I.

Quiz Time
II. Who is your ideal person?
III. Person A?
a. Very unique; non-conformist
b. Can make you believe
c. Acts quickly
d. Not afraid to fight
e. Risk Taker
IV. Person B
a. Very independent; can achieve things on his/her own
b. Chaste
c. Not affected by criticism and ego stays the same when praised
d. Emotionally consistent
V. Person C
a. Full of zest and energy
b. Has many interests
c. Acts quickly
d. Cannot be dictated
e. Frank/Honest
VI. Person D
a. Life of the party
b. Seductive
c. Expressive
d. Entertaining
e. Open to Experience
f. Intimate
VII. Person E
a. Confident
b. Has sense of achievement
c. Can make people follow
d. Firm
e. Imaginative; high-spirited
VIII. Person A
a. Very unique; non-conformist Does not conform to social norms
b. Can make you believe Deceitful; manipulative
c. Acts quickly Impulsive
d. Not afraid to fight Aggressive
e. Risk Taker Reckless
Person A is Antisocial Personality Disorder

IX. Person B
a. Very independent; can Does not want relationships; likes to
achieve things on his/her own be alone
b. Chaste Not interested in intimacy
c. Not affected by criticism and Indifferent to both praise and
ego stays the same when criticism
praised
d. Emotionally consistent Emotionally cold

Person B is Schizoid Personality Disorder

 X. Person C
a. Full of zest and energy Hyperactive
b. Has many interests Lacks focus
c. Acts quickly Impulsive
d. Cannot be dictated Does not listen
e. Frank/Honest Tactless; disinhibited
Person C is Attention Deficit Hyperactivity Disorder

XI. Person D
a. Life of the party Need to be noticed
b. Seductive Inappropriate sexual behavior
c. Expressive Rapid shift of emotions
d. Entertaining Need to draw attention
e. Open to Experience Suggestible
f. Intimate Dependent
Person D is Histrionic Personality Disorder

XII. Person E
a. Confident Arrogant
b. Has sense of achievement Has sense of grandiosity
c. Can make people follow Exploitative
d. Firm Lacks empathy
e. Imaginative; high-spirited Believes that he can do things
beyond his abilities

XIII. Will you change your mind just because they have a label?
XIV. The point is…. We all have Side Bs
a. Obsessive-compulsive Organized
b. Schizotypal Imaginative; mystical
c. Paranoid Protective
d. Autistic Talented
What is your Side B?

XV. Module 2: #AkoDin: Tungo sa Pahinga at Paghinga

 Fostering Positive Emotions: Contentment, Happiness, Hope
 Self-care: “Not me first, but me too”
 Self-care and Adaptive Coping Strategies

XVI. An excerpt from Dr. Sanj Katyal’s article in the thehealthcareblog.com (2018)

Most physicians are not burned out.

We are able to function. We get through our days, make it to some of our kids’ activities and even
manage to go out to dinner on the weekends. We survive the work week as we look forward to our
next vacation. We do this because that is what we have always done.

We put our heads down and do our work. We often project ourselves past the next exam or to the
next stage of our lives to help us get through the stress.
We become masters of delayed gratification. We develop the mindset of “I’ll be happy when…” I get
into medical school or match into a good residency spot or make partner or have enough money to
retire etc…

Along the way, we may have some bright spots – falling in love, having kids, taking great vacations.
We may even reward ourselves for our hard work with a new car or nicer house. We deserve it. But
deep inside, “something is missing”.

We have achieved most, if not all of the goals we have set for ourselves. Yet despite our hard work,
many of us remain unfulfilled with our careers and often with our lives. What is it that we need? A
better job with more money? A different car? A different title? Better vacations?

I have struggled with these questions and many more.

How do I stop wanting what I don’t have and start wanting what I do have? How can I fully enjoy the
present while also preparing for a better future?

How can I spend quality time with my kids while they are still around?
How can I have a career that uses all of my potentials?

Of all the questions that I’ve asked myself, the most important one was this – How can I learn to
FLOURISH and not just function?

XVII. What is FLOURISHING?

A multidimensional construct
One of the most important and promising topic studies in positive psychology.
Dr. Martin Seligman: flourishing is the result of paying careful attention to building and
maintaining the five aspects of the PERMA model

XVIII. The PERMA Model

P – Positive Emotions
E – Engagement
R – Relationships
M – Meaning
A- Accomplishment

XIX. To flourish is to find fulfillment in our lives, accomplishing meaning and worthwhile tasks,
and connecting with others at a deeper level – in essence, living the “good life” (Seligman,
2011)

XX. Fostering Positive Emotions

What are Positive Emotions?

(Use mentimeter)

XXI. Broaden-and-Build Theory of Positive Emotions

states that discrete positive emotions, including—joy, interest, serenity, love, etc.—although
phenomenally distinct from one another, all share the ability to broaden individual’s
momentary “thought-action repertoires” or ideas about possible actions.

 Joy inspires play and creativity

 Interest provokes exploration, learning, and an expansion of the self,
  Serenity broadens one’s ability to savor current life circumstances and integrate
these circumstances into new views of the self and the world,
 Love creates recurring cycles of urges to play with, explore, and savor experiences
with loved ones

 Researchers at Cornell University found that (Isen, Rosenzwieg, & Young, 1991)

Physicians who were induced with positive emotions before seeing their patients were actually
better than their control counterparts at integrating patient case information. These positively
induced doctors were less likely to become fixated on initial ideas and come to premature closure
on their diagnoses

XXII. Fostering Positive Emotions

1. Savoring

Savoring is defined as the use of thoughts and behaviors to increase the intensity, duration, and
appreciation of positive experiences and positive emotions.

It helps us to internalize our positive experiences to maximize the effects of our positive emotions.

Three temporal forms of savoring:

1. Anticipating/looking forward to positive events
2. Savoring the current moment, or intensifying and prolonging enjoyment that is occurring right
now
3. Reminiscing, or looking back to ignite or rekindle positive feelings
(Insert Mentimeter)

4 types of Savoring (Bryant, 2003)

1. Basking: Being receptive to praise and congratulations; Internal focus of attention, cognitive
reflection
e.g. Enjoying the afterglow of performing a flawless surgery

2. Thanksgiving: Experiencing and expressing gratitude: External focus of attention, cognitive

reflection
e.g. Spending the afternoon with your mother, expressing gratitude that you have such a
beautiful, close relationship

3. Marveling: Losing yourself in the wonder of experience; external focus of attention, experiential
absorption
e.g. Waking up early to watch the sun rise

4. Luxuriating: Engaging the senses fully; Internal focus of attention, experiential absorption
e.g. Enjoying a relaxing bubble bath, slowly eating a piece of delicious chocolate, or slowly
sipping a glass of fine wine.
(Insert mentimeter)

10 Strategies to enhance Savoring (Bryant & Veroff, 2007)

1. Share good things with others
2. Actively build memories, take “mental photographs”
3. Be proud of yourself! Self-congratulate
4. Use downward comparison (moderately): remind yourself that things could be much worse
5. Sharpen your sensory perceptions; slow down
6. Be absorbed in the moment: turn off mental chatter
7. Use your body! Laugh, jump for joy, shout it out from the rooftops
8. Remind yourself to enjoy the moments; time flies!
9. Count your blessings and acknowledge gratitude
10. Avoid kill-joy thinking (don’t focus on the negative)

Something to think about….

Set yourself up for a savoring experience using a temporal form and savoring type of your choice.

Throughout medical training and practice, there will be so many moments to savor: having a
meaningful experience with a patient, hearing gratitude from a patient’s family about how you
helped their loved one to heal, graduating from medical school, beginning a residency,
graduating from residency…

Savor these moments using the techniques listed earlier. Congratulate yourself about all the
hard work you have accomplished; celebrate with family and friends; and don’t let anyone
squash your positive affect for no good reason at all.

2. Three Good Things

 Each night for a week, after dinner before going to sleep, write down three things that went
well that day. These things can be relatively small (I had a great time at dinner with friends),
or relatively large, such as (I helped to deliver a baby today!).
 After each positive event on the list, answer in your own words, “Why did this good thing
happen?” You can speculate, for example, that you had a great time at dinner with your
friends because “you have fantastic friends”, or because “you went to your favorite
restaurant”. When asked why you delivered a baby, you might say, “Because I am a doctor,
my calling in life!”
 Feel free to continue this exercise beyond one week, however, do stop after the week if it
begins to feel burdensome. Pay attention to whether your outlook about life events changes
as they happen. Reflect on whether this exercise makes you more attuned to good things
as they unfold.

3. The “ABCs” (Ellis, 1991; Reivich & Shattӗ, 2002)

 About building resilience, or the ability to grow and thrive in the face of challenges and
bounce back from adversity.
 Some core competencies that we need to help us recover from adversity are:
Self-awareness, self-regulation, mental agility, our character strengths, connection with
others, optimism.
By understanding how we react to challenges, we can cognitively transform challenges into
opportunities to find deeper meaning, expand our perspectives, develop deeper bonds with
others, and experience personal growth with time.

 The ABCs exercise

Understanding how some of our beliefs elicit distinct emotional states.
 By understanding this cause-and-effect relationship between our beliefs and the emotions that
result from these beliefs, we can intervene and question some of those beliefs to change the
way we react to challenges.

A (Activating Event) B (Beliefs)

C (Consequences
Describe a recent activating Describe what you said to What did you feel? What
event yourself in the moment, physical sensations did you
what your beliefs were experience/ actions did you
carry out?

In what ways were those beliefs/thoughts productive? In what ways were these beliefs
counterproductive?

4. Avoiding Thinking Traps

Thinking traps are common patterns of thinking that cause us to miss critical information and
help us to justify our own thoughts.
Getting around Thinking Traps
 ABCs + Thinking Traps Exercise

Activating Event Beliefs Thinking Traps Consequences

Describe a recent Describe what you What did you feel?
activating event said to yourself in the What physical
moment, what your sensations did you
beliefs were experience/ actions did
you carry out?

XXIII. Self-care: “Not me first, but me too”

Self-care is the ability of individuals, families and communities to promote health, prevent disease,
maintain health, and cope with illness and disability with or without the support of a health worker.
(WHO)

4 Domains of self-care

 Physical health: Maintaining a good diet, getting enough exercise and rest, and committing
to a healthy work–life balance
 Mental health: Pursuing wellness through mindfulness and relaxation techniques, taking
resilience training, and getting psychological therapy to cope with disorders or grief
 Emotional health: Protecting and maintaining cultural and recreational interests outside of
medicine, and protecting personal time and relationships with family and friends
 Spiritual health: Taking time to worship, nourish the spirit, pursue spiritual practices,
exercise compassion, and reflect on spiritual faith and gratitude

 The habit of “living for tomorrow”

XXIV. Self-care and Adaptive Coping Strategies

1. Exercising Mindfulness
a. Informal – mindful attention during daily activities
b. Formal – structured meditation exercises

Reflection: Practicing mindfulness in daily life

• Allow yourself a few mindful breaths in the morning before you get out of bed.
• Try preparing and eating your breakfast quietly, without distraction, once a week.
• Notice your environment.
• Drive the speed limit and stop on orange lights.
• A few times during the day, stop, take a few breaths, and re-center yourself.
• Let the world wake you up: when you notice a phone ring, a door slam, and so on, take a
moment to sense where you are and how you feel.
• Sign up for a class on meditation, yoga, tai chi, etc.

2. Journal Writing

A journal of the grieving process

Dr. Milne was going through a complicated grieving process.

She was distressed by the loss of two young patients, from two very different families, who had
died during the same week. She began to write intermittently in a journal, describing her thoughts
and interpretations of these difficult events. She purposefully wrote without much forethought,
letting the words flow, letting her feelings bubble up to the surface. She described the rooms
where Jason and Steven had died and was surprised at how vividly she remembered certain
details: Jason’s fish tank, the morning light filtering through the curtains onto Steven’s tired face,
the muted sounds, the encounters with various family members.

She recalled how she had bought a large bouquet of helium balloons on her way home from work
the day after Jason died. She was coming home to her two-year-old daughter, and to her son,
who was Jason’s age. She wanted to deliver to her own children some emblem of joyfulness and
hope, and something that pointed toward heaven.

In the weeks that followed, Dr. Milne occasionally reread her journal entries, adding more
recollections. This process allowed her to reflect on her responses and to consider her personal
reasons for feeling so overwhelmed at the time. She was aware of how much she identified with
Jason’s family and also how much she would miss seeing Steven and his family.

In articulating these thoughts, she learned to be more patient with herself. She also began to
speak with a more experienced colleague about how she was handling things. She realized that
these memories were important to her, and that the act of writing them down, had given her more
insight, more acceptance of her emotions, and a measure of comfort as well.

3. Exercise and physical fitness

Fun.
Physical activity must be enjoyable. Activities that are tedious, uncomfortable or intimidating are
not likely to form the basis of a lifetime of healthy physical activity. Find something you enjoy and
look forward to the release it offers from the pressures of a busy professional life.

Feasible.
Activities that require elaborate equipment, specialized facilities or significant travel are difficult to
integrate into daily life. A lunchtime walk, an evening jog, or a regular swim or aerobics session at
a nearby “Y” requires little equipment and minimal preparation and can be integrated easily into
daily routines. Biking to work and taking the stairs whenever possible will add to the ease with
which physical activity can be included in daily schedules.

Family and friends.

Physical activity that frequently involves family and friends has a further motivation built in.
Encouraging the whole family to engage in regular physical activity can allow you to pass on your
exercise “values” to your children, optimizing their growth and development. Skiing, biking,
sledding, hiking—he choices are limitless.

Forever.
Participation in physical activity is for life. Establishing favorite physical activities early in a career
helps to ensure that enjoyable, anticipated and active periods will be integrated into weekly
rhythms for the long term. Realistic expectations of exercise intensity will help prevent injury and
increase the likelihood of enjoyable physical recreation over a lifetime.

4. Spirituality

“At heart, spiritual practice is about noticing life as we live it. The wisdom and compassion that this
engenders does not make us more expert; it makes us more human. Science teaches us how to
do; spirituality, how to be. As physicians, we can benefit from practicing both.” (Smythe, n.d.)

Compassion Fatigue
Compassion that does not include oneself is incomplete. And it often leads to burnout.

Burnout sufferers describe feelings of isolation, depersonalization and emotional exhaustion—or

“compassion fatigue”—associated with a sense of reduced personal accomplishment. They have
what might be regarded as a spiritual illness: if engagement with one’s life is a sign of spiritual
health; burnout is the opposite. Physicians who were once wholeheartedly committed to medicine
begin to avoid work, become less interested in their patients, and doubt their career choice.

Given that burnout is an occupational risk for physicians, how can they lessen it? One important
way is to develop spiritual resilience.

Spiritual resilience and self-awareness

Immunizing ourselves against the inevitable stresses of our profession requires us to

regularly nourish the spirit. One essential means of doing this is to deepen self-awareness
by consciously paying attention to our own selves.

There is much talk these days about the importance of balance. Diet, exercise,
relationships, study, play, work—these all need to be integrated into a balanced whole.

But who decides on the relative weight we place on each aspect of this whole, and how do
we know when we are out of balance?

We do, through self-reflection.

5. Finding a family physician

Physician needing physicians
 https://tenor.com/view/therapist-therapy-my-therapist-calling-his-therapist-as-soon-as-i-leave-
therapists-walter-white-gif-25012041

6. Nutrition
 Eat breakfast.
 Carry healthy and convenient snacks with you.
 Schedule nutrition breaks as a priority within your work day (e.g., mid-morning, lunch,
mid- afternoon, evening).
 Plan for a balanced nutritional intake (should include carbohydrates, protein and healthy
fats). Learn to recognize the emotional and physical symptoms that declare it’s time to
eat and drink (irritability, fatigue and hunger pangs).
 Model and reward healthy nutritional behaviors for your colleagues and trainees, and
educate others on the benefits of nutrition breaks for improving performance.

Last note on flourishing…..

Do you already know your mission in life as a physician?

Physician’s Personal Mission-Vision

1. What is it in Medicine that… (all)

 Excites you intrisincally and you do it almost voluntarily
 You do with passion
 Engage you; as if time runs so quickly
 You are really good at
 Challenges you
 Makes you feel productive after doing it

Answer___________________________

2. Which group of people who.. (any or both)

 You think can benefit from your answer in no.1
 Can be changed by your answer in no.1
Answer _________________________________

3. What change (vision) do you want to see when you do no.1 with no.2?
Answer______________________________________

4. Choose ONE that really appeals to you and gives you power.
 5. Choose ONE that captures your identity

Physician’s Personal Mission Vision

 I am a ________________________________ (No.5)
Who will _______________________________ (No.4)
The ___________________________________(No.2)
To/Through/In ___________________________ (No.1)
So that _________________________________ (No.3)

Sample Mission-Vision

I am a psychotherapist
Who will nurture children
Through play therapy
So that their parents will recognize their potentials and help them develop these.

Mission Title
 Think of a title that will capture your mission;
 Examples:
o Educator of Young minds
o Teacher of Arts
o Psychologist to the Masses
o Ambassador of Sports
o Promoter of Mental Health

Angelica’s Mission-Vision

Nurturer of Young minds

I am a psychotherapist who will nurture children through play therapy so that their parents will
recognize their potentials and help them develop these.

References: