you're going to go into, I don't know, marketing and you have to pay marketing people. Well, you, you might say yeah, that's really expensive. I'm not doing that, but higher, you might say, Hey, actually I understand the long-term game. I'm willing to wait it out to six months. It'll probably take for me to recoup money back and let's go for it. Right. I would ask the right questions and it would know the right information and it would make the right decision. Right. So, I mean, when it comes to mindset and looking around your life and finding the things that you don't like, that's the start, but now what are you kind of leaning towards and what are you pushing away from?

Speaker 1 (21:41):

What have you settled for? Okay. Like notice that, because a lot of times in our lives, we settle for certain things. We want this ideal image, but then we're like, oh yeah, it's okay. You know? And so look at all these things because they all add up. I mean, there's a, there's a bunch of questions you can ask yourself, but I would really just start with, where are you, where did you want to be? Why did you want to be there? That's a big question. Okay. So, you know, think about all the people that go to college at, went to college and pick a major that had nothing to do with them. Right. you know, I wanted a big house in New Jersey when I first became a lawyer because I grew up and that's what everybody had. I didn't realize I don't even want to live in New Jersey.

Speaker 1 (22:25):

And I don't think Jesus, you know, I mean, like it, but because it was so familiar to me, I thought that's what I should be doing. And I wanted nothing to do with it. And so it caused every time I wanted to go look at property or do something, it always fell through, it always didn't happen. Well, it was the universe saying peace woman. Like, what are you doing? Just stop. But in the, my reality in that moment, it was frustrating. Like I tried so hard trying so hard and it's not working out. Right. And it was just like but you do get the signs. I mean, I think the biggest thing is, you know, again, with no negative, you start to look at your stressors too. You start to see the common themes of what you're saying to yourself, what you're hearing and really stop.

Speaker 1 (23:08):

You know, one of the, one of the, another thing that I love doing is when you're really in it in the moment. And when you're super about to be reactive, you know, about the Chuck that, that coffee across the room, just throw a big red stop sign in your head. It's called a pattern. Interrupt to stop, throw the sign in your head, just see it and just stop, stop, stop, stop, stop, stop, stop, stop, stop. And just stop. Because what you're doing is actually stopping that subconscious chatter. When you do that, and that's like an immediate thing that you can do that you don't have to deal with everything that's going on around you, because sometimes you can't because it's so in your face. But as long as you stop, as long as you stop that thought pattern, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop.

Speaker 1 (23:49):

Right. That actually just practicing that alone starts to stop the mental pattern that you have going on. All you have is a mental pattern, a little talk pattern, a little, you know, little repeat on loop, right? That's what you're stopping that alone can elevate you like everybody listening to this, you know, if you think of your life right now on a scale of one to 10, 10 million, like, oh, yo upper rockstar, one being like, dude, am I still alive? Like, how am I even still here? Didn't I like do something last week. That caused me to not be here because it's so miserable, right? Like that level. Okay. So on a, on an overall one to 10 rate yourself, then do no negative and stop just the pattern. Interrupt. Stop yourself every time. You're when the, when the bar reset. Isn't fast enough. Stop. Stop, stop, stop.

Speaker 1 (24:33):

Stop. When the dog just, you know, somebody else's dog ran across your foot. Stop, stop, stop, stop. Stop. When a door closes on your dress, your skirt, and you're about to get stop. Stop, stop, stop, stop. Just stop. You don't even have to think any further, just stop that's at the top. Move on, do it for a week. Now again, one to 10, how do you feel rate yourself? Your number is going to go up and then your brain is going to start with this. Oh, but nothing changed. Why do I feel? But, and then you're gonna question it don't it just is. And it's actually just that easy. So excellent. That's a great exercise and very, very easy. Anyone can do that. It takes nothing. You just have to stay, say stop. Yep. And those, when that those thoughts start rushing in and we all have them every single day.

Speaker 1 (25:24):

Yes, we all have them. I think that's great. So now, as we start to wrap things up, what do you want the audience to take away from our conversation around mindset? Well, I mean really just the basics. I mean, the fact that it is important, you have to pay attention to it. The reason you're here, wherever that is in your life is because you didn't, maybe you didn't know, maybe you didn't care to, maybe it wasn't as bad yet, but if, if you're still trying to get to that next level, then you have to pay attention to what you're saying yourself at this level. And I don't care what level you're going to or where you're coming from. That's just it, you know, where they're coming from, coming off the streets to your next level, or you're coming from your, your $50 million company and you want to make it a hundred million.

Speaker 1 (26:10):

It's the same thing. You have to hear what you're saying, because it's dictating your reality period. And so it's really important. And that there's a lot of resources out there. I mean, I can give you some resources as well, but you know, there's tons of stuff out there and it really is simple. It's just, it's, it's simple and taking action and everything changes and it can change in minutes. Yeah. It's the taking action part. That's the hard part, right? Everybody can read. You can understand the action that has to happen. Let me tell you, let me just really quickly tell you that that's my too. So you have to live into the being. So let me just give you an example. So I was very athletic when I was younger. You know, I didn't work out at all. When I had my child, my child is now 12.

Speaker 1 (26:52):

At the time that I had to do this to myself, she was 11. And I was like, oh, I'll kind of get into that place where you still look good with clothes on, but not so much when you take them off. So I was like, maybe I should work out. And I thought, oh, this is second nature. I'll just go work out. I live on central park here. So I'll just now. And I did everything. The micro habit, the be dressed in your sleep thing, the sneaker girl, if I tell you that at some point I felt proud that I got out the front door and want a cup of coffee to come back. And that was my workout. And I had to do my own techniques myself, which is what is it? I believe like what happened? I obviously no longer believe I'm an athlete because if I did, I mean, this is easy.

Speaker 1 (27:30):

Right? And that's what I thought I believed consciously. Well, when I dug down to it over the past, you know, 10 or so years, my friends had been getting a little snappy with me saying things like, oh, you eat like an a-hole, you still look good and I didn't work out. So then they knew that like, how do you not work out? And, and we work out 10 hours a day and what's going on. And there was part of that, that seeped into me that was like, oh, that's right, girl, eat whatever you want. Look good. You don't, you don't need that. Right. And well, it worked for 10 years, but obviously I needed to change. And the second I realized that I was letting those things come in, that it was easier to hang out in bed that I always had tomorrow that, and I changed that core belief.

Speaker 1 (28:11):

And I, and I really had to dig down into why, like, I want to be the grandma who like flies through the trees on zip lines with her grandkids. I can't do that in 10 years. If I don't exercise now. Right. I had a drill into my head. Oh my God, I love running by the way. Don't really, but I love running. I love running. I love running the second I did all that stuff. Right. And it actually took overnight. That's all I did. I did it one day. I wrote down the thing. I said it to myself again and again. I said it to myself in the mirror and I was like, yo, you, you have this, like, what's wrong when you have this right now woke up the next morning. I actually ran a whole mile. Now it doesn't sound like much, but 10 years sitting on my.

Speaker 1 (28:47):

Pretty good. That's great. Yeah. That's nice. So it's really convincing yourself that you are the person who does the thing. If you are the person who loves to do all this weird, you know, personal development stuff, and you'd love to say stopped yourself and you've loved it. Guess what you're going to do. You're going to do it. That's it? It's that simple. Yeah. Yeah. Oh my God. That's such a good example. Thank you for that. Now, speaking of resources, where can people find you, your podcast? Talk about the podcast, your resources, everything else. Yeah. Awesome. I mean, you guys can go to just my name.com. So it's Kiersten franklin.com. And I don't know if you're able to put that in the description. And then the podcast is just girl on fire. So if you want to just Google girl on fire, it's unbelief B L E V network.

Speaker 1 (29:36):

You can find it anywhere, apple, iTunes, all that good stuff. Yeah, that's it. Yep. And D and we will have links to everything, to all of her information at podcast dot healthy, wealthy, smart.com and the show notes under this episode. And we'll have your on social media. Do you want to give a shout out to your social media handles really quick? So someone can find you really easily. That would require me to know what they are. Well, it's all on your website. Yeah, we got it. We got it. No problem. We will have, I will put them all in the show notes individually. We're good. Don't worry about it. Now, the last question I always ask everyone is knowing where you are in your life and in your career, what advice would you give to your younger self?

Speaker 1 (30:29):

I would tell myself that none of it is a big deal. It's not as big a deal as you think it is, you know, all that lost time on stressing out and trying to make things happen and living by force, as opposed to living as a conduit where everything's flowing through you. Massive difference. My whole life has been lived by force winning, winning, winning, getting by force. I probably could've gotten the same exact stuff, Ben, the same that, and just nice and easy, you know, massive difference in life. Let me tell you. Yeah, I was relaxed. I love it. And I've heard that several times from people guests on this podcast. So there's clearly something to that. So for all of you, new new grads out there, college kids listening, relax. And I love, can you say that again? You want to be sort of a conduit versus a forest.

Speaker 1 (31:25):

Can you repeat that one more time? I mean, I, you know, listen, there's two ways to manifest, right? There's the manifestor force, right? Like, like you're going to get it. You're going to get it. You're gonna do everything class. We're going to fight, fight, fight. It's by force and you're gonna get it versus actually when you open up and you let the universe and all of his power flow through you, you're going to get the same things only. It's nice and easy, right? When, when something doesn't happen or someone candles or it moves when you know that it's okay, that it's all just going to be fine. It's your life flows through you. You are a conduit. I it's true about finances, about love, about anything, right? If you, if you're having financial difficulties, right. And this is going to sound crazy, I know it's gonna be painful for some, but if you open up and you just let it flow through you, all of a sudden you're going to just have more and more and more money, right.

Speaker 1 (32:15):

Because it's not about you getting money. You're the conduit. So the university saying, all right, I'll throw money at you because you're giving it here. You're helping people there. You're doing this. Right. And it just, just like, love like energy. It's just things you're, you're, you're a vessel it's supposed to come through the gifts that God gave. You are not for you. They're supposed to float through you so you can help others. If that makes sense. Yes. It, and thank you for that. I love it. So Kiersten, thank you so much for coming on the podcast and spending the time with us today. I really appreciate it. Absolutely. Thank you so much for having me. It's so fun. I always love seeing you. Yeah, my pleasure, my pleasure, and everyone tell the listeners out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, CEO and Founder of Practice Freedom U, Jamey Schrier, talks about creating success by changing mindsets.

Today, Jamey talks about developing a growth mindset to achieve greater success, what the biggest problems are that owners face, and how to ‘fix’ those problems. What’s your goal for the next 30 days? How do you keep your energy tank full?

Hear about the different growth mindsets that owners get wrong, reacting versus responding, and get some valuable advice on how to grow and become more successful, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• “How someone thinks determines the actions they take, and the actions they take produces results.”
• “The eyes only see, the ears only hear what the brain is looking for.”
• “You have got to look at a yourself as the owner, the CEO, the entrepreneur, the head honcho.”
• “Being busy is not an owner mindset.”
• “You have to slow down. You have to pause. You have to spend more time getting out of the immediate present.”
• “The biggest problem with the overwhelmed operator is there’s not organisation in place, there’s not systems in place, there’s no control over one’s time.”
• “The more you can bring people in an organised, systematic way, the less overwhelmed you’ll be later on.”
• “The best is yet to come. The future is brighter than the present and it’s brighter than your past.”
• “Business is all about trying things, failing, learning, and trying again.”
• “What you focus on, what you pay attention to, grows.”
• “You don’t know what you don’t know, and you never will no matter how smart you are.”
• “It’s not enough to be busy - so too are the ants. The question is, what are you busy about?”
• “Keep your tank full.”
• “Reacting is an emotional response. Responding is a rational response.”
• “When things get busier at the office, there’s one thing that you sacrifice more than anything else - that’s your self-care.”
• “You don’t strengthen the weak by weakening the strong.”
• “Overcome your ego. It’s okay you don’t know everything. Enlist some help. Invest in your business. It will pay off dividends in your future - not only to you, not only to your family, but for everyone that’s around you.”

More about Jamey Schrier

Jamey is the founder and CEO of Practice Freedom U, and the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion. He is a sought after speaker on systems, marketing, and elevating the patient experience. Over the past decade, Jamey has helped hundreds of physical therapists, occupational therapists, speech therapists, and mental health professionals build their highly successful practices and create more financial security without working longer hours.

Suggested Keywords

Owner, PT, Physiotherapy, Business, Entrepreneurship, Purpose, Mindset, Success, Actions, Thoughts, Leadership, Freedom, Productivity, Busyness, Progress, Reacting, Responding, Self-Care,

Jamey’s Book: The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion.

Discovery Call: https://www.practicefreedomu.com/discoverycall

To learn more, follow Jamey at:

Website:          https://www.practicefreedomu.com

Facebook:       Practice Freedom U

Twitter:            @jameyschrier

LinkedIn:         Jamey Schrier

YouTube:        Practice Freedom U

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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Read the full transcript here: 

Speaker 1 (00:01):

Hey, Jamie, welcome back to the podcast. I am happy to have you back. I always love having you on, well,

Speaker 2 (00:08):

Thank you Karen. I am so happy to be here.

Speaker 1 (00:12):

And so every time you come on, we talk about some aspect of the physical therapy business, which is great because I know a lot of the listeners want to know more about how to run a business, how to be successful, what's going on in the market. So let's kick it off with what is in your opinion, the biggest problem facing physical therapy, practice owners today,

Speaker 2 (00:42):

Karen, you're just going, you're just right out of the gate. Like you're just like, you know what? We're not messing around. Hey, Jamie telling me about yourself or, or give it. It's just, I'm going fast ball down the middle either. You're going to hit it or you're going to strike out and we're going to be done.

Speaker 1 (00:57):

Yeah. They, they, they know who you are. You

Speaker 2 (01:01):

That's a good sign though. Right? what's the biggest problem facing practice owners today? That that's a really great question. And the answer may not be what people might think the answer is. The biggest province, really what, the topic that we're talking about simply put it's how we think it's just that simple. There, there's a, there's a simple formula that, that I've been following for years now, years and years and years. And basically it's just says how we think, how someone thinks, determines the actions they take and the actions they take, including their communication and their stuff. They do produces results. And too many times I've heard people that are not happy with their results, whether it's referrals, whether that's revenue, whether it's profit, whether it's hiring, whether it's retention, whether it's time, God forbid, people want time and control. They don't have that.

Speaker 2 (02:03):

So if you reverse engineer the result back to, well, why isn't the result we want? Is it some strategy? Is it some technique and answers? No. It's how an owner thinks. I mean, let me, let me give you an example. We went to school, right? All your listeners went to school. We are highly educated, very smart people. Now who educated us, right? We had professors in school and we, and, and, and PT school. We had professors who were educating us on what they were educating us on how to be a clinician, more specifically, how to pass the boards, because that is what schools do. They help you pass the boards. So then you can become a licensed clinician, licensed physical therapist. So you do that, whatever one year, you're five years, 10 years, and you have this urge, you have this thing inside you that says, I want to be a business.

Speaker 2 (03:07):

Now I want to run my own thing. So do you go back to school? Most people do not go back to school care and they don't get an MBA. They don't get any kind of, maybe they read a book, hopefully my book, right? The practice, freedom method, plug, shameless plug, but they, they just signed the dotted line. And now they're an LLC. And what are they doing? They are making decisions with the brain that was built and created with all of the information of how to be a talented clinician, which they are. But now that same brain is making decisions around business and there lies the problem.

Speaker 1 (03:48):

Okay. So you just described most physical therapy owners. So how do we fix this? How do we, what do we do if this is, if this is our mindset or if this is where we are, this is where we're thinking. And you know, everybody gets, I think people start their own practice because they want to help people. They want to see patients the way that they feel they should be seen, et cetera, et cetera. Right. So how do we take off the clinician hat and put on the owner hat? Or, or do we split it into, how does that work? How do we fix it?

Speaker 2 (04:27):

Yeah. So there's a great quote by one of my mentors, Dan Sullivan, and it says the eyes only see the ears only hear what the brain is looking for. And we've seen this, right. You know, you're, you're thinking about buying a car. You know, the last car I bought was a Jeep. Right. I bought a Jeep. I've never seen Jeeps on the road. Oh my God. I feel like the whole world has a Jeep. Right. You're seeing them everywhere. Did they magically all of a sudden become more Jeeps in Maryland? No, because you started your, you started to tell your brain Jeeps, Jeeps, Jeeps. So it really starts with recognizing that this is an issue and you don't know what you don't know. And Karen that's, that's hard for a lot of people that was very hard for me because I'm a smart person.

Speaker 2 (05:24):

I did really well in school. So did you, so did everyone, I haven't really made a million mistakes in my, at least academic life course. We wouldn't have been through school, but then you get in the business and you realize that, you know what, I, I don't necessarily know how to do this. Maybe I should get help, whatever that means. Like, I think it's just recognizing that I shouldn't be an expert at all this business stuff, because I'd been taught. I've never been trained. I haven't done self-development and work on that. I think that's one of the biggest things we just need to recognize. We'll get into, you know, I have some specific things that people can do, some tangible things they can do. But I think I just want to get people just to recognize that that's the issue, because if you don't think that there's a problem, even though you're working 50, 60 hours a week, you're not making the revenue you want your, your staff is coming and going, or you can't get them to actually do what you want them to do.

Speaker 2 (06:30):

So you're taking on some of their job, all those things that we complain about, if you don't actually say, look, you have created this model. So the only way to uncreate this model is to start to change how you're thinking about the business. And that starts with how you think about yourself. You have got to look at yourself as the owner, the CEO, the entrepreneur, the head honcho. You have to see yourself like that. That's scary, right? I don't think myself, I'm just a PT. The problem is that's how everyone else is looking at you. And you have to own that. Now you are playing multiple roles here. I've said one time, multiple personalities. It's not really multiple personalities. It's multiple roles, but your role as a clinician own it when you're treating treat. But when that ends, you have got to shift your mind to perhaps the role as the director, and then you have to shake.

Speaker 2 (07:36):

It shifts your mind. The role as the owner, the mindset you have for each of those three is so different, especially between the clinician and the owner, how you see your business, how you see your staff, how you communicate to people. That's very different than a clinical mindset. So I think that's the first thing we have to own it. The, the, the other big thing is success is 90% preparation and 10% perspiration people may have heard that they may have heard it in different types of things. 99%. This 1% that I've heard that before, never really understood what it meant. What does that mean? It means that we are by human beings. We are naturally doers. We do do, do I call up the home Depot model, you know more savings, more doing we're here to help the doers. So doers like to do they get off on doing stuff.

Speaker 2 (08:38):

And then those people like to be busy, busy, busy, busy, which is, seems to be the mantra of everyone nowadays, what are you doing? I'm really busy, but that is very different than being productive. That is very different than being efficient. So being busy is not an owner mindset. An owner mindset is how can I be more productive? How can I run things more efficiently? How do I utilize my time? Better? That alone will change what you focus on and how you start putting your business together. So this 90% preparation stuff is all about. How about having time to think about your business. If you're busy all the time, constantly filling your schedule with patients, with meetings, with putting out the fires in your business, just constant stuff. Where's your time Karen, to just think about what is it, where's my business going in the next month or three months or week.

Speaker 2 (09:39):

You don't have that time. You're just on the hamster wheel of doing, doing, doing busy, busy, busy, and the results don't really significantly change or worse. They start to improve a little bit, but they improve only because of the effort and the work that you're doing. So now you're trapped because if you shift that all of a sudden the results will, will go down. So you get trapped by that. So that, that, that motto of 90% per preparation and 10% perspiration and having this shift of you have to slow down, you have to pause and you, we have to spend more time getting out of the immediate present. And that is my first mindset shift.

Speaker 1 (10:30):

Yeah. It's hard to sometimes get out of your business so you could work on it, you know, and how, if you can make that mind shift, I think you still, so you can make the shift of like, Hey, I'm the owner. I need to not just work in my business, but work on it. Be creative, things like that. So what advice do you have for people to, let's say once they've gotten that mindset, okay. I am a business owner. There are other things I have to do here. What, what can they do to get to that, that area of creativity and of, well, let's look at how we can streamline things and be more efficient if you're always like, well, I have to treat patients because if I don't treat any patients that don't have any revenue coming in and that's not good because I don't have a business. Right?

Speaker 2 (11:26):

So unless you bought an existing practice, we all come in as what we call it at practice freedom, you a committed clinician, right? Your solo preneur, that's it. Maybe you have an, a, maybe you have a part-time PT PTA or somebody, but it's really just you. Okay. That's how we all come in. That's how I came in. That's how you started your business. We all do that. Now committed clinician. The biggest challenge, because the challenges are different between the two examples I'm going to give the challenges with that person is, well, you got to get busy and most of your bills, dizziness is going to, or you got to get busy, meaning you got to generate more work referrals and get your schedule busy. So your job is to start delivering great care, maybe going out, meeting some different referral sources. That's what most of us do.

Speaker 2 (12:17):

And your schedule will get busier. It always happens. Then there's going to come a point where you're like, I'm running at a time. Every time I start to mark it by place gets busy. And when I stopped play starts to go down. So we call that kind of, that role of poster. And you start teetering on the next slide level of business ownership. And the next level is called overwhelmed operator. Love that term. I coined that term years ago because it just describes that type of owner. This owner has hired people. And when you start hiring people, you probably don't have a lot of organization and systems in place. You just kind of doing it. You're trying to, you know, I got some good people. I know how to judge people, but you're you still have your schedule. You're still doing your stuff. When you hire people, now you're responsible for them.

Speaker 2 (13:12):

So now all of a sudden this whole HR there's human resources stuff comes into play. Ignorance is an excuse. It doesn't matter if you're ignorant. Like I broke the law department of labor, reached out to me and say, Jamie we got to investigate you because you're doing some illegal acts. What? Well, you're supposed to be paying overtime to certain employees. I'm like, I didn't know that. I thought they were a exempt from that. Like, no, these are exam these. I mean, then all of a sudden I'm like, well, I didn't know that. And I'm like, well, you're going to find out, cause we're going to find you. And I'm like, okay, from now on, I will make sure I have someone on my team that knows that stuff. So what happens with the overwhelmed operator? You start bringing in staff, not only do you have your job now, Karen, but you start taking on other people's jobs.

Speaker 2 (14:01):

Maybe not the whole thing, but you're taking on a little bit of it. Right? And there's reasons for that. The biggest problem with the overwhelmed operator from I call it crossing the street crossing well sometimes. So it's a big, big, huge river crossing over to more of this idea of practice freedom, which I'll get to that in a minute is there's not organization in place. There's not systems in place. There's no control over one's time because you're busy, busy, busy. That's why I started with the idea of the problem is we're not thinking like an owner. You are still an overwhelmed operator thinking like maybe not only a clinician, but you're probably playing the role of clinical director is not an owner director. So leadership position in your company, but it's not where the practice owner needs to be. Right? If you're a director, you need to remove yourself from that position.

Speaker 2 (14:58):

That's where people are. They're in one of those two categories. So if you're, if you're a committed, if you're an owner, if you're a committed clinician, your job is to start bringing people in. But the more you can bring people in, in an organized systematic, having some things in place way, the less overwhelmed you'll be later on, there's still going to be somewhat overwhelmed. It's just kind of part of growing a business, but there's a way to do it where it's not so much. So one of the things that we that, that, that I want to share with the group, one of my mindset shifts that nobody spends any time on. I never did. Cause I thought it was a waste of time, whether you're committed clinician, whether you're a overwhelmed operator is the mindset shift of the best is yet to come.

Speaker 2 (15:52):

The best is yet to come. I won't get into the story around this, but really what it means is the future is brighter than the present. And it's brighter than your past. The future is brighter. You have a vision, you, you have something that you want. Is it written down? Have you taken the time to describe it? John Lennon CRA wrote, imagine, right? Talking about peace and unity. Martin Luther king has I have a dream, not, I have a project plan. I have a dream little kids go to Disney world and Disney land. But when you get older, you think that's stupid. Why? Because you're too busy doing it, doing it, doing it, doing it. You don't step out of the fray and say, where is this all leading to you? And I, before this call, we're talking about you know part of, part of the program that you're taking is focusing on, well, what are your personal goals?

Speaker 2 (16:58):

What's your purpose about what are you about Karen? See, we all have something we're about. And when you start to create that and develop that, that gives you your north star, that starts to give you direction. That's a shift. We all have to have to make, you know, I love Bruce Springsteen like the next person, but let's not have glory days. Our favorite song. Cause that means the best is in the past. So we have to shift that. Why is that important? Because it gives you a a plan. It gives you kind of like the horizon to know the direction you're moving the company. What, it also does, little known secret. What it also does is let people that you're hiring, know what they're a part of. Most of us, most of the owners, at least I can share my own story. Most of the owners I've talked to Karen. They don't have a clue, dental have anything written down a lot of a plan. They don't have a vision. They don't even have, they couldn't even articulate just a dream. Like the, you know, I just imagined the place being like this. It's usually a half a sentence of kind of, sort of, because they're just overwhelmed and busy and that's the place we have to start.

Speaker 1 (18:17):

Yeah. And, and I think getting, making that shift in the beginning, I know I can speak, well, I can speak for myself. Is uncomfortable of like, well, wait a second. I'm not in the, in this role.

Speaker 2 (18:34):

So Karen, why I agree with you, but is it uncomfortable?

Speaker 1 (18:39):

And, and again, I think it's, it's I, and again, I'm just speaking for myself. It's hard to like, let go of that control. It's hard to step away from being the clinician because part of my identity as a person and an owner is wrapped around being a really good physical therapist, not an entrepreneur.

Speaker 2 (19:01):

So what you're really saying is a there's some fear there. And the fear is, and this has been my experience working with hundreds of practice owners. What if I'd only achieve it? Yeah. Karen, I'm not used to failing. What if I don't achieve it, then I'll feel like a failure. I'm already overwhelmed. I'm already feeling bad about myself. I'm already feeling ashamed that I didn't deliver what I said to my spouse and my friends, what I would do when I opened my practice. See, I think it's more about that fear of failure. And that's one of the things we have to learn to embrace because this isn't school, business is all about trying things, failing, learning, and trying again. That is business. And if we want to protect ourselves in a little too Kuhn, you're going to be miserable. And I hate to see that I was miserable for so many years.

Speaker 2 (20:03):

You'll never hear anyone say it because I've been there. I've been in the private practice section. Now for 10 years, I've never heard one person ever telling me they're not doing well. Even though the odds are 85% of them are, how is that? Because it's pride and you don't want to tell people that stuff, but it's really happening. So by writing it down just for you, this is the exercise. Just write it down, create what's your vision. I don't care if you use six months, a year, two years, something reasonable, but just write it down. If anything was possible. And remember anything you want to do has been done a hundred million times before. There's nothing you're going to want that some other company hasn't created. So it's not like it can't be done, but anyone that helps you, you come to me, first thing I'm gonna say is, well, what do you want?

Speaker 2 (20:58):

Well, I don't know. Then how can I help you? I don't know what you're trying to keep. If you're going to hire someone, a good somebody, a good person that is going to work for you, better ask you. So what's your vision? Where are we going with this? Because they're looking at themselves as what is my growth opportunity here. So it is your duty as an owner. And to your point, yes, we as practice owners have an identity crisis. We actually don't know who we are. We have to embrace the fact that we are in owner. I know I'm going against what probably people have said before. You will always be a PT. Yes, you will always have a license. You always be a PT, but mentally you have to embrace it. You're an owner because you chose to go into business ownership. You didn't have to, it's a free country.

Speaker 2 (21:49):

You chose it. And there is more that you want. So how about we embrace it? And when you embrace it, it's amazing what you're going to be able to achieve. And you're going to make this whole process a lot more easier right now. You're making it difficult because you are battling these two kinds of brains. You're battling that clinical brain, that kilt brain that I don't know who I am. I'm just a PT and all, but I want this. I want to go on vacation for three weeks. Oh, I want him, I want to make money so I can put money away and write a check for college or, or have this or buy this. I want to help more people than I'm doing right now. And right now I'm not helping enough people. So it's your purpose. Your impact has to be the keys to this.

Speaker 2 (22:32):

So that's one thing. I do want to share a, another one. If I may. The other a growth mindset shift is focus. First one is the best is yet to come. The next one is focus. What you focus on, what you pay attention to grows. Now here's the caveat. It includes crap. You focus on a flower. You cultivate that flower. You put that little seed in there and you water it and take care of it. You're going to get a nice blooming flower. You cultivate that piece of crap and make it really nice. That maneuver is going to wreak real good. So whatever. So what does that mean? What's the manure stuff. It's the stuff that you're doing. That's not moving the needle in your business and in your life. It's the things that, although may be important. It's not what you should be doing because you can't do it all.

Speaker 2 (23:42):

And having the mindset of, I gotta do it all. I'm a great multitask. If I get one more person, tell me how great of a multi-tasker they are. Do you realize we are all researchers and science people? There's no, it's impossible for the brain to multitask. It can only focus on one thing at a time. All you're doing is focusing on a lot of one things really, really quickly. And then there's this thing called residue. This delay, right? If you're focused on something for a while and you focus on something else that delay, that thing stays with in your brain for a period of time, come on. You're not going to have a badge of honor saying what a great multitasker you are. Now. I'm not talking about the moms out there. And I, yes, yes. That's a whole nother world and I've seen it with my wife, but I'm talking about business owners, oh, I'm doing this, I'm doing this. I'm doing this. When they do that to me, they do it like they're bragging. And I go, why, why, why would you want to do that? You don't even like half the stuff you're doing. Why can't you get rid of it? And then we get back to the identity crisis. Well, I can't let it go. And there lies the issue. So focus having laser focus is like taking a magnifying glass to your business, letting the sun come in and dialing that energy. That is so strong. It can burn through wood.

Speaker 2 (25:07):

You have to have as an owner. And I've never met a successful business owner, entrepreneur, CEO that didn't have laser focus, never in any industry. Never because they couldn't be in that position. They couldn't have the level of success. I've met CEOs that their company wasn't great. Oh, they're all over the place. I've seen that plenty of times. So I don't necessarily what I had my practice. I didn't call myself the CEO. I couldn't get around that day. Those two corporate is it doesn't matter what you call yourself. Just think of yourself as you're the leader. This is your business. This is your thing. But it doesn't mean Karen that they have to do it all. No one said to dude, do it all. You're making this up. You're taking it all on. And it ain't working. If it was working, I'd be like, keep doing more, do more.

Speaker 2 (26:07):

Don't worry. We'll add more hours to the day. Do more. We'll take more time away from your family. Do more. It's not working. So focus. How do you, do you ever see the video? The invisible gorilla talk about focus, type invisible to grill. It's also called monkey business illusion. So here's what it is. There's six people, three in black shirts. I believe three. And white shirts. They're passing a basketball, right? And the, the, the exercise is count. How many passes? The white shirt? People throw to each other. That's it? That's all the directions is. I've seen it before. The first time I saw it at the end, the person goes, did you see it? And I'm like, see what? That was 18 passes. Yes. The number of passes were 18. Did you see the gorilla? And I went gorilla fricking no gorilla. There was a gorilla that come out.

Speaker 2 (27:09):

I'm gonna ruin it for people, but you have to see it. There is a grill that comes through the screen that starts dancing around and then walks off the screen. 50% of the people that see it, don't recognize it. Gorilla. This was a psychology experiment by, by the person that who the psychologist who did this. So being the smart Jamie, I just watched this the other day too. I've watched another version of it. Here's what's crazy. Of course. I saw the gorilla cause I was looking for the gorilla, but you know what? I didn't see. I didn't see the background completely changed colors. I didn't see one of the people that were passing the ball leave, like it's wild. What the brain is looking for the brain will see. So we have what's called and I don't want to get too technical here, but we have, what's called a bias. Our brain has a bias. Every single one of us, more specifically, it's called a negative bias. No matter how much we think we know, we can't think outside of our own bias.

Speaker 2 (28:17):

So the way you can kind of play with this a little bit is getting very clear at what you are focused on. Thinking through what you're focusing, then executing the plan. That's the only way to get through the bias except to have. And this is what I absolutely recommend. Someone else, someone else that's mentoring or coaching you, you don't know what you don't know and you never will, no matter how smart you think you are. And that's one of the problems we have because we are very smart people, but intellectually smart around physical therapy and anatomy. Yeah. That's great. But that's not going to help you with your business, right? So what you focus on, what you pay attention to grows. If you want more referrals, if you want more time than focus on the things that are going to help you do that.

Speaker 2 (29:17):

But the mindset shift is you have to be very honest with yourself. You have to ask yourself, do I like the results I'm getting? Do I like the income? Do I, I know we feel really weird about money and income, but it does pay the bills. Right? Can't pay the bills in likes, right? Oh, I got a thousand likes. Okay. Well how much you make nothing. Okay. You know, it does take money. It's okay to make money. What about time? Do you have control of your time? We call it freedom of time. Are you controlling your schedule? You're missing your kids' games. Are you missing events with your friends? Are you doing notes on the weekends? And so I was talking to someone yesterday, say, Jay, man, I do notes until 12 o'clock at night. I go, this is your business. And he goes, yeah, I'm working for a lunatic right now.

Speaker 2 (30:06):

Right. But that was kind of funny. So so that's, that's the thing. So I like to break it down for most of the committed clinicians and overwhelmed operators out there. 30 days, we, we have, we have a tool called a 30 day sprint. You can use that to 30 day goals. What's your goal for the next 30 days? Not 90, not a year, 30 days. What does it do you want to accomplish and choose one thing. Karen, just blend it because it's going to be hard for you to choose one because you're used to doing 20 and not achieving really any of them at least completed. So that's, that's an exercise that everyone can do. What area do you want to improve? Like I said, I gave you, I gave a bunch of examples. There's one, there's one code. I'm not monopolizing this conversation about, you know, that you're like, this is great. I have Jamie on 32 minutes. I'm like, thank you.

Speaker 2 (31:06):

I'm still answering the first question. Right? Henry David Thoreau. Great, great quote. It says it's not enough to be busy. So two are the ants. The question is what are you busy about? So by focusing more, you change your busy-ness to being intentional with what you're doing, that moves to being productive. The difference between productive and busiest productive is moving towards something that is desire busy. It's just activity. And there's a whole dopamine thing that we all have in our brain that, oh, but when I'm busy and I, I, you know, I take a post-it note and I throw it I feel so good about myself. I'm like, I know it's that quick dopamine hit that you achieve something. But the reality is you throw all of them away. You keep creating new ones and then you step back a little bit and you realize you haven't moved anywhere.

Speaker 2 (32:02):

You're still kind of doing the same stuff you were months ago or even years ago, you know? There's a, there's, there's, there's one more thing that we have, do we have time? Are we good? We're good. There's one more thing I wanna, I want to leave your audience with a growth mindset tip. And that is and this is probably now not probably it's the most important one and that is keep your tank full. And when I re referred to the proverbial gas tank, I'm referring to your energy level. We have all been in places where we are exhausted. Our energy is zapped. Our brain is fried and we just want to be left alone. If you have kids, you've been there many a times. If you have lots of patients, you've been there many a times. If you are running a business, you've been there many a times. If you've got annoying friends, you've been there many a times.

Speaker 2 (33:05):

And if something happens when you are in that state of just exhausting fed up, what's happening is your energy take low, near empty. A problem happens. How do you see that problem? Well, according to research in our beautiful little amygdala or my daughter calls it, the Amy, the gala, when emotion is high, such as when you're exhausted, fed up too much, intelligence is low. Your brain is hijacked. This goes back millions of years ago. When the Tiger's coming after you, you're not going to rationalize the tiger. Your body's going to go into overdrive and start running. However, what hasn't changed, even though we've transformed and we've we've, we've, we've, we've got all this new way. And in the neocortex, this is all old school brain stop. Something can happen. And you'll still get that feeling. You'll still get that emotional, like, oh my God, I got to react to something.

Speaker 2 (34:12):

And when your energy is low and your tank is low, you start to make really bad decisions. And when you make a bad decision with your friend, you yell at her, right? You yell at your friend, you yell at your kids, you yell at your spouse. You yell at your boyfriend and girlfriend, whoever you yell at people. And then later on you say, I wish it ends. I apologize. I shouldn't have said that. But when you make a bad decision in your business, oh boy, this is a decision that will, that could cost you thousands of dollars or tens of thousands. I've seen hundreds of thousands of dollars with literally one decision. It can cost you employees. It can cost you culture. It can cost you time and it can cost you a hell of a lot of frustration. Now imagine you're making these types of decisions, some grander than others, all the time, that's what's happening.

Speaker 2 (35:10):

Karen, we are making way too many decisions when our tank is well below halfway, and we're doing nothing to bring our take back up to full. What is a full tank? A full tank is your highest, most creative, innovative place. It's the place that you just feel on top of the world. It's the place of the highest level of confidence. It's the place that your friend says something stupid. And you're like, oh, you're foolish and come on. But that same person says something. When your tank is empty, you're going to bite our head off in business. You have someone asking you a question or someone coming to you for the umpteenth time that so w w if I want to take off next week, what do I have to do? And you just blow up on the person next day. You're like, yeah, yeah. You know, I'm sorry, whatever that person doesn't forget.

Speaker 2 (36:09):

Something like that. And when you start doing that and you start reacting, there's a difference between reacting and responding. Responding is what we do when the tank is full. Reacting is what we do when the tank is near empty. Reacting is an emotional response. Responding is a rational response. So what can we do? The fastest thing you can do when your tank is down is evoke physiology. What we do. So what's going to turn around deep breaths, count to 10, take 10 deep breaths. I guarantee whatever the problem is, it will subside. And you will think differently about it. Exercise. I know for me, when I exercise, God, I feel great, right? Anytime. And I've, I've, I've infused as I'm not perfect at it, but I've infused as, especially the last few years, especially last year during COVID when I think I might've come on here.

Speaker 2 (37:20):

And you're like, Jamie, what's the secret to dealing with. COVID pause. Just pause. Just stop. Just take care of yourself. Take care of your team. Like just personally. So I'm a great thing to do is don't make any decisions until after you exercise. I don't care if it's a walk. I don't care if it's, you know, basketball, I'll give it a round of golf. If you consider that exercise whatever it is running, you will think differently about the issue. If you have a problem with an employee, take some deep breaths and pause, do not address it in a high level of emotional state. This, if you just stop doing this so often, I will promise you, your business will get better. I promise because you'll just stop making these decisions that you don't even realize. We don't even realize we make these decisions, but then all of a sudden problems happen.

Speaker 2 (38:16):

And then we justify why. And I guarantee, at least with me, the justification was well, Jamie it's because you're in a high emotional state. That's why this problem. No, I started looking for someone to blame. I look for the prop, the answer to the problem, somewhere outside of where it really came from, that gets expensive. That causes you then to hire people you shouldn't hire to pay. I mean, I paid so much money in marketing and stuff like that. Why I was in a really bad emotional state. And I was just trying to solve it, writing a check on it. Wasn't it, it wasn't, it, it wasn't a rational thought through issue. And I did that again and again, and I did that with a lot of other problems too. So you know, when emotions are high intelligence is low. Karen, this is an opinion.

Speaker 2 (39:09):

This is a fact. We like facts as PTs. This is a fact. So pause 10 seconds, 10 deep breaths exercise before decision. And you don't have to wait for your, for your tank to get low. I know we do that. Like I'm, I'm one of those. Not only does the light come on, but that, that thing gotta be at the line. Or even below the line for me to go to the gas station. We can't do that with ourselves. When that thing gets around half, half full it's time, start, start doing some things, put this into your regular routine. Here's what I've learned over the years. I didn't realize this. So I started talking to a bunch of people around this particular point of keep your tank full. And I don't know the exact number, but it's overwhelmingly more than I would say, 80%. When you, when you get busier, when things get busier at work in the office, there's one thing that you sacrifice more than anything else. That's your, self-care you exercise. Normally you stop going to the gym, right? You do yoga, you stop it, you meditate, you stop it. You go, you stop. The thing that actually is keeping you sane and keeping you mentally strong and mentally fit. That's when you have to pause and saying, I'm the most important person in this company, my thinking and how I think about this business affects everyone in the business, including the staff and the patients and the community. So when I'm feeling like that, I know it's time to do some serious take care of me time.

Speaker 1 (40:57):

Yeah, absolutely. So now, if we start to, we'll start to kind of wrap things up here. So I just want to review some of the things that you said that physical therapy owners can do to kind of change their mindset around them being clinician, a PT an owner, to help them be successful. So you just talked about not making decisions on an empty tank or a near empty tank. We talked about changing we talked about some little like mindset tricks and tips and things like that. What else?

Speaker 2 (41:40):

Well, the, the three things that specific thing could be talked about, cause a lot of them have to do with that is growth mindset tip number one, the best is yet to come. The exercise for that is take 15, 20 minutes. You can, you can, you can handle that. Write down what the heck you want one year from today, one year from today, if you and I had a conversation and we were going to look back on to this moment, what would happen for you to feel happy about your business, about your bank account, about your family, about your personal life, what would you, what would have to happen? Write that down. I don't care if it happens or not. No, one's going to call you on it, but I want you to go through what it feels like to actually put that down on paper.

Speaker 2 (42:27):

Don't type it out on the computer. There's something special about writing it out on paper, right hand to paper. That's number one, that's number one, number two, focus, growth mindset. Number two, focus. What we focus, what we pay attention to grows. So what are you focused on? One thing for the next 30 days? What is one outcome? One goal that you want once you do that reverse engineer, that and then say, okay, in order to achieve that goal, what happens? What do I have to achieve this week? Say that exact line. What do I have to achieve for this week? Do that four weeks in a row. And I promise you, I promise you, call me out. If I'm wrong, you will be either hit the goal, go way past the goal or make significant progress, which you won't be is where you are. Excellent is the 80 tank.

Speaker 2 (43:28):

Keep your tank full. If you get into a high level of emotional state resist making decisions, or if you have to make a decision deep breaths count to 10 exercise, something that helps you increase your energy level. And then of course the second part of that is incorporate that on a regular basis every day, maybe a couple days a week, three days a week, but on a regular basis. And for whatever you do, no matter how busy and crazy life gets, do not sacrifice your time, your self care is the most important thing. There is you are not a hero by killing yourself. You don't strengthen the weak by weakening, the strong you killing and sacrificing yourself is not helping anyone. You don't need to do that. And then of course the overarching thing that we've talked about is, you know, some of the ideas around really thinking of yourself and considering yourself and talking about yourself as a business owner, right. If you're treating tree, that's great. But other than that, you own a business.

Speaker 1 (44:49):

Yeah. Perfect. All right. Where can people find you?

Speaker 2 (44:55):

Yeah, learn more. You can just go to my website practice freedom, U the letter u.com. I got some goodies on there. You can download my book on there. What I would recommend if people want to dive in deeper with me and, and just kind of, you know, you want to have a conversation. I am offering a, what we call a discovery call and we'll see kind of where you are mentally. We'll see where your mindset is. We'll see where your business is and we'll see if there's ways we can help you. We do have programs. We'll see if it's a, if it's the right fit for you, if not definitely give you some things that you can do in the meantime, maybe point you in some other directions. So you can go. I'm sure you'll put that in, but you can go to practice freedom, u.com/discovery call.

Speaker 1 (45:41):

Perfect. And yes, this will all be in the show notes at podcast out healthy, wealthy, smart.com under this episode. So last question, Jamie, what advice would you give to your younger self?

Speaker 2 (45:53):

Oh my God. Overcome your ego. Jamie it's okay. You don't know everything enlist. Some help invest in yourself, invest in your business. It will pay off dividends in the future. Not only to you, not only to your family, but for everyone that's around you, including your staff and community.

Speaker 1 (46:15):

Excellent advice. I love it. I love it. And I feel like you've given different pieces of advice each time you've been on very impressive. Cause I've asked this question before and the advice is always different, so well done. You so thanks so much for coming on and sharing. This was great advice for anyone who is a current owner or who's maybe thinking about becoming an entrepreneur. So I thank you very much.

Speaker 2 (46:41):

You're welcome. Thank you so much, Karen.

Speaker 1 (46:42):

Yeah. And everyone who's listening. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.

In this episode, Co-President of the American Association of Pain Psychology, Dr. Rachel Zoffness, talks about treating chronic pain.

Today, Rachel talks about the failed biomedical model, pain neuroscience, and effective non-pharmaceutical pain treatments. When is the right time to refer someone to a pain coach? What are some multidisciplinary approaches to pain management?

Hear about the biopsychosocial nature of pain, how pain treatment in the US is actually about money, how thoughts and emotions affect pain, and The Pain Management Workbook, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• “What science tells us is pain is not purely biomedical. It’s actually this different and more complex thing, which is biopsychosocial.”
• “Pain is complex, and doing one single thing over years and years that has not worked, is probably not the right way to go.”
• “Pain is never purely physical. It’s always also emotional.”
• “Unless we’re taking care of our thoughts and emotions, we’re actually not really treating this thing we call pain effectively.”
• “If it’s okay to go to soccer coach to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain.”
• “96% of medical schools in the US and Canada have zero dedicated compulsory pain education.”
• “Pain, by definition, is a subjective experience.”
• “Keep doing exactly what you’re doing and follow your gut. Trust your intuition, and know that following the path of the thing that you love is the thing that’s going to bring you to where you need to be professionally.”

More about Rachel Zoffness

Dr. Rachel Zoffness is a pain psychologist and an Assistant Clinical Professor at the UCSF School of Medicine, where she teaches pain education for medical residents. She serves as pain education faculty at Dartmouth and completed a visiting professorship at Stanford University. Dr. Zoffness is the Co-President of the American Association of Pain Psychology, and serves on the board of the Society of Pediatric Pain Medicine.

She is the author of The Pain Management Workbook, an integrative, evidence-based treatment protocol for adults living with chronic pain; and The Chronic Pain and Illness Workbook for Teens, the first pain workbook for youth. She also writes the Psychology Today column “Pain, Explained.”

Dr. Zoffness is a 2021 Mayday Fellow and consults on the development of integrative pain programs around the world. She was trained at Brown University, Columbia University, UCSD, SDSU, NYU, and St. Luke's-Mt. Sinai Hospital.

Suggested Keywords

Pain, Psychosocial, Emotional, Physical, Neuroscience, Treatment, Thoughts, Management, Healthy, Wealthy, Smart, Coach, Physiotherapy, Healing,

Dr. Zoffness Latest Podcast: Healing Our Pain Pandemic

Dr. Zoffness’s Book: The Pain Management Workbook

To learn more, follow Rachel at:

Website:          https://www.zoffness.com

Twitter:            Dr. Zoffness

Instagram:       @therealdoczoff

LinkedIn:         Rachel Zoffness

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

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Read the full transcript here: 

00:00

Okay, so whenever so I, you will know when we're recording because like I said, I'll do like I'll do a quick clap. And then I'll just say, hey, doctor's office. Welcome to the podcast and off we go. Okay, ready? Perfect. Okay. Hi, Dr. softness. Welcome to the podcast, I am excited to have you on today to talk about chronic pain and treating patients with chronic pain. So this is a real treat. So thanks for coming on. I think you are very cool. Karen Litzy. And I'm excited to be here. Excellent. So what I what we're going to talk about today, just so the listeners knows, we're going to talk about kind of treating chronic pain from a bio psychosocial standpoint versus a biomedical standpoint. So I know a lot of people have no idea what those terms mean. So doctor's office, would you mind filling in the listeners as to what a biomedical model is and what a bio psychosocial model is? to kind of set the tone for the rest of the podcast?

01:10

I totally Can I talk about this all the time, because it makes me so mad. Okay. So the biomedical model is the one that we all know the best, because it's the way we've been treating pain for many decades. And the biomedical model of treating pain and health in general, is essentially viewing and understanding and treating pain as a problem that is purely the result of bio biological or biomedical processes like tissue damage and system dysfunction, and on anatomical issues, and then throwing pills and procedures at it. That is how we've been treating pain for many decades. And of course, we know it isn't working, we have an opioid epidemic, the opioid epidemic is getting worse during the COVID pandemic. People are really suffering, chronic pain is on the rise. It's not being cured. It's not magically disappearing. incidence isn't even decreasing. So the way we're doing it is broken, and also very expensive for people living with pain. However, what science tells us is that pain is not purely biomedical. It has never been purely biomedical. It's actually this different and more complex thing, which surprises nobody, which is bio psychosocial, which is a big and complicated word, but makes intuitive sense, once we start talking about it, I think to people who have experienced pain, which means that yes, of course there are biological processes at work when we're living with pain, acute and chronic. And I can say what those mean to short term pain versus long term pain, longer term pain.

03:02

Yes, and there are also many other processes that work too. So if you imagine this Venn diagram of three overlapping bubbles, which I draw a lot, but I cannot draw right now, we've got the biological or the biomedical bubble on the top. And then we've got the psychological bubble. And that's the one that I struggle to explain to people the most, because I think there's so much stigma around this idea that cognitive and psychological processes might be involved in this experience we call pain because there's so much shame and embarrassment and stigma around anything to do with psychology, which is so unfortunate. But in this psychology bubble of pain, there's a lot of stuff that I think people know intuitively can amplify or reduce pain. So there's thoughts about your body and about your pain and just thoughts you're having about life in general. There's emotions, like stress and anxiety and depression, even suicidality. And we know that negative emotions amplify pain. And we know that positive emotions can sort of turn pain volume down, there's memories of past pain experiences. And those are stored in a part of your brain called the hippocampus. And we know research shows that memories of past pain experiences can change your current experience of pain. And also in the psychology bubble, we've got coping behaviors. So that's quite literally how you deal with the pain you have. And a lot of us who have lived with pain, and that does include me engage in a lot of coping behaviors that make sense in the moment. But actually, they can make pain feel worse over time. And a great example of that is the resting indefinitely plan or the doing nothing plan, as I like to call it which is totally, you know, normal and natural for those of us who pay into Engage in because when your body is telling you, you know that you're hurting, it's understandable that the thing you think you're supposed to do is stop all activity. But ultimately, what we know about that particular coping behavior is that it makes chronic pain in particular worse over time. So the do nothing plan or the stay home or rest indefinitely plan is a coping behavior that lives in the psychology bubble that can actually make pain feel worse. And of course, there's coping behaviors that can make pain feel less bad, like the counterintuitive things like leaving your house and seeing people and walking and getting out into the sunshine. And, you know, these things that we don't necessarily know can help pain. And then the third, overlapping bubble, and our bio, psychosocial Venn diagram, is the social or the sociological domain of pain. And that's what I like to call the everything else bubble. So it's socio economic status. And family and friends have culture and race and ethnicity and access to care, and socio economic status, and history of trauma and early adverse childhood experiences, and culture, and context. And environment, like quite literally, everything else your environment, believe it not changes the pain you feel. And in the middle of those three things, and I know that's a lot of things, is pain. So when we try and pretend that pain is just this simple biomedical thing, the treatments don't work. And I think all of us who have lived with pain know that our pain is much more complicated and sticky. I know that was a lot of words.

06:44

No, and, and I'm glad that you described everything in the way that you did, because I think that gives the listeners a really good idea of what's in each of those bubbles. Number one, and number two, how complex pain actually is. Exactly, it's not. So if I think if the listeners take away anything from this conversation, if pain is complex, and doing one single thing repeatedly over years, and years and years and years, that has not worked, it's probably not the right way to go.

07:15

That's right. And you know, the other misconception that we all understandably have is that, you know, the way to treat pain is just by going to your physician. And, of course, that makes perfect sense. But we have this misconception in western medicine, that either you have physical pain, and you see a physician, or you have emotional pain, and you go to a therapist, or a psychologist, someone like me, and the really fascinating thing about pain, and the reason I love studying it, and treating it and talking about it so much is that neuroscience tells us that pain is never purely physical, it's always also emotional, because the part of your brain called the limbic system actually processes pain 100% of the time. So pain is always both physical and emotional. But most people don't know that most people have never been told that. But the limbic system plays a huge role in the experience of pain. And we know that, you know, emotions are always changing pain volume all the time. So this idea that pain is either physical or emotional, is not actually a thing, you know, and the way we treat pain by going to a physician exclusively is not actually nine times out of 10, probably more than that going to actually, you know, be the answer for any sort of chronic pain problem.

08:37

And so I'm glad that you brought that up that yes, we know emotions play a role in pain. And as a matter of fact, the International Association for the Study of pain, change their definition of pain in 2019, I believe to include that it is an emotional experience. And I think that really set the stage for greater discussion and research, which I think is amazing. But when you say to someone,

09:05

let's see, can I interrupt the flow to say, they did change the definition, but the the word emotion was always in there? Oh, was it? It was? Okay.

09:16

Let me so when we talk about kind of the emotional part of pain, and I have had patients say this to me, which probably meant I was explaining it incorrectly, and I take full responsibility for that. And I'm sure you've heard this before his patients saying, so you're saying it's all in my head. Totally. And how do you react to that?

09:42

Yeah. I love that. You asked that question. I think probably the worst thing about being a pain psychologist is you know, you're the last stop on the train. You're the last person anyone wants to see nobody wants to go to a psychologist or a mental health professional for a physical experience like pain. And I know you can't see me, but I'm putting air quotes around the word physical. Because again, pain is not a purely physical experience. It's physical and emotional. But of course, no one wants to go to a pain psychologist for pain, right? You think you're supposed to go to a physician, and a referral to a psychologist means you must be crazy or mentally ill or the pain is on your head. And no, that's not what it means at all. And I find that the way that I most effectively target that is by explaining, believe it or not pain neuroscience. And I, I usually do that in the simplest way, I know how just by distilling down that, that, you know, it's easy to believe that pain is something that lives exclusively in the body, right? Like, if you have back pain, it's so easy to believe that that pain lives exclusively in your back. But what we know and what neuroscience has taught us is that actually, it's your brain working in concert with your body that's constructing this experience we call pain. And we know that because of this condition called phantom limb pain, wherein, you know, someone will lose a limb like an arm or a leg and will continue to feel terrible pain in the missing body part. And if pain lived exclusively in the body, no limb should mean no pain. So if you the fact that you can continue to have terrible leg pain, when you have no leg tells us that pain can't possibly live exclusively in the body. And I find that when I explain this to the patients who come see me, first of all, there's more buy in that the role of the brain in pain is really significant. And second of all, it sort of gives me some leverage to then explain that, again, one of the parts of the brain. And one of the most influential, influential parts of the brain that processes pain is your limbic system, which is your brain's emotion center. So unless we're taking care of your thoughts and emotions, we're actually not really treating this thing we call pain effectively, we're just treating one small component of it. So that's, you know, and I also always, by the way, validate that, of course, you have, you know, of course, it feels like someone's saying that the pain is on your head, or that it's a psychological problem. Because of this, again, this like false and ridiculous divide we have in western medicine between physical pain and emotional pain, when neuroscience has known for decades that that's not actually a real distinction, like your head is connected to your body 100% of the time, you know?

12:24

Yeah, absolutely. And as let's say, as a practitioner who's not a pain psychologist, a physical therapist, occupational therapist, maybe your yoga Pilates, and you are working with someone with persistent pain? How, how can we encourage our patients or recommend to our patients, that, hey, you might really benefit from seeing a pain psychologist, without them thinking that we're telling them they're crazy? Yeah.

12:57

I do think that taking 30 seconds, or maybe even 60, to explain, you know, this basic painter science thing. And the phantom limb thing is a really, really effective strategy. So anybody can use that. That piece of information. You don't have to be a pain psychologist. So that's thing one is just like taking a few moments to talk about how pain works in the brain. I think patients are so grateful to learn that no one's ever told them this before you're going to be the first person to ever let them know. And then the other thing that I always do is a trick that I learned from a really nerdy journal article I read years ago by a guy named Scott powers. And he said that one trick that we can use is to call pain psychologists or you know, therapists who are trained in things like cognitive behavioral therapy for pain, pain coaches, and I love that. So I usually tell physicians and other allied health professionals to refer to me as a pain coach. And the way I pitch that to families and tell other health care providers to pitch it to their patients is to say, if it's okay to go to a soccer coach, to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain. Because living with pain is so hard. And you deserve support. You know, and usually that removes the stigma and the stigma, especially when you present that in conjunction with some science that supports the role of the brain and the role of cognitions and the read the role of emotions and coping behaviors. In the experience of pain, I find that that really is super effective.

14:41

Yeah, that's really helpful and a great way to frame how to frame that recommendation to someone coming from someone like me coming from a PT because people often come to physical therapists I mean, it's in the name Because they want us to heal or to fix their physical problem, which in this case is persistent pain or chronic pain. And so then that leads me to my next question is, as a physical therapist or as someone who's working with the body, when do we refer this person to a pain coach or pain psychologist?

15:25

I'm curious to know what you're going to think of my answer. Ready? Here's my answer. I once had a friend who said to me, man, like, everyone's always going around talking about how many miles they ran today. And you know, how you like the Strava app, like, you know, how many miles they biked? And how many hours they did yoga this week? And can you imagine what it would be like if everybody, you know, came, came to each other and started bragging about how many hours they spent working on their shit? Like, what I spent three hours working on my anxiety today, or like my family stuff? Or like, my complicated relationship is, like, just why do we prioritize working on the body over working on our minds? You know, it's so strange. So my honest answer is if you're ever treating a patient who's living with chronic pain, and again, that's pain that's lasted three or more months, I think it's worth a referral to a pain psychologist or therapist who's trained in cognitive behavioral therapy. I just, I can't imagine any human being who wouldn't benefit from the opportunity to navigate the complicated experience that is living with pain and having someone in the role of support and coping behavior coach is just, you know, and partner and in processing, the experience of it just just seems to me like such a great gift to be able to give to patients.

16:51

And my answer to how I react to it is I agree. And, and again, this takes into a takes into account really this multi discipline, multi disciplinary approach to pain and approach to pain treatments and management. And so in your opinion, what makes that multidisciplinary approach effective for that patient?

17:20

I mean, what the research shows is that trying to approach and treat pain from just one angle is usually not sufficient, because as we were saying at the beginning, pain is such a complex, bio psychosocial thing. So if we're just looking at the biomedical components, we're not really doing our job, if we're just looking at the psychosocial components, we're not really doing our job. So, you know, a multidisciplinary team as a team made up of, you know, psychologists and pts, and OTS and physicians and nurses and biofeedback providers, and all these different people who are sort of coming at this complicated things from maybe slightly different angles and perspectives. And when we do that, what the research shows is, we have the most robust outcomes, the care is most effective, and the most comprehensive, and people walk away with a whole tool belt of tools to use when treating their pain, you know, across scenarios and across symptoms. So multi disciplinary is really like, how can we all come together as a team with our unique backgrounds and our unique training because, you know, as you know, trainings, especially in the United States, the disciplines are also siloed. You know, like, psychologists are trained in this one way, and pts are doing this thing over here. And OTS are over there. And anesthesiologists are over there as physiatrist. Or, I mean, it's just it's so fractured. So a multidisciplinary team is hopefully working together to target this complex animal that we call chronic pain. And what's really interesting is, you know, I have a private practice, where I see a lot of patients with chronic pain. But I feel like the bulk of my work sometimes is coordinating care with this really complicated treatment team. And I'm seeing a really complicated patient right now who has crps complex regional pain syndrome, which is a really tricky, chronic pain syndrome. And, you know, the way that we his case has been so complicated. It's been many years of treatment. And I think today as a team, we finally decided upon a treatment plan. And it really wasn't until we all were talking that that came together and jelled. So I think that's one of the most important components of treatment actually.

19:38

Yeah, I, I agree. And and when you're in private practice, like you said, sometimes it can be a little bit more difficult, but the more communication you have with people on that team, again, we're doing all of this for the person in the center and that's the patient and so being being able to provide vied so much coordinated care for that patient. Like you said, the research has shown that this is that this works versus a piecemeal, one person's doing this over here. And someone's doing this over here, and they're hearing, and then the patient's hearing contradictory treatment plans. And so it gets really confusing.

20:21

Yeah, it gets super confusing when there's, it's almost like too many cooks in the kitchen, if you're not working together, because they're getting all this different advice from all these different people. And oftentimes, and I'm sure you've seen this, too, they're on, you know, 40, they've tried 40 different medications by the time they've gotten to you. And, you know, I mean, I think what it leads to is like, this treatment, burnout, where like, our patients are just so burned out on all the treatments they've tried, and they have this sense of hopelessness, like, nothing's gonna work. Nothing's working. So far. I've tried all these things. I've seen 40,000 million doctors, and, you know, I've, yeah, I've tried herbs. And yeah,

20:58

I've heard that from people like, they're like, I don't want to go to one like I'm all doctored out, if I have to go see one more doctor, or take one more medication, or do one more procedure, or one more scan, like I'm done. I don't want to do this anymore. Yeah. And I blame them. Yeah, it's exhausting. It's totally exhausting. And you know, we've been talking about things that don't work. Right. So we talked about all that being on medication after medication, opioids, we know these, they don't work for people with chronic pain. So let's talk about non pharmacological treatments. And what does work or what can work for people with chronic pain, so I'll throw it over to you.

21:44

Yeah, so non pharmacological treatments, there's like a whole host of them, there's a wide range of them. And there's a lot of literature on a bunch of different things. So what I use the most in my practice, because I really love it and have found it to be so effective is cognitive behavioral therapy, or CBT, which is different by the way than CB, cb, D, that's something different CBT cognitive behavioral therapy. And an arm off of that is a treatment called Act, which is acceptance and Commitment Therapy, which is become very big in the PT world, which by the way, originated from CBT, and was adapted for pain. There, there's also Mindfulness Based Stress Reduction, or mbsr, which has a huge literature base for the treatment of chronic pain. And there's other things too, like biofeedback, I happen to really love as a treatment for pain. And there's a whole host of other things, too. But, yeah, God,

22:43

I was gonna say, could you explain briefly what biofeedback is so that people understand what that is? Exactly.

22:50

I'm so glad you asked. I've been doing this for so long that I forget. I just forget that. Certain things are not known entities. But I also did not know what biofeedback was when I first started treating chronic pain. And so I'll someone said to me, oh, you're treating patients with pain, you should refer them to biofeedback. And I said, You know, I don't refer my patients to things that I don't understand. So I did a buttload, of reading about biofeedback for pain, and I got a bunch of books. And then I found myself a biofeedback provider. And I went to this gentleman, his name is Dr. Eric pepper. Dr. Pepper is just a great name for any doctor. And He is a professor at the University of San Francisco and I admired him right away, he was obviously very smart. And he sat me down in a chair. And he hooked me up to this machine. And he said, This machine is going to read a bunch of your biological outputs, it's going to read muscle tension, galvanic skin response, your finger temperature, and a bunch of other things, your heart rate. And I was like, what that's really interesting. And he showed me which monitor was, you know, giving me feedback about which thing and hopefully you're picking up on the fact that there's biological processes that you're getting feedback about? And he said, and now I'm going to teach you to raise your finger temperature to 90 degrees, using your mind. And I said, Excuse me, sir. I am a scientist. And I do not believe in Voodoo. And he said, Well, how about you just try it out and see how it goes. So he did a couple of techniques with me had me close my eyes, he did some relaxation strategies, and diaphragmatic breathing, and he used imagery of like hot soup and hot air flowing down my arms from my shoulders into my fingertips, and autogenic training and autogenic phrases and that's when you say things to yourself that are suggestive like my arms are heavy and warm. My hands are heavy and warm. And as I was doing, as I was doing all these things, I noticed, because the machines were giving me feedback about my biology, that my hand temperature was going up. And within two sessions, I was able to warm my hands using my mind. And I am a person with chronically cold hands, because I'm stressed out all the time. And no one had ever told me that cold hands and feet, by the way, are a sign that you are stressed out. So I can now warm my hands on command, which is absolute magic. And when I teach it to my patients, they oftentimes say things like, Oh my god, I can make fireballs with my hands with my mind, what else can I do? And that's exactly what we want. For people living with pain, this idea that the mind and body are connected 100% of the time, and that you have more agency and control over your body than you thought you did. And you can make changes to formerly unconscious biological processes like skin temperature and muscle tension and pain. And biofeedback teaches you some skills to do that. Which is why I really like it so much.

26:13

Yeah, it sounds so like sci fi doctor who kind of stuff. Dr. Pepper. Exactly. Yeah, right. Exactly. Right. But yeah, it just sounds like Wait, what? But yes, I mean, I've never I have not done biofeedback myself, but it is something that I'm just constantly interested in for the exact reasons that you just said, like, Whoa, I can control what my body does. This is pretty cool.

26:41

It's worth it, I highly recommend it. It is so worth it. It's it makes you feel like, you know, it's this sense of like, if you almost feel like the Incredible Hulk like gotta have all this untapped power and potential that I just didn't even know about.

26:55

Yeah, it's, it's wild. Thank you for giving us that kind of definition of biofeedback, because I guarantee a lot of people who are listening did not know that at all. I didn't either, I totally didn't either. Very, very cool. So now, all of this, these non pharmacological treatments, CBT, a CT, biofeedback, we can maybe put physical therapy, occupational therapy into that as well. I mean, obviously, all of these things, cost the system money cost the patient money. But let's talk about the money aspect of treating pain, especially here in the United States. So what, you know, when people think about treat treatment of chronic pain, they often don't think about the money involved. So I will throw it over to you to kind of elaborate on that, and what does what that means for the patient and for the system.

27:52

You're actually making me realize that when you asked me about non farm approaches, I of course, immediately went to like, you know, like psychological treatments for pain. But yeah, of course, you're right, PT, OT, all these things, of course, are all the things and approaches. Yeah, absolutely. So yeah, it was a really sad day for me, when I realized that the treatment of pain historically has actually been about money. That was a really sad wake up call for me. So I used to be a member of this organization called the American pain society, it was very well established, very well known organization. And they went belly up after it came out. And I don't know if this is proven or not. But I should say, after they were accused of taking money from Big Pharma, to promote the use of opioids for the treatment of pain, despite the fact that it was known that opioids a were highly addictive, and habit forming and B sensitize the brain to pain over time and are therefore not actually effective. Because if you go off of them, as most people who have tried this, no, pain feels worse, your brain is actually more sensitive to pain. And so they went belly up, and they were, and then I read this book that was formative for me, by Anna Lemke. Le MBKE, who is now a friend of mine, called drug dealer, MD, drug dealer, MD, a very controversial and very compelling title. It is a thin, little book, I think it came out in 2016. If I'm not mistaken, I read it. Or I should say, I consumed it in a couple of hours. And I am not someone who writes in books. But I must have written on every page of this book. You must be joking. Oh Mfg. Like curse words and exclamation points. Because essentially, it's the story of how pain medicine has been about earning a buck off of people who are suffering and as we all know, with these lawsuits that are now how Like with the Sackler family and a lot of and also big pharma, you know, what we're learning is that despite the fact that these people and these companies have known for many, many years that opioids are highly addictive, highly habit forming not actually effective over time. And, you know, especially in high doses. Yeah, it's sort of this story of like, you know, follow the money. It's sort of horrifying. So, you know, I also have had conversations with physician colleagues who say things to me, it's a true story that, you know, it's clear that pain psychology plays a huge role in pain and pain management, and would be hugely helpful as with all of these psychosocial treatments, but that a lot of the times because insurance doesn't reimburse these treatments, they either don't get recommended, or they don't get integrated into pain management programs, even at hospitals sometimes, because insurance reimbursement is so crappy, which is just like another eye opening moment like we wait. So you're saying that, you know, these things work? You say that, you know, they're effective, but we're not recommending them and we're not hiring pain psychologists, because insurance doesn't reimburse. So again, it's a money thing. What? So the effective treatments are out there, they're known entities. But, you know, big pharma has billions of dollars to, you know, promote this idea that pain is a purely biomedical problem that requires a purely biomedical solution. So as long as you believe that you're going to buy into that model, and you know, as long as insurance companies are not reimbursing non farm approaches to pain, then you know, we're going to say stay stuck in this loop of treating pain, like a biomedical problem when we know it's a bio psychosocial one. So it's really complicated. Just this discovery that pain medicine has historically really been about the dollar. And it's sort of nauseating and horrifying.

31:56

Well, I mean, I think you can take away pain from that and just say medicine.

32:00

Yeah. Insert health condition here.

32:03

Yeah, yeah, I think it doesn't matter what it is, right? Because it's always going to come back to following the money and where, where can you get the biggest bang for your buck? And unfortunately, that, like you said, Those non pharmacological treatments are oftentimes not covered. So you're getting zero bang for your buck. So as a business, which a hospital is, even if it's not for profit, or an outpatient clinic, are you going to do things you're not going to get reimbursed for? Right, you know,

32:35

no, you know, that's true. And like, I don't mean to sound on empathic. Like, of course, yes, hospitals are businesses, and they have to stay open, and they have to earn money. So so the question for me, like, as I roll along, in this world of this totally insane world of pain medicine, and build my own business, by the way, like, how do we change the system? Like, yeah, we really are patient, patient centric, and like our goal, actually, at the end of the day, is to help our patients get well, what needs to change first, like, does public perception and understanding of pain need to change first? Like, do we need to be training our healthcare providers across disciplines better, like in PT, school, and in OT, school, and in psychology programs like mine, where By the way, I was in school for 40 100 years, and I got zero training and pain, like in my undergrad, brown neuroscience class, we learned about pain, and I became obsessed, and then like, wrote papers and stuff, but but that was it, like not, I have two master's degrees never learned about pain. At no point in my PhD program, did we get training and pain? So? So like, do we need to go, you know, backwards and insert pain education programs in medical schools? Yeah, I know, I know, you and I have talked about this, like the statistic that I'm obsessed with, like 96% of medical schools, in the united in the United States and Canada have zero dedicated compulsory pain education. So it's like, where do we start with this problem, isn't it? Do we like go after the insurance companies and reimbursement rates? where like, where the it's the system is so broken, I sometimes get discouraged, like, where do we start? But I think I actually think what you're doing is a really great place to start, like educating healthcare providers, and the general public about pain, and getting enough people riled up and angry about the way pain has been mistreated, and the way we're Miss educating our health care providers are just not even bothering. Maybe that's the place to start. Like maybe if there's enough of a clamor, and enough people are pissed off about it. Something will change.

34:38

Yeah. And and I agree, I think education, education, education, it has to start there. And especially in medicine, in medical school, especially with the physicians who are oftentimes they are the frontline providers, right, your your regular, your local PCP, primary care physician is often your frontline person and But they're also the people who were traditionally prescribing opioids for everyone, when they would come in with back pain instead of saying, Hmm, maybe maybe you need to see a physical therapist or a pain psychologist, let's sit down and talk to you. How can we let's find out what your needs are, what your bio psychosocial needs are. And so I think if, as the practitioner if you're not getting any education in that you don't know what you don't know. So you're not going to do it. And then I agree, I think, and I think insurance companies need to reimburse doctors and therapists across the board to talk to their patients. Talking doesn't get reimbursed procedures get reimbursed. Right. Right. What's the most important part of diagnosis when you're with a patient? talking to them, understanding what's going on with them, like that is paramount, and that needs to be reimbursed. But insurance companies won't do that they won't reimburse you for talking with your patient. Especially if you're like a PT, we get reimbursed by codes. And and none of those codes are, I'm going to really sit down and try and get into the nuts and bolts of what my patient's problem is. So

36:20

yeah, we need to code for pain, education, community, healthcare provider to patient.

36:25

Yeah, yeah. And some people say, Oh, you could use like the neuromuscular, neuromuscular treatment code for that. But there should be a code for let's talk to our patients, there should be a code for the subjective exam. Yep. Yeah. Oh, yeah. Because how were you supposed to learn about their bio psycho social situation, if you can't talk to them? And ask those probing questions, ask those open ended questions, like you said, In the beginning, bio, psychosocial, a lot of things go into that bucket. And we as the practitioners need to learn as much as we can about all those things that go into that bucket, if we're going to treat this patient efficiently.

37:10

There's so many things in the bucket. And I think, when we assess issues that have to do with pain, we really are assessing the biomedical bucket like 99% of the time. And, you know, if we really are thinking about this as this Venn diagram with three bubbles, if you're only assessing or looking at the biological domain of pain, you're literally missing two thirds of the pain problem. It's just wild to think about it that way. Yeah, if not more? Yeah, yeah, exactly more right now. So like, maybe all of us should be assessing for history of trauma. And maybe all of us should be assessing for aces, the adverse childhood experiences, which we know there's like this slew of studies that show that aces impact, you know, the development of chronic pain and illness and adults, maybe we should all be assessing for, you know, abuse and, you know, poor access to care. And just like so many things that we need to assess for if we're actually going to, you know, do a workup of pain, and instead of just this, you know, tell me about your anatomical issues. And let me do some scans.

38:14

Right, right, on a scale of zero to 10. How would your pain? Oh, it's a 10 out of 10? Well, this is like my little soapbox is what I hate. I see this a lot in physical therapy, student Facebook groups, things like that. Yep. And you know where I'm going with this? They'll say, Oh, well, if someone comes to me, and they're 10, out of 10, I'm going to call the ambulance because they must need to be in the emergency room. Poor education, that therapist was not educated on pain. No, I've not. No, that's wild. Yeah, I hear this all the time. Or those similar Sam 10 out of 10. It's a really, because if like I chopped your hand off, that would be 10 out of 10. So what's your pain now?

38:57

Right? Like this? Right? This lack of awareness that pain, by definition is a subjective human experience. And whatever your patient says it is, that is what it is. And you you actually don't get to argue with them about it. You don't negotiate down someone's pain. Right. And I mean, I think what I've learned over time about pain is there's really valuable clinical information when your patient tells you, like I hear a lot of times like 11 out of 10 literally what your patient is communicating to you is I can't handle this anymore. It's beyond my capacity to cope with this level of suffering. That is what they're saying to you. And usually also, at least for me as someone who really, really likes and appreciates the pain catastrophizing scale, the PCs, which is a potentially controversial term, some people don't like the term catastrophizing, I happen to appreciate it. I think it's very valuable, but don't want to go down that rabbit hole. But the pain catastrophizing scale, but they're also telling me is that when people tell me their pains, Out of 10 or an 11 out of 10, there's a high likelihood that their thoughts around their pain are very intense and catastrophic, and that they're having very intense emotions around their pain too. So it's good clinical information. You know, like you said, You can't bargain with someone about their pain number. Yes, we don't pain haggle. Right. Right. It's not like being at the market. No, like a price price that you get on fish. But but there's rich clinical information in there, if you're willing to, like, Listen for it, they're telling me that they're having an emotional experience that's beyond their ability to

40:37

navigate. Right to cope. And, and that's where I think like, I'll ask that question to all of my patients, because for me, that's my window to crawl in, and really get down to maybe the psycho or the social part of their pain experience. So like you said, if someone says to me, oh, my pain is like, it's at 12 out of 10. Today, and I'll say, Okay, well, can you tell me a little bit more about that? You know, what are you? What are you? What are your feelings around that? Or what's going on at home? What are your responsibilities at home? How does, you know? How does that play into why this pain is? 12? out of 10? Today, right? Right, you know, so it is, like, I always ask the question, but it's a nice way to kind of get in and be able to ask more questions. And, and just because someone says their pain is 12 out of 10, it doesn't mean you call the ambulance, they shouldn't be in the emergency room, they probably worked all day have to go home and have two kids to take care of. Yeah. And they're doing all of this at a 12 out of 10. because like you said, they've reached the end of their way to the ladder. And our job as clinicians is to increase their capacity to handle that. And how and to do that, like you said before, through a multidisciplinary approach to pain management is really the way to go. Because now you have more people who can add to that capacity. Yep. So anyway, that's my soapbox. I will come down stepping down from the soapbox. I appreciate your soapbox. I think Kevin, I'm Sherif share box, but it drives me crazy. Okay, so we talked a lot about different treatments. And I want to talk about treatment that you have created the pain management workbook. So let's talk about that. And how this book that you wrote, can help people who are experiencing pain.

42:40

One of the nicest emails I got in the last couple of weeks was from someone named Karen Litzy, who responded to my email and said that she really liked the pain management workbook and was referring to her patients. And I happen to admire Karen Litzy. So I was really flattered by that. So so the pain management workbook isn't on its own, like some new fangled treatment plan. But rather, I got really frustrated by what I felt like was a lack of resources out there for people living with pain, and also for healthcare providers. In particular, you know, I am a nerd, like a real nerd. And I think pain is just so interesting, and complex and fascinating that I have like, amassed all of these books and journal articles and, you know, resources. But I felt like there really wasn't something that synthesized it in language that all of us can understand and easily give to our patients. So I took a lot of stuff that I loved and was reading, like there's a book called pain, the science of suffering, that I happen to really love. And there's all this work by Lorimer, Moseley, and Adrian low in the PT world, I happen to really love the way I love the language they use for explaining pain. And there's all this neuroscience literature out there that I think is so fascinating and so useful, like melzack, and walls, gate control, theory of pain, and all the things that have evolved from there. You know, and there's all these workbooks on cognitive behavioral therapy for pain, but I couldn't find something that, in my mind, put together all of it into one resource that, you know, anybody with pain can pick up and use right away and use have exercises and guided audio and handouts and all that stuff. So So I wanted to create something that was very user friendly, and I felt like especially during COVID, having accessible and affordable resources could not be more important because here we are talking about how pain at the end of the day is often about money and care is so expensive, and you know, cognitive behavioral therapy and these other things that are not easily or readily reimbursed, end up costing families and patients, sometimes many 1000s of dollars and it should Then be that way. So I literally took everything I was doing in my practice, and everything I was reading and stuck it in a workbook. So it's a lot of pain education. And I have to say, you know, a big thanks to Lorimer Moseley, and Adrian Lowe, who both of them were kind enough to agree to read through my pain education content and give me feedback and consultations and edits, which was like, so kind, and they didn't even charge me anything. And I offered to pay them both. And I wish they had taken my money. But yeah, I wanted them to vet the content. So there's this pain education piece, and then it's a series of chapters of tools. So, you know, again, affordable, accessible care isn't just, by the way, here's how pain works. It's now what can I do about it? So I wanted to make sure that I was offering, like a tool belt of options for healthcare providers to offer their patients like here are 17 different pain management strategies that have evidence of effectiveness that come straight out of the literature, you know, pick a few that work for you, whether it's mindfulness or using guided imagery, or, you know, cognitive strategies, or, you know, sleep hygiene and nutritional tips, like, how do we put this all together to create a unique pain management plan for each one of our unique patients who walk through our door with a unique profile of suffering. So that's how that happened. And I should also say that the book almost did not happen, because my deadline was in 2020, which, as everyone knows, was a shit show of the year. My, my bandwidth was zero, I would sit down to edit, you know, my lovely publishers would send me a couple of chapters, and they'd say, here are some edits, go ahead and make some changes. And I like, couldn't even read through the work I had written, I like my brain just was on overdrive. And I was trying to process what it meant that we were in the middle of a global pandemic. And I sent them an email, and I was like, you guys, I don't think I can do it. So the book almost didn't happen. But in December, it was actually shockingly painstakingly born. So I'm more proud of it than anything I've ever done. I don't know if anyone will ever read it. But I, I'm very proud of it. So I hope it's of use to health care providers to people living with pain.

47:21

Yeah, absolutely. And is this only for adults.

47:25

So the pain management workbook I wrote in language that's usable for everybody. I mean, it's not only for adults, it's. So the book I actually wrote first is called the chronic pain and illness workbook for teens. So it has a lot of similar content, but I wrote it for kids, because there just isn't anything out there for kids. And there's even less for health care providers who are working with kids with pain. So this is adapted from that it has like twice as much content, I would say and is expanded content. So the pain management workbook is sort of intended to be for everybody. And the chronic pain and illness workbook for teens is more specifically for kids in the health care providers working with them. But I've been told by people who just have that book that they have used it successfully with adult patients, too. So

48:14

yeah, so excellent. And where can people find all of this and find you if they want to get in touch with you? They have questions. They want the book, they just want to chat, where can they find you.

48:24

So the pain management workbook. And the chronic pain and illness workbook for teens are both on Amazon. And they're like 20 bucks, which is so much less expensive than around of cognitive behavioral therapy. But I do recommend oftentimes to healthcare providers that they offer the book to their patients, and then offer to go through it with them. Because it's just so nice to have a pain coach to be going through a treatment protocol with. But of course, it can be used as a self help book, you know, on your own. I

48:50

just like love that. I

48:51

love the supportive model. So yeah, there are those are on Amazon. And yeah, I have a really dorky website that has a ton of resources on it. It's just my last name. It's softness, calm. And there's a resources page with like, apps and websites and books and podcasts and guided audio and all sorts of stuff for people living with pain and their healthcare providers. And I also joined Twitter during the pandemic, because I don't know, it seemed like social media was where everybody was, and I couldn't see any of my friends and I couldn't go to conferences. I couldn't have conversations with cool people like you. So I joined Twitter and Twitter, my Twitter handle is at doctors office. That's been really interesting and fun. It's been a really interesting platform. That's I think that's actually how I found you. And then I'm also on Instagram where I post some pain education content too. And that's at the real Doc's off, because I couldn't think of a better name and I got really nervous because social media makes me nervous. So

49:49

well, at least now people know where to find you. How to get in touch with you where to get your book. So this is great. This was a great talk. I you know, I could keep going on and on and on too. about this, I could do like a 10 hour podcast, just on on pain alone. Because it's something I'm passionate about. And it's there's just not enough good information out there for people to access. So hopefully people listening to this will then access some of your resources and education, education education right. Now, before we end, I have one last question for you. And that's knowing where you are now in your life. And in your career, what advice would you give to your younger self?

50:33

What advice would I give to my younger self? Oh, wow, you know, the advice I would give to my younger self is keep doing exactly what you're doing and follow your gut. And trust your intuition and know that following the path of the thing that you love is the thing that's going to bring you to the place you need to be professionally. Like, I wanted to live at the intersection of medicine and psychology, and education and science writing. And I couldn't figure out how to do that. So I had all these different jobs. You know, I was like, a science teacher at the Wildlife Conservation Society. And I was a science writer at a Science Magazine, and I worked at the NYU child Study Center, and I got a PhD and I just couldn't, but but I think, you know, organically what happened over time, just from following my passion, my like, actual passion is that I was able to do all these things. So now I have a private practice. And I'm seeing patients, and I'm writing books. And I have a column in Psychology Today called pain explained where I do a lot of science writing about pain, and I'm teaching pain education at Dartmouth, and at UCSF, which I deeply, deeply love because I get to connect with physicians and other health care providers. And, you know, it's just sort of the it is sort of naturally and organically, exactly what I feel like I was called to do you put it out, you put it out into the universe, and it happened. Yeah, I mean, but not without a lot of trial and tribulation. But I think I would just tell my younger self to trust your gut and trust your instinct and you you actually are on the right path. If you're doing something that you love, you are on the right path, even if you don't know

52:09

1. Excellent advice. Well, Rachel, thank you so much for coming on the podcast and chatting today. I really appreciate it and I appreciate you. So thank you so much. Thank you for having me. Absolutely. And everyone. Thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart.