Amanda: Okay, guys, welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today we are going to revisit some things we have in the past and add a little for your future. But one thing that we see frequently with clients is a difficulty separating thoughts and feelings, and we're going to bring into that memories and triggers as well. So the first thing we wanna do is define thoughts, feelings, and memories as well as triggers, and then we'll show you a little bit about how they're all connected and what you can do about it. So the first thing we're gonna talk about is thoughts. This is literally a sentence in your mind. It is mind blowing to me that apparently, allegedly, there are people who walk around in this world and they don't have sentences always going in their mind. That's very fascinating to me because my mind is constantly saying stuff to me constantly. She is real caddy; chatty, not caddy. Well, she's caddy too. But, so thoughts are sentences in your mind, doesn't mean that they're true. Right. It's also wonderful because some of these can be changed when they're not serving us. Once we're aware that we're having these sentences that are constantly running, we can change them through neuroplasticity. The thing is, and this is from Caroline Leaf’s, we're gonna talk about Caroline Leaf a lot. Caroline Leaf is Kendra's person. She loves her. There's a true love deep from her heart. She's a PhD, in South Africa, right, Kendra?
Kendra: Yeah, she lives in the States, but she's from South Africa. And the majority of her work that she did on this idea of neuroplasticity, she worked with thousands and thousands of patients in South Africa. Those that had sustained traumatic brain injuries, but also were born with learning disabilities, a lot of those ones with cognitive problems. And so her research is 25- 30 years with thousands and thousands of patients, all for which she was able to use these kinds of same concepts.
Amanda: Love it. So the thing is, a thought is a real physical thing from her studies that occupies mental real estate in the brain after cultivating our thought, right? It gets implanted in there. So the thought is, in our mind, brain and cells of our bodies, it creates feelings. You get a feeling from the thought that you have, right? And then your feeling creates actions that ultimately lead to the results that you have in your life now. There is non-conscious versus conscious thoughts. Conscious thoughts are just like I'm having right now trying to form a sentence, right? Non-conscious, and correct me if I'm wrong cuz Kendra is our Caroline Leaf guru, is more the things that are running in your mind that you're not necessarily paying attention to. But for me, sometimes it's the very self-critical thoughts that I'm not really trying to on purpose think, but they're happening anyway. I'm listening to this constant commentary of things that are going on good and bad, or actually, I guess I shouldn't even label those things that are leading to more favorable and less favorable feelings.
Kendra: And the non-conscious is always on. That's a big difference too. The non-conscious is 24/7. Even after you go to sleep, it is always on. So sometimes people feel like, “oh, I'm mentally exhausted”. And it's because when we wake up, open our eyes and our conscious mind is now working on top of all the work the non-conscious mind has been doing 24/7.
Amanda: So tell me Kendra, so would most of us have been labeled this subconscious? Although she uses subconsciousness in a different way. But most of us, when we're walking around, not Caroline Leaf PhD, we would label the “non-conscious”. It's been a misnomer. We've said subconscious? Yeah. Okay.
Kendra: Yeah, that's correct. Yes. So the non-conscious, there's really not a subconscious and she talks about that really early in her first book that I read. It is not really the right term to use. Of course she is a neurocognitive scientist, neuro cognitive psychologist, all the things. So she definitely uses the correct terminology, but it is that kind of nonconscious level that is out there always going. But until you become aware in the conscious, that's how she differentiates the two.
Amanda: She's always on…judging, judging. So, the thing is, once we start to pick up on this, that thoughts are what create our feelings, we can start to choose how we want to feel because we have control of our thoughts once we have awareness of this. Because, again, we are not our thoughts. We are the watcher of our thoughts, and so we can become conscientious observers of what's going on in our minds. Toxic thoughts like trauma and bad habits can be broken down and rebuilt. And she says it in the cutest way. Kendra, I can't remember what, how Caroline Leaf says it. She's got this most amazing South African accent, but it's like reconfigure.
Kendra: She does, “reconceptualize”. Yes. Reconceptualize. We reconceptualize. I love it. Yeah, it's my favorite.
Amanda: She does have her podcast called “Cleaning Up the Mental Mess”.
Kendra: Yeah, right.
Amanda: Yeah, yeah. If you wanna check her out and we will obviously have links to that. Okay. So thoughts are sentences in our mind. Now feelings are emotions or vibrations. Now this is where doctors; we can tell when you're cut off below your cerebellum and completely detached from your body. Because we will say things like, “well, how did that make you feel?” And invariably, like 80% of you guys are like, “well, it made me feel like they think I'm crazy”, or something like that. That's not a feeling, guys. That is not a feeling. If you need help, there is something called feelingswheel.com and it gives you a whole circle of potential human emotions that you might be feeling. That is an emotion. It is something like anger or sadness, or disappointment or shame. That's a feeling. And it's not just the naming of it, it is the experience that you have in your body. The opposite way that a sensation is like you stub your toe, the body sends a message to the brain. An emotion is an experience in your body, sent from your brain down into your body. So for instance, for me, excitement feels like kind of a fluttering, like it's definitely forward in my chest. Sadness sometimes is a deep pit, sometimes with apprehension. There's a tightness in my shoulders. I certainly carry a lot of tension in my upper traps. That's a feeling. It's the experience in your body. It's a feel-ling. And they're directly related to the thoughts we're thinking. And so we can create, when we want to have a result in our life, we can think about the actions we would need to take. And we can decide what sort of feeling a person would be needing to feel in order to do those actions. So in a way, your thoughts. You can hack your thoughts with neuroplasticity to give you feelings more often, to do the things you need to do more often, to have the results that you need in your life. Accurate, Kendra?
Kendra: Yeah, I like that because just like you said, so over time before you became aware of this concept that we are telling you right now, your brain is gonna have to accept that data and as it accepts the data of the words we're saying, you are going to form a thought, like things are going to come into your conscious mind as we're speaking about maybe yesterday's shift or today's shift, if you're listening on your way home. Finally that awareness comes and, but then you also become aware, like, I didn't really mean to show up that way, or I didn't really mean to say that, or let me figure out where that's coming from. So it starts to become real, that awareness, that conscious mind, and that's what Amanda said. Even though you possess kind of what we call toxic thoughts, and Dr. Leaf, she uses a tree. She loves to use her tree cuz it looks like a neuron and a dendrite. And she so loves to use every aspect of her tree. But she says, you know, the toxic thoughts, those are kind of the black thoughts. But as you know, as we develop thoughts they come from the non-conscious into the conscious. And once that awareness comes, then you can recognize, become aware, break them down, and then rebuild into that new, more desired action thus a result.
Laura: I just love this so much. And Amanda, I love how you talk about us all as being cut off from everything below the tentorium, really. And it just reminds me so much of some attendings I've had in the past who talked about patients' issues being supratentorial. So much of what we deal with is actually supratentorial for us, and we just don't even know it. And it's the thoughts coming from the supratentorial that are causing these emotions and we don't even recognize what's happening. It's just, I don't know. It's just so amazing to me. So memories, memories are collections of thought. So thoughts are the big picture and the details of thoughts are memories. There's three types of memories in a thought. Informational memories are all the details, particulars, facts, data associations, links, and so on, associated with that thought. So these are like the branches on the thought tree. Emotional memories are the feelings associated with the information memories. So for example, the informational thing might be, I'll give you an example. My son, when he was four, had this traumatic experience on the playground and he can remember, “I was on the playground at school that day and I introduced myself to another kid” and said, “Hi, I'm William”. And the other kid said, “You're not William, my brother's William”. So these are like the neutral circumstances of what happened without emotion tied to them. But what he remembers with that, was this shame and embarrassment that he had put himself out there to try to make a new friend. And she had, it was a girl. She had reacted in this unkind way. And so bless him. He's still a little bit, he's just like now overcoming being triggered by that. But so these are, these emotional memories are the feelings associated with those information memories and they are the leaves on the branches of a thought tree. Physical memories are the physical embodiments of the sensations we experienced at the time the thought was built. So with that example of William, and he listens to this, so I feel like I can talk about him. I haven't asked him the physical sensation, but I know for me, the feeling of shame is associated with this sick feeling in my stomach and a warm flushing feeling on my chest and face. So that might be the physical memory associated with the emotional informational memory of this experience he had on the playground. So the physical embodiments of those sensations that we experienced at the time that the thought was built, which are coupled with the emotional memories and informational memories. So these are, they're built into our body, into our nervous system, and are re-experienced when we recall the informational, emotional memories. So when we, for lack of a better word, feel that we've been triggered or we feel some unexplained distress that is not explained for by the current circumstances. This may be that we are reliving one of these memories from our past, so once that thought is planted, so William had this thought, I'm not sure what the thought was he had at the time, but it was something like, “I'm not good at making friends” because I remember him telling me this. The conversation that you have, what you hear, what you read, and so on about that thought. It begins to grow and for years for him, he kind of watered that thought and believed it so much that it became, it became part of his truth. So when you water a thought with additional thinking, it grows into a little thought plant. And if, say we decide it's not useful and we decide to ignore it, it will, it will fade away and die. However, if we give a lot of energy to that thought, if we think about it more and more and focus on it, it eventually gets bigger and stronger. So whatever we think about the most is what is gonna grow. So it's important for us to be intentional about the things that we think and recognize what is useful and what's not. Make sure that the things that we pay the most attention to are the things that are gonna be useful to us. Because over time, that thought, as it's watered with thinking, it's gonna become a big tree. And not only dominate our minds, but our behavior and ultimately the results that we have in our lives is going to depend on what we think about ourselves and everything that happens in our lives. Especially what we think about ourselves and what really we are capable of.
Amanda: I'm not gonna lie, I love this little analogy of the plant. Maybe we start using the little plant. It just seems really cute to me.
Laura: I love the plant. I love the plant.
Amanda: It’s cuter than gravel roads and super highways.
Laura: Well, you know, we use the plant at my school. For those of you guys who don't know, my daughter and I founded a little school, a hybrid school, four years ago. And we used that. The big thing at school is we have this very wholesome kind culture for the kids. And our interest is not in sheltering them or protecting them from, you know, like the real world is out there. But keeping them safe from bullying long enough for them to be able to develop a healthy sense of self. In fact, it's on the back of our t-shirts. There's little, there's like little plants growing up. So I am a huge fan of the plant and tree analogy.
Amanda: Adorbs. All right, Kendra.
Kendra: Yeah, so I agree. What I love about Dr. Leaf is, she is a brilliant scientist, but man, she makes everything so accessible and she uses things like this tree analogy, and it really does look like a dendrite where it's the main point and all of the little branches coming out and then the leaves. Even though it seems kind of mystical and out there, it really does make it accessible and real and something that everyone can relate to. So just like Laura was saying, William developed a memory that was associated with a thought he had way back when, but it was still affecting his thought about himself. So when we talk about triggers a lot in the psychology world, which is some of what I got from an article: verywellmind.com. But when we talk about triggers, it usually is pretty extreme. Like an emotional reaction to something like a violent act or abuse of some sort, or the mention of harming yourself or others. So, we indicate in podcasts and some posts and stuff that this could be triggering. But really it's anything that reminds us of a traumatic experience. So just like the memory that William had of like maybe a little bit of rejection, maybe a little bit of embarrassment. Like, well, is that the only William or something? I don't know what he thought, but it's really triggering. So then he developed the thought, “I'm not good at making friends” when he's absolutely just the most charming individual. So no doubt there. But what it does is forms a thought that he watered over time, because either he just wasn't aware at the time because once again, this is frontal lobe kind of stuff. This is the higher cortex, not the primitive brain. This is our new brain, and so we have to become aware in order to make the changes. But those memories triggered some sort of trauma all over again, and then it watered that kind of the thought that he had. Triggers can also come from a non-traumatic event. Clearly, I think William felt trauma in his soul, but it wasn't like a physical trauma or something like that, something violent. It was kind of a non-traumatic event. I don't know who that girl was, but I'm sure she didn't even know what she was saying and may have not had any kind of agenda behind it, but obviously it's still staying with him.
Laura: Actually, I've read about it recently. Apparently four year olds, she probably meant it. She probably didn't realize there could be more than one, so.
Kendra: Yeah. Right, exactly. Very literal. Four and five year olds are very literal. There cannot be more than one. So we have internal triggers, which come from within, like a memory, what we said. A physical sensation or emotion that obviously comes from the thought. Remember, the memory is a collection of thoughts; and an internal trigger is that physical sensation or emotion. So the feeling, so anxiety, anger, sadness, embarrassment, rejection, whatever it may be. That is an internal type of trigger. An external trigger comes from the environment. So if we watch a scary movie or we look at trauma, like I can even remember the memory I have of 9/11. I know exactly where I was standing when it came on the news, what time of day, like I can recall that no problem. But I'm not really sure where I took my boards. Like, I can't remember. I think I took them in Chicago. I don't know. Like something that's just not, you know, as triggering as something like planes hitting, you know, the Twin Towers. So it's an external source that comes from our environment that becomes a trigger. So what do we do? Well as ER docs, just like Amanda and Laura said, yes, we are kind of supratentorial. We know we have thoughts. That's not the hard part, but it's the feelings that develop from the thoughts and the memories triggering feelings we have. Even in the trauma bay, like you know, patients I've had. Especially kids, once I became a mom. I had a very bad case of neglect that ended up in the death of a child that looked like my son and about the same age. And so when I got the call, that was pediatric code in progress. I already, my heart started racing. I got really hot and flushed because I was not sure what that meant, obviously. But already, because I have memories of my children, which are an external trigger, I was like, whatever this is obviously is not good. And so I really just tried, didn't really know how to cope at that moment, but just game face on, let's do this. It’s what makes us very good at our job. However, I never debriefed from that, and so it created a memory and now, any bad pediatric patients always trigger me. And anger came because I'm like blaming the parents and doing all this when sometimes it wasn't the case. So a trigger can cause an emotional reaction before the person realizes when or how they even became upset. And so that's where the memories come. Often triggers have a strong sensory connection. So sometimes just seeing something, sometimes just hearing something. Like, I didn't see that kid at all and I was already triggered just because I heard the flow sheet or the trauma sheet or the EMS run report. And so I just heard what was coming and it was already triggering me. Tasting something, smelling something. So any of the senses that are ignited, that are associated with a strong memory can be a trigger. So they're linked in some way to a deeply ingrained habit or we can call a habit a thought cuz that's really where they come from and trying to avoid the trigger sounds reasonable. However, I can't choose what's coming by EMS. You all know as ER docs, we don't choose that. We have to take what comes. Some of the suggestions in this article were once you become aware. So that's the first step, figuring out where this trigger. Is it an internal trigger or is it an external trigger? Once you become aware of that, there's a few things you can do. And in the moment when we're at work, one thing I think of what I can do in the moment is once that run report comes in and I hear that, I have developed a habit of just taking some breaths just to really focus and be present and prepare. So breathing in for four, holding for four and out for four, allows me to really clear that trigger or clear that physiologic response that's going in my body, like the palpitations and the flush, the hot feeling from my neck up. It just allows for my parasympathetics to do a little bit of work. Before I just have this surge of no return of my sympathetics. So deep breathing is an option. Obviously in the moment we can't exercise or call on some kind of social support, but this really is the idea behind having a debrief fairly quickly after our team deals with either a bad outcome or just a horrible case or whatever. The idea is to have a debrief pretty quickly after, so that it's in real time and that support and the team and the social support really does help to develop a habit with these types of patients that usually triggers us. You can write in a journal. A lot of people journal. Expressive writing is a way that people really can get everything down on paper and then read it and start to work through some of that. Obviously I'm a big fan of mindful meditation, also known as prayer. I do a lot of that before, during, and after my shift. But also just empowering yourself with recognizing what triggers you. Learning to acknowledge how it makes you feel. Not just name the feeling, but also acknowledging how it makes you feel in your body physiologically. And then you get to decide which strategies you are going to equip or employ to help calm yourself or shift your emotional state. They say basically just to be more protective of yourself, because like we always say, our most important relationship we have is the one with ourself. And so part of standing up for yourself is also being able to recognize, name, feel, change, and then empower.
Laura: Yeah. I think that just being able to recognize when you're being triggered is so empowering. Because we can go through life thinking that people are annoying us or people are offending us or things are happening. Otherwise, if we look at them objectively, don't make sense to us. But, so I'll give you an example. Like the other day, I was coming in the front door and my 12-year-old was hiding behind the door and he jumped scared me. And I, like the whole neighborhood, probably thought I was being murdered. And it just comes out and he's terrified by me doing this. And I'm, I'm like, buddy, I'm sorry. It just comes out. Why does that happen to me? And just being able to kind of look back and understand, you know, looking back at things that may have happened in the past that may create that for us now, even if it's something as simple as you're annoyed by your husband eating something in particular, like if he's eating extra butter on his popcorn or something. If that annoys you, like what? Like really? Why? Why? Why would that? He's an adult. He gets to eat what he wants. But maybe it's because you saw your dad eating way too much and you were afraid that your dad was gonna die because he, you know, was overweight and made himself sick. There are oftentimes, if you find yourself persistently annoyed, scared, anxious about situations there, there may be a reason. And being able to find that reason and having self-compassion over it. It’s just, it's just so helpful. I think.
Amanda: I've noticed that when all of a sudden I have a certain feeling about a patient, not, I don't mean like spidey sense. I mean like, why am I so annoyed by this patient? If I really took some time to think about it, almost always that person in some way or another is doing behaviors, or reminding me of some way of like, family members, you know what I mean? I'll give an example. When the patient won't speak or like will never come and fully answer my questions directly. And is always very coy and very like, excessively polite, but like, I'm not getting the information that I need. That is, that is something that is not an uncommon thing in my family and I'm just like, I can feel it rising in me. And now that I'm aware of it, I'm like, oh, okay. Yeah, I'm just getting, I'm getting projections from things in the past where I'm just like, just tell me what you need me to do. But this patient had nothing to do with it, but I'm carrying that with me from memories.
Laura: Yeah and creating like all this negative emotion that we don't have to have.
Kendra: And I think too, just like you said, Laura, becoming aware of some of these triggers and what I kind of do in the moment, like if it's traumatic, like I said, I do the breathing thing cuz I'm like begging for my parasympathetics to kick in. But secondly, sometimes I find it a little humorous. Like, I've made it a little bit funny. I mean, you know, us ER docs, we loved dark humor and sarcasm. So, I just turn on the sarcasm a little bit in my mind. Not necessarily in front of the patient, but if it is that type of patient, just like you said, Amanda, that is triggering me because of a memory. Then I'm like, “Ah yeah, this is the 1985 Uncle John. Like, I got this guy. This is who this is”. So anyways, I kinda turn it into a little bit funny. It helps, it helps go a little smoother and it helps me to not rage against the machine. But what's important here, guys, is what, what we've talked about today is it's important to do the work. Like this isn't really a lot of work. I'm not saying I'm adding to your plate or doing anything, but it is important to do the work. And the work is just recognizing, becoming aware, bringing those memories that were stored away, packed away in your non-conscious. When they come to the conscious, just to recognize them, become aware, and then do the work to name the feeling. Feel the feeling. Decide what you wanna do with it, and then get that result. Get that result that you want. It doesn't have to always be the same. It doesn't have to be that programming or that memory that was made way back then with that collection of thoughts. It can be whatever you decide works for you now.
So, we're grateful that you found us today on this podcast. We had great conversation about thoughts and feelings and memories, and we want you to stay connected. So go to our website at www.thewholephysician.com and sign up for our weekly well check that's delivered right to your inbox. We also have a CME course that offers 12 weeks of great content and one-on-one coaching. So head over to our website and check it out.
Until next time, you are whole, you are a gift to medicine and the work you do matters.
