Welcome back to the Healing Pain Podcast with Julie Hamilton, LCSW
Thanks for joining me. For those of you that follow along each week, you know that I release a new one once every seven days, so once a week with COVID-19 and the amount of stress that we have been all under. I wanted to do a special episode with regard to healthy ways you can cope with stress during this pandemic. When you can access and learn some healthy coping strategies with regard to stress, it will make you the people you care about and your community is stronger. Stress during an infectious disease outbreak such as COVID-19 can include fear and worry about your own health and the health of your loved ones, changes in your sleep or eating patterns, difficulty concentrating, a worsening of a chronic health condition, a worsening of a mental health condition. Finally, the increased use of alcohol, tobacco or other drugs. Healthcare workers are under immense pressure amid the Coronavirus pandemic. They face shortages of protective equipment such as gloves and mask. They’re pulling long shifts and they risk being infected by the virus.
Joining us is a licensed clinical social worker, Julie Hamilton. Julie has over 25 years of experience in the field of clinical social work, including supporting people living with anxiety, depression and chronic pain. She’s the Coordinator of Counseling, Health and Wellbeing at the Detroit Mercy School of Dentistry, working with dental students as well as the faculty. She also serves as an Adjunct Instructor of Social Work at the University of Detroit Mercy. You’ll learn how Julie has developed an Acceptance and Commitment Therapy Intervention for physicians, residents, nurses and other medical personnel at the Henry Ford Health System. This includes a virtual support group that runs three times daily as well as a night shift, 1:00 AM support group to help those that are working overnight. I want to thank Julie for the work she’s doing, supporting healthcare workers on the frontlines that are treating and helping them cope with the stressor at this time. I hope you enjoy this and learn from it. Please make sure to share it with your friends and family. Let’s begin and let’s meet Julie.
An Acceptance And Commitment Therapy Approach To Coping With COVID-19 For Healthcare Workers With Julie Hamilton, LCSW
Julie, welcome. How are you doing?
Thanks for inviting me. I’m doing well. How are you?
I’m good. Thanks for coming on such short notice and accepting the invitation. I know you’re busy. You are working on the frontlines in healthcare with COVID, which is why I wanted to have you on. Thanks for taking the time. First, tell us what your job was like before COVID-19. Let’s start there.
I work in the Henry Ford Health System, one of the larger health systems in the Michigan area and mostly Southeast Michigan. I work in Downtown Detroit. I was approached to join Henry Ford in a new position that they developed to come in and provide wellness services to the physicians, residents and fellows. That’s been my primary goal. When I interviewed, I was forthright in saying that I use this approach called ACT and I can talk about it. I can show you what it’s like and proceeded to share with them the types of tools that I use and they hired me right there.
It was the ACT model that made the difference that we could bring in an evidence-based approach to assist physicians with stress and burnout. We’ve developed a lot of programming, different types of programming that are pure ACT-based in nature. We developed a six-module series, one hour a week for six weeks, ACT-based tools for stress and burnout prevention. We know there’s so much research that backs it up that science shows how to use it. We condensed that down into a three-module series because it was too hard for the physicians and residents to be able to attend for six weeks straight. After doing a few pilots with that and collecting data on it, we were getting ready to launch the new series and then COVID hit. What we’ve been basically doing is we developed a mindful drop-in program once a week over by the main hospital.
Even though I worked the entire system for Henry Ford, we have about five different main campuses. I am servicing all the physicians and residents throughout the system. I go to a lot of different sites, but primarily at the main campus running drop-ins once a week where they can drop in for 15 minutes or 30 minutes, whatever they want, and get introduced to mindfulness and some ACT tools. I provide face-to-face and virtual coaching, counseling for the physicians. They have responded tremendously well to an ACT-based approach. That’s been exciting to be able to work with them directly. I get called into their departments, but we’ve been using this for all the ICU nurses. They have gotten trained and ACT and mindfulness. I have a relative who’s an ICU nurse and so it hits home. Now with what we’re dealing with this tremendous, traumatic pandemic, it’s hit even closer to home. ACT feels normal to provide to individuals and groups going through this.
Your timing is perfect for that setting that you work in. As you and I are here having this conversation, back when you interviewed for the position and you were thinking about starting different types of programs, you’re addressing the chronic stress that many healthcare practitioners are susceptible to. Did you think that there could be an acute stressor like this that would show up that you would have to tackle?
There are many things that pop up on our radar, but none to this extent, so directly affecting many. I certainly remember the AIDS epidemic rolling out, SARS and many others, but this seems much more far-reaching. It’s both a little frightening, but it’s also exciting or rewarding. Even though I’m supporting the frontlines, I consider our healthcare workers, the nurses and doctors, and their immediate staff to be the frontline. It’s rewarding to be working with this population and providing them services. I spoke to somebody who hasn’t seen their child in over a month because being in the field they’re at high risk for not knowing if they’re carrying around COVID. They’re taking these precautions.
To realize how it’s impacting people’s lives on a daily basis, that hit me. My brother ended up having to leave for two weeks because he started feeling sick and they tested him for COVID early on and he tested negative. We’re still not sure. We’re not sure about all the testing. There’s so much I don’t know in this situation and we know the human mind does not like ‘I don’t know.’ It reacts strongly to it and it triggers so much in us. That’s something that brings it home. I feel comfortable, and I’m sure you do as well, leaning into this pandemic, what it’s triggering in many people. We know that science shows us that ACT works well in these types of situations and this context.
Some of the ACT work was developed in countries that were under great turmoil and were interesting as I see people like yourself and other mental health professionals that are using ACT and other mindfulness-based approaches. I have great ways that we’re going to discuss how we can cope with COVID-19 from an ACT approach or an ACT perspective. I’m in New York City, you’re in Detroit, so we’re both in two cities that are hit hard. I’m curious, as you were watching first New York go on this pause and then other cities and states follow suit, I wasn’t quite sure when Michigan followed, probably not too long after that. What conversations were you and your colleagues in mental health having about how you should react to what’s coming down the pipeline here?
We went immediately at issue to look at what did we have control over that we could do? I’m fortunate to work with an excellent psychiatrist, Dr. Lisa MacLean, here at Henry Ford. Lisa and I worked closely together. She developed the physician program and was the one who hired me. We all started putting our heads together and immediately came up with a variety of different types of services that we could provide. That is still evolving. This is a major evolution that’s happening here, but it’s still evolving. One of the services was developed, a series of virtual support meetings. It started out, maybe we would do 15 minutes or maybe we would do 30 minutes, but they’re going three times a day early in the morning, mid-afternoon then after work.
We started a 1:00 AM version of it. I’ve been helping to lead the 1:00 AM virtual sessions and allowing people a chance to talk if people would like a mindful exercise. It’s dependent on who the leader is of that group. Everybody’s got their own approach to this. If I’m leading and I always ask that it and I try to talk in an active way. By saying, “This has triggered a lot in our minds and we know our mind. How many of us are on the call are in the chat room?” We can double that number and then set it up. If people are interested in having a mindful tool quickly, we can do that, and then going ahead and getting that started. Using a little bit of creative hopelessness and talking about what percentage of our time is spent worrying, dwelling, trying to problem solve, analyze, fortune tell, story tell about this pandemic and what it’s going to do to us.
How many of us are experiencing anxiety and stress that is getting triggered up and that the abnormal now is perfectly normal? If we woke up and everything felt fine, we would probably be a little happy and normal. Having all these experiences are things that we can cope with and science is showing us how to do that. That’s where ACT comes in and is helpful in giving us tools that can help us start relating to those reactions, those things that are being triggered up in a way that fits in with engaging in our lives while we’re going through this, even if you’re working from home. That is stressful. I’ve been coming downtown to Detroit to work. I’m not at the main hospital. I work with a lot of physicians who are over there and hearing from them, it’s stressful, but they’re dedicated. They find that this approach is working for them in a short period of time. Often, we can have a couple of sessions and they have limited time. This works beautifully.
Are they brief interventions you’re working on?
What’s happened before COVID is usually we’d say, “We can set up a session,” but now it’s like, “If you want to touch base if you find it might be helpful, I know you don’t have a lot of time. Everybody’s strapped.” Two of our residents from ICU I worked with and they’re so strapped. I said, “Even if you have twenty minutes.” They’re setting up twenty-minute drop-ins where I can go ahead and touch base with them briefly and then say, “Would you like a tool to take with you?” Ninety-nine percent always say, “Absolutely. I’m tired of talking about this or worried about this.” That’s been helpful. Also, working with the residents and the doctors, there has been a connection. What’s been helpful about that is they’re starting to reach out and get in touch. Now, I know that I need something to help me to span this traumatic situation that we’re all dealing with. Now that’s been helpful. They know the type of work that we’re doing in this program and opening up for a jumpstart or to keep moving.
You mentioned creative hopelessness. For those who have studied ACT, they’re familiar with that term. For those who have not studied ACT and have never heard the term creative hopelessness, it sounds a bit strange to them. For people who followed my work, they have an idea of taking my courses. They have an idea about creative helplessness. Where does it come in with COVID-19 and a pandemic?
It’s basically asking people how they’re coping. What do you notice and how do you find yourself coping and going through that repertoire of coping skills that seem to pop up or reactive experiences that are showing up? I find myself worrying, I suppose the big one is people waking up at 2:00 or 3:00 in the morning and having their minds wake them up trying to figure this out or wondering whether they’re going to catch it. Are they going to bring it home? Many of the people working the frontlines are terrified of bringing this home to their families, my brother included. His wife’s an MP, he’s an RN. Fortunately, she’s doing fine. We don’t know if he had COVID and he could have, but he’s doing fine now.
Creative hopelessness helps a person look at, how they’re coping and then whether it’s workable or not. I’ll ask you a simple question, “What percentage of your time, your days and evenings, are spent worrying about this, thinking about it, trying to problem solve it?” It’s normal now that people are saying 80%, 90%, 100% of their time is spent that way. I always ask them, “Where would you like to get that percentage down to?” We can’t get rid of our minds and they do great things for us, but if we can shrink down the amount of time that’s spent trying to figure this out, what would you like? Often, “If I could cut it down 20% or 40% or 60%, I would love to do that.”
I’d say, “What would you be doing differently with your time?” That’s a real shift that I see in people when they see that they can use their time differently versus internally struggling quietly with this and then trying to cope with the stress that brings up. That’s worked well for my clients and the people that I coach, it’s mostly coaching that I’m doing with them. That’s a simple thing that then sets up the consent for. “It sounds like you’re using short-term ways of coping. Are you interested in some longer-term ways of coping that may be beneficial?” It’s always, “Absolutely. Yes.” That opens the door for ACT and immersion and begin moving forward.
ACT takes a pro values approach to life and to care for people living with chronic conditions or people living in acute stress like you’re dealing with now. Where have values popped up as people have come in looking for help and support?
It’s important. There’s always the curve but also the opportunity, that double-edged sword of what we can gain by going through something traumatic like this. Before, it was all people shutting down and trying to be safe. Now, people are getting in touch with what’s important to me. I use Kevin Polk’s matrix a lot. Now, we’re switching to a whiteboard where we can do that easily. Look at what is important to you. If you look back a year from now, and hopefully we’re through all of this, but you found yourself getting past it well and staying in touch with what’s important, what would you want to be talking about?
That is a nice way to connect with the values and then have them look at what would some of those values be. In the medical field, compassion and commitment to other people and doing 150% to make sure the other person is cared for and serviced is a normal day for people. What we tend to in our field as well as the medical field is to have a big disconnect between values towards ourselves versus servicing others. This is one of those situations where the opportunity is people getting more in touch with values. What is important to me? It’s bringing it right into our faces. We can’t avoid it. We, humans are great to avoid value behavior. People are getting in touch with what is important?
Not having access to my child for a month is important or not being able to see my partner or not being able to go out and have dinner. I live in downtown Detroit, it’s all great new restaurants. There are new ones popping up. I belong to a running group here in Detroit and there’s something different about this, but there’s an opportunity as well. That’s what I want to tap into is how do we turn this in and open it up to something where we can bring those values and it makes something of that, make it meaningful for ourselves?
I’m also curious as we talk about values, you mentioned as healthcare providers, we identify with the value of helping other people readily. However, now we’re in a time where I’m wondering if you’ve noticed a values conflict or maybe a little bit of confusion in any way. Let’s say I’m a physician. I love my job. I love working in the ER. I love saving people’s lives on a daily basis. However, now I’m finding my work may be conflicting with other values I have, like being a supportive father or being there for my children or other aspects of living. They’re interesting things that start to think about from where you’re sitting.
Context means everything. The shift in context that’s emerged is real. It has people thinking it has people sitting back and looking at again, what is important to me and how do I create some balance with this. I need to be able to be with my kids or I need to have time with my family versus constantly working. Henry Ford is doing a good job of trying to create opportunities for their employees to have time. We’ve rolled out a lot of services, but there’s a lot of permission for people to take time for themselves and make sure that they don’t ignore that. Leadership is very cognizant of that.
As you and I are dancing around the hexaflex, I also think are there are opportunities for more pinpointed, committed action there. For example, let’s say that a physician or a nurse maybe is a little bit lax at times with personal protective equipment or wearing a mask at work, which all of us are like that at times during an average day. Although now during COVID, we may have to be more committed to certain actions that keep us in line with our values and ways that are healthy.
We have to have those other parts of the hexaflex. We need to be tapping in those for that to start then to happen. The awareness providing opportunities to practice being more mindful opens us up to even consider that. Bring that in and say, “That is important to me. My safety towards my patients, my family, my community is important.” If we’re not being mindful, it’s easy to forget that, even in a pandemic. I do believe the pandemic is making that happen. It’s creating an influence on us that is opening up that opportunity to reconnect with what do I think is important, who’s important in my life, and that willingness to commit. I’m hearing it in our professionals who are working at the main campus and at the other campuses that they are working to take more time out for themselves. Making sure they’re keeping themselves safe. I see it in my brother who’s over there and many of the other people that I’m working with.
I also noticed a lot of pro-social values poking up through the frost as this pandemic continues.
I see it in how things are evolving, the different programming, the supports that have been put together. There’s a real enthusiasm. We had our behavioral health team here be furloughed. They lost their jobs and we’re sitting at home. What we’ve done with them is ask them, “Would you come back?” What they’ve done is they’ve developed a 24/7 COVID hotline for all employees. They’re giving a lot of activity. From that, that’s turned into, “Why don’t we develop some mindful drop-ins?” I had been doing that at the main campus, but now we’re doing this twice a week for about 15, 20 minutes. I ran the first two and got it started.
We’ve got all these people in behavioral health. It was interesting because I was supposed to go into behavioral health and train them in ACT. I was doing a day-long training for them and because they had been using ACT, but they wanted to have everybody trained in it. I’m always going in with Lisa MacLean and going to do this training, and then all of it got canceled. Now, we’re doing it through the back door with the different services that are being rolled out. Fortunately, we’ve been able to bring them back in and have them handle some of these other services. They’re back now on the payroll. That’s been a real blessing in a lot of different ways.
They’re learning some ACT and mindfulness, some of them I’m sure are skilled in it. It’s nice to be able to use our employees. We do have job cuts that are going on right now. Our program is not at the highest level as some of the other health systems. There’s that vicious shifting context that’s going on as well. We hope that it’s going to be very short-term, but it’s public knowledge that there are a lot of cuts going on. The stress continues, this feeling of powerlessness. I don’t know how this is going to turn out, what’s all going to happen? It’s a tremendous amount of strain and triggering so much inside each of us that most of us haven’t been through before.
It’s all new for everyone. We don’t have a whole lot of history to fall back on, at least not recent history. We’re all experiencing lots of different things together, which is interesting. You put together a list of ways to cope with COVID. People can download that for free. Can you give me some highlights from that list that you’ve found to be the most helpful for people?
The big thing is focusing more at the moment, trying to go through the day and allow yourself to focus on what’s happening. Pick some simple things that you can do. One of the things that I’ve picked through all of this is hydrating. I’ve been trying to be mindful of hydrating and notice every time I pick up a water bottle, try to focus on being present with it, notice what the bottle feels like. It’s having a few basic things in regard to commitment to our self-care and our safety. Steve did a great thing about not touching your face. If you count, you’ll catch it. Things of that nature to be able to go through the day and focus at the moment, how to notice our thoughts and then notice the great storyteller.
We have a great, wonderful mind that does amazing things. When it comes to all the loose thought that is getting triggered, one of the big things that our mind does is act as that storyteller. For people to try to notice the storyteller ask themselves, “Did you ask these thoughts to show up? Did you ask that story to show up? Is this something that the mind has created on its own? Is it okay to label it?” That’s a story. “Is it okay to let the stories sit there? What was I doing fifteen minutes prior to this story popping up in my head and getting in my face?” Being able to pull it back and say, “That’s a story.” Let me get back in touch with what’s important to me for the next 5, 10, 15 minutes and it’s time to hydrate. It’s easy. I was noticing that I wasn’t hydrating.
I would forget to hydrate and then be parched by the time I left the building. You haven’t drunk anything. That became important to your own self-care. Is it okay to refocus on what’s important? I don’t have the list in front of me, but it was primarily staying present, bringing the values into it, defining what is important and making a special list. What are my top three things that are important that I want to touch as I go through the day? Am I willing to stay present with those? A lot of people are setting little timers up to signal for them it’s time to lean into the value of sleeping, trying to get decent sleep or not overdrinking. A lot of people talking about is triggering these urges to drink. These are all human reactions I’m noticing here, like the hair and nails that are falling off and things, we didn’t think about before.
Now, being compassionate to ourselves when we’re going through this and allowing ourselves some space to hold these thoughts and feelings gently. I know for myself it’s been a racing heart. I’ve always had normal anxiety that likes to show up now and then, but I’ve definitely noticed it being more dialed up lately. It’s consciously stepping back and allowing it to arise and move on. It’s been more pronounced and it’s helping in that way. It’s helping me to be more aware by saying, “Wait one second here. This is part of you. This part of your experience, so we’re going to let you notice that your heart is racing,” and then hydrate. Do the things to take care of yourself and make room for all these different experiences that are being triggered up. There’s an opportunity in that.
One of the reasons why I was drawn to ACT is because it’s experiential and as we’re talking, I’m noticing that you use your hands a lot, which as an Italian-American, I love people who talk with their hands. Using your hands to gesticulate is another great way to talk. When you’re saying things, notice where your thoughts are and you have your hands. Her hands are in front of her face and she’s wiggling her fingers as like thoughts that are almost clouding your vision basically instead of noticing thoughts and creating distance. She pulls her hand far away from her face, almost like she’s reading a book that’s far away and there’s the distance between you and your thoughts. You’ve done this throughout the interview. I’ve noticed this since minute one. It’s a brilliant way. Often with counseling, no matter what type of counselor you are, whether you’re a physical therapist or a psychotherapist, there’s a lot of talking that happens and a lot of ways you want more action. Using your hands and the way you’re doing it is brilliant.
I appreciate that, but you’re right. I’m always demonstrating without even realizing it. I have told out these for the first time. I haven’t used these except in the three-hour module series that we’ve been training the docs in. Having something visual that you can show somebody virtually and how do I get out of this? Even some of the old traditional ACT things, but definitely when a thought gets in our face, are we willing to pull it back, make room for it? We don’t have to spend the day getting rid of that. If we’re willing, allow it to sit there and refocus and continually do that. Bringing our attention back to what is important right this moment and gently lean into the next moment of our day.
One of the things you mentioned on your coping list, which is excellent, is keeping to your daily work and your home routine as much as possible. Once we got into this settled in place, I like to call it, I noticed everyone’s routine was completely disrupted. A lot of my friends and some colleagues were having a hard time, “How do I wake up? What do I do? What are my first steps?” It’s like their shoes have been taken away and they can no longer take their first steps throughout the day.
This vagueness sets in and we have to now think about it. Part of that thinking can start off innocent, “When do I want to eat?” We get fused into our thoughts about, “How’s this? Maybe I should be doing this.” People are discovering that’s the opportunity again to let me get back to my normal routine, “Am I willing to go work out, take some time?” It’s easy to feel like you can’t get out and the mind will say, “You’ve got to stay indoors and lock yourself away. Is it okay to drop on the floor and do some yoga?” Stretch yourself out, go for a run, go for a walk. It is healthy. They think it’s even healthier to be outside, but our mind’s not going to think that way. It’s going to be, “Don’t do it.” Getting that structure, some sense of structure can be helpful.
I’m glad you mentioned that because I had been promoting physical activity as a way to cope both with your mind as well as the things that are happening in your body. That doesn’t mean go to an indoor gym, but there are lots of great ways to get outside where you can maintain physical distancing or even go with maybe a family member who you’ve been socially isolated with and it’s safe. It’s a great way. Physical activity is a great way to cope with a lot of this as well.
Also a great opportunity for people who had felt like they’ve been too busy before this was going on to exercise. I can’t do this and I can’t do that. It is maybe a time to experiment with. Let me go ahead and do the opposite of what my mind is telling me and let me go out there and let’s see how this goes. Let’s see what a run is like during a time of COVID or C-19, as I like to call it. Allowing ourselves to engage in life. There are people who I hear now are doing things that they have put off cooking, drive-by, walking the dog, going out for a run. Maybe there’s an opportunity.
Kelly Wilson talks about there is that little golden nugget in all of this that it might not be there, and it’s up to us to lean into this and experience it fully. Perhaps we’re going to discover a little golden nugget there that’s going to be something worthwhile. I heard on NPR before we started this, there’s a rise in people wanting to be connected and who are signing up for getting married, going out and trying to get marriage licenses, even though the offices are all shut down, just because they’ve gotten in touch with this is more important to me, my relationships, my connections that are important to me and I want to commit. I committed an action that you were talking about.
In that quiet and calm, we’re starting to notice there are things that are important that start to bubble back up to the surface that hasn’t been there in a while. That’s interesting for me to observe.
To people, probably we’re on junk food, comfort food and some of that is healthy to nurture oneself in that way. Probably people have been talking about getting to an extreme and now it’s like, “Let me create maybe a new normal that’s more value-based,” and lean into that.
I have been speaking with Julie Hamilton, who is a licensed clinical social worker at the Henry Ford Health System in Detroit, working with people on the frontlines with regard to COVID-19, and approaching this all from an ACT-based perspective, which is wonderful. Julie, if people want to learn more about the great work you’re doing and some of the things that you’re up to, how can they learn more?
They can contact me at Hamil14@HFHS.org. That’s the easiest way to get in touch. Feel free to reach me there. My number here is (313) 874-7121.
I want to thank Julie and the rest of her coworkers in mental and behavioral health who are doing such important work for people on the frontlines with COVID-19. Make sure you share this with your friends and family and your colleagues who are interested in how you can use ACT and other types of mindfulness interventions to help buffer stress and to help people cope with COVID-19 during this epidemic. Make sure you share it out on Facebook, LinkedIn, Twitter, your favorite social media group.
Julie Hamilton, LCSW
Julie Hamilton, LCSW has over 25 years of experience in the field of clinical social work. Populations treated include: eating disorders/BDD, pain management, depression, anxiety/panic, OCD, and perfection. Her training is in following areas: Behavioral/CBT/ACT/DBT. She has also provided counseling and coaching services to athletes and professionals at all levels with stress, anxiety, eating disordered behavior, perfection, staleness and performance issues.
These last five years Julie has been Coordinator of Counseling, Health and Wellbeing at the Detroit Mercy School of Dentistry working with dental students and faculty. She also serves as an adjunct instructor of social work at The University of Detroit Mercy. She provides a wide variety of professional training in ACT/Psychological Flexibility, Mindfulness, CBT, and Behaviorism both locally and nationally.
Julie is an active member of the Association of Contextual Behavioral Sciences (ACBS), an international organization of clinicians, trainers and researchers, specializing in Acceptance and Commitment Therapy (ACT), an evidence-based CBT treatment approach.
In addition, Julie has participated in the planning and revitalization of the Viola Liuzzo Park in northwest Detroit. The park is named in honor of the local civil rights activist murdered by the KKK following the March on Selma. Viola’s death was one of many which led to the signing of the Voter Rights Act in 1965.